Does my child need braces?

Orthodontics: The most important facts in brief

During orthodontic treatment, pressure and traction forces act gently on the teeth to move them. This is possible thanks to special appliances that are either removable or fixed. For example, brackets are bonded to the outside of the teeth and connected to each other by wire arches, the classic braces. Aligners, transparent plastic splints that are worn for a fortnight at a time and then replaced with a new splint until the desired result is achieved, are suitable for smaller corrections.

In this article you can read when exactly the time is right for braces and whether a crooked tooth is really bad or can stay that way.

It's a typical picture: teenagers sitting together in the park or by the lake, fooling around, some laughing and the metal of their braces flashing in their open mouths. According to a study by the Federal Statistical Office, a good third of all Swiss people have worn braces at some point in their lives, and more than half of 15 to 24-year-olds have done so.

However, the reason for such a correction is not primarily of a medical nature. Rather, parents nowadays decide in favour of orthodontic treatment for their children primarily for aesthetic reasons. «There are very few parents who say that crooked teeth should only be corrected if it is medically necessary,» says Daniel Feldmann, an orthodontic specialist from Zug, «most of them want their son or daughter to have beautiful teeth - even if some are reluctant to say so openly.»

The timing is crucial

The key question with orthodontic treatment is timing. If interventions are carried out at the right time, they can sometimes be significantly less costly than if they are decided too late. In the case of children and adolescents, dentists and orthodontists have two main time frames in mind. There is the first window, which opens around the age of seven to eight. Then come the permanent front teeth. «The upper jaw can still be stretched well now, as the palatal suture is still soft and open,» says Feldmann. Early intervention may also be necessary in the case of a functional crossbite in the front if the upper incisors are behind the lower ones.

If interventions are made at the right time, they can sometimes be significantly less costly than if they are decided too late.

Treatments at this age have nothing to do with aesthetics, but actually have medical relevance. Theoretically, the malocclusion could also be corrected in 14-year-olds, but then the whole thing is more complicated. It is even more difficult to make expansions at a skeletal level in adults - for example of the upper jaw bone. «If the dentist and orthodontist focus on the child's development, a lot of things can be put on the right track with relatively little effort,» says Feldmann.

The child must want the brace

The second phase, which is exciting from an orthodontic point of view, begins around the age of ten to eleven. This is when most children start to change their posterior teeth. The canines and the first and second milk molars fall out and the permanent teeth follow. «Let's assume that the teeth are crooked due to a lack of space in the jaw,» says Feldmann, «then now is a good time for an intervention.» However, the orthodontist emphasises that this must be decided jointly by parents and child. Especially during puberty, the thought of having to go through life with braces for two to three years is sheer horror for some girls and boys. It often doesn't even help that friends already have braces. In rare cases, when a child flatly refuses, that's fine with Feldmann: «I then say: you can still correct this problem when you're 20 or 30 years old. It might be a bit more difficult, but there's always a solution.»

Not all parents and teenagers are bothered by crooked teeth

Feldmann also realises that the aesthetic requirements of his patients vary greatly. Not all parents and teenagers are bothered by crooked teeth. «I have to accept that; I can't impose a treatment costing 10,000 to 12,000 francs on someone that the parents and children don't actually want,» says the Zug-based specialist. Conversely, it is important for him to take an existing need for correction seriously and not to dismiss it by saying that it is not medically relevant. The costs of orthodontic treatment must be borne privately; only in serious cases is this covered by disability insurance. «Many parents therefore take out supplementary insurance for their children, which then covers 50 to 90 per cent of the treatment costs, depending on the insurance,» says Feldmann.

Parents who are not sure whether their child really needs orthodontic treatment or whether everything will somehow work itself out should definitely take the trouble to get a second opinion.

Aesthetic requirements vary greatly: not all parents and teenagers are bothered by crooked teeth.

Even if an orthodontist usually only becomes active when the first permanent teeth appear: Certain anomalies may require treatment much earlier. «It therefore makes sense to consult an orthodontist if there are any abnormalities in the primary dentition, even if nothing needs to be done at first,» explains Peter Proff, «President-elect» on the board of the German Society of Orthodontics.

When measures are essential

For the Director of the Polyclinic for Orthodontics at Regensburg University Hospital, orthodontic measures are particularly essential when biting or chewing does not work properly, as well as in the case of disorders of lip and tongue function, breathing and speech, as well as malformations that jeopardise the teeth, for example because they favour periodontal disease and tooth decay. «We also correct anomalies that affect the child or adolescent psychologically, such as malocclusions that change the profile, cleft lip and palate or canines that protrude outwards,» says Proff.

On the other hand, minor rotations or tilting of individual teeth that do not affect the patient functionally are not mandatory, but optional. Good dental care and prophylaxis, says Proff, is also one reason why we see more children and adolescents with braces today than we did a few years ago. This means that fewer of them fall through the cracks because anomalies are not recognised and treated in time, if at all.

The limits of orthodontics

Like any other treatment, there are limits to orthodontic measures. Specialists are helped by the fact that teeth in a healthy set of teeth can be moved on the jawbone well into old age. «In the case of very pronounced skeletal anomalies, orthodontic treatment alone may no longer be sufficient, meaning that orthodontic measures must then be combined with oral surgery,» explains Proff. However, this is really the exception.

As a rule, normal treatment with braces is sufficient to correct misalignments in children and adolescents. «With removable braces in particular, it is important that girls and boys understand why they should wear the often unpopular appliance and cooperate,» says Proff.

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