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.

When Should My Child See an Orthodontist?

Have you noticed more young kids with braces on these days? Why so young? Don’t they still have baby teeth? When should I take my child to see the orthodontist for the first time?

According to the American Association of Orthodontists, the best age for children to be seen by an orthodontist for the first time is 7. Why age 7? What can be done at that age? As you might guess, not every orthodontic problem can be treated at age 7. Surprisingly however, most problems can be identified by that age. Here are a few things that I’ll look for at your child’s first visit.

Tooth Loss and Eruption: Teeth are lost in a fairly specific order. Deviations from this pattern may indicate that a child has developmental issues that need attention. Between the ages of 6 and 8, it is normal for a child to lose his first eight primary teeth. Ideally these eight primary incisors are replaced immediately by eight permanent incisors. It is also normal for the child’s first four permanent molars to emerge at age 6 (hence the name “6-year molars”). By age 7, children should have at least four permanent molars and four permanent incisors. If there are more or less teeth than this, there may be problems with crowding, missing, or extra teeth. Sometimes removing a primary tooth early or maintaining a space where a tooth has been lost prematurely can prevent bigger problems later on.

Crowding and Spacing: By age 7 it is possible to tell if a child has a problem with excessive crowding or spacing. Spacing may mean that a baby tooth has been lost prematurely, a tooth never developed, or that the teeth are just too small. Crowding may require that the arches be expanded or that teeth be removed to help improve the situation.

Alignment: Although teeth can be aligned at an older age, crooked teeth are more susceptible to uneven wear or damage due to trauma, and the shape and position of the overlying gum tissues can be compromised. Crooked teeth can also have social implications that if dealt with at an early age ( 7 or 8 ) will have less impact on a child’s self-esteem.

Protrusive Front Teeth: As mentioned earlier, by age 7 it is obvious if the front teeth stick out farther than is safe or attractive. Although I know that I cannot permanently correct overbites before growth has finished, I can help reduce the severity of the problem and make things easier for young patients both dentally and socially while waiting for growth to be complete.

Underbites: Although it is best to wait to finish treatment in patients with underbites until they have finished growing (usually ages 16 through 18), it is important to try and normalize the anterior bite as early as possible to eliminate bite shifting and damage to the front teeth due to traumatic occlusion. If I notice an anterior underbite at age 7, I will recommend trying to at least “jump the bite” at that age even though definitive correction may not be accomplished until later in their teenage years.

Posterior Crossbites: Not only do posterior crossbites create crowding, they may also cause the jaw to shift laterally (to one side or the other). Expanding the upper jaw at age 7 can reduce the crowding and create the space necessary for the eruption of the anteriors as well as eliminate any shifting that may be present due to a constricted upper arch. It is also likely that the jaw shift will create a skeletal growth asymmetry so it is important to eliminate the sideways or forward shift as early as possible.

Anterior Openbites and Deepbites: By age 7 it is possible to detect vertical problems with the bite. Bites that are too deep (where the top teeth completely cover the bottom ones when biting) may indicate that the patient has a small lower jaw. Bites that don’t overlap enough (openbites) may signal that there is a finger or tongue habit that may be causing dental problems. I like to eliminate these destructive habits early so that normal development can occur.

I recommend screening ALL young patients at age 7 so that these and other conditions can be identified and corrected as early as possible. Although some may be able to wait until all the permanent teeth are in, interceptive treatment can make the final results faster, better, and give your children an additional three to four years of having a great smile at an age when their self-image is developing. If you have a child who is 7 or older, why not set up a screening with an orthodontist today?