When should children first see an orthodontist?
The American Association of Orthodontics recommends children are screened for braces at the age of seven. By then they have enough second teeth for the orthodontist to see how they’re transitioning from baby teeth to second teeth. We can look at the size and the shape of the jaw and if this needs to modified, we can do it easily because the bones are soft and still developing.
But you wouldn’t necessarily need braces that early?
No. But around 50 per cent of children require braces this young – usually to correct a cross bite, a narrow upper jaw, or big jaw size discrepancy. We can also help children break habits such as thumb sucking –
which does affect the alignment of the teeth if the habit persists. Dummies can do the same thing after the age of five or six.
Is there an average age for braces to be fitted?
Yes, 12. But this is often because parents think braces can only be fitted once all the second teeth are through. Actually, orthodontists prefer to work with children before they hit puberty, so they can work with the child’s main growth spurt.
But what’s so bad about having a ‘Great British smile’?
Well, crooked or crowded teeth are difficult to clean because food gets trapped between them. The poor hygiene then leads to gum problems and decay – and more dental work further down the line. Secondly, kids are notoriously cruel and if you have a weak spot, they will find it. I see a lot of little girls who feel very self-conscious about their teeth – and I see them regain their confidence once the problem is fixed. Parents shouldn’t underestimate that side of things. Finally, protruding teeth, apart from being unattractive, are very susceptible to trauma. If a child falls over on their face, they’re usually the first thing to get clunked. Ouch!
What’s the process?
There are two stages. Phase one is for kids aged seven to 10. During this stage, the orthodontist examines the growth of the jaw and the position – and potential position – of the second teeth. The child may be fitted with braces to ensure their teeth are correctly spaced, so there’s enough room for the second teeth to emerge. Braces will typically be worn for 12 to 18 months at a time. Phase two occurs when most of the second teeth are through – at around 12 years. If you’ve been treated in phase one, you may not need any treatment in phase two. However, you might want some additional straightening depending on how your second teeth emerge.
What if your child needs braces, but doesn’t want them?
Don’t push them into it. Let the orthodontist talk to them and explain why they need treatment. They will be shown before and after pictures and have the whole process explained. But if the child isn’t willing – it isn’t worth pursuing. This is because children have to be motivated to take extra care of their teeth while they have the braces. If they are resentful about them, the braces could end up doing more harm than good.
Why is that?
Braces trap bacteria, so cleaning is critical. Brushing with an electric toothbrush after every meal and flossing daily is important. It takes more time to clean your teeth when you have braces – and you have to be prepared to put the work in. There is no point in fixing the alignment if there is bad hygiene, which then causes more problems. We’ve had to stop treatment of some braces because oral hygiene wasn’t good and the teeth were being damaged. You can also end up with unsightly white spots if you don’t clean them properly.
Yes. Where the braces have been fixed, the teeth remain white, while the rest of the tooth becomes stained. It looks horrible and it’s difficult to fix. But Invisaline, a removable, clear brace, is great for older kids. It has indicators to tell the dentist the number of hours the patient has worn it – so you can see if the patient is being responsible in their treatment. Dentists also allow kids to have six free-of-charge replacements –
because they frequently lose them and that’s always an expensive worry for parents.
Are braces geeky?
Not at all. You can choose the colours and have teddy bears or hearts – and you can change the band colour. It’s cool. However, it is less popular here than in the US, where kids pester their parents for braces. The dental IQ needs to be worked on in Dubai.
How do they feel after fitting?
The fitting takes a couple of hours and your mouth will be sore for the first two to three days. I ask kids and they tell me on a scale of 0-10 the pain’s a three, so it’s more of a discomfort. Some can initially get ulcers and grazes in the mouth, which we treat with dental wax until they get used to their braces.
What foods should be avoided?
Fizzy drinks are the biggest no-no. We tell children to enjoy their last soda before the braces are fitted. Foods that require you to bite hard – like apples and raw carrots, can cause damage. And popcorn, along with toffee and chewing gum, should also be avoided.
How much does it all cost?
From between Dhs6,000 to Dhs25,000. Re-payment plans are available. Boston University also offers ‘residents cost’ – supervised trainee orthodontists will work for a vastly reduced fee.
Dr Lana Dalbah is director and professor of orthodontics at the Boston University Institute for Dental Research & Education, Dubai Healthcare City (04 424 8777, www.budubai.ae)