As orthodontia shifts, braces aren't just for teenagers anymore

By Laura Hambleton
Special to The Washington Post
Monday, January 17, 2011; 8:33 PM

Sophie Weich has worn orthodontic appliances to correct a bad under-bite for the past four years and recently got a mouthful of braces to align her jaw - and she's just 11 years old. Her younger sister, Sara, 8, has her own set of brackets and wires to straighten crooked front teeth.

"I thought at first: how weird to put braces on someone so young," said the girls' mother, Julie Stewart, of the District. In Sophie's case, a dentist suggested she go to an orthodontist. In Sara's case, Stewart worried that her daughter was becoming self-conscious about her teeth after kids at camp had teased her. "I am from another generation where you waited until your teens," Stewart said. But "I am used to it now."

A generation ago, braces were a rite of passage for teenagers: a couple of years of metal mouth. No more. Spurred by new technologies that makes it easier to spot and treat problems earlier and by an awareness that teeth continue to move after braces come off, parents and their children see orthodontia as a long-term commitment to keep that perfect bite.

More than 3.7 million children in North America wear braces, according to a 2008 survey by the American Association of Orthodontists. That's up from 2.6 million in 1989. The AAO recommends that an orthodontist evaluate children by age 7 to spot "any subtle problems with jaw growth and emerging teeth." According to the AAO, "early treatment may prevent or intercept more serious problems from developing and may make treatment at a later age shorter and less complicated."

Orthodontists say examining a child at age 7 does not translate into braces immediately. That was more common just five years ago, but research suggests that except for dealing with some specific problems, putting a young child in braces is unwarranted.

Robert Williams, a clinical associate professor at the University of Maryland Dental School, said, "Very few orthodontists render treatment to children who have only primary 'baby' teeth. Personally, I have used habit management techniques to treat [thumb and finger] sucking habits, and removable appliances to correct cross bites of front teeth in children who were 6 to 7 years old. More often, I defer treatment of most problems until a child has only a few posterior baby teeth remaining, since this results in a shorter overall treatment time and less expense for the patient."

"The window for treating a developing mouth depends on the child," said District orthodontist Darlene Byrd, who has been practicing 25 years. "It's more a stage than an age."

Once in braces, kids wear them for 12 to 36 months, according to the AAO survey. In addition, orthodontists routinely fit their young patients with retainers after braces and install such appliances as metal palate expanders before braces. These days, orthodontists recommend that kids wear retainers indefinitely, even into college and beyond, to keep their new bite from reverting back to its old pattern.

"There is no time that teeth are set in concrete," Byrd said. "We think we are done growing, but we go on growing through life. Whether you've had orthodontics or not, your teeth are changing. You have to accept wearing a retainer."

Teeth are supported in a socket of pliable ligaments with give and take, like the bands of a trampoline. An orthodontist exploits that natural movement by pushing teeth into position through pressure. As teeth are moved, the ligaments and underlying bone adjust. A retainer then acts like a splint or a cast, holding a tooth in place until the bone settles. Even then, a tooth could gravitate toward its old position.

After three years in braces, Charlotte Kettler of Bethesda, a 19-year-old freshman at the University of Virginia, wore a retainer for four years, until she lost it last year. Now her bottom teeth have begun to shift.

"I wish I had my retainer, because I still would wear it," she said, adding that the cost of a new one was stopping her from replacing it. "I am traumatized by my dad's experience," she added, jokingly. "He stopped wearing a retainer and had to get braces again when he was 40."

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