The Importance of Age in Orthodontic Treatment
One of the most frequently asked questions by our patients is at what age orthodontic treatment should be started or whether it is too late for orthodontic treatment. The answer to this question is that there is no age in orthodontic treatment. In other words, orthodontic treatment can be performed at any age. But this should not be understood as age does not matter for orthodontic treatment. On the contrary, age is very important because treatment alternatives are different for each age.
Orthodontics in Childhood:
As a dentist, we recommend starting tooth brushing and oral care from the newborn period when the first teeth appear. Although these first milk teeth will change in the future, if oral hygiene is not adequate, these teeth may lose material at an early age due to caries formation or they may need to be extracted before they should fall out. In such cases, it is a baby tooth anyway, it should not be approached with the logic that it will change, and the necessary fillings should be made on time. Because the gap in the milk tooth that is extracted prematurely or falls out due to caries will be closed to some extent by the shifting of the other teeth next to it, and in this case, the space for the permanent tooth that will replace this milk tooth in the future will be narrowed.
From the very beginning, under the name of preventive orthodontics, it is useful to take them for an orthodontic examination as early as possible in childhood in order to detect any decayed teeth during the milk teeth period and send them to a pedodontist for the necessary treatments.
However, when the age of starting orthodontic treatment is understood to mean an appliance to be installed in the mouth, the period between the ages of 7 and 9, when the front milk teeth change and permanent teeth begin to emerge, is generally expected to determine whether such treatment is needed. Because the gaps or crookedness seen in primary teeth until this period may correct themselves after a while or may be a part of normal development.
In some skeletal problems that concern only the jawbone, especially if there is a genetic predisposition, it may be necessary to start treatment at the earliest possible age, during the milk teeth period. The best example of this is patients whose lower jaw grows forward faster than the upper jaw and whose family members have a pointed chin tip or a large chin appearance. We have theoretical knowledge that treatment should be started as soon as this type of problem is seen, but it would still be the right decision to wait until the age when a removable appliance can be tolerated by the child, with the joint decision of the family and the physician.
It is common for families to rush to the orthodontist between the ages of 7 and 9, especially when the lower incisors begin to appear in the mouth. Because at this age, the first teeth to appear may appear on top of each other or one in front and the other behind, due to temporary narrowness of the jaws not reaching their final width. During this period, the orthodontist will not start treatment unless he finds it necessary during his examination, and he can wait for the jaws to improve with normal development. Sometimes, when he sees more crowding than normal and decides that there is enough jaw stenosis to prevent the permanent teeth from settling correctly, he can start his treatment with removable screw appliances.
In some cases, two-stage treatment may be required. For example, in a patient whose upper jaw stenosis is diagnosed at an early age, intervening in this situation early and ensuring that it reaches the required width will ensure that the development of both the upper jaw and the lower jaw is directed correctly. Later, after all the permanent teeth have emerged, the treatment can be continued with fixed appliances. In such skeletal or functional problems, the early treatment phase should not be skipped just because fixed treatment will be required in the future, because jaw expansion has a certain age limit (until the canine teeth appear in the lower jaw) and since expanding the upper jaw at an early age will also widen the nasal passages, it will ease breathing through the nose and lower and lower jaws. It will be of great benefit in normalizing the development of the upper jaw.
Orthodontics in the Era of Permanent Teeth:
Around the age of 12-13, it is expected that all milk teeth in the mouth will change and permanent teeth will be completed. After this age, treatment with removable appliances provides less benefit and is not recommended. Treatments with brackets fixed on the teeth or fixed expansion appliances give faster and more permanent results after these ages. The fixed orthodontic treatment phase includes an active treatment period lasting approximately two years, in which many mechanics and techniques are used together, followed by a phase of at least 3 years, which we call reinforcement treatment, which aims to ensure the permanence of the achieved improvements.
During the active fixed treatment phase, arch wires are placed in holders attached to the teeth, called brackets, and tooth movements are achieved by applying the desired forces to the teeth through them. Movement of many teeth at the same time can be achieved in a controlled manner.
The type of treatment called functional treatment involves the use of fixed appliances to direct the development of the jaws during this period.
It can be carried out in combination with added moving parts (face mask, headgear apparatus, intraoral elastics) or fixed functional apparatus (fixed springs, pusher tubes, etc.).
In the consolidation phase at the end of the active treatment period, visible or invisible fixed appliances in the mouth are removed and fixed thin wires are glued to the invisible surfaces of the teeth on the tongue side, or removable transparent or acrylic appliances are used.
Orthodontics in Adults:
Orthodontic treatment is also possible for adult patients who were not treated during childhood or adolescence and who are not satisfied with the appearance or closure of their teeth or jaws. Many aesthetic treatment alternatives developed especially for older patients who are afraid of the appearance of braces in their working life or social life have made orthodontics much more common in adults. Just as alternatives that make fixed orthodontic treatment more aesthetic, such as transparent brackets and lingual brackets glued to the inside of the teeth, have been produced, treatment procedures performed with transparent removable plates have greatly expanded the options of orthodontists and patients.
All kinds of orthodontic tooth movement can be achieved in adults, but there are limits in correcting problems related to jaw bones with orthodontic treatment alone. Especially in the presence of serious skeletal problems, surgical alternatives come into play as the option of correction by directing the growth and development phase in adults is eliminated. Orthognathic treatments carried out together by a plastic surgeon and an orthodontist are treatments applied exactly for these ages and conditions and make significant contributions to the aesthetics of both the teeth and the entire face of the patients.