Part 1: Baby Teeth and Braces-What Every Parent Needs To Know

Dental BracesDon’t we have to wait for all the baby teeth to come out? When is the best time for my child to get braces?

These are very common questions ‘that parents ask me. The short answer is no, one does not have to wait for all the baby teeth to come out.

While it is true that a full set of braces is only complete when all the permanent teeth(including 2nd molars) erupt into the mouth (not including 3rd molars/wisdom teeth) that is not necessarily a reason to delay beginning orthodontic treatment. There are certain types of orthodontic problems when early intervention is beneficial; this is referred to as Two Phase treatment.

Two-Phase treatment is recommended in young patients typically between the ages of 7-10 years. When this particular set of problems are not addressed at an early age than the resolution of these problems becomes more challenging and may necessitate more aggressive treatment. At times, a child’s sense of self-esteem is adversely affected by the appearance of their teeth and so they would benefit from early care. Certain bite problems may cause the child’s teeth to be more susceptible to injury, so early treatment is advisable.

So, back to our original question about starting braces with baby teeth still present. Do all baby teeth need to have been lost before orthodontic treatment is started?

Let me explain our approach to the timing of treatment.

The average loss of all the baby teeth occurs sometime around the age of 12 and all the adult teeth typically have erupted by this time. However, if the young person has a history of delayed eruption than this pattern of late eruption of the adult teeth will most likely continue.

The eruption or lack of eruption of the 2nd molar by the age of 13 is helpful in assessing the teenager’s dental maturation. This is the last adult tooth to emerge(not including 3rd molars/wisdom teeth).

When a teenager presents to our office for an initial orthodontic examination we determine what their dental developmental status is. If they don’t have a full complement of permanent teeth by the age of 13 years old it may be that they are merely behind schedule with no associated issues. Or, on the other hand, it may be indicative of a problem that is responsible for delaying permanent tooth eruption.

Another valuable indicator that helps me determine an abnormal or normal eruption pattern is how the baby teeth have been lost. Are the teeth being lost in the appropriate sequence and just delayed? For example, if all four primary second molars remain in a 13-year-old, the patient is probably just slow. Conversely, if only one primary second molar remains and it is not loose but the other three have been shed and their replacements are in, it is likely that there is some issue that requires deeper probing. When a tooth is lost prematurely or on one side only there may be a problem. So patterns of tooth loss are a very valuable part of orthodontic diagnosis and we will always recommend a panoramic screening film to be taken at this time.

If you have any questions about early treatment, don’t hesitate to contact our office, Mark Feinberg Orthodontics. Also please feel free to request a copy of our resource guide on early orthodontic care.


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