Here are answers to some of the questions you might have about the importance of milk teeth to the development of your child’s dentition.
Since milk teeth fall off anyway, is it really important to keep them in good health or retain them if they become bad?
Milk teeth are critical to the proper development of permanent dentition. If they weren’t there to keep spaces for the permanent teeth, then the latter would not find room to eventually come out; they’d become crooked.
How do I make sure they remain healthy? Is there anything that can be done to prevent future problems?
Visit your child dental specialist as soon as possible and follow his/her instructions. The best way to prevent future problems is by ensuring that cavities do not develop and teeth are not lost early.
What happens when the milk teeth are lost early?
Premature loss of milk teeth especially the back ones causes the permanent teeth that come in behind them to move forward. This results in a situation where the permanent teeth that come in the place of the missing ones to find themselves short of space.
What can be done if the milk teeth are lost early?
Your Child Dental Specialist will fit a thick wire brace on the inside which will prevent the forward movement of the permanent teeth. These braces are called space maintainers.
How long do these need to be worn?
Depending on when the milk teeth are lost, anywhere between 3-5 years.
How about if the milk teeth are lost early and the permanent teeth have moved forward?
Your Child Dental Specialist can then give you braces called Space regainers which, although similar to the Space Maintainers, are designed to move the teeth back to where they came from.
Some of my child’s upper front teeth are biting behind the lower front teeth. Is it OK?
No, it’s not. This condition is called an anterior crossbite. Depending on its severity and the number of teeth involved, it may need a simple (removable) or a complex brace to correct it. Such a condition, if it affects the back teeth, is called a posterior crossbite. It will also need to be corrected.
What happens if crossbites are left uncorrected?
Uncorrected crossbites may eventually distort the way the jaws grow. So, what essentially was a tooth problem early on becomes a jaw problem later on.
My child sucks his/her thumb. Will he/she grow out of it?
Thumb sucking and other habits can distort the shape of the jaws and the tooth arches if they go on long enough. They are considered OK upto 4 years of age. A lot depends on the duration and intensity of the habit, however.
How can the dentist help?
If other methods have failed, then the dentist can fit either removable or fixed braces in the mouth to make the habit less pleasurable for the child. Such braces are called Habit Breakers.
Do they work?
If the child is motivated enough, then yes, they do work.
How frequently do I visit the dentist for adjustment of the above braces?
Frequent (usually 3-6 month) visits are mandatory to ensure teeth are developing satisfactorily. If crossbites are being corrected or space is being regained, then monthly visits are in order.
How do I keep them clean?
It’s easy to keep them clean be proper brushing and flossing.
If my child’s teeth are developing crookedly, is there anything that can be done early on or do I need to wait till he/she is 12 years old for something to be done?
If your child has a good jaw bone relationship and the crookedness is because he/she has very large teeth in relation to the jaw bone size, then sometimes it is possible to let them come in straight by removal for certain milk teeth followed by certain permanent teeth at various times.
What kind of time frame are we talking about here?
Timing is crucial. The first milk teeth are remove between 7 and 8 years of age. The next set are removed between 8 and 9. The permanent teeth may be removed between 10 and 11. During this time the child may have to be seen every 3 to 6 months.
Will this sort out all the problems?
No. Fixed braces may still be needed in the end for fine tuning the child’s teeth. The advantages are that the child need not go through 3-5 years of life with crooked teeth, the duration of braces is less and the results are more stable.
If you are thinking of having orthodontic treatment as an adult you may have some questions you would like answered first.
Why might I need orthodontic treatment?
Is it always possible to have braces as an adult?
Age is not necessarily a limiting factor. It more often depends on the type of bite you have, the position of your teeth and the condition of both your teeth and gums. For instance, if you have active gum disease, it is important this is brought under control before having a brace.
What types of braces are there?
There are those that can be removed for cleaning, known as removable braces.
The second type of brace is fixes to the teeth and cannot be removed for cleaning. An example of a fixed brace can be seen in the following picture:
Does it have to be so visible?
It is sometimes possible to have tooth colored brackets on the upper front teeth. These are less visible at a distance, although the wires are still likely to be noticeable. Tooth colored brackets are generally more expensive than metal brackets and are more difficult to remove at the end of treatment. They are usually not placed on the lower teeth because they can lead to wear of the opposing upper teeth. It is also sometimes possible to have the brackets placed on the inner side of the teeth (lingual brackets). These are virtually invisible, but are more noticeable to the tongue. They are also more expensive and treatment can take much longer to complete. Only a few orthodontists offer this treatment.
How long will treatment take?
It usually takes 12-24 months but will vary according to how complex your case is.
If teeth need to be extracted who will do this?
Your own dentist will do this.
Is it painful?
Having the braces fitted is not painful. However, it is common to have slightly tender teeth for 3-5 days after each fitting and adjustment appointment.
