Insights every parent wished they had before their child started orthodontic therapy
Many parents face this important dental health decision: should their teen or pre-teen have dental braces to improve their bite or smile? For those who can afford it, it’s almost a rite of passage for their child to have their teeth straightened by the local orthodontist. With the internet increasing the access to health information, those interested can now read professional level information to help decide whether it’s prudent to continue that tradition.
When considering braces, the not-so-obvious question to ask is, how successful are they? If they are initially successful, how long did it take for teeth, gums, bite or sensitivity problems to become evident? While once a broadly accepted dental recommendation, a closer look at results of braces merits some scrutiny.
A perusal of the professional research shows there’s a dearth of proof that orthodontic braces yields lasting benefits or prevents negative positioning changes. In fact, recent research has found that:
- After treatment with braces, teeth repositioned to less desirable locations 70%-90% of the time.
- Dental braces might not yield lasting improvements and may create some dental detriments which might not have otherwise occurred.
- Pre-teens and teenagers who’ve had dental braces or clear orthodontic aligners are more likely to have receding gums.
As is common during medical and surgical consultations, likely and potential outcomes and consequences of dental braces should be reviewed. Many orthodontists will transfer the decision on how to best prevent the negative changes to teeth positions from themselves to their patients or parents of patients. Regardless whether that’s based on their training, their office policy or for medical-legal reasons, if you’re going to be asked to make that decision, be prepared.
A parent should refrain from making an impulsive, unilateral or under-informed decision. It’s best to start the conversation during the initial consultation. Ask the orthodontist and general dentist “Are you confident that the treatment you’re proposing is likely to yield stable, healthy and long lasting dental results?”
An alternative to traditional braces is Arch Reformulation Therapy (ART) with periodontal aligners. ART is a recently developed disruptive innovation to help those who have bone, bite, gum, spacing, crowding or a number of other dental maladies. Not appropriate for pre-teens, it’s an option many parents who prefer long term results might find appealing.
Before initiating dental braces, ponder these five thoughts:
1) If at the end of active therapy my child’s teeth are in positions where they’re likely to remain stable, why would they ever need to have a permanent glued-to-the-teeth splint?
Periodontal aligners have two unique measures of success: the health of the gums and the ability of the teeth to stay put. Once re-positioned teeth are on their way to being stabilized, there’s rarely a need for a permanent splint.
Let’s see some results from ART (Arch Reformulation Therapy):
Caption: 1a- The patient in the photo had dental braces as a teen. Based on his and his dentist’s recollections, it’s unlikely that a stable result was ever achieved. Four years later at age 21, he agreed to have Arch Reformulation Therapy (ART).
Caption: 1b- Based on the health of his gums, this same patient in photo 1a was declared to have successfully completed the active portion of arch reformulation. He was now ready for the full time retainer phase. When teeth positions and the bite are stable, and the gum health is excellent, there would never be a need for a glued-to-the-teeth retainer. These results are typical and what one should expect from ART.
2) If my child’s teeth were unlikely to remain stable, why would an orthodontist stop braces therapy? Why would a patient be told they were ready and given retainers if their mouth wasn’t ready for them?
Those questions are best answered by the treating orthodontist or general dentist, but let’s get a better understanding with another example.
2a- This woman completed dental braces a few years before these photos were taken. Her teeth weren’t stable when the orthodontic therapy was declared finished. New problems arose post-treatment. Without prudent intervention, the problematic positioning of her teeth coupled with an unstable bite would continue to act as a negative impact to her dental health.
2b- Same patient. The blue lines make it easier to visualize that a number of teeth are oriented in asymmetric and undesirable directions. Left uncorrected, her dental issues (e.g., exposed roots, gaps, flaring) would increase and become more serious.
2c- Same patient. A side view shows adjacent teeth with vastly different angulations. The flaring was caused by strong undesirable forces from her bottom teeth. Until corrected, these bad forces will continue to have an adverse effect on the bone which supports the teeth, too.
2d- Same patient. Yellow arrows point to the splint glued to the backs of her top four front teeth which failed to prevent the teeth from shifting. The size of the growing gap is easily visible in photo 2e.
