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Section Questions and Answers

Orthodontics for Children and Adolescents

  1. My child needs orthodontic treatment. What is it?
  2. Why is it important to have orthodontic treatment?
  3. What are the early warning signals of orthodontic problems?
  4. Why should orthodontic treatment start when the child is young?
  5. When should I have an orthodontic consultation for my child?
  6. Which conditions cause orthodontic problems?
  7. What dental and jaw conditions usually need orthodontic treatment?
  8. How long will the orthodontic treatment take to complete?
  9. What is the plan of action for the entire treatment period?
  10. What happens in the planning phase?
  11. What happens during the active phase?
  12. What happens during the retention phase?
  13. Is orthodontic treatment painful?
  14. Can my child participate in sport while wearing braces?
  15. Can children play an active role in their orthodontic treatment?

 
1. My child needs orthodontic treatment. What is it?

  • Orthodontics is the branch of dentistry that corrects irregularities of the teeth, jaws and face.
    Corrective treatment is carried out by a specialist dentist, called an orthodontist.
  • The orthodontist re-positions teeth and jaws that are not in their correct alignment and position.
    The dental term for this is malocclusion or bad bite.
  • Orthodontics aims to ensure that the teeth and mouth look good, and function well.

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2. Why is it important to have orthodontic treatment?

  • Orthodontic problems can disfigure the face and mouth.
  • Orthodontics can improve the appearance of the teeth and face.
  • Normal speech and chewing can be made possible by orthodontic treatment.
  • A bad bite can make biting or chewing difficult or even impossible, and can cause the teeth to wear down.
  • Crooked teeth are very hard to brush properly.
  • If teeth are not kept clean, this can result in tooth decay, and loss of teeth.
  • Orthodontic problems can damage the gums and underlying bone structure.
  • If the jaws are not properly positioned, pain in the jaw joints can result.
  • Orthodontic problems can get worse if they are neglected. They will not just "go away".
  • If not treated in time, a problem can become more difficult and more expensive to treat later on.

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Crooked teeth

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3. What are the early warning signals of orthodontic problems?

  • The warning signals to be aware of are:
    • Baby teeth not falling out when they are expected to.
    • Baby teeth that are lost too early because of decay.
    • Top and bottom teeth not meeting properly.
    • Problems with biting or chewing.
    • Crooked teeth caused by crowding.
    • Mouth breathing.
    • Thumb and finger sucking.
    • Biting the cheek, or the roof of the mouth.
    • Jaws and teeth out of proportion to the rest of the face.

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The result of
thumb sucking
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Crowding

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4. Why should orthodontic treatment start when the child is young?

  • There are many good reasons for early orthodontic treatment:
    • When the jaws and teeth are still growing it is much easier to move teeth and influence the position and size of the jaw.
    • Early treatment will shorten the treatment time.
    • Treatment of thumb-sucking and abnormal swallowing patterns is more successful in a young child.
    • Protruding front teeth are easily damaged, so the sooner they are corrected the better.
    • The space left by the early loss of a baby tooth must be kept open.
      If left untreated, this space will close, as adjacent teeth will drift into it. The permanent tooth may then not have enough space to grow into and may become impacted. Early treatment can keep the space open and allow the permanent tooth to erupt normally. Insufficient space for permanent teeth often results in crowding.

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Space maintainers

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5. When should I have an orthodontic consultation for my child?

  • Consult an orthodontist immediately after you or your dentist become aware of a problem.
    • Jaw growth and development problems can be identified by the age of seven.
    • If it is necessary to widen or lengthen the upper or lower jaw, this can begin by the age of 10 for girls, and 12 for boys.
    • Starting early can make the treatment easier and shorter.

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6. Which conditions cause orthodontic problems?

  • Crowding
    • Teeth affected by crowding are difficult to clean and are prone to decay.
    • Crowding may prevent other teeth from erupting, causing them to become impacted.
    • Crowding spoils the appearance of the mouth and smile.

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Severe crowding
  • A mismatch of tooth and jaw size
    • Teeth can be too big or too small for the size of the jaws.
    • This can be a congenital or inherited problem.
  • Upper and lower jaws out of proportion to each other
    • The lower jaw may be too large or too small for the upper jaw, and vice versa.
    • This can also be a congenital or inherited problem.
  • Missing or extra teeth
    • This is not uncommon and can be an inherited problem.
  • Premature loss of teeth caused by:
  • Breathing problems
    • When adenoids or tonsils obstruct normal nasal breathing, this can affect the teeth and jaws.
  • Thumb sucking or dummy sucking
    • This can and often does affect the development of the jaw and the position of the teeth.

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7. What dental and jaw conditions usually need orthodontic treatment?

  • Crowded and irregular teeth

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Before
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Treatment
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Treatment
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After
  • Protruding upper teeth

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Protruding
upper teeth
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After treatment
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Front view
  • Protruding lower jaw and teeth

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Lower jaw
protrusion
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Treatment
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After
  • Lower jaw protrusion
  • Deep overbite

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Overbite
  • A crossbite

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Crossbite before
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After
  • Spaces between the teeth

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Before
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After
  • Crowded and irregular teeth
  • Finger or thumb sucking

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Finger sucking
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Thumb sucking
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Removable brace
to move top teeth
backwards
  • Teeth erupting out of position (ectopic eruption)

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Ectopic eruption

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8. How long will the orthodontic treatment take to complete?

