Early orthodontics, early treatment, and early intervention are common terms that have been floated around in the orthodontic profession in my career. Many traditional orthodontists suggest it is a waste of time. I strongly suspect none of those skeptics advocating against early treatment understand that orthodontists in the early 1900’s were using braces and knew about airway health for kids as they treated children prior to them having any permanent teeth (age 6 and under)!
In the last 20 years there has been a growing interest in using pediatric braces or other forms of child orthodontics for airway development. At this point it is not a mainstream thing, but many in the profession are getting on board. Many are doing so because they have children and have seen in their practices that things generally get worse over time. Many, like me, feel that by the time all the permanent teeth are in the mouth in adolescence it is too late to do the best treatment. So many kids have faces which have fallen back with their airways being reduced. For too many kids today, no matter what is done to straighten their teeth, the treatment in adolescence is much like rearranging the deck chairs on the Titanic. The airway is so compromised with the soft palate and tongue following both jaws back in the face that insufficient growth exists to modify to improve a child’s airway. Insurance companies generally provide orthodontic benefits more for adolescent treatment. In my opinion, if they provided benefits for early orthodontic treatment with a goal of optimizing the airway they would help children live healthier lives.
Sleep disordered breathing and breathing disordered sleep are interchangeable terms that are often used in our profession. No child should stop breathing for more than 10 seconds during sleep, but many do. If they have a certain level of oxygen desaturation this is called an apneic event. One such event during an entire night qualifies a child to be diagnosed with Obstructive Sleep Apnea (OSA). Doctors in the early 1900’s recognized this long before the term OSA was coined.
For parents who want their children to have the most attractive face they can have (who doesn’t?) it is critical to treat early to correct the poor rest oral posture which causes both jaws to fall back. A face that looks good functions well (good airway).
Much early ortho treatment focuses on the teeth and seeks to retract the upper front teeth to “normalize the bite”. This is the exact opposite of what should be done. I have three goals for all early orthodontic treatment. It should optimize facial balance. It should optimize the airway. It should encourage proper rest oral posture so that every child has teeth together, tongue to the palate, and lips together at rest. Then the child has a chance at having future dental development be favorable. I strongly support early treatment when this is the goal. I strongly disagree with anything which brings the teeth back in the face at any age. A patient is better off with no treatment than retractive treatment.