Braces: Sooner or Later?
It's neat to see how our issues change over the years as our kids move from infants to toddlers to preschoolers and now school-aged kids. One of our readers emailed recently about orthodontics. My 8 year old son will inevitably need braces, but at a recent visit to the dentist, our doctor wasn't too concerned about looking into at this age. Conversely, one of his classmates had braces starting at age 7. Perhaps you have some perspective for this mama. She writes:
I am looking to canvass mothers of OLDER kids (which there seem to be some who read the site, hm?) about orthodontics. Yes, I'm interested in finding a good orthodontist--but also interested in advice others would give about a) how much you have to take orthodontists' word for it that your kid NEEDS braces; b) parents' experience dealing with the whole braces process, and advice therein; c) cost and insurance coverage--our current insurance doesn't cover and I am eager to find out if this is an anomaly or totally typical.
The long and short of it if you are interested is that I recently found out that my daughter is lacking four adult teeth, two tops and two bottoms, all close to the front. What this means is that they are suggesting tooth extraction (of the babies that haven't yet come out) and braces for her in the next year or so. I'm frankly horrified...but want to do the right thing, of course. And w/out insurance this will all START at $2K.
I can't answer a) or b) but I can tell you my experience with insurance coverage. I have always had coverage for 50% of cost for braces up to either $1k or $1,5k of a lifetime maximum per person.
Posted by: aj | August 18, 2011 at 03:20 PM
I was just at OHSU for an ortho consult for 2 of my kids (we use their Peds school of dentistry too; I think it's great, but time consuming) and I found out that 1) it's much cheaper there than outside OHSU, and 2) our OHP dental plan does NOT cover orthodontics (the consult was free). It seems to be that EVERY mouth is so different that you'd have to consider the necessity on a case-by-case basis. What my 10-year old needs *might* change as his head continues to grow into his huge adult teeth, so it's wait-and-see. What my 8-year old needs is more imminent (affects her future jaw development) and *might* be able to be done by the regular dentist (or OHSU resident, in our case), wherein the insurance would cover it. I think the whole process takes patience and investigation, and possibly 2nd opinions, especially when considering a surgery, yanking teeth, etc.
Posted by: wen | August 18, 2011 at 04:23 PM
I cannot really answer your questions but I could tell you a bit about my own experience with braces... I had them from 6th grade-beginning of my Sr. year of high school and I think that if I had had any choice in the matter I would have preferred to have them sooner b/c so much changes in middle school and high school that it would have been nice to get them out of the way as a kid. Also I think that my orthodontist secretly hated children and this majorly effected my feelings about myself and my willingness to comply with the treatment (ie chewing gum and such).
Posted by: Kaley | August 18, 2011 at 04:40 PM
Taking the orthodontists word for it? ha! they will always (of course) try to sell you on the idea. It's their business! If you really want to know whether your kid needs braces, get the opinion of a dentist who doesn't have any "interest" in it, someone who's not in the ortho business, along with your own opinion of how your kid's smile looks. My son will need braces, it's obvious from the way his smile looks. That's all the information I need, although I did take him to the ortho to see what he said and of course he agreed. We like the orthodontist on the corner of 37th and tillamook. I went there as a teen as well as my of our friends.
Posted by: jln | August 18, 2011 at 05:10 PM
My husband is an orthodontist. We have this conversation all the time with neighbors and friends. He always says how early a child needs braces depends on the situation. A crossbite for example is somewhat severe and can be fixed as early as age 6. He also said that unless there's a severe issue that needs correcting, the usual time for braces is between 9 and 12, and the length of time they wear the braces sort of depends on how severe the issue.
Hope that helps!!
