Age: 11-14 yo
Typically, most adolescents will get started when they have all or "almost" all their baby teeth out. Usually the baby teeth all fall out at the age of 12. About 75 percent of all kids and teens will have some type of problem when their adult teeth come in and will require orthodontic work to correct these problems. These problems usually range from having major bite issues which could affect important tooth functions to simple esthetic cases of crooked teeth.
Why to start now:
Although it's never too late to get orthodontic treatment, there are some reasons to get started soon.
Social acceptance: A majority of those kids with orthodontic issues will have them corrected once the braces come in. At the age of 11-14, braces are considered very socially acceptable. In fact, many kids want braces in this age range. However, it's important to know that braces are a tool to creating a amazing smile which is meant to last a lifetime. Once these kids get older, the novelty of braces slowly fades until they graduate from high school.
Easier to move teeth: As kids are growing and their teeth are erupting, the teeth have not yet settled and it is actually easier to move the teeth around which allows for a shorter treatment. When patient's get older, their bone becomes more dense and the teeth will move slower. Finally, older patients, typically report more discomfort.
More stability: As we get old, the teeth move slower and the bone typically "heals" (fills in the voids created by tooth movement) at a slower rate as compared to young kids. When the bone fills in certain areas, this creates much more stable tooth positions. This does not mean that young patients do not need to wear retainers. While the teeth are more stable in the bone, tissue changes and growth can cause shifting of the teeth if the retainers are not worn.
Kids are overall, more resilient than adults: Typically, the older we get, the less likely we be able to accept change such as wearing braces or aligners. It may also be difficult to get used to a changing bite. As we get older as well, our bone become more dense and tooth movement will decrease as discomfort will increase.
Other reasons to start sooner:
Crossbites:
Anterior crossbites: These bites are problematic because the teeth are not designed to bite in this manner. While back teeth are designed for heavy forces, the front teeth are prone to wear on the edges because they are thin from back to front. Edge to edge and complete crossbites can often cause wear and are considered reasons to get started as early as possible to make sure they do not create more wear.
Posterior crossbite: A shifted bite can also cause TMD issues. The most common cause of the shifting bite is a unilateral (one sided) posterior crossbite. In growing patients, because the lower jaw growth is dictated by muscle attachments, this may cause the jaw to grow asymmetrically. Over time, this sideways slide may cause wear and tear on the joint in a way the join was not designed to take force.
Speech issues: Often gaps between the teeth or open bites (front teeth cannot touch together) can cause articulating issues such as lisps or the inability to make "s" sounds where the speaker is forced to use their tongue to block out the gap.
Getting made fun for their teeth: Bullying is a big issue. During the adolescent and teenage years, social acceptance is very important in a child's development. If a child is being made fun of due to their teeth, this would be a reason to get started ASAP so that they are proud of their smile. Proper retention will insure that a beautiful smile is maintained for a lifetime.
Recession: The area where the most recession is found is in the lower anterior. Typically, the bone and gums are very thin here. This is typically the area that most crowding is found. When one or two teeth are pushed forward due to crowding, it is not unusual to see recession, as the crowding continues to get worse and due to biting forces, these teeth get pushed from the bite causing the crown of the tooth to go back toward the tongue while the root gets pushed out. Continued biting on these recessed teeth will over the years cause more recession. As teens and adults, bringing these teeth out of the heavy forces can keep the recession from progressing but in most situations, the gum level does not go back up without a gum grafting procedure.
TMD: There are many different causes of TMD. Often, the overclosure of the bite can often cause TMD issues by placing heavy pressure on the joints. Braces and clear aligners help to open up the bite relieving pressure on the joints. A shifted bite can also cause TMD issues. The most common cause of the shifting bite is a unilateral (one sided) posterior crossbite. Over time, this sideways slide may cause wear and tear on the joint in a way the join was not designed to take force.
Oral Hygiene: Crowding can cause oral hygiene issues especially in areas that are overlapped. It is important to note, however, that proper oral hygiene is maintained throughout treatment. This is often a good teaching point for those who are learning responsibility.
Traumatic bites: These bites include edge to edge bites or side to side bite. In some crowding cases heavy occlusal or biting forces can cause recession and wear on the tips of the teeth. Teeth are designed to take forces in a very specific direction. In cases where front teeth are clashing due to crossbite or edge to edge bite, often wear on the edges are likely to occur. When molars or premolars are taking side occlusal forces, abfraction may occur. Abfractions are wedge shaped lesions on the side of the tooth close to the gums. Abfractions are not only a breakdown of the integrity of the tooth but also lead to sensitivity due to the exposure of dentin (the second layer of the tooth).