2e- Same patient. The green arrow shows the gap caused by her teeth shifting. Undesirable movements from unstable and poor teeth positions led to these problems. The professional permanent splint was unsuccessful.
3) Pre-teens and teenagers who’ve had dental braces or clear orthodontic aligners are more likely to have receding gums. As a result, they will be more likely to require professional gum treatment with a periodontist or general when they get older. The topic of one’s gum health is an integral component of every ART consultation, but is infrequently discussed during a braces consultation.
3a- This 19 year old finished one year of dental braces a few years earlier. The blue arrows point to the inflamed and irritated gums which were healthy before the start of his orthodontic treatment. The purple arrow points towards the exposed portion of the tooth root no longer covered by gum. As we can see, a lot of protective and healthy bone was lost during his routine braces care.
3b- Same patient. The tongue view of the backs of his bottom front teeth. The yellow arrow points to unwanted tooth movements so fierce they’ve severed the splint. The orange arrow points to where the next break will be, where destabilizing forces have stretched and frayed the splint. The white arrows point to the buildup of dental plaque, stain and calculus (dental tartar); the magnitudes of which are exacerbated by the presence of a permanent splint.
4) Sometimes a splint is secured to teeth which are unlikely to become stable. When that happens, placing the permanent splint often coalesces and amplifies their collective bad bite forces. That will often lead to dental problems which will require attention and correction.
4a- The blue arrow is pointing to a “splint bubble” which has been re-glued by his orthodontist on more than one occasion. This splint is not providing any dental benefit because it’s attempting to retain teeth that are in such unstable positions, they’re unmaintainable. Only a return to active dental therapy (ART is the preferred treatment option) will correct the shortcomings, stabilize his bite stable and allow his gums to achieve their optimum level of health.
5) There’s no consensus amongst orthodontists when or whether a permanent splint should be used. Three recent independent surveys of US, Swiss and Malaysian orthodontists confirmed that a “Best Way” to keep teeth in place after braces treatment doesn’t exist. Opinions are still scattered regarding best practices.
5a- This splint poses a serious oral hygiene challenge. Large amounts of dental plaque and calculus start to accumulate within days after each professional cleaning, leaving him with persistent bad breath.
5b- Same patient. The blue arrow in this close-up view points to a break at the center of the splint. Until proper corrective action is taken (ART is the preferred modality), there is a modest silver lining – he can now floss between those two teeth. When he asked his orthodontist how long it should remain in his mouth, he was told “as long as you want to have straight teeth.” The insinuation was that it should remain in place and likely not need any attention throughout his lifetime.
In most professional dental procedures (e.g., implants, crowns, bridges), leaving the gums healthy is an important variable to be considered when judging its success. For example, a crown placed on a single tooth would be deemed unsuccessful if the gums became irritated, created sensitivity or caused the loss of healthy bone. So unsuccessful in fact that corrective dental action would be warranted and recommended. That’s why a dental result which leaves the gums in good health is important and valued. Yet, out of 8 criteria used to determine if braces had a successful outcome, leaving the gums healthy is not one of them.
ART is presently the most dentally gentle solution for those with a gum, bite, bone or general sensitivity problem. Because it’s so natural, some will be tempted to refer to the arch reformulation process as holistic or organic. Since one of ART’s goals is to leave the gums in a healthy state, it is integrated throughout the entire process, resulting in both the bite and positioning of the teeth to be sufficiently stable so the results will last a long time.
So, what should a conscientious parent do?
As is often the case, it’s best to be proactive.
- Before one initiates treatment, seek both an orthodontic and if available, an arch reformulation consultation.
- Focus on the clinician’s results in the years after the care they provided was finished.
- Appreciate the clinician’s philosophy and what steps they take to ensure that the gums will remain robust once care has concluded.
If the traditional metal dental braces or popular clear removable orthodontic aligner treatment has already started, let the treating clinician know that your goal is to have the gums and bite be made as stable and healthy as possible prior to starting the retainer phase.