Some orthodontists recommend treating crooked teeth or teeth that do not occlude (bite together properly) in two phases or treatment steps.  The first phase usually starts around second or third grade and a second phase around sixth grade.

Treating jaw problems early has not been well supported with excellent randomized controlled clinical trials.  These studies show that equivalent results are achieved with either one or two phases of treatment but that two treatment phases usually costs more and takes longer.

I believe that there ARE tooth alignment or spacing problems that are best treated early; before the back primary teeth come out. 

Reasons to treat early:

• Congenital problems such as cleft lips are best treated very early, then off and on for many years.
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• Thumb or finger sucking, pacificer use or tongue thrusting all can move teeth and even bend the jaw bones. 
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• Appliances to treat these problems early are very appropriate if other methods fail.
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• Upper teeth that stick out very far risk being broken in an accident so braces can help pull these back to safety.
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• Upper teeth that bite inside lower teeth are called crossbite teeth and should be treated early.
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• Narrow upper jaws are best treated early when the bones are most flexible.
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• Very crowded teeth may need to be extracted to make room for the others to straighten up.
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• Holding space is always a good idea with primary tooth loss.
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• Because the lower primary molars are usually much larger than the permanent premolars that replace them, holding this space with a metal wire appliance can usually save space for alignment without extractions.

Reasons to wait until later for orthodontic appliances:

• Two sets of braces costs more than one set.
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• The novelty of braces  wears off quickly so they are not so fun to wear any longer than necessary.
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• Putting braces on, getting straight, taking off, wearing retainers, putting braces on, getting straight, taking off, wearing retainers: just takes longer.
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• The longer braces are on, the more difficult it is to keep them clean and avoid cavities.
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• Braces come off when the second molars are straight, usually after age 12. 
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• Retainers for life follow orthodontic appliances so the sooner you start, the longer you will need to have retainers.

As you can see, there are some reasons to start early but if your child has crowded teeth and can wait until middle school, you and your child will be better off for waiting.

Post from: Great Grins

When to Start Kids Braces?

Why is it important you ask?  To completely correct a badly positioned tooth, the tooth must slide the brace along the wire in the brace only a few millimeters.

That is NOT very far!  Two years to move something the thickness of a pencil!

When the brace or bracket and the wire is coated with sticky plaque, it takes much longer to get them to slide and align the teeth.  Every little bit of cleaning helps move faster.

Flossing between teeth that have braces on them is especially difficult.

There are three possible techniques to clean between teeth with braces:

1. Use a floss threader (a stiff plastic loop) to stick the floss under the wire and then pull the floss through.  Repeat this for each tooth.
2. Use a toothpick or similar device to rub under the wire and between teeth.
3. Get a flossing aid that can fit one side under the wire and the other side across the tooth and floss normally.

This last option is made possible with a Platypus tool that we give samples of to each orthodontic patient.

A floss popper tool used to be available but is no longer made.

See this link for general brushing & flossing instructions.

Post from: Great Grins

Flossing Braces

There are several different types of spots found on teeth:

• white spots
• chalky yellow spots
• chalky brown spots
• dark brown spots
• black spots

Each of these have different causes but most have similar treatment: Treatment is either leaving it, polishing off the surface of the tooth or placing a filling of some sort.

White spots can be caused by:

• beginning cavities
• too much fluoride during tooth development – NOT after they are in the mouth
• trauma can leave a white mark on teeth
• extra thick enamel will look whiter
• baby teeth are always whiter than permanent teeth

Chalky yellow spots can be caused by:

• poor development of enamel; fevers near birth can affect front teeth
• cavities that are just starting and are actively growing

Chalky brown spots can be caused by:

• poor development of enamel, more serious than the yellow spots
• cavities that are older

Dark brown spots can be caused by:

• older cavities
• severe over exposure to fluoride during tooth development
• stains inside the tooth; some childhood antibiotics can cause this

Black spots can be caused by:

• old cavities that are not actively growing
• old food stains

Surprisingly, often the ugliest spots are the least damaging and the subtle yellow or white spots are where cavities are actively growing.

The spots that are easiest to just polish off are the white ones.  They are usually just on the surface of the enamel.

The hardest ones to treat are the deep stains in the tooth caused by antibiotics (tetracycline for example) taken while in the womb or as infants.

These usually need crowns or veneers to cover up the deep dark colors.

Post from: Great Grins

Spotty Teeth

What I found was two normally colored permanent teeth growing up between normal blue-white-colored primary teeth.  Many parents get concerned when they see the contrast in color but it this is perfectly normal.

Permanent teeth are always darker than primary teeth and the difference is especially noticable when they are next to each other.  Once all the primary teeth fall out, the permanent teeth should look just fine.

Occassionally, the permanent teeth come in especially yellow.  This can be treated with dental bleaching.

Ways to bleach your teeth:

• A one day Zoom treatment using very powerful bleaching agents with bright light to active it.
• Dentist-made bleaching trays to wear for an hour or so each night over a few days to a week.
• Buy bleaching strips at the drug store and wear them for a few weeks at night.

All work, but there are pluses and minuses for each:

• The drug store ones are less expensive but do not reach all the teeth and feel slimey.
• The one day treatment is fast but are expensive and can cause more tooth sensitivity.
• The custom tray seems to be a good compromise of cost, time, and sensitivity.

Our Portland office has been using clear retainers after orthodontic treatment that can also double as a bleaching tray for many years.  This approach works well because all the permanent teeth are present and in a stable bite, and the additional brightening just makes the newly straight teeth look fantastic.

Post from: Great Grins

Bleaching Kids Teeth