Posted by: layla | August 18, 2011 at 05:17 PM
My son is now 11 and has had braces since April 2010. Although he'd had a very irregular eruption pattern so we knew he'd need orthodonture at some point, it was our dentist who determined when it needed to happen (when she had to x-ray higher and higher up his jawbone to find the adult teeth and there was no room for them to come in...clearly it was time!) and gave us a few orthodontist recommendations. The boy is now on phase 2; phase 1 was the "this work needs to happen NOW to make room for those teeth way up there" plan; phase 2 is the more typical reshape-the-funky-alignment plan. Both our DDS and ortho are against the current trend of braces earlier and then braces again later; however, it was obvious to everyone that letting the boy's teeth follow their own plan would have been detrimental (besides the cosmetic aspect, he was starting to develop sinus problems due to issues with his alignment and palate). Also, physically he's responded really, really well as his bone structure is still so flexible and has made progress at an exceptional rate. I have braces too, and believe me, it's a huge drag as an adult! Phase 1 took less than a year and if he were older (later teen or early 20s) it would have involved surgery. My son's ortho is Rebecca Kuperstein, Parkside Orthodontics. Oh, and we have additional orthodontic coverage on our dental insurance; it's extra coverage that we pay a little bit more for. Even with that, it still costs a bunch. Luckily everyone takes monthly payments.
Posted by: Andrea | August 18, 2011 at 05:17 PM
I have to disagree with the statement that orthodontists are ALWAYS going to recommend braces. My son's dentists (he has been to two different ones) have been telling us he'll need braces from the time of his very first appointment at age 3. When the dentist told us it was time for him to see an ortho at about age 7, I think, I took him in for a consult (consults are always free) with Dr. Dugoni, fully expecting to hear that it was time to have them put in because that's about when I started my braces as a kid. Instead Dugoni recommended strategically pulling a couple of baby teeth and then coming back in for another consult (still free) in a year or two. So back we went, again with me expecting that now we were in for the real thing. Nope, more strategic extractions to maximize the space in his mouth, and again the request to come back for another consult.
The third time, Dugoni recommended pulling permanent teeth. I was shocked and asked tons of questions. Then I went for consults (still free, mind you) with two other orthodontists, Kuperstein and Saferstein. Both said the same as Dugoni, so we had that procedure done. Back to Dugoni for another consult a year later. Still no braces, but we'll probably start them some time this winter at age 12.
Now, that's a lot of time spent for absolutely no money by these three professionals and no pressure to put him in braces immediately. Yes, they are recommending eventual use of braces, but the delay will diminish the time he spends in the braces (and therefore the ortho's income). He has real problems with his teeth that will have to be addressed, and this is confirmed by every professional who has ever looked in his mouth, including his pediatrician. So while I'm sure there are some orthos who are more concerned with their bottom line and just trying to line up customers, but my experience has been far more positive.
As for insurance, we haven't had to pay for any braces yet, but we've sometimes had dental insurance that would cover 50% and sometimes not. Some orthodontists also have plans for payment that give you a discount for paying some up front.
I felt much better about the direction of my son's care when I got the second opinions about pulling the adult teeth. Get a copy of your child's x-rays (your dentist will have a copy if you don't feel comfortable asking your ortho) and go to a couple of consults. Ask lots of questions. Ask about the consequences of waiting a year or two, about waiting for the teeth to fall out instead of having them pulled.
Also, talk to your child's dentist about the long-term implications of her untreated teeth. Problems that are sometimes dismissed as "cosmetic" can have implications for wear patterns on teeth, difficulty keeping teeth clean, pressure on the jaw while chewing, etc.
I was really impressed with all three orthodontists I've dealt with for my son. Dugoni practices with Dr. Rensch, who was my ortho as a kid, and they are in Hollywood. Saferstein is close to Lloyd Center. Kuperstein is next to Laurelhurst Park.
Posted by: j | August 18, 2011 at 07:43 PM
My 7 yo is just starting orthodontics, she has a pretty major crossbite. We're with Kuperstein, also had a consult with Safirstein, both seem great and pretty conservative in terms of recommended treatment: they felt it necessary to deal with the crossbite now because there is a window of opportunity while her palate is not yet formed completely, so still easily movable. Yet neither wanted to address any more than this now though she'll likely need braces or something else when she's older. They both said the cosmetic straightening part (braces) should come later once all permanent teeth are in, but the jaw issues are easier and faster to treat while kids are young. I don't at all get the feeling that they're trying to talk me into unnecessary work. Our dentist is the one who sent us to ortho due to the crossbite.
