A Parent's Guide to the Different Types of Braces for Kids

What Is Orthodontics for Children?

To better understand the techniques of orthodontics for children, we can first look at the etymology of the word "orthodontics."

It comes from two distinct Greek words: *orthos*, meaning straight, and *odontos*, referring to teeth. The goal of orthodontics is to bring teeth into order and harmony. This is, of course, for aesthetics, but it is also functional, especially in the case of children's orthodontics.

Early evaluation, sometimes as early as age 7, can help anticipate cases that would become much more complex later. This field of orthodontics is called interceptive orthodontics.

Orthodontics is often recommended for a child's oral health. It is very common for children to have alignment problems or malocclusions, which can quickly lead to food traps or increased tartar buildup.

Malocclusions can have several origins. Some may be genetic, while others are related to habits. Indeed, the way a child eats, sucks their thumb or a pacifier, and the position of their tongue can influence the formation and alignment of their teeth.

Poor alignment or malocclusion can have direct or indirect effects: food getting stuck more easily or protruding teeth that are more likely to break during a fall.

Orthodontics in children therefore plays a major role in oral health. Orthodontic treatment helps optimize chewing and proper jaw development. It can prevent issues not directly related to oral health, but that stem from it, such as digestive problems. If teeth cannot properly cut food, digestion will be longer and more difficult. Orthodontics in children also promotes nasal breathing.

Orthodontics for children has a dual objective:

• Preventing future dental health problems.
• Giving every child the opportunity to have the most beautiful smile possible!

At What Age Should Children Start Orthodontics?

The American Association of Orthodontists (AAO) recommends that a child have their first orthodontic evaluation no later than age 7. At this appointment, your orthodontist will tell you if they think treatment will be necessary or not.

The consultation may, for example, reveal the importance of early treatment for a severely retruded lower jaw; in this case, it is advisable to start treatment so that things do not worsen later. In the case of a retruded jaw in a child, we can take advantage of their growth to achieve a forward movement that in an adult would only have been possible with jaw surgery.

The orthodontist may also recommend starting early orthodontic treatment (around age 7) because the child has problems not so much related to their morphology as to their habits (thumb sucking, tongue thrusting...).

However, in the majority of cases, comprehensive orthodontic treatments rarely begin before the age of 11 or 12, once most permanent teeth have erupted.

What Is Interceptive Orthodontics?

But what exactly is interceptive orthodontics? Also known as early or Phase I orthodontics, it refers to treatments for children that have two main objectives.

1. The first goal of interceptive orthodontics is to achieve a good positioning of the child's jaws, so that they align well with each other, thus avoiding certain problems that would later have required surgery (e.g., a severely retruded or protruded lower jaw).
2. The second goal of this early orthodontics is to prevent certain anomalies related to teeth and their alignment from developing fully. Indeed, these problems can be either related to a hereditary malformation or to habits acquired by the child that need to be corrected.

Early orthodontics is therefore a way, through certain procedures and techniques, to prevent or correct certain anomalies, because if they are not addressed immediately, they could worsen over time and require much longer and more expensive treatment in adulthood.

It is very likely that the child will still need a second phase of treatment (Phase II) during their teenage years, but it will be much easier since some of the major issues have already been addressed.

Invisible Orthodontics for Kids: Invisalign Teen and Invisalign First

In 1997 in the United States, Align Technology (Invisalign) developed its first clear aligners. Since then, this technique has become very popular. This technique is an effective substitute for traditional braces, even in children, provided that the orthodontist using it is trained and experienced with it.

This led to the creation of Invisalign Teen and Invisalign First! As the names suggest, these are aligners dedicated exclusively to children and adolescents.

An aligner is a plastic tray, like a thin transparent layer, that is placed over the teeth and covers them. By changing the trays over the course of the treatment, it is possible to change the position of the teeth.

Each tray is unique and adapted to the patient's teeth because it is custom-made using a scanner and a 3D printer. This process has several advantages, notably being almost invisible.

The child can therefore wear the aligner throughout the day without their classmates noticing anything (which can be a major psychological asset for the child). Being very thin, it also offers maximum comfort (no pain) as it is very light. Moreover, this removable system allows the child to remove the appliance when brushing their teeth, for example.

Invisalign aligners for kids include "compliance indicators" to know if the child is wearing their aligner enough and correctly. This is a blue dot at the end of the aligner that fades when worn correctly. Thus, it is possible to monitor the proper progress of the treatment with ease.

Kids' Orthodontics: Traditional Metal Braces

Alongside the increasingly popular aligners, there are still more traditional dental appliances. Indeed, traditional metal braces (multi-bracket appliances) continue to be used and are still considered by orthodontists to be an excellent way for children and adolescents to correct the alignment of their teeth.

