By Dr. Amy Glaser
In middle-class homes, braces and adolescence go together like chips and salsa. However, braces are a huge expense for most families, and many parents must ask themselves if there really is a need. Among the affluent, braces seem almost like a rite of passage that get placed regardless of any misalignment. While it is unclear what proportion of children, if any, get braces they do not need, it is important to recognize that braces are not always placed to create a perfect smile. According to Dr. Elliott Moskowitz, a Village orthodontist, it is far more common to employ braces to create a healthy bite and thereby prevent future damage to the teeth and gums than it is to prepare children for their Hollywood career.
Have parents ever left an orthodontist’s office having heard that their child does not need braces? Dr. Moskowitz assures us that it does happen, particularly if aesthetics are the only concern. In early adolescence, it is improvement in function and stability, which, along with aesthetic improvement, represent the three major goals of orthodontics, that usually serve as the reason to proceed. Teeth shift as the teenager matures, so braces on the basis of aesthetics alone may not be advisable in a young adolescent without noticeable misalignment.
When deciding on orthodontics for an adolescent the questions to pose are what are the goals of braces and what outcome can be reasonably expected. Prophylaxis against misalignment, a result for which the assurance of benefit may vary according to the child’s age and the duration that the braces are worn, might be reasonably considered a relative indication for which cost will be an important factor when deciding whether to go ahead. A significant deformity of bite likely to lead to significant health problems over time more closely resembles an absolute indication. In patients with craniofacial syndromes, a treatment plan may include collaboration with an oral surgeon or an otolaryngologist.
Due to different goals, the timing of braces varies. In some cases, treatment on and about the pubertal growth spurt is desirable to modify bones as they develop. In others, it may be appropriate to intervene earlier. At times the orthodontic correction is done in stages so that an initial step is placed to approximate a healthy bite, and then a second set is placed when the permanent teeth have come in. Dr. Moskowitz reports that due to the important potential health benefits of braces, most referrals to the orthodontist are done by pediatric dentists or pediatricians.
For parents who remember their own painful experiences with braces, Dr. Moskowitz pointed out that times have changed. Braces require less frequent visits than they once did for tightening, they are less painful, and they can be less visible. Although some 13-year-olds use colored brackets to make a fashion statement, there are also now nearly invisible materials. This is a big advantage for the older adolescent (or adult) who has become dissatisfied with misaligned teeth and seeks braces later in her teenage years. Although braces require a certain maturity on the part of the patient to avoid foods that can break the braces or sweets that can produce tooth decay, newer materials are more tensile and less breakable.
Can you consult an orthodontist about braces for your child and hear the word “no?” Good orthodontists can be found the same way other good professionals are found. Besides word of mouth, you can verify that the orthodontist has met board certification. The American Board of Orthodonture maintains a Web site that lists practitioners and their credentials. Like other professionals, the orthodontist you are considering for your child should make you feel comfortable. It may be especially helpful if your child also feels comfortable. After all, this will be a relatively long relationship in the life of the young teenager.
Amy Glaser MD has a private adolescent practice at 430 West Broadway, 212- 941-1520 or aglasermd@aol.com
Reader Services