Our insurance covers up to $1.5k per person in their lifetime (which we're using up now, so won't have coverage for later work); I'm told this is unusually good but I don't know.
We've only had a few aptmts but the experience has been positive so far. Both orthos we consulted with were great at making sure my daughter understood what was going on, what they planned to do and why, and made her feel comfortable.
Posted by: Emily | August 18, 2011 at 09:15 PM
My daughter went to Dr. Angle, on 162/Stark, who was just fine, but I wasn't in love with his practice. No arguments with his work and the outcome, though. I've heard great things about Dugoni, and was a patient of Dr. Rensch myself.
My girl went through orthodontia in 2 phases, with retainers in between. Phase one went on when she was 7, I think, and she was done with phase two just short of age 13. The total of the 2 phases was approximately $5200, and seems to be about what friends are paying who go through orthodontia treatment in one phase.
She was covered by her father's dental insurance during phase 1; it paid 50%, up to $1500. She was covered by my insurance during phase two, and the coverage was the same. We were very, very lucky in that regard.
Posted by: Sheryl | August 18, 2011 at 10:03 PM
I did not have braces as a child or as an adolescent. And have not had any experience with my children. But, having moved to Sweden, I have got to say that it is striking that NO ONE has braces here. And people seem to get along just fine. It is amazing to read that there are dentists out there telling you your child will need braces at 3? And they are placing them at like age 7? My daugher is 6 and has yet to lose her first tooth. Seems like the child should be getting their teeth and growing (manibles grow to accomodate the adult teeth over time)..before some "corrections" need to be made. Not meaning to sound judgmental, but even as a physician myself (although not a dentist), my initial reaction is that this can not be "right". Discussing them later in life maybe...
Posted by: Rebecca in Sweden | August 19, 2011 at 01:44 AM
My daughter is also lacking adult teeth but the dentist decided not to remove the baby teeth but to work around them. I am almost 50 and still have two baby teeth! My son had a serious cross bite and so started orthodnontics early with excellent results. My daughter just needed staightening and her bite adjusted and they had her wait until 13 braces off by 15. I highly recommend Daniel Yaillen. My daughter wanted braces because of appearance and he made her wait until the time was right and kept their wear to a minimum also with excellent results. He doesn't push treatments but does what needs to be done at the appropriate time. Our insurance covered part and we did a payment plan for the rest.
http://www.smileatlife.com/dryaillen.html
Posted by: Kelly | August 19, 2011 at 07:47 AM
Rebecca--
My son's baby teeth were completely packed together with no spaces so that it was hard to get dental floss between them, so it's easy to see that there was no room in his jaw for his adult teeth to come in and align properly. And that was the primary reason that dentists told us from an early age that he would need braces of some kind. Had we done nothing, and just allowed his baby teeth to fall out and his adult teeth to come in, some of the adult teeth would have had to come in sideways, overlapping adjacent teeth, or stacked behind other adult teeth. His incisors would have erupted from high up in his gum line and pointed diagonally. Yes, his jaw has grown and will continue to grow. But that growth would not magically allow the crooked, overlapping, etc. teeth to line up.
Some problems can be dealt with very effectively at an early age, and in fact must be addressed early to avoid complications. There are a couple of examples of that in the comments above.
Most kids in the US don't need or get braces. Some kids who do not need them, strictly speaking, do get them. And some get them earlier than some orthodontists would recommend--as in any medical field there are differences of opinion, and the procedures and approaches have changed greatly in the last 30 years so that some people's personal experiences are no longer relevant, and some orthodontists have not kept up with the field. That's part of why it is so helpful to get second opinions.
