What is the purpose of an orthodontic "supervision" appointment?

We know that moms and dads have busy schedules. Leaving work, picking up their children from school and taking them to the orthodontist is no small task. Sometimes the appointments are very short and seemingly meaningless. One of these appointments is the observation or supervision visit. These appointments are usually less than 15 minutes and many wonder if they are necessary at all. Supervision or observation appointments are very important, however!

Observation or supervision visits are scheduled for orthodontic patients who are either not yet quite ready for braces or have had an interceptive phase of treatment and are waiting for their remaining permanent teeth to come in. The orthodontist may take a progress x-ray at this appointment to help him evaluate your child’s dental development. There are three things that I look for when your son or daughter is in my chair.

First, if the patient has had an interceptive phase of treatment, it is important to check the condition of the retainers. The Phase 1 retainers that we use on the lower teeth are often bonded directly to the teeth.  Sometimes the bonding material wears thin with normal eating or the bonding material comes loose from the tooth surface. If a retainer comes loose or is lost, the teeth can move and the result of the initial treatment compromised. It only takes a couple of minutes to add cement to an intact retainer. If teeth have shifted due to a broken bonded retainer oftentimes braces must be put back on in order to restraighten the teeth. On the upper teeth we normally use a removable plastic-and-wire "Hawley" retainer.  These retainers may need periodic adjustment and tightening if they become loose fitting.  As well, the new permanent teeth that are erupting are a different size and shape than the baby teeth that were lost.  We can trim the plastic on the retainer to accomodate these new erupting teeth and keep the retainer fitting well to preserve the correction we gained.

The second objective of this appointment is to evaluate the loss of primary teeth and the eruption of the permanent replacements. Losing primary teeth on time and in the right order can help the permanent teeth come in straighter. If I notice that a baby tooth is not falling out on time, or I identify in an x-ray that the permanent teeth are headed in the wrong direction, I usually recommend that a patient see their family dentist to get the offending baby tooth removed. Evaluating the loss of primary teeth and the eruption of permanent ones doesn’t take much time, but ignoring developing problems can add months or years to a patient’s orthodontic treatment.

The third objective of an observation appointment is to advise the family about the timing of the next phase of treatment. My philosophy is that I will begin no treatment before a patient is ready. This might mean waiting a few months or even years. If we start too early, your son or daughter may have the braces on longer than necessary. If we wait too long, we might miss the opportunity to keep treatment as short as possible, or miss a growth spurt needed to correct a bite problem.

Having your orthodontist follow your child’s development will help them receive the care they need when they need it. Although they are short and sometimes seem like a wasted trip, your orthodontist knows exactly what to look for at an observation or recall appointment and will make sure that your child is progressing towards an excellent orthodontic result. Next time your son or daughter has an observation visit with your orthodontist, make sure and ask for an explanation of the things he was looking for and what was found. I think you’ll find that these short, to-the-point appointments are as important as any you’ll have.