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If you had braces, your child probably needs them too

Eung-Kwon Pae, associate professor and chair of the department of orthodontics and pediatrics at the University of Maryland School of Dentistry.

Many children can expect to be outfitted with braces at some point, but parents often don’t know when they should head to an orthodontist for an evaluation. Eung-Kwon Pae, associate professor and chair of the department of orthodontics and pediatrics at the University of Maryland School of Dentistry, said there are a few key indicators for when someone is ready for treatment and what kind of treatment is needed. And, he said, there are now options beyond the metal bands.

When should parents first speak to a dentist or an orthodontist about whether braces may be needed?


When a habit is noted, it’s a good time. Habits most times result in harmful outcomes. For example, a digit-sucking habit (mostly a finger or fingers or rarely toes) causes various troubles such as an open-bite (upper and lower front teeth are not touching, sometimes called under-bites), excessive overjet (abnormally sticking out upper front teeth) and narrow upper jaw if the habit continues longer than four to six months. Orthodontists want to break these kinds of habits as early as possible because it could be very difficult to fix the abnormalities once they are fully expressed. Luckily, most habit-related distortions can be fixed using habit-breakers such as tongue cribs.

When a lack of space for erupting cuspid teeth is noted, it’s the right time. Crowding (irregularity in teeth alignment) in new permanent front teeth may be another indication. At around the time all four front teeth are in the mouth, the arches (dental arches are the two crescent arrangements of teeth, one on each the upper and lower jaw) are often short of space for incoming cuspids. The driving force for the erupting cuspids from both sides pushes front teeth toward the middle. This results in crowding. When you see crowding in front teeth, it is a good time for consulting.


If you or your spouse had braces when you were young and your child is 9 or 10 years old, it is a good time to go to your family dentist or orthodontist. The second growth spurt may be a valuable opportunity for orthodontic treatment.

What methods of straightening teeth are appropriate for kids?

This is one of the most frequently asked questions an orthodontist hears.

Any combination of the following three methods are frequently used, depending on the kinds of problems the kid has and how old the patient is.

First, regular fixed braces can be used when a patient has all permanent teeth or mostly permanent teeth with small numbers of deciduous (baby) teeth. Advantages of using this method include precise control and relatively quick results. The disadvantages are more discomfort during treatment and higher cost.

Second, removable appliances are preferable if a patient is young and has deciduous teeth with a limited number of permanent teeth. When a patient is on a growth spurt and has upper and lower jaws that are unbalanced in size, a functional appliance is also useful. One advantage is they are less costly. Disadvantages include the prospect that a patient does not wear the appliance or the appliance does not work. There also is less precise control.

Third, Invisalign (a clear appliance) can be used if patients have permanent teeth with a mild form of malocclusion. This method is for limited occasions for a short period of treatment time particularly if the patient is actively growing.

What about braces for adults?

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Over the last 20 years, the number of adults wearing braces has increased dramatically. Metal braces in adult smiles no longer seem awkward. In fact, when new technology, such as Invisalign, arrived in the field about 30 years ago on a catchphrase of “invisible braces,” dentists thought metal braces would fade away immediately for two reasons.

Brace-shy adults favor this almost invisible tool and the technique is simple enough to be adapted by non-specialists. But it was quickly discovered that Invisalign was not a panacea due to its innate limitations. A critical one being that this removable tool only works when patients wear it. The detachability of this tool, which was a significant selling point, backfired immediately. Dentists now realize if the patients do not wear the appliance, incomplete treatment results fall on their laps.

Further, this type of appliance does not work on every case. In fact, any removable appliance has a critical limitation, that is, it’s unable to move teeth a long way. Thus, orthodontists do not recommend Invisalign for cases when adults need extraction of teeth to camouflage disharmony in jaw size.

Adults living in a modern society are not afraid of wearing visible metal braces. In fact, many feel metal braces signify youth. As was the case for an 87-year-old who I treated in Los Angeles which demonstrates that there is no age-discriminating factor in orthodontic treatment.

How long are braces usually required and what does follow-up involve?

A case involving average severity and difficulty requires two to two-and-a-half years of treatment time. Factors deciding active treatment time are many, such as severity of malocclusions, patient age (whether a patient is in active growth period), other underlying medical conditions, restrictions in treatment methods and other factors. Some occasions suit a two-step approach: an early intervention followed by regular treatment. Treatment time for such cases are often extended five to six years.


After orthodontic treatment patients go through a so-called retention period without exception. Retention is a critical portion of active treatment because teeth that are moved to new positions want to go back to where they were. Dentists call this phenomenon relapse. Relapse forces patients to wear retainers. A retainer holds the teeth in their new positions until they settle in the new functional relationship. This retention period can be from two to three years or sometimes longer than 10 years. Unfortunately, there is no short cut.