Does your kid really need braces?

Here’s the latest on orthodontics from Canadian experts

Q: It seems to me kids are getting braces earlier and earlier. Is it just a cash grab?

A: You’re wise to be cautious about agreeing to any pricey service, whether it’s a brake job for your car or braces for your child. But mostly, we’re seeing younger children in braces simply because of what orthodontists have learned about treatment since we were kids in head gear.

Kids with suspected tooth troubles will be referred to an ortho around their seventh birthday. That’s when most kids have all their primary (“baby”) teeth, and adult teeth begin their descent — giving orthodontists a clear window into what’s happening, and what will happen, in the mouth. If you haven’t already discussed it, ask your child’s dentist if any othro visit is necessary.

That first visit shouldn’t cost anything, since most orthodontists don’t charge for consultations. They look for two things: tooth crowding and jaw misalignment (either severe overbite, where top teeth extend way beyond the bottom teeth, or under bite, which is the opposite).

Early intervention can make it easier to fix both issues: Young children have softer, more malleable bones, so their jaws are more readily encouraged to move or grow in a more ideal shape. And because younger kids grow faster, treatment takes less time.

Early intervention can also prevent crowding down the road. For example, a six-year adult molar normally erupts right behind a baby second molar. If your child loses that baby molar early (perhaps due to decay), the adult molar may drift forward, severely crowding adult teeth that emerge. By moving that adult molar back into its ideal position early, you can avoid having to pull it out it later on and possibly avoid further orthodontic work.
Q: Will I be able to tell if my child needs her teeth fixed?

A: You can definitely keep your eyes open for signs of possible problems. Your child’s 20 primary teeth should be in by the time she’s about three.

Permanent teeth begin to pop out between ages six and nine, beginning with the front teeth and the back molars. Why those teeth? They’re the biggest and need lots of room.

You and your dentist can watch to ensure that adult teeth are growing in according to plan and that there’s enough room for them.

Q: How do I choose an orthodontist?

A: An orthodontist is a dentist who’s had two years of additional training to become licensed in his specialized field, and will have “Dip. Ortho” (Diplomate in Orthodontics) after his name. If the diploma isn’t displayed in his office, you can ask to see it. Because technology is constantly advancing (see “What’s new about braces?” below), you also want a doctor who’s on top of the latest research, so ask what kind of training he continues to get.

Then, ask for referrals: Have previous patients been happy with their level of care and experience? You might even want to look at before and after photos — most orthodontists have them.

Finally, be sure to visit the office with your child. Is the staff welcoming? Does the doctor “get” kids? Your child will be spending up to 24 months with the ortho you choose, so make sure the relationship is a solid one.

Q: What about just having my child’s dentist do the work?

A: Your dentist may also be qualified to straighten teeth (see above) — but be sure to check. Ask how often he puts braces on kids. One patient a year? One a week? Yes, your child may be more comfortable with her regular dentist, but you don’t want to sacrifice experience for comfort.
Q: How important is it for my kid to have straight teeth, really?

A: Straight teeth don’t just look nice, they help a child chew better and speak more clearly. Braces can also be used to bring impacted teeth out of the jaw where they’re stuck, avoiding surgery down the road. Straight teeth can boost self-esteem too; many adults get braces because they’re embarrassed about their smiles.

Q: How much should I expect to pay?

A: The cost depends on how much work has to be done. A patient who needs a simple retainer and four months of treatment will pay less than one who needs full upper and lower braces for two years. But generally speaking, fees range anywhere from $2,000 to $8,000.

Most employee benefit plans cover a portion of the cost — typically to a maximum of $2,000 to $2,500. You can ask your orthodontist to map out the phases of treatment and the costs associated with each phrase, in order to spend your insurance money strategically; you may want to save those insurance dollars for the most costly parts of the treatment, and budget for the rest.

Keep in mind, too, that there isn’t an orthodontist on the planet who expects to be paid all at once. They’ll usually ask for 10 to 25 percent of the total fee up front, followed by monthly, or even quarterly installments. So a $5,000 treatment might break down into an initial payment of $1,000, followed by 24 monthly payments of about $165 each.
Q: What can I say to reassure a nervous child?

A: Today’s braces are more comfortable than the ones mom or dad might have worn, plus they’re more efficient, meaning your daughter will get faster results. (While you may have had to bear up for three years, she’ll likely be finished in two.) She’ll also have to endure fewer visits to the orthodontist: The wires in her braces will need tightening and adjusting only once every eight to 12 weeks, compared with three or four.

If your daughter’s vanity is at stake, she can choose clear, plastic braces, which work just as well as metal, but are less conspicuous. If she’s older, there’s a chance your child won’t even need a set of “train tracks.” A new product called Invisalign Teen consists of one or two clear, nearly invisible trays she can remove temporarily for cleaning or for a first date. Yet they work as well as traditional, non-removable braces.

Our expert panel

Jonathan Britton is an orthodontist in private practice in Burlington, Ont. He is a former staff orthodontist at Toronto’s Hospital for Sick Children.

Willy Dayan runs City Orthodontics in Toronto. He is a guest lecturer at the University of Toronto and Tel Aviv University.

Howard Steiman is the president of the Canadian Association of Orthodontists and a clinical instructor of dentistry at the University of Toronto. His practice is based in Ajax, Ont.

Sol Weiss is a cosmetic dentist in Toronto and a former assistant professor at the University of Manitoba.

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