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Determining the Correct Age to Start
by Alexander Waldman DMD MMSc
Determining the correct age for a child to start orthodontic treatment is one of the most critical steps in the orthodontic treatment planning process. Starting braces, or any other appliance, at the right age translates into minimizing the amount of time that the braces must be worn, and maximizing the quality of the result. However, in order for this decision to be made properly, a number of biological factors must be considered. Interestingly, the patient's chronological age (number of years), has the weakest correlation to readiness for orthodontic treatment. Skeletal age, which helps determine the child's growth potential, and dental age, which tells us the specific stage of dental development that the child is in, are actually the most important factors. Another significant determinant of the best time to start orthodontic treatment is the type of problem at hand.
In order to determine the patient's skeletal and dental age, a number of factors are taken into consideration. Dental age can be determined through a routine examination and a panoramic x-ray. Skeletal age can be determined through an x-ray of the hand and wrist, as well as a newly developed analysis of the cervical vertebrae that I have been using successfully for the last five years to help estimate the onset of the mandibular (lower jaw) growth spurt. We do not need to take an extra x-ray for this, as the bodies of the cervical (neck) vertebrae are easily visualized on the cephalometric (head) x-ray which is taken routinely as part of our detailed diagnostic work-up.
Since we do not know how each child is developing until we actually examine them, and perhaps even take some x-rays, I recommend that I see the child be seen as soon as there is a concern he or she may need orthodontic treatment. If the child is not yet ready for treatment, he or she is placed on our pre-treatment observation program, which allows me to track their growth and development until they are ready for treatment.
The other major consideration with regard to orthodontic treatment timing, as was mentioned above, is the type of problem at hand. If the problem is a relatively routine one, such as moderate crowding or spacing of the teeth, the best time to initiate treatment is during the final stage of the transition from the baby teeth to the full set of permanent teeth (on average between ages eleven and thirteen). If there are problems that have to do with the growth or size of the jaws (such as a crossbite, an underbite, or a severe overbite), treatment may be initiated when there are still many baby teeth in the mouth, anywhere from age six to ten. Children who display severe crowding of the teeth are also candidates for early, interceptive treatment.
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Dr. Alexander B. Waldman, Orthodontist |
99 N La Cienega Blvd Suite 301, Beverly Hills, CA 90211 |
Tel. 310.652.1515 |
Fax. 310.652.1717
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Orthodontic Website by Sesame Design™
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