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Kids Braces – Phase One: Interceptive Orthodontics

Decades ago most orthodontists would start orthodontic treatment in children that had reached their early teenage years. By this age the permanent teeth had already erupted and the orthodontist could easily assess what orthodontic treatment was needed. However waiting until after permanent teeth had erupted meant that some teeth often needed to be extracted before dental braces could be placed. Today most orthodontists would recommend having a child screened at age seven—before the permanent teeth have erupted. Why start orthodontic treatment this early? The jaws can be changed more easily to permit all or most of the erupting teeth in a process called interceptive orthodontics.

Interceptive orthodontics and orthopedics

In most cases, interceptive orthodontics is more accurately considered orthopedics since it is the jaw that is altered rather than the teeth. As the child’s jaw is developing several functional orthodontic appliances are used to change the shape and size of the jaw. In most cases the jaw is expanded and lengthened to accommodate all of the teeth. This prevents crowding and promotes the eruption and extrusion of the teeth. Because the jaw is moved rather than the teeth at this stage, the process would be more accurately called dentofacial orthopedics but is commonly referred to as interceptive orthodontics.

Dental devices used in interceptive orthodontics

There are a number of dental devices that are used to change the shape of the jaw and palate in young children. These devices can be removable, like retainers. They can also be fixed, like the Nance appliance which holds the molars in place until other permanent teeth have erupted. The dental devices can work primarily on the teeth, on the jaw, or both. For example, a rapid palatal expander (also known as a Hyrax appliance) is a device that may be anchored to the upper teeth, but it actually provides pressure to the palate to increase its size.

Alternatively, if a child loses a tooth, the orthodontist may require a space maintainer. A space maintainer is used to occupy the space left vacant by a lost tooth so that erupting teeth do not invade that space inappropriately. Commons examples of a space maintainer have names like “unilateral,” “crown and loop,” “band and loop,” and “distal shoe.” These dental devices are chosen based on which teeth are missing. A space maintainer may be cemented in place for the duration of the interceptive orthodontics treatment.

The goals of interceptive orthodontics

The goals of interceptive orthodontics can be described as preventative rather than corrective in that this orthodontic treatment is aimed at preventing problems from developing before they need to be treated later. This is not to say that interceptive orthodontics can eliminate the need for braces. On the contrary, interceptive orthodontics is usually just the pretreatment or first treatment phase in children before active treatment with braces begins. This second phase of kids braces begins when the permanent teeth have fully or almost fully erupted.