How often will I need an appointment?
Once your braces have been fitted you will need frequent, usually monthly appointments for them to be adjusted.
Is treatment finished when the braces come off? Do I need to be seen again?
Once the active phase of your treatment has been finished, it will be necessary to wear a retaining brace. This may be removable or it may be fixed behind your front teeth. It is common for both to be given at the same time.
How long are the retainers to be worn?
The fixed ones can be worn indefinitely since they are easy to keep clean and practically invisible. The removable ones need to be worn only while sleeping after a year of use. The longer the retainers are worn, the better the stability.
If your Orthodontist has advised you that you might need a functional appliances, here are a few questions you may want answers for:
What is a functional appliance?
A functional appliance is a removable brace that works on the upper and lower teeth at the same time. If worn properly, it has the capacity to change the way the jaws grow.
How much do I need to wear the brace?
The number of hours per day that you are expected to wear the brace will be explained to you. For the treatment to work it is important you follow these instructions. With the correct number of hours of wear you may find the improvement in the position of your teeth can be quite dramatic.
Will it be painful?
Your teeth might be sore for about 3-5 days each time the brace is adjusted. After a few months, you may even find that your jaw joints ache if you tried to bite the old way. The soreness can be relieved by painkillers you’d normally take for a headache. If there is an obvious area of soreness as a result of the brace, see your Orthodontist as soon as possible. At the same time, try not to stop wearing the brace or else you will have to go through the 3-5 days of discomfort all over again.
How else might it affect me?
Your speech will be different. Practice speaking with the brace in place e.g. read out aloud at home on your own and your speech will improve in a couple of days. You may also find yourself swallowing a lot to begin with. This is quite normal and will quickly pass.
Can I eat normally?
You may find eating difficult with the functional appliance in place. Whether you have to do it or not will depend on your orthodontist’s advice.
What about tooth brushing?
You should brush three times a day. You can use your tooth brush and paste to clean the appliance as well. Do it carefully so as not to damage or distort the wire components.
How long will treatment take?
This will vary depending on the severity of your case. Most work with this brace is completed in about 9-12 months. Bear in mind that these braces improve the jaw position only. A second phase of treatment with fixed braces may be necessary to fine tune the position of the teeth. Your orthodontist will advice you accordingly.
Now that you have a removable brace you may have some questions you would like answered.
Will it be painful?
It is likely to be sore for about 3-5 days each time the brace is adjusted. If necessary, painkillers such as the ones you would normally take for a headache, may help. If there is an obvious area of soreness as a result of the brace, ring for an appointment as soon as is reasonably possible. If possible, do not stop wearing the brace or else you will have to go through the 3-5 day of discomfort all over again when you start wearing it once more.
How else might it affect me?
Your speech will be different. Practice speaking with the brace in place e.g. read out aloud at home on your own, and in this way your speech will return to normal in a couple of days. You may also find yourself swallowing a lot to begin with. This is quite normal and will quickly pass.
Can I eat normally?
Yes you should be able to eat normally. It is important you keep the brace in whilst eating unless you are otherwise instructed.
Although it may be difficult at first, eating with the brace in place will become easier with time. After each meal remove the brace and rinse it thoroughly.
For your orthodontic treatment to work well and in the shortest possible time it is important you take care of your teeth and brace. In order to avoid damage to both, you should:
Avoid eating toffees, boiled sweets, sugared chewing gum, chocolate bars, etc.
Avoid drinking fizzy drinks (including diet drinks) and excessive amounts of fruit juice.
Take care eating hard foods which might damage the brace such as crunchy apples, crusty bread, etc. Cut them up first.
What about tooth brushing?
It is important you brush well three times per day and use a fluoride toothpaste. If possible carry a brush with you for use after lunch. Take the brace out to clean your teeth. You should also gently brush the brace, taking care not to damage the wires. A daily fluoride should also be used last thing at night, after tooth brushing. Failure to keep your teeth and braces clean will lead to permanent scarring of your teeth.
Can I remove the brace?
Yes but you should remove it only for cleaning. Do not repeatedly click the brace in and out with your tongue as this will break the wires and increase the length of time the treatment will take.
How long will treatment take?
It usually takes 6-24 months but will vary according to how severe your case is. Failed or cancelled appointment or repeated breakages of the brace will increase the length of time the treatment will take.
How often will I need appointments?
You will need regular, usually monthly, appointments for the braces to be adjusted.
What do I do if my braces break?
Ring up for an appointment as soon as is reasonably possible. Do not wait for your next routine appointment as the breakage my slow your treatment, or may result in damage to your teeth.
Pearl Medical Clinic,
Above JESCO supermarket, 1st Floor ,
Flat No-103, Nasser Square, Deira, Dubai.
