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Why Early Orthodontic Intervention Matters

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.

FAQs About Why Early Orthodontic Intervention Matters

Why is early orthodontic intervention so important?
The best analogy to make here is to say that no one waits to call the fire department until the flames are going through the roof. Wise people call when they smell smoke. Parents should all understand and be able to identify “the smoke” that predicts the later fire in their child’s dentofacial development. The longer the problem is ignored the further back the face falls and the smaller the airway gets in the process. In my opinion, in an ideal world any orthodontic treatment should be completed prior to the eruption of the first permanent tooth at age 6. Will this prevent the need for braces in adolescence? Maybe or maybe not. But for my patients I can’t stand to see things get worse. Virtually every parent understands this and wants treatment as soon as any problem is recognized. Our goal is to educate the parents and the profession to recognize the obvious signs of an orthodontic problem even before any permanent teeth emerge.
I believe a child should see an airway-focused orthodontist as soon in their life as any problem is recognized. That would include seeing a child prior to age 3. Many pediatric dentists are being trained to recognize and treat airway in young kids and are seeing kids immediately after birth to look for tongue tie issues which may negatively impact facial growth. If your child is a mouth breather and/or has sleep disordered breathing you absolutely should see an orthodontist ASAP. If you are told to wait I strongly suggest a second, third, or fourth opinion if necessary to find someone to help. You may or may not find anyone anywhere close to where you live (even in a big city) to help so be prepared.
If one believes, as I do, that every malocclusion starts with the upper teeth starting to fall back in the face, then that problem alone needs to be recognized. The poor rest oral posture which allows this to happen can and must be treated in order to keep the facial growth from getting worse. Faces with jaws recessed not only are not as attractive, but they function poorly when the airway is compromised as the soft palate and tongue follow the jaws down and back in growth. Orthodontists were treated in the primary dentition over 100 years ago to prevent mental retardation.

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).

I love the old FRAM oil filter commercial from 30 years ago. The mechanic standing by the car with the hood up holds an inexpensive oil filter in his hand held high and says, “You can pay me now, or you can pay me later.” Would you rather pay a few dollars for an oil filter or for a complete engine overhaul? There are problems which can occur with ignoring airway/breathing problems which no amount of money will correct. Has someone come up with a way to regrow brain cells which have been permanently damaged? (Look at the research of Ron Harper PhD neurobiologist at UCLA.) I’m not wanting to let my kids have such damage. It is hard to put a value on preventing neural damage which Harper has shown.
Crowded teeth, overbite, underbite, forward head posture, lip-apart posture, narrow upper jaw, gummy smile, short attention span, falling asleep in class, bedwetting after the normal age to stop, noisy eating, and many other signs should alert a parent that a problem exists. If you measure with a millimeter ruler from the tip of the nose to the edge of the upper central incisor tooth and the number is more than 21 mm plus the patient’s age for a female and 23 mm plus the patient’s age for a male it is probable that his/her jaws are falling back from ideal positions, and treatment should be sought from an airway-aware dental professional. Be prepared to get many opinions before you find someone who understands. I hope to change this by training others.

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.

There are no promises in life. I firmly believe that early orthodontic treatment to make every child a nasal breather with lips together at the earliest age can have a positive impact on a person’s health-span. Untreated OSA is good for a 20% reduction in life expectancy. Virtually every chronic disease known to man is associated with OSA. I cannot prove it, but I firmly believe that helping a child to be a nasal breather with early orthodontic intervention can have a positive impact on health. Do you know anyone who wants to gamble with their child’s health? You have to get the necessary information and make your choice.