What is the best age for braces? 

What is the best age for braces

Braces are orthodontic appliances placed on the teeth to align them, improve esthetics and function. It does wonders to your teeth, jaws and smile. However, ideal results are achieved if intervened at the right age. In this article, I will discuss the best age for the braces to get the best outcome.

Let’s get started;

recommended age for your child’s first orthodontic appointment

The American Association of Orthodontics (AAO) recommends that an initial orthodontic evaluation be carried out at age 7. In most cases, orthodontic treatment isn’t required at this young age. However, early evaluation provides early diagnosis and better opportunities for timely treatment.

There is no specific age to get the braces. You can get them at any age, but there are pros and cons of getting braces at any age. We will look into them separately. 

Braces At A Young Age – the best age for the braces treatment

The best approach is to get the treatment at an early age. Parents should monitor their child for any crowding or spacing in the teeth or growth problems with the jawbones. Early diagnosis and treatment fix the teeth and related problems while the face and jaws are still growing and produce more desirable and stable results.

Since 90% of the face development is completed at age 12. Therefore, treatment involving jaw bones must be dealt during the period of active bone growth. The problems in jaw growth can lead to foward-positioned (prognathic), backward-positioned (retrognatic) or narrow jaws. Specially designed growth modification appliances are given to stop the growth in foward-postioned jaws, accerlate the growth in backward-positioned jaws or to expand the narrow jaws.

The treatment is initaited slightly before the growth spurt. The growth spurt of the bone is the period of rapid bone growth. The growth spurt is utilized to accelerate, stop or expand the jaws.

The maxillary (upper jaw) growth spurt occurs during mixed dentition period. In girls, it is seen between 7-9 years and in boys between 9-11 years. Mandibular (Lower jaw) growth spurt occurs late, between 11-13 years in girls and 14-16 years in boys.

Functional or myofunctional appliances are used to correct the jaw growth. Functional appliances stretch and create traction in the muscles and soft tissues attached to the jaws and stimulate bone growth. However, the jaw deformities after growth cessation can be corrected with surgery.

Surprisingly, 75% of children have some degree of malaligned teeth by age 12. The treatement of malaligned teeth with no underlying lying jaw deformity can be delayed till the eruption of all the permanent teeth.

The disadvantage of treatment at a young age 

The disadvantages of starting treatment at a young age are prolong treatment and patient burnout. Patients with jaw deformities may require a two-stage treatment, an initial phase of growth modification followed by straightening of the teeth. The whole treatment may take 4-5 years to complete, which leads to patient burnout.

Teeth alignment can’t be done earlier. The orthodontist has to wait for the eruption of all the permanent teeth to bring them to the correct position at the end of othopedic phase.

Braces In Adults 

The dental or teeth-related problems with no underlying bone problems can be treated at any age. However, skeletal or bone-related problems are best treated when bones are growing. However, jaw surgery can be done to correct the jaw deformities after growth completion.

It is important to note that it’s never too late to correct your teeth. So if you are an adult and you are not happy with the way your teeth and smile look, you have bite or speech issues due to malaligned teeth, book an appointment with your orthodontist right away. 

Problems with braces in adults 

To start an orthodontic treatment in adults, your orthodontist will evaluate your teeth and jaws on the following grounds to see if you can get the braces. 

Any disease that precludes you from orthodontic treatment

The medical conditions that affect orthodontic treatment are relatively few, although their incidence is likely to increase with age. Among them are pregnancy, diabetes, rheumatoid arthritis, and kidney problems. 

Certain medicines have a bearing on orthodontic treatment, for instance, steroids, bisphosphonates, and non-steroidal anti-inflammatory medications (advil, aspirin). Their long-term intake and the way they work (mechanism of action) interfere with bone resorption and the eventual tooth movement. 

An Orthodontic Treatment in the past (treatment relapse)

If your treatment has relapsed, and you wish to go for another round of orthodontic treatement, your orthodontist may evaluate your teeth and gum health to see if they can tolerate another course of fixed orthodontic treatment. 

Why does treatment relapse occur?

An orthodontic retention appliance is given for a year or may be longer to every patient at the end of the treatment to retain the teeth’ new position. The treatment relapse occurs if you don’t wear the retention appliance for the recommended time.

Your orthodontist assesses if there are any root resorptions or decalcifications on the teeth from the previous orthodontic treatment. 

Root resorption is the permanent shortening or blunting of the root and is an undesirable side effect of long orthodontic treatment. The rate of resorption is reported to double in retreated cases. These teeth need to be closely monitored with a minimum possible force application. 