The braces are obviously much more noticeable than Invisalign aligners and are not removable (which can cause initial discomfort and requires impeccable oral hygiene). Nevertheless, they remain a very widespread technique.

They consist of "brackets" (the metal part fixed to the outer surface of the tooth) which are connected by a metal archwire to move the teeth and bring them to a different position.

It is also possible to add colored elastics to each bracket (depending on the child's choice) for more originality.

Kids' Orthodontics: Ceramic Braces

Ceramic braces work just like metal braces. The difference lies in the brackets, which are not metal but ceramic. This material is much less noticeable than traditional braces because they are the same color as the teeth. A white wire can also be used to be very discreet.

They also provide better comfort for the child, but it is important to note that they require more diligent maintenance than aligners. Thus, the child's oral hygiene must be very consistent.

A Closer Look at Other Types of Orthodontic Appliances for Children

There are other types of appliances, less known because they are less common, but just as effective. We can classify them here into two categories: those that are removable and those that are fixed directly to the child's dentition.

Palatal Expander

A palatal expander is an appliance whose role is to widen the upper dental arch to rebalance a width discrepancy between the lower and upper jaw.

This maxillary expansion must be carried out manually by the parents or the child themselves using a key. The appliance must be activated once or twice a week according to the orthodontist's instructions to achieve the expansion.

Bite Plate

An orthodontist uses a bite plate when the child's upper incisors are too far forward and, in most cases, cover the lower incisors (a deep bite or "supraclusion"). This appliance helps to create more space for the lower jaw to develop by correcting the relationship between the two jaws.

Removable Appliances for Habit Correction

These appliances work on the same principle as the previous ones, but this time with the addition of elastics that must be changed every 2 or 3 days. This technique helps to correct the position of the upper incisors when they are misaligned, for example, when they are too tilted forward. The appliance can be removed for meals and brushing.

Functional Appliances (e.g., Herbst, Twin Block)

These sophisticated appliances help to harmonize the child's jaws. Their system, often composed of two removable or fixed parts, allows for the correction of problems in both jaws simultaneously, typically to encourage lower jaw growth.

Rapid Palatal Expander (RPE)

The RPE is a small fixed appliance placed on the upper molars to allow for the widening of the palate. One of the parents will have to turn the screw with a key, once or twice a day as instructed by the orthodontist, to gradually widen the palate.

The Quad Helix

The Quad Helix is an appliance that widens the upper jaw with two bands placed on the first two upper molars and a soldered metal wire that passes over the palate (acting as a spring) to also allow for the expansion of the palate.

Nance Appliance

The Nance appliance is used to stabilize certain teeth (the molars) when baby teeth have fallen out prematurely or had to be removed due to cavities. This appliance acts as a space maintainer.

A Closer Look at Different Retainers for Children

First, we must recall what retention for children is and the importance it plays in finalizing orthodontic treatment. As its name suggests, its purpose is to "retain" the straight alignment achieved through orthodontic treatment. This prevents relapse, which is the tendency of the teeth to return to their original incorrect position.

The Bonded Retainer

The bonded retainer is the most used method. It is a simple device that, by means of a metal wire, maintains the teeth from canine to canine to preserve the gains of the orthodontic treatment. It is placed on the lingual (inner) side of the teeth. Glued directly to the teeth and very thin, it is not at all bothersome but simply requires rigorous hygiene.

Clear or Essix Retainers

Clear retainers work on the same principle as standard clear aligners. However, for retention, it is not a matter of changing the trays to evolve the tooth layout (active treatment), but of always keeping the same one to maintain the teeth in their current state (passive treatment).

Hawley Retainer

The Hawley retainer is the 3rd most used retention device by orthodontists, especially in children. It consists of two parts, a resin part that fits against the palate and a metal wire that encircles certain teeth (with clasps) to prevent the teeth from moving.

It is custom-made by a specialized lab technician and must be worn as directed by the orthodontist. It is important to note that this removable appliance can be taken out for brushing the child's teeth, but must nevertheless be cleaned once a week with a product designed for this purpose.

Conclusion on Orthodontics for Children

In conclusion, it's important for parents in the United States to know that orthodontic treatment for children, regardless of the appliance used, is often covered in part by private dental insurance plans.

Most dental insurance plans with orthodontic benefits have a "lifetime maximum" per person, which is the total amount the plan will pay for orthodontic treatment. This amount typically ranges from $1,000 to $3,000. The insurance usually pays a percentage of the cost (often 50%) until this lifetime maximum is reached. It's essential to check your specific plan details to understand your coverage.