I'm sure that as a physician, you can understand the challenges in comparing Sweden's relatively homogeneous population to the United States' heterogeneous population. A simple measure of differences in dentition might be in looking a the percentage of impacted wisdom teeth in Sweden compared to the US (using something like the Kaiser system to track this? all health data in the US is hard to gather). There are also great differences of diet, lifestyle, and health care that could affect the outcome you're reporting--no need for braces and everyone getting along fine. Or it could be that the Swedes are NOT getting along fine and that there are unaddressed problems there. It would be interesting to know what a Swedish dentist might say about the situation.
But I understand the disbelief that braces are so widespread here. Both of my parents have good teeth--not crooked, no overbites or other strange arrangements of the jaw. All 5 kids in my family had serious problems that necessitated several years of braces per kid. How does that happen?
Posted by: j | August 19, 2011 at 11:02 AM
I posted earlier. With my older child the braces were mainly cosmetic since she had pretty crooked teeth, some baby teeth to work with and a bit of trouble with her bite that caused clicking. My dentist gave me a referral and the. The orthodontist said it would be best tomwait a few years and we did with great outcome. My younger child, like a said, had a serious cross bite and by treating it early we were ablt to avoid painful intervation like headgear. Both times the orthodontist was very judicial in his treatment and assessment. Like I said, insurance covered some and the rest we did as a monthly payment plan. The older child just had straight braces the younger had a specialized retainer to treat the cross bite and then a short time in braces to make sure the aligment was right. Both had post braces retainers to maintain. As far as the process the older child wanted a lovely smile and so was happy to have braces...it really wasn't that bad. The younger child with the cross bit had to start at seven with a 24/7 retainer that was difficult at first but easily became part of his routine and spared him headgear. The braces were also not a big deal and now he's set. Both were done with the process by high school which was a good deal for them. If you have any doubts get a second opinion. I've never met a professional who objects.
Posted by: Kelly | August 19, 2011 at 08:43 PM
I would most emphatically recommend Dr. Crowe at North Portland Orthodontics. We have known for several years that our 10 year old would need braces. We've been seeing Dr. Stephen Waldram (whom I ADORE) her entire life and he gave us the heads up and suggested Dr. Crowe. We have had 2 visits already, numerous X-rays, photos, and a mold of her teeth, all at no charge. The office is incredibly comfortable. She has explained everything in a no-nonsense way that makes perfect sense to us and my daughter. I trust Dr. Waldram and I trust Dr. Crowe. If it doesn't feel right, or if you don't trust them, get a second opinion.
As far as insurance, I think you can choose different plans during the open enrollment period that pay different amounts. 2k does seem to be a pretty normal ceiling amount. I do think most doctors take payments, however.
Posted by: DRG | August 19, 2011 at 09:47 PM
Do them later. The kid who wears the braces must have very good dental hygiene while they are on to make sure you don't permanently scar the teeth. Also, I've heard young kids wearing those appliances to stretch their palates having terrible migraines.
My teens went into braces at 12 and had them off 18 months later using the Damon bracket system. Worked great and they entered high school with beautiful straight teeth.
http://www.dischingerteam.com/damon-system.php
Posted by: jackson mom | August 20, 2011 at 04:45 PM
I agree with later. I was a crooked toothed kiddo and braces were always on the horizon. My parents did a lot of research, and waited until I was in 8th grade to get them. For several reasons. I no longer had baby teeth, so extractions weren't needed. Also, the ortho recommended that the longer you wait, the more "settled" teeth will be, meaning less likely to revert once braces were off. As a female tween, this was tough for me. I wanted my crooked teeth fixed! But in the end, I was older, better at taking care of them, and didn't need them for as long as friends that got them younger.
Posted by: birdonfly | August 21, 2011 at 10:25 PM
I think that some problems need to be treated early and others can wait until later...there's not one right answer for every child. I agree with others who say get a second opinion. Amoungst my children's friends some needed braces earlier, some not until middle school and others early high school. Each was a different child with a different problem/need.
Posted by: Anon | August 22, 2011 at 10:07 AM
Someone earlier mentioned "painful intervention like headgear" -- hm. Not my experience.
