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It is interesting how often unusual orthodontic situations can be discovered with a simple exam and X-ray. Just this week I have diagnosed young children (8 to 10 years of age) with multiple missing permanent teeth and/or supernumerary (extra) teeth.

Both missing permanent teeth and supernumerary teeth are common conditions, and they can only be first seen with an X-ray. This is because permanent teeth form underneath baby teeth long before they ‘push up’ to the surface of the gums. By seeing where and how teeth are forming (as well as how many), an orthodontist can adjust a patient’s treatment plan accordingly.

In the X-ray image below, you can see how clear it is that this patient has several extra teeth coming in below the permanent teeth:

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Supernumerary teeth can mean crowding for existing or future permanent teeth, or these teeth could possibly come in at other places in the mouth. A lack of permanent teeth, on the other hand, results in gaps and spaces.

Fortunately, there are many treatment options available whether a patient will have too many–or not enough–permanent teeth. A combination of timely extractions, oral surgery, orthodontic treatment, or cosmetic treatments will make sure a child will have a great looking smile as an adult.

In both cases I saw this week, these diagnoses made a significant impact on the patients’ treatment plans. Although their treatment (braces) will not happen for a year or two, we were able to make sure the treatment works best at that time through the use of X-rays.

Treating a patient whose permanent teeth are still coming in and changing makes this process more difficult. So if your child has not seen an orthodontist by 8 or 9 years of age, please schedule a consultation soon. The earlier your child’s orthodontist knows how his or her teeth will come in, the easier the treatment process will be. It can really make a difference.

An earlier blog, “Does your child need braces twice?” briefly addressed the trend of correcting smiles in two phases, once when a child is between the ages of 6 and 9, and again in the child’s early teens.

Orthodontists know from many studies and from experience that two treatments will not produce a significantly different result, so why is this recommendation still made by dentists and orthodontists?

This is a tough question to answer. First, not all dentists and orthodontists may be aware of the research regarding two phase treatment. Secondly, you are always going to encounter unethical practitioners in any business, and orthodontics is no different. There are some orthodontists that will recommend two stages of treatment for children knowing that while it will not necessarily help anything, it will not hurt anything either (besides the parent’s wallet).

Second, children often want to have straight teeth, and many parents are not averse to treatment before all permanent teeth have come in if it may mean a straighter smile now as well as down the road. Some orthodontists believe there is cultural pressure on kids to have straight teeth–as well as other aspects of their appearance–at younger and younger ages. If well-meaning parents see other young kids with braces and an orthodontist approves, many of them will go along with it, even if it means a higher overall cost.

Even though a first treatment at a young age does not make a difference in most cases, that is not to say that no child could benefit. In exceptional cases such as those which inhibit the normal function of the mouth, early braces would certainly be beneficial. And of course, if a patient wants to improve the look of his or her young smile, that can be done. Problems arise, however, when a young patient or parent is led to believe that early braces are absolutely necessary when that is often not the case.

The fact is that teeth and jaws tend to move back to their original position after correction, especially in growing children. Therefore, it’s crucial that you do your homework, get second opinions, and find a professional orthodontist in St. Louis that you can trust. A good orthodontist will want you to make an informed decision based on what is best for your individual smile. Period.

“Do I need braces to preserve the health of my teeth? My only concern is to keep my teeth for the rest of my life.”

A recent article in the American Journal of Orthodontics and Dentofacial Orthopedics (AJO-DO) by Associate Editor of the journal Peter M. Greco addressed this question and the importance of ethics and trust in orthodontics.

The article presented a hypothetical situation in which an opera singer is referred to an orthodontist. The patient’s teeth could use some improvement, but he practices good hygiene and is primarily concerned about his health. In this situation, an experienced orthodontist begins to consider the possibilities of giving this patient a more beautiful smile:

“You ponder for a moment, and in your mind’s eye, you picture the dramatic esthetic change your treatment could provide. You’d certainly like to close those spaces for this high-profile performer. You would like to tell him that your services would enhance his dental health and prognosis—and you wouldn’t mind starting another patient—but how should you respond?”

Greco points out that in most cases there is little or no evidence to suggest that orthodontic correction will improve the health of already-healthy teeth, so while correction wouldn’t hurt, would it help enough to justify doing?

Here, the orthodontist faces a choice. He or she can:

  • Tell the patient that correction will improve his dental health and gain a patient
  • Or, risk losing a patient by telling him that correction may or may not improve his health of his teeth, but it will definitely improve how they look

An orthodontist interested in maintaining trust and respect for his or her patients (and their patients’ respect for them) will choose the second option. It is the responsibility of an orthodontist to make sure that a patient is as informed as possible in order to make the right decision for their teeth.

If the patient in Greco’s article only wants to do what is best for the health of his teeth, he may not choose correction. However, if he likes the idea of a more beautiful smile, he may decide to do it. The choice is ultimately his, and it’s the orthodontist’s responsibility to make sure that that choice is the best one for the patient.

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