What is early orthodontic treatment as you practice it? Funny how verbiage changes from year to year and from generation to generation. I can say to you that orthodontic treatment is an awesome option for many patients -and not that many years ago, you might have thought it odd that I would use the word “awesome” to describe orthodontic treatment. After all, “awesome” meant something that would induce an overwhelming feeling of awe, like seeing Michelangelo’s ‘David’ carved from one piece of stone, in all its detail, or seeing the immensity of the Grand Canyon. Today, the word awesome is used to describe things that we like. Orthodontic treatment might be called awesome, when we mean pretty great, OR when we mean it induces true awe in its results. Another term that has changed is “early treatment.” Not that many years ago, early treatment meant treat-ment of a 9-or 10-year old patient. Now, early treat-ment may mean treatment of a 1-year-old Class III patient. The meaning of early treatment has broadened as the evolution of orthodontic treatment by general-ists, the gatekeepers of comprehensive dental care (including our modern terms the “GP” and the “pedi-atric dentist”), has expanded. This has meant a broad-ening of possibility for the child patient and for his or her parents. This expansion of treatment possibilities provides an opportunity for beauty and lifetime func-tion that can only be called awesome -in every sense of the word. Now, pediatric orthodontics brings mirac-ulous and amazing possibility to the child patient and his parents. you imagine, less relapse? Can you imagine a child not being teased by other children with phrases like “Why do you have so many teeth? They are ugly!” What benefits do you see from performing early treatment? Most any child with adverse growth -growth that is off the normal -can benefit immensely from treatment to direct and redirect growth toward the normal. And, many children and their parents can rejoice in “Phase I and done” -orthodontic treatment in the mixed denti-tion, when the permanent incisors and molars have erupted. The bite can be corrected, the tooth alignment can be made beautiful, and the space can be created in the upper and lower jaws to allow the remaining teeth to erupt without problems. “Phase I and done” can happen with a knowledgeable pediatric orthodontist in about more than 50% of children. (There are children who will need a second phase of treatment because of their severely ectopic -out-of-place -erupting teeth, or because of adversities like tongue position, severe trauma, extra teeth or missing teeth.) And for those children, the Phase I treatment will reduce the length and complexity of Phase II treatment and will reduce the need for permanent teeth extractions. In addition, Phase I treatment will improve the view the child has of himself and the view others such as peers, teachers, coaches and other parents have of the child. The Phase I treatment will reduce the need and risk for surgeries later. The Phase I treatment provides more stability and less need for compensation -moving teeth around to hide the FLK face. The Phase I treat-ment will reduce the need for the child to adapt to less-than-ideal growth, less-than-ideal bites, and less-than-ideal esthetics. At what age or stage of development do you recommend early treatment? In pediatric residencies around the country, young doctors learn the term “FLK”. That is a descriptive acronym standing for “Funny Looking Kid.” We can now offer children the opportunity for early esthetic changes that erase the risk of being an FLK. A thumb sucker, who otherwise may suffer from a distorted maxilla and mandible, as well as an open bite and protruding tongue, can be treated as soon as the two-year molars are erupted. By treating at this time, they do not have to grow up as a FLK and have dental compensation treatment provided in the difficult middle school years. A Class III infant can be treated at around age 12 months and avoid being thought of as “tough” or as a “bully”, and thus not be teased. A Class II child with severe protrusion can avoid having repetitive trauma to their protrusive incisors, with resulting fractures, and need for root canal treatments, occurring barely after the permanent incisors have erupted at age seven or so. In addition, the need for future crowns being done and redone is also eliminated. A child with crowded incisors can have much more stable alignment of those incisors when treatment is begun before the teeth have completely erupted and connective tissues forms to hold them in rotated and unattractive positions. Can www.orthodontics.com Spring 2019 39
Journal of the American Orthodontic Society Spring 2019: Page 39