I had headgear -- but by having a night brace (does anyone even do that now?), I never had to have braces on all my teeth. Headgear meant that I had braces on my rear molars, which the night brace slid into, and the "headgear" kept it in place overnight. There was later a rubber band that went around my front teeth at night & moved my overbite back.
Painful? Not.
And most of my friends never saw the headgear because I only wore it to bed.
(I had a small head, though, so the orthodontist had to shorten the night brace, which meant that I tore a lot of pillow cases -- perhaps painful for my mom!)
Posted by: SusanOR | August 22, 2011 at 12:21 PM
I was probably the poster. My child was facing having to wear the headgear during the day as well and so a different circumstance. I am glad it wasn't too bad for you bit think it would have been physically and psychologically difficult to deal with headgear and I'm grateful we were able to avoid it.
Posted by: Kelly | August 22, 2011 at 01:34 PM
Kelly, good for your dentist for not pulling those baby teeth. I had baby teeth pulled when I was around 13 because they hadn't come out (they were the ones on either side of my two front teeth). The dentist said x-rays showed the adult teeth were "just sitting there, waiting to pop down." Well, guess what. They didn't pop down. Not for over a year. During which time I looked like a damn vampire.
Posted by: zinemama | August 22, 2011 at 03:37 PM
Lots of excellent reading here, many thanks! I had been searching on yahoo when I discovered your post, I’m going to add your feed to Google Reader, I look forward to much more from you.
Posted by: north face discount | August 30, 2011 at 01:45 AM
My dentist recently told me that children's jaws don't stop growing until their teen. If they have braces make sure they put in a permanent retainer.When the jaw grows the teeth won't become crooked again.
Posted by: Debbie | August 30, 2011 at 11:28 AM
You can always ask for a second opinion. Remember to consider listing down all the options you can gather so that you can pick the best option for you. If you decide to go with the braces option early, you have to visit the dentist regularly to check if the braces are working effectively.
Posted by: Timothy Eastwood | November 09, 2011 at 07:06 AM
When the orthopedist recommended braces, sometimes we need to seek a second opinion. Braces are not for life but it can take years for them to be removed.
Posted by: dental consultant | November 22, 2011 at 08:31 PM
I am also surprised on how much the dental operation would cost. $2K is too much in my opinion. But if it is needed, then maybe a monthly installment plan is viable.
Posted by: denture repair | November 23, 2011 at 10:26 PM
I have the same dilemma too. I don't know how long and how early should a child get braces. I think this all depends on your dentist.
Posted by: dentist Sippy Downs teeth whitening | January 26, 2012 at 12:50 AM
Hello,
Are you a Oregon driver requiring support with the sr-22 insurance application? Search no further than Bill Higley Insurance. Our agency has considerable familiarity dealing with many applications which are encompassed in establishing a complete automobile insurance policy for Hillsboro Oregon.
Posted by: Devyajoti | January 30, 2012 at 08:14 AM
I suggest getting braces for your kids as soon as possible. Most health insurance do not cover these dental costs for your kids in their basic plans. However, you can add these on your insurance for extra premiums.
Posted by: dc cosmetic dentist | April 03, 2012 at 09:35 AM
It's easy to know if your child needs braces. It's obvious from the way his or her teeth are arranged. I had braces when I was only 12 years old and my dentist extracted two teeth in order to adjust my braces.
Posted by: dental clinic florence south carolina | May 09, 2012 at 08:53 AM
Wow, Dr. Dugoni is still practicing? He did my braces almost 20 years ago, and my teeth still look great. This post reminds me it's about time to think about braces for my 11 year-old.
Posted by: ED | May 10, 2012 at 10:59 PM
I was thinking about getting braces for my kids. I'm still leaning towards sooner being better in the long run, but if they get them later, then they will most likely take better care of them. Well, I'll just stick to what I think and see what happens. Thank you for sharing!
Posted by: Braces in Albuquerque, NM | March 06, 2013 at 09:58 AM