Wednesday, January 27, 1999
Bracing for new smiles
When children need orthodontics depends on individual characteristics
BY SUE MacDONALD
The Cincinnati Enquirer
Back when 15-year-old Sherry Barsman lost her baby teeth, it was clear that she would need braces.
“We knew the teeth were crooked, but you never realize how crooked they were until you look at the before-and-after pictures,” says her mother, Marsha Barsman, a Cincinnati Financial Corp. computer programmer who lives in Symmes Township.
But the choices weren't as clear for Sherry's brother, 10-year-old Zach. His bite was fine, and his teeth were fairly straight, but the family's orthodontist said braces could improve the boy's smile.
“It was a much more difficult decision with Zachary, whether to go through the time, the expense, the pain ... but we opted for it,” Mrs. Barsman says, explaining why Zach got braces a few weeks ago.
According to the American Association of Orthodontists (AAO), an estimated 3.6 million American children under 18 in 1996 were under orthodontic treatment, up from 2.6 million in 1989 and 2.9 million in 1992. Average age is about 10, with most 10-12.
Yet the decision to put a child in braces or some sort of orthodontic treatment is not always clear — and neither is the decision on when to start.
Some dentists push treatment as early as 7 or 8 (even earlier), while others say it's best to wait until all a child's baby teeth have fallen out so that treatment can be timed with a child's growth spurt and the arrival of permanent teeth.
AAO recommends an orthodontic screening for every child by age 7. Early evaluation with a panoramic X-ray of a child's mouth can provide good information about how a child's teeth, jaw and bone are developing, says Blue Ash orthodontist Dr. James Weber.
“Just because you're going into an orthodontist's office for an evaluation, you're not signing up,” he points out. “You're just doing your homework.”
Some children need braces or orthodontic appliances early, especially if the lower jaw is pulled back and creating a large overbite, if the jaws don't align properly while biting or if the teeth are extremely crooked, crowded or overlapped.
Orthodontists have a variety of devices, such as head gear and jaw expanders, that encourage bones to move and grow during early elementary-school years to improve a child's bite (the way the top and bottom teeth meet) and to make room for permanent teeth and braces. Some teeth may have to be pulled to make room for others.
Treatment can be launched in phases, with jaw expansion, jaw movement and pulled teeth followed by the braces that actually move and straighten permanent teeth.
“Two-phase treatments are very good and very common,” Dr. Weber says, “but they're not appropriate for everybody.” Children also need a level of maturity to handle the brushing, flossing, cleaning and routine that comes with taking care of and wearing braces and other devices, Dr. Weber says.
“You need a competent orthodontist, a committed patient and a concerned parent,' he says. “If you don't have all of those, you're almost setting yourself up for failure.”
Unless problems are severe, most children are ready for braces by 11-13, when all the baby teeth have fallen out.
Can it wait?
Sometimes, the pressure to put a child in braces comes from parents, says Dr. James Steiner, director of pediatric dentistry at Children's Hospital Medical Center.
“The parents get real concerned if the teeth aren't straight,” he says. “They're concerned about children being teased in school, and they'll begin to ask questions. Is there anything you can do? Can you fix it?”
It's important for parents to realize that children go through what dentists call an “ugly duckling” stage when they are about 6-8, when permanent, adult-size teeth that are out of proportion to the size of the child's head begin replacing baby teeth, Dr. Steiner says.
“It's normal, and it's the way kids are supposed to look,” he says. “Sometimes the teeth are jumbled, and they come in as adult-sized teeth and look really big and scary. It's usually normal. Just ask about it.”
In many cases, teeth will fall back into line over the next few years as the child undergoes a growth spurt.
“I'm probably an old-school conservative, and I tend not to push for things until I see a real strong indication,” he says. “What if we wait?' is a great question to ask. But if a parent has a concern, I'll usually say, "We'll be more than happy to send you to an orthodontist for a consultation. But quite honestly, I think this is pretty normal for your child, and we'll continue to follow the child and see how things develop.' ”
Second opinion?
The goal of orthodontic treatment is good timing, so that teeth and jaws can be moved in a minimum amount of time with maximum results, Dr. Weber says.
Second opinions can help parents gather information in order to make an informed decision.
“If what you're hearing isn't comfortable or doesn't make sense, then I would get (a second opinion),” Dr. Steiner says. “And if somebody's offended that you're going to get a second opinion, then I'd definitely get one. A lot of these treatment decisions are based on open communication and trust, and I think that's what you really look for in a health-care provider — somebody you can trust.”
Dr. Weber especially urges parents to see an orthodontist — a dentist who specializes in braces — for advice. Some general or pediatric dentists do orthodontic work as part of their practice, but he recommends a specialist because of their added training and experience and because their work is monitored by an outsider — the family dentist.
“Experience is what you want to buy,” he says. "'If all you base your decision on is the price or convenience, buyer beware.”
Mrs. Barsman found it helpful to talk to her son's dentist, friends who are dentists, other parents and the orthodontist before deciding on his treatment.
“If you're unsure of what the orthodontist is telling you, get a second opinion, just like with everything else,” she says. “You're never hurting yourself by getting a second opinion.”
Bracing for new smiles
Braces? Here are warning signs
Braces? What to consider
Lunchtime in a little town served warm
Pope gets rock-star greeting
Pope gets CD, music video
Pope's schedule
Chicago-Cincinnati bullet train gets nod
Silver Grove awaits word of 'rebirth'
Taft's minister: Spare Berry
Anti-tax activists rally against school levy
Parole board says no to serial killer
Some Tristate senators no-commenting on witness issue
Western residents split over growth
Instant dam limits gasoline spill
UC profs' 3-year deal approved
'Seinfeld' lawyer argues case
City job could stay in family
Club gives stay-at-home mothers a reason to get out
Covington, Kenton Co. to share repair of road
Doctor says estrogen compounds problema
Drawbridge policy 'shortsighted,' convention group says
Driver guilty in chase, shootings
Fire's cause may remain a mystery
Ft. Washington Way closed tonight
GOP gives Patton pass in election
Jury acquits on DUI
Killer's friends get year
Last payment in pacemaker wires suit
Levy renewal may go to a vote
Missing teen's case hits national TV
No closed meetings, judge tells Lebanon
Pneumonia is peaking
Retired judge of appeals court dead at 72
School nurses do more
School technician dies in crash
TRISTATE DIGEST
Warren transit fares likely to rise
With help, injured boy battles back