Decalcification is a chalky white appearance of the teeth that shows areas of mineral loss. It makes them more susceptible to tooth decay. It is also a common adverse effect of the long orthodontic treatment. Decalcifications don’t preclude you from re-treatment. However, strict oral hygiene measures and periodic periodontic evaluation are essential in retreatment cases. 

Patient Motivation And Co-Operation

The treatment takes 2 or more years, and the appointments are scheduled every month after braces placement. It’s common to experience pain, discomfort, difficulty in eating, lip blisters or ulcers during the treatment. Therefore, patient cooperation and motivation are paramount for a successful treatment.

Patient cooperation and compliance during the treatment are also age-related. Young patients with skeltal problems often prematurely discontinue the treatment due to prolonged treatment and patient/parent burn-out. On the other hand, adult patients seek treatment because they are self-motivated to improve their aesthetics and show up more regularly at their appointments.

Lack Of jaw Growth

As discussed earlier, face development completes at age 12. Adults seeking braces treatment due to enlarged, shorter or constricted jaws have limited treatment options because of growth completion.

Mild to moderate problems with jaw growth can be camouflaged with braces alone. Yet, severe cases require corrective jaw surgery (orthognathic surgery) with pre (aligns teeth for jaw surgery) and post (minor teeth corrections after surgery) surgical orthodontics.

During orthognathic surgery, an oral surgeon removes the excess bone from enlarged jaws or adds bone grafts in small jaws that need augmentation.  

An age related decrease in bone elasticity

Aging is associated with decreased blood supply and bone remodeling, with subsequent decrease in the rate of tooth movement, and a simultneous increase in treatment duration.

Risk of Root resorption

Children are less prone to root resorption due to growing, vascular, and more elastic bone. Also, newly erupted teeth with an open apex in young patients are less susceptible to root resorption. 

Newly erupted teeth have roots with an open apex. The open root apex closes within 2-3 years of tooth eruption and terminates into a small hole through which blood vessels and nerves enter the tooth. 

Problems with the temporomandibular jaw

Over half of the adults suffer from temporomandibular dysfunction (TMD) at any point in their life. Signs and symptoms of TMD increase with age, particularly in adulthood, and post-menopausal women. 

The temporomandibular joint (TMJ) is the joint between the lower jawbone and skull, allowing your lower jaw to move forward, side to side, and up and down. The upper jaw is fixed, however, the lower jaw allows all sorts of jaw movements.

Temporomandibular joint dysfunction (TMD) is a disorder of the jaw muscles, temporomandibular joints, and nerves and is associated with compromised movement of the jaw, muscle pain, and difficulty in eating. Orthodontics is often deferred until TMD is stabilized.

Periodontal health of the teeth

Chronic periodontitis is the gradual destruction of the bone and soft tissues that support teeth in the mouth. It can occur at any age, but it commonly affects people 35 years and above. On average, it affects 56% of teenagers, 74% of adults, and 86% of older adults. 

Patients with active periodontal disease have compromised tooth structures supporting, making them unfit for braces. Moreover, continuous force application during orthodontic treatment in such patients can exacerbate the existing condition. 

Malaligned or overlapped teeth harbor more plaque and tartar and play a role in initiating periodontal disease. Periodontitis also alters the stability of teeth, leading to drifting, tilting, or rotation of teeth. 

Orthodontic treatment results in aligned teeth that are easy to clean. It can be initiated in patients with controlled periodontal disease to improve the stability and appearance of the teeth.

Previous Dental Treatments 

The presence of metal fillings or porcelain crowns may cause difficulty in placing an orthodontic appliance. It is possible to bond brackets to gold, porcelain, and ceramic, but it requires complex techniques and an special armamentarium.

Additionally, adults with multiple fillings, root canals, and crowns indicate patients’ low motivation toward oral hygiene. Orthodontic appliances make cleaning difficult, so patients with compromised oral hygiene before the treatment aren’t good candidates for the treatment. Furthermore, multiple and heavy restorations can complicate tooth movement.

Summary 

The best age for braces treatment are teenage years when bones and face are still growing. However, you can get braces treatment at any age, but the results may not be ideal if done in adults.

Also, treatment in young patients produces more desirable and stable results. Adults need proper medical and oral examination to intiate an orthodontic treatment, such as, periodontal evaluation, medical, dental and drug history and history of previous orthodontic treatment. These conditons don’t absolutely contraindicate the treatment, however, these factors can complicate or delay the treatment. 

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