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Growth and Orthodontic Patients

I see patients of all ages from age 7 to 99 years old. Approximately 75% of my patients are under 18 years old and growth plays a factor when diagnosing treatment timing for patients. Treatment timing for patients is individual and is controlled by the patients’ growth pattern. The average child has all their permanent teeth by age 12 and is ready to start orthodontic treatment.

For my younger patients (age 7-10 years) that have a narrow palate, the palate is soft and pliable at this age and easily expanded orthopedically. Frequently, a narrow palate causes moderate to severe crowding or a crossbite. In a normal patient, the upper teeth fit over the lower teeth like a lid on a jar. In a patient with a narrow palate, the upper back teeth fit inside the lower back teeth and an expander can correct that. Parents often ask if no palatal expander was used, would the patient’s jaw grow wider on its own? Unfortunately, the answer is no. Not only that, there is a window of opportunity the expander can be completed. If its not done during a young age and needs to be done in adulthood, it would require more invasive methods including surgery in a non-growing adult to correct.

Besides age, there are other methods used to determine growth. One is a cephalometric x-ray which is an x-ray of the profile of your head. From this x-ray you can see if there is a discrepancy in the jaw that needs to be corrected. For example, sometimes the lower jaw protrudes causing the underbite. In a patient like that, the evaluation of the x-ray can tell us more about the severity of the underbite. If the underbite is mild, its okay to treat a bite of this type early. If the underbite is severe, often times its best to wait until growth is fully completed as orthopedics may not be beneficial at all and jaw surgery is the best method for correction. Cephalometric x-rays also show images of the cervical vertebrae and your orthodontist can tell by their shape when the best timing for treatment is.

Another method is using a hand wrist x-ray. There are several bones in your hands and they can also indicate to an orthodontist the best time to intervene depending on the development and the shape and the appearance of the bones.

In addition to the above methods, other factors that are considered are genetics. Does dad have an underbite? Does mom have an overbite? The apple doesn’t fall far from the tree! How tall is the patient? Did he/she have a growth spurt yet? As you can see, the evaluation of treatment timing is not as straightforward as it may seem and that timing of treatment depends on the type of problem that needs to be fixed and it is very individualized. To find out the answer to these questions, see an orthodontic specialist.

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