Children and growth

Question 1

My child has been offered treatment with aligners. Do aligners work for children?

Accepted Answer

Clear aligners are an alternative to braces for straightening teeth. In children, teeth move more easily than in adults, so any type of appliance can be used successfully. One of the recent innovations of the Invisalign aligner system is early treatment with aligners in the mixed dentition, while the child still has some baby teeth. The aim of this treatment is to correct the shape of the dental arch, which is often part of the bite problem at this age, and to make room for and align the permanent teeth that have already come through. The results are excellent, and children prefer aligners to traditional removable appliances – they're comfortable and invisible.

Question 2

What is the best age to start orthodontic treatment?

Accepted Answer

The best age to start orthodontic treatment is while the patient is still growing. If we start treatment early – at 8, for example – we widen the jaws and make it easier for the next teeth to come through in line, but starting at this age usually means we have to finish treatment once the child has replaced all their teeth, at around 11–12. That's a very long time, and it's normal for the patient to get tired of wearing appliances. That's why we only start early treatment if there's a situation in the mouth that we believe will interfere with the normal, natural growth of the jaws. If treatment is started at 10–11, for example, when all the baby teeth have been replaced by permanent ones but the jaws are still growing, the overall length of orthodontic treatment is shorter. It's important not to miss the growth period.

Question 3

Can my child have braces before all their baby teeth have been replaced?

Accepted Answer

Braces are usually fitted to permanent teeth. These start coming through as early as the age of 6, and by 8 the front teeth have been replaced. If necessary, we can fit braces at that point, even though there are still baby teeth in the mouth. Braces don't stop the baby teeth from becoming loose and falling out, because they aren't attached to them – only to the permanent teeth already in the mouth.

Question 4

Should I wait until all my child's baby teeth have been replaced by permanent ones before taking them to an orthodontist?

Accepted Answer

A child's first visit to an orthodontist can be at the age of 3. At that point we check for harmful habits, such as finger or dummy sucking, mouth breathing and incorrect tongue position when swallowing. We point these out to the parents and give them guidance on dealing with any problems. If such a habit is stopped at this early age, it will have no effect on jaw growth. In older patients who have started losing their baby teeth, we make sure that the permanent teeth come through without becoming misaligned. At 6–8, for example, a child may already be wearing an appliance. As I've already mentioned, braces can be fitted even before all the baby teeth have been replaced by permanent ones. So don't wait for your child to lose all their baby teeth before bringing them for a check-up. To parents, 16-year-olds are still children, but to orthodontists they're already adults. If any problem is found, it's important to correct it during the growth period.

Question 5

Until what age do children's jaws keep growing?

Accepted Answer

In general, the jaws develop most during the pubertal growth spurt. This means that orthodontic treatment progresses most quickly and effectively if it starts shortly before the child reaches their teens. Parents can tell when this period is approaching from the visible increase in the child's height and the appearance of secondary sexual characteristics – the voice breaking in boys and periods starting in girls. After the peak of puberty, we can still hope for some jaw growth, but it decreases.

Question 6

Can a 7-year-old have an expander fitted to widen the jaw?

Accepted Answer

At 7–8 years old, the patient is still in the early mixed dentition. By this point only a few teeth have been replaced, and after the four upper front teeth come through there is a resting phase in which tooth replacement stops for about a year. Treatment involving expansion can be started at an early age. A reason for fitting an expander at this age may be a narrow jaw and a crossbite. However, some problems with tooth alignment, and even with the jaws, can correct themselves naturally with growth. For this reason, early orthodontic treatment is only undertaken when necessary.

Question 7

Up to what age can jaw expanders be used?

Accepted Answer

Generally speaking, widening the jaw sideways is possible up to the age of 13–14 in girls and 16 in boys. Any specific age is only a very rough guide. The timing of growth varies widely, because children reach puberty at different ages, and this also determines when the jaws grow. In some girls the growth peak occurs as early as 10–11, while sometimes expanding the upper jaw with an appliance is still achievable at 18, for example.

Question 8

Is it normal for a gap to appear between the front teeth when a jaw expander is fitted on the back teeth?

Accepted Answer

Expanders usually push the back teeth outwards (towards the cheeks). If the patient's jaw is growing, a gap may appear between the front teeth that wasn't there before. This is because the growth zone of the upper jaw is in the middle of the palate – where its left and right halves meet – and a gap appearing between the two middle teeth shows that new bone has formed. You may see this effect with a so-called rapid expander – one that is activated every day for a set period. With slow expanders, the teeth have time to shift and fill the space that opens slowly and gradually between them, before you even get the chance to notice it.

Question 9

Which is better for treating children – clear aligners or removable appliances?

Accepted Answer

Both types of appliance are suitable for children. Removable plates have more effect on jaw growth, but they are bulkier, affect speech and are often not worn regularly, which undermines their effect. Aligners are better accepted, invisible and comfortable; they act more on the teeth and less on the jaws. Motivation for treatment with them is higher – but so is their price.

Question 10

What is a lip bumper used for?

Accepted Answer

A lip bumper is an appliance used to create space and anchorage, mainly in the lower jaw. It is made of thick wire shaped like the dental arch, and its curved front section is covered with plastic so that it is comfortable for the lip. It is prescribed for children to create space for the lower side teeth to come through, by holding the back teeth (the first permanent molars, or ‘sixes’) in place or pushing them backwards. It uses the force of the lower lip muscle, which presses on the appliance and gives it a backward force. It can also be fitted in the upper jaw, but then it relies on the pressure of the upper lip, which is considerably weaker. This appliance is worn for 12–14 hours a day and gains 1–2 mm of space in the dental arch.

Question 11

How many hours a day does a removable appliance need to be worn to work?

Accepted Answer

The usual recommended wear time for children's removable appliances (plates) is 22 hours a day. They are taken out only for eating, brushing teeth, sport and singing. If the appliance is worn only at night, it often drops slightly away from the teeth, because our muscles are relaxed while we sleep, and over time it stops fitting. Results can be seen even with night-time wear alone, but because of the effect I have just described, wearing it that way isn't recommended. The minimum wear time for an appliance is 14–16 hours, which means all of the child's free time after school and through the night.

Question 12

Can my child stop wearing their removable appliance while they're ill?

Accepted Answer

If at all possible, wear of the appliance should not be interrupted during an illness. If the illness really is incompatible with wearing the appliance, we recommend finding a short time to wear it during the day and, if possible, sleeping with it during that period, without activating it. Once your child has recovered, you should book an extra appointment with the orthodontist to have the appliance adjusted to the mouth and possibly to change the activation schedule. Don't keep turning the screw on the appliance as usual if it isn't being worn for the recommended time.

Question 13

The teeth get used to each tightening of the removable appliance within two days. Can we tighten it more often than recommended?

Accepted Answer

The feeling that the teeth have got used to the appliance being tightened comes quickly – in some children even within a day of turning the screw. Even so, moving the teeth through the bone takes a certain amount of time, so if the appliance is turned more often than recommended, one of two things happens: either the appliance stops fitting the teeth and ‘drops’, or you turn the screw and the pressure from the teeth pushes it back, so you are making ‘empty’ turns that achieve nothing and don't move the treatment forward.

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