When Is It Okay To Delay Braces?

You may have heard that some kids can benefit from braces at an early age, but how important is early orthodontics?

The American Association of Orthodontists recommends that children be seen by an orthodontist by age 7, but in most cases orthodontic treatment does not begin that young. “Orthodontists generally aren’t putting braces on baby teeth,” says Lewis Kay, DDS, a pediatric dentist at Episcopal Hospital in Philadelphia. The goal for younger children is to intercept conditions before they become more serious.

While some orthodontic conditions, such as cross bites, buck teeth and teeth growing into the incorrect position, should be treated early, “treatment for most conditions can be safely put off,” if desired, says Dr. Michael DeLuca, DMD, an orthodontist practicing in Hamilton, NJ.

Kids who do start orthodontic treatment in elementary school (generally ages 7-9) require two phases of treatment, with each phase lasting one to two years. Phase one treats jaw discrepancies and skeletal abnormalities. Then after a few years off, phase two, the teeth-straightening phase, often begins at age 11 or 12, after the permanent teeth have come in.

Quality of Life

The Trends

In 2008, approximately 3.6 million U.S. kids under the age of 17 received orthodontic treatment, according to the American Association of Orthodontists.

This was down nearly 8% from 2006, perhaps due to the economy, but represented an increase from 10 years before. Of new patients in 2008, 73% had dental insurance with orthodontic benefits.

Orthodontics is a preventative division of dentistry, says Robert Vanarsdall, DDS, Chairman of the Department of Orthodontics at the University of Pennsylvania. Crooked teeth in themselves don’t cause health problems for the mouth, but they can be a contributing factor to gum disease. Teeth also play an important part in other functions of the mouth, like chewing and speech.

Like plastic surgery, most orthodontic treatment is elective. For orthodontic patients the cosmetic improvement is what is most noticeable, but the patient receives health benefits from the procedure too. “What looks good usually works a little better too,” says Dr. Vanarsdall. He says straightened teeth improve the quality of life.


“The impression from the public is that we do this for aesthetics,” says Dr. Vanarsdall. But in actuality, says Dr. Kay, “The main reason is not cosmetic. The main reason is function.” Straighter teeth offer advantages to speech, chewing food and in oral hygiene to prevent gum disease. However, these functional advantages are not usually discussed with patients and their parents, says Dr Vanarsdall, because the topic of benefits beyond cosmetics usually does not come up.

Self image can be very important to teenagers, notes Wilmington, DE orthodontist Clifford Anzilotti, Sr., DMD. If your child is not upset about how his teeth look, and there are no functional problems, don’t feel guilty about putting braces off, he says. “It’s not a life or death thing,” Dr. Anzilotti says. “You can straighten teeth at any age,” says Dr. DeLuca.

That said, many orthodontists see advantages to wearing orthodontics in adolescence. “You can do it in adulthood, but if you have the choice, you’re probably better off having it done at a younger age,” says Dr. Kay. Adults with braces can experience more pain and discomfort because their bones are harder and therefore moving teeth becomes more difficult.

Ask for an Explanation

The Cost of Braces

A full set of braces can cost as much as $6,000, usually paid over two years while the work is being done. If your child requires two phases of treatment, look for an even higher figure. Dental insurance can help.

“The majority of patients have some sort of insurance coverage,” says Dr. Anzilotti, but it usually doesn’t cover the full cost, he says. Many plans cover half of orthodontic costs up to a predetermined lifetime maximum.

If you’re considering putting off treatment for economic or other reasons, ask your orthodontist for a recommendation and discuss options. “Most times the answer is yes, it can wait,” says Dr. DeLuca. Ask your orthodontist whether and why treatment should be done now, and about the possible consequences of delaying treatment.

Don’t be reluctant to question your doctor’s recommendation, says Dr. Kay. “You have the right to discuss this with the orthodontist. It’s your right as a patient and as a parent,” he says. “No doctor should refuse to discuss his recommendation.”
Although the American Association of Orthodontics estimates that 50-75 percent of people could benefit in some way from orthodontic treatment, “the choice to do it or not is obviously yours,” says Dr. Anzilotti.

Suzanne Koup-Larsen is a contributing writer to MetroKids.

Categories: Health & Nutrition, Medical