Diagnosis & Treatment
Most people who come for an orthodontic consultation know that they or their child needs treatment. Either there are obvious cosmetic issues or their general dentist has referred them. But for some people the need is not obvious. In some cases treatment is needed, but not immediately. If treatment is appropriate now it will be discussed and x-rays, photos, and molds will be scheduled.
Early Treatment or Phase I
There are some bite problems that should be treated as early as eight years old when (typically) there is a mixture of baby and adult teeth. This is referred to as Phase I treatment and it is appropriate if one of the following conditions exists:
Upper teeth in the back are inside the lower back teeth. (posterior cross bite)
Lower front teeth in front of upper front teeth. (anterior cross bite)
Back teeth touch but front teeth do not. (anterior open bite)
Lower front teeth are severely behind the upper front teeth. (severe Class II)
Tongue thrusting habit problems or lower lip caught behind upper teeth. (para-functional habits)
These problems can exist alone or in combination. They are primarily skeletal or soft tissue problems, not dental problems. The growth spurts that young children experience are utilized, through treatment, to correct the upper and lower jaw relationship problems and tongue and lip (soft tissue) problems. Left untreated until adolescent years these problems are more difficult, take more time, and may require extractions or even jaw surgery to treat.
Dr. Cain prefers to treat cosmetic problems in young children only if there is a self esteem issue, or teasing problem due to cosmetic problems. These psycho-social issues are reason enough to treat a cosmetic problem with orthodontia.
In the absence of skeletal problems, para-functional habits or psyco-social issues, Dr. Cain prefers to wait until all or almost all of the baby teeth have been lost before starting treatment.
There are many situations that are appropriate not for active early treatment, but for space maintenance. Space maintenance is not intended to move teeth or change skeletal jaw relationships; it is intended to preserve space for permanent teeth. This sort of holding pattern is a wonderful example of the old saying “An ounce of prevention is worth a pound of cure.”
The adolescent patient
This treatment is started when nearly all baby (deciduous) teeth are gone. Each side of the patient’s bite is classified. They can be Class I, which is upper molar half a tooth behind the lower molar and is the ideal bite relationship. They can be Class II, which is upper molar half a tooth in front of the lower molar positioning the teeth of the lower arch too far behind the upper teeth. They can be Class III, which is upper molar a full tooth behind the lower molar, usually positioning the lower front teeth in front of the upper front teeth. The correction of Class II and III to Class I is a common goal of treatment. There are many devices and techniques to accomplish this correction. Patient growth and cooperation are important to success. In addition to Class I, adolescent orthodontics addresses any spacing or crowding of teeth.
The adult patient
Some adult orthodontics is typically adolescent treatment without patients’ growth to help. However, many adults with missing teeth are referred to us by their dentist. These patients need bridges, implants or partials. By orthodontically putting the teeth in a better position, their general dentist can then provide better looking and more functional restorations.
The surgical patient
Surgical orthodontics is only done on non-growing patients with very significant upper and lower jaw misalignment. The upper and lower teeth are aligned properly and then the upper and/or lower jaw(s) are surgically positioned into the proper fit.