Limitations of Early Orthodontic Treatment

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I am a big fan of early orthodontic treatment. I treated all three of my own children with two-phased treatment and would do it again. Wonderful things can be accomplished during the first phase of a two-phased treatment. It is time, however, that I “fess up” and explain the things that interceptive care will not accomplish for your child.

A lot of the problems we fix through orthodontic treatment are genetic and no matter how accurate our diagnosis and treatment plan, we just can’t overcome the patient’s DNA. There are other corrections that can’t be made in young children because they don’t have all of their adult teeth. Knowing what to expect from each phase of a two-phased treatment plan can save parents a lot of worry.

Orthodontists don't have access to all of the teeth in Phase 1

One limitation of early treatment is that we don’t yet have all the teeth in place to finish treatment. We can’t straighten those we cannot yet see. Although there are some preventive measures we can attempt when we identify problems with an unerupted tooth, there are some things we just can’t fix until it is actually in the mouth. Examples of these kinds of problems include impacted teeth and teeth that just don’t come into the right place.

Orthodontists can't change your genetic tendencies

Another limitation over which we have no control is a patient’s genetic makeup (or DNA). If everyone in your family has an over bite or and under bite, chances are that you will too. Even when we are able to correct or reduce the amount during an interceptive phase of treatment, we cannot control the way that you grow between phases. Young women continue to develop dentally until about age 15 and young men until about 17. Overbites corrected in Phase 1 may partially re-appear between phases. Underbites may continue to develop in young men into their early 20’s and there is little that the patient or the orthodontist can do so stop it.

Habits that continue after Phase 1 can cause relapse

Some orthodontic problems are caused by environmental factors. These included thumb and finger habits, mouth breathing, low tongue posture, and airway obstruction (i.e. deviated septum or large tonsils). Sometimes correcting these habits will help prevent relapse, but tongue posture and oral function cannot always be modified and the problems they cause can reappear before Phase 2.

Some corrections must wait until all permanent teeth are in

Lastly, there are some orthodontic treatment techniques that cannot be used until all the permanent teeth are in. Some functional appliances are anchored to the permanent teeth and won't work as well with baby teeth. Auxiliaries such as rubber bands are better saved until the patient has all permanent teeth. For this reason midlines and deep bites may not be fully correctable until the last phase of treatment.

Knowing that there are so many limitations to early treatment, why not just wait and do it all after patients are through growing? First, early treatment can simplify comprehensive treatment later on. A surgery case might be converted into just an extraction case. An extraction case may become merely an expansion case. Second, it is impossible to quantify the improvement in self-esteem that accompanies early treatment. The years between Phase 1 and Phase 2 (usually 9 until 13) are some of the most difficult when it comes finding one’s social self. I’ve had parents claim that their child’s early orthodontic treatment changed their life… that’s why I’m a believer!


NOTE: The author, Dr. Greg Jorgensen, is a board-certified orthodontist who is in the private practice of orthodontics in Rio Rancho, New Mexico (a suburb on the Westside of Albuquerque). He was trained at BYU, Washington University in St. Louis, and the University of Iowa in the United States. Dr. Jorgensen’s 25 years of specialty practice and nearly 10,000 finished cases qualify him an expert in two-phase treatment, extraction and non-extraction therapy, functional orthodontics, clear aligners (Invisalign), and multiple bracket systems (including conventional braces, Damon and other self-ligating brackets, Suresmile, and lingual braces). This blog is for informational purposes only and is designed to help consumers understand currently accepted orthodontic concepts. It is not a venue for debating alternative treatment theories. Dr. Jorgensen is licensed to diagnose and treat patients only in the state of New Mexico. He cannot diagnose cases described in comments nor can he select treatment plans for readers. Please understand that because he has tens of thousands of readers each month, IT IS IMPOSSIBLE FOR HIM TO RESPOND TO EVERY QUESTION. Please read all of the comments associated with each article as most of the questions he receives each week have been asked and answered previously. The opinions expressed here are protected by copyright laws and can only be used with written permission from the author.