Conservative Treatment Philosophy

Growth and Development

The dental specialty of orthodontics is more than just braces. It also focuses on the growth and development of an individual’s jaws and teeth. An orthodontist is best educated to help monitor the changes that occur in your growing child and make appropriate recommendations for treatment.

When to Visit

The American Association of Orthodontics recommends children be seen by an orthodontist around the age of seven. By this time, the six-year molars have come into the mouth and the front incisors have come in or are in the process of “erupting.” This does not translate into “it is time for braces.” But rather, it is an opportune time to develop a good relationship with a provider who can monitor the changes that occur with growth and dental development.

Why are so many elementary school children in braces?

The most common orthodontic problems (crowding, overbites, underbites, cross-bites) will all be present in the young individual. Just because these “problems” exist does not automatically indicate orthodontic treatment is required at that time. The ideal age to start orthodontic treatment is when all of an individual’s permanent teeth have come in, sometime between the ages of 12 to 14. Only in a small percentage of young people is an early phase of orthodontic treatment (Phase I) beneficial. Cross-bites and underbites are universally recognized as the issues requiring early intervention. However, this occurs in less than eight percent of the population. For the majority of cases involving crowding and overbite, early treatment is not required.

Early treatment is more costly both in terms of the amount of money you have to pay and the number of visits you make, and there is a greater burden of treatment with no benefit for most children.”

Dr. William Proffit, Professor Emeritus, UNC Chapel Hill

Things to Consider: Who really benefits?

There are reasons for early orthodontic treatment outside of underbites and cross-bites. Significant front tooth crowding or spacing can leave young people susceptible to teasing. The question to ask them is, “Do your teeth bother you?” If not, then early braces are not likely indicated. Also, there is often a simpler alternative, such as removing a couple of baby teeth earlier than usual which can make enough space for crowded teeth to “straighten” on their own. Braces for second and third graders have almost become the “popular” thing to do. Parents are also wanting to make sure they are doing everything they can to provide the best for their children, and understandably so. But, if there is little clinical benefit for early braces, an increase of cost, an increase of time spent overall in braces, significantly more office visits and overall effort, is that truly the best thing for our children? Early braces does not eliminate the need for a second round of braces. Ninety-seven percent of patients who have Phase I treatment also receive Phase II. With advances in technology and the ability to accumulate and analyze large samples of patient treatment data, much of the orthodontic mythology of the past has been rewritten by sound treatment principles. However, providers must be willing to adapt to the ever-advancing landscape of scientific evidence.

What does the scientific evidence say?

For children with an overbite or buck teeth, “there is no advantage to starting early,” according to Dr. William Proffit, a professor at the University of North Carolina's School of Dentistry in Chapel Hill. That was the conclusion of three major, randomized clinical trials comparing the outcomes of treatment for younger versus older children. “The most common issue in children is crowded teeth that are either crooked or protrude. For this group early treatment ‘works,’ but you have to do two phases of treatment. So they're going to be in treatment for four years — a first phase, then a break, and a second phase when all the permanent teeth are in. Early treatment is more costly both in terms of the amount of money you have to pay and the number of visits you make, and there is a greater burden of treatment with no benefit for most children.”

Dr. William Proffit is regarded as one of the best minds in the orthodontic profession, with more than 40 years of clinical and academic experience.