By Dr. Nathan Coughlin
Let me walk you through the steps I look for to determine if you or your child needs braces. First and foremost, we need to look at age. Just because your child may have some symptoms or signs that they need braces doesn’t necessarily mean they can get them yet.
The American Association of Orthodontics recommends you come in for a visit at the age of seven. I typically look for the front four adult teeth and the first molars to erupt fully. And why do I do that? Because I need those teeth as anchors and as a guide. Specifically, I need the first molars, or what we sometimes call the six-year molars, to have erupted so that I can use them for appliances such as expanders or to be able to retrude or protrude the front adult teeth.
Let me walk you through the nine specific signs to determine if you or your child needs braces.
HOW TO DETERMINE IF YOU OR YOUR CHILD NEEDS BRACES
Number one is spacing. If there’s excessive spacing, that may actually prevent other teeth front erupting. Sometimes teeth looked spaced out, but underneath the gums, there are other teeth trying to come in. Also, spaced-out teeth cause gum recession if you get too much food impaction.
Number two, crowding. If it’s too crowded, sometimes teeth can’t erupt properly and aesthetically, it just doesn’t look good. And that is probably the number one thing people want to be corrected.
Number three, open bites. When some people bite down, their front teeth do not touch. If you’re younger, sometimes that’s caused by finger or thumb sucking. If you’re older, it could be because your jaw is growing differently. So there are a bunch of different ways to get it.
Number four is a deep bite. People often tell me, “Hey, I have an overbite. I don’t want an overbite”, but yes, you do actually want an overbite. You just don’t want the overbite to be too much. When it’s too big, we call that a “deep bite.” It can damage your front teeth if it’s too big.
Number five is an Anterior or front crossbite. Suppose the top and bottom teeth are in the opposite relationship. Instead of your top teeth being in front of the bottom teeth, your top teeth are behind the front teeth. We call that an anterior crossbite, which can damage those teeth, especially the front teeth because they get pushed outwards, and there’s no bone there. Sometimes, it gets pushed so far out that those lower teeth get lost.
Number six is a posterior or back crossbite. So same as the front, you want your top teeth to overlap the bottom teeth. If it’s the opposite, if your lower teeth are too far on the outside of the top teeth, which is called a crossbite, our teeth are not meant to bite like that. If you’re young enough, if you are below the age of 16, you can get something called an expander, which makes crossbites easy to correct. If you’re an adult, you cannot use an expander. Sometimes, you have to get jaw surgery or use these mini-screws or all sorts of things to expand those top teeth as much as possible.
The seventh thing is an underbite. An underbite differs from a crossbite in that it involves most, if not all, of the front teeth. There are a couple of ways to fix that. One is if you’re young enough, if you’re maybe eight years old or so, we use something called a reverse-pull headgear, and that allows those top teeth to come forward. If you’re an adult, that may not work. So you’re probably going to have to have jaw surgery. An anterior crossbite is a little different than a full-on underbite. An underbite is when all those teeth are on the outside of the top teeth.
The eighth thing I look for is overjet. Overjet is when the top teeth stick out too far. This is different than an overbite. An overbite is a vertical issue. When the top teeth overlap the front teeth we call that an overbite, and if it’s excessive, it’s called a deep bite. Overjet is when they stick out too much. People come in thinking they have an overbite when in actuality, they have a large overjet. This can either be a lower jaw or a top jaw issue.
The ninth sign is an ectopic eruption. It’s probably the last thing I’m looking for as well. Ectopic eruption happens when a tooth is growing, but it doesn’t even look like it’s in the right area. So it could be a canine tooth, one of those sharp teeth, growing out near the molars, or maybe there’s an extra tooth or a missing tooth, etc.
These are all different things we’re looking for. If you’re coming in for a consultation, whether you’re seven or eight years old or fifty-seven years old, these different things are things that I’m looking for when I’m looking at every single consult.
When coming in for your consult, I’ll take a look through your mouth and radiographs to determine if you need braces. I will go through these nine issues and talk to you about your questions and concerns.
I hope that helps show you what I look for to determine if you or your child need braces. Come on in for your free consult if you are in the Dallas, Fort Worth area.