  • Treatment takes from a few months to about 3 years. The average is about 2 years.
    • The length of treatment depends on how difficult and complicated the problem is.
    • Some people respond to treatment more quickly than others.
    • Co-operation by the patient, or lack of it, can affect the length of treatment.
    • Your orthodontist will be able to give you an idea of how long it will take.

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9. What is the plan of action for the entire treatment period?

The treatment plan is divided into three parts.

  • The planning phase
  • The active phase
  • The retention phase

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10. What happens in the planning phase?

  • A pre-treatment record is made, which includes:
    • A medical and dental history.
    • The making of casts for the upper and lower teeth and jaws.
    • Photographs of the face and teeth for before and after treatment comparisons.
    • A complete set of x-rays of the jaws and teeth.
    • A computer-generated photograph of the anticipated result.
    • Formulation of the treatment plan.

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X-ray showing tooth
growth in jaws
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Casts
(models of jaws)

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11. What happens during the active phase?

     Some of the following procedures will be included in the active phase of treatment.

  • Extraction of teeth
    • This is needed when there is crowding, because the jaws are too small for the teeth.
    • The extraction of teeth is made in a carefully planned way, to make room for the movement of teeth.
  • Space maintenance
    • A space maintainer is used to keep a space open for the permanent tooth to grow into, when a baby tooth has been lost prematurely.

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Space maintainers
  • Orthodontic appliances
    • Orthodontic appliances are used in conjunction with braces to influence the growth patterns of the jaws.
    • They can be either removable or fixed.
  • A. Removable appliances
    • Removable appliances are used to move one or a few teeth.
    • The appliances are made of plastic and may have wires that exert a slow gentle pressure on the teeth to be moved.
    • Removable appliances must be worn continuously or as your orthodontist instructs.
    • A removable brace may for example be used to correct teeth that have been forced forward and outward by a thumb sucking habit.
      It can also be used to hold or retain teeth in their corrected positions.
    • Removable and fixed appliances can be used to increase the width of the upper jaw.

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The thumb sucker
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Removable brace
to correct front teeth.
  • Removable head gear
    • This influences the rate of upper jaw growth and tooth eruption.
    • It is worn for 10-12 hours daily.

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Removable headgear
  • B. Fixed appliances
    • Fixed appliances are attached to the teeth and remain in the mouth for the duration of the active phase.
  • The placement of fixed braces
    • Little metal, ceramic or clear acrylic brackets are bonded or cemented onto the teeth.
    • Specially bent wires are then attached to the brackets.
    • Tightening of the wires causes the controlled movement of the teeth.
    • Fixed or removable braces are used in conjunction with rubber bands.
    • Braces are designed to exert a constant gentle pressure on teeth in order to move them into their correct positions.
    • New, high-tech materials and modern methods of bonding brackets to teeth, make braces less obtrusive and easy to fit.

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Brackets and
rubber bands
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Braces fitted
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After braces
  • Herbst appliance
    • This is usually fixed to the upper and lower back teeth.
    • It is used to treat protruding upper teeth, and helps to correct an underdeveloped lower jaw.
    • It cannot be removed by the patient.
  • Bionator
    • The lower jaw is held in a forward position by this appliance.
    • It guides erupting permanent teeth into position.
    • A bionator helps the upper and lower jaws to grow in proportion to each other.
    • Because this is a removable appliance, the patient has to co-operate very positively if the treatment is to succeed.
  • Palatal expansion appliance
    • It is fixed to the upper jaw and expands the width of the upper jaw.
    • This treatment improves the alignment of the upper and lower jaws.

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12. What happens during the retention phase?

  • When active treatment is completed, the braces and other appliances are removed.
  • To maintain the changes that have been made, a special removable retainer is made for the patient.
    • It is designed to keep the teeth and jaws in their new positions, and to prevent a relapse.
    • The retainer must be worn continuously until the teeth and bone have stabilised in their new positions.
    • This may be a temporary or a long-term measure.
  • Once the corrections have "set" in their new positions, the improvements should last a lifetime.

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Retainer
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Retainer

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13. Is orthodontic treatment painful?

  • When braces or other orthodontic appliances are first placed in the mouth, some discomfort or pain is experienced, but this soon passes.
  • Adjustments to appliances may cause temporary pain or discomfort.
    The appliances may initially irritate the lips, teeth or tongue, but the orthodontist will adjust them to minimise any discomfort.

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14. Can my child participate in sport while wearing braces?

  • Sporting activities can continue, but a mouthguard should be worn for contact sports.
  • Ask your orthodontist for advice on a professional mouthguard.
  • Only professional mouthguards that are custom made should be considered during orthodontic treatment.

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Mouthguard

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15. Can children play an active role in their orthodontic treatment?

  • They can, and they must! Children must be motivated by parents to get a good result. This is what to consider and aim for:
    • Full co-operation by the patient is essential for successful treatment.
    • Proper regular brushing and flossing of teeth are most important.
    • The health of teeth and gums must be maintained during the orthodontic treatment.
    • Avoid eating sticky and crunchy sweets and foods.
    • Keep all scheduled appointments with the orthodontist. This is most important.
    • If appliances work loose, the orthodontist must be contacted immediately.
    • The retainers must be worn exactly as instructed.
    • If the patient doesn't wear the retainers after the active phase of treatment, the teeth and jaws may go back to their old, incorrect positions.
  • This instruction is worth repeating. Wear your retainers for as long as your orthodontist deems necessary, or your teeth can move back to their previous positions!

Final advice to patients: Remember that the discomfort and inconvenience of treatment is temporary. Your new smile and good looks should last a lifetime.

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