Introduction to Two-Phase Treatment and Starting Early
For some people, early orthodontic treatment means that a child simply has braces placed on the teeth at a young age. While that concept may be somewhat true, early orthodontic treatment embodies considerably more than moving the teeth. Early treatment philosophy includes a basic understanding that the body has an innate ability to heal itself. When faced with structural problems such as orthodontic problems, it helps to understand that most of these problems are due to structural or functional deficiencies, and that the body needs a little help to "outgrow" these problems.
Planning now can save your smile later
Because they are growing rapidly, children can benefit enormously from an early phase of orthodontic treatment utilizing appliances that direct the growth relationship of the upper and lower jaws and help them outgrow the problem. Thus, a good foundation can be established, providing adequate room for the eruption of all permanent teeth. This early correction typically will prevent later removal of permanent
teeth to correct overcrowding and/or surgical procedures to align the upper and lower jaws. Leaving such a condition untreated until all permanent teeth erupt could result in a jaw discrepancy too severe to achieve an optimal result with braces alone and can strongly predispose one to jaw joint problems later in life. In other words, delay will also potentially cause unnecessary damage to the jaw joints. This is the best opportunity to take advantage of the principle of FORM and FUNCTION, which will be discussed later.
First Phase Treatment: Your foundation for a lifetime of beautiful teeth
The primary goals of the first phase of treatment are to develop the jaw size in order to accommodate all the permanent teeth and to relate the upper and lower jaws to each other. Children will typically exhibit early signs of jaw problems as they grow and develop. An upper and lower jaw that is growing too much or not enough can be recognized at an early age. If children after age 6 are found to have this jaw discrepancy, they are ideal candidates for early orthodontic treatment. This phase typically is accomplished over a 16-18 month period of time before a resting phase is recommended to periodically monitor development until which time all remaining permanent teeth erupt.
Resting Period and Periodic Observation
In this phase, the remaining permanent teeth are allowed to erupt while retaining the accomplishments of the initial phase. The retainers are adjusted in such a manner to retain the dental alignment but not interfere with growth and development. A successful first phase will have created and maintained room for the remaining permanent teeth to find an eruption path in as close to an ideal position as possible. It is important to understand that by the end of the initial phase of treatment, the teeth are not in their final positions. Once all the remaining permanent teeth erupt, decisions can be made regarding the treatment options available to achieve functional and esthetic stability.
Second Phase Treatment: Stay healthy and look attractive
The goal of the second phase is to make sure each tooth has an exact location in the mouth where it is in harmony with the lips, cheeks, tongue, other teeth, and the jaw joints. When this equilibrium is established, the teeth will function together properly with the best likelihood for long-term stability.
Movement & Retention
At the beginning of the first phase, orthodontic records were made and a diagnosis and treatment plan established. Certain types of appliances were used in the first phase, as dictated by the problem. The second phase is initiated when all permanent teeth have erupted, and usually requires braces on all the teeth for an average of 18-24 months. Retainers are worn after this phase to ensure you retain your beautiful smile.
So......what about this idea called Form and Function?
Form and Function
The reason one needs to consider treating a child when younger is to capture the assistance of growth and development. This approach establishes a considerably better foundation for long - term stability. We saw this for ourselves in East Germany in 1979 when our research team was able to evaluate the orthopedic/orthodontic stability after 10-15 years after treatment was completed. Personally, what I saw was considerably better than what we were achieving in the United States. We all know someone who had orthodontic treatment previously and still look like they need orthodontic treatment. What was the major difference here?
In East Germany, the children received their first orthodontic evaluation by age 7. By American standards, this was considered too early; the old orthodontic thinking was to wait until all permanent came in. Waiting means that growth is not going to help create the best foundation for a stable outcome. There is a reciprocal relationship between FORM and FUNCTION. What this means is that structural discrepancies will determine function, which in turn determines form. In other words, the body will adapt or compensate for any imbalances in the system (structure or FORM), which in turn will determine FUNCTION and so the balancing act continues. Some of this adaptation will lead to functional disturbances and will alter how the facial bones develop (FORM).
Let’s use the example of breathing. If a child is a “mouth breather” at night (FUNCTION), the facial bones will develop differently (FORM) usually resulting in narrow jaw structure, and a facial height that is longer than normal. One of the most important considerations for a growing child is to make sure that breathing dynamics are normal.
So the next question should be: why is my child “mouthbreathing?” Obstruction to the nasal airways involving enlarged adenoids and tonsils can be obstructive to normal nasal breathing.
However, these potential airway conditions should illicit the following question: why are the adenoids and tonsils enlarged anyway? If a child as a history of allergies, then the next question should be: Why does he have allergies?” At times, it is important to consult with the pediatrician or an ENT specialist for an evaluation. As our routine; however, we take a naturopathic approach to these issues and discuss matters of nutrition and all other underlying causes behind the malocclusion and airway problem.
As in all health matters, failure to identify and treat the underlying issues, will ultimately result in, you guessed it, failure. Did you know that the most common reasons for allergies and sinus issues are related to poor nutrition and unsuspecting sensitivities to the foods we commonly eat, which in turn can cause disturbances in our endocrine system? Genetics? I don’t believe so.
The current scientific evidence, since the identification of the human genome in 2003, suggests that we can influence at least 70% of our genetic expression. The good news is that we can significantly influence our health outcomes. The bad news, is that we can significantly influence our health outcomes. Whoa!! I hate the words responsibility and accountability.
Do you have questions for Dr. Dierkes? We encourage you to make an appointment us to bring your child in for a consultation. We'd love to meet you!
Dr. J. Michael Dierkes, DDS, MS, NMD is a nationally recognized orthodontic specialist who has been creating beautiful smiles for over 30 years. His services have improved the lives of people from Roswell and the surrounding areas, including residents of Sandy Springs, Alpharetta, Marietta, and Atlanta. Whether you are an adult, a child, or a teenager, our knowledgeable staff is committed to helping you achieve the radiant, beautiful smile you deserve. Please call us today to schedule your initial consultation!