There are times that children exhibit signs of crowding teeth or jaw problems as they are growing. Jaws may grow too much or too little. Sometimes they may be much too narrow or wide. These children (over the age of 4 may be excellent candidates for early orthodontic care.
Because children are growing at a rapid rate, appliances (shown below) can be utilized to direct growth to improve the jaw and teeth alignment. Most often it is simply creating enough room to have all the permanent teeth erupt without the need for extractions. With some cases, if this early care is not provided, corrections later would likely involve orthognathic surgery.
Some children may have early orthodontics (braces) placed on just a few teeth, such as one molar on each side and the front 4 teeth. The goals of partial braces are front tooth alignment and assisting in establishing a correct relationship between the upper and lower.
Early treatment may decrease the treatment time required for the second phase. Most often, at the end of first-phase, the teeth may not be in their best or final position, this will be accomplished during the second-phase. Periodic recall appointments are set in order to check the progression of jaw growth and permanent tooth eruption.
Second-phase treatment most often consists of straight-forward orthodontic therapy that will align the teeth.
The major advantage of two-phase therapy is to maximize the opportunity to accomplish the ideal healthy, functional, aesthetic, and comfortable result t hat will remain stable. Optimizing the the time when the child is growing is of utmost importance in these cases. The main disadvantage of waiting for permanent eruption of teeth is that the final result may not be functionally healthy or stable. Tooth extraction or corrective jaw surgery (orthognathic surgery) may be required as well.
The most common appliances are:
1. Palatal expanders - these come in different formats depending on what is needed (ie: molar rotation or over-bite correction. The palatal expander is placed on the upper and cemented to molar teeth. There is a small screw assembly in the middle of the palate that is usually activated daily by the parent placing a small tool into the screw assembly and turning it a prescribed amount. These are only effective in a growing individual.
2. Swartz expanders (lower jaw) - this type is activated from every other day to once a week. The Swartz expander is effective at any age but less so in people who are skeletally mature.