Photo above from Loren Joseph via Unscrew.
Your child’s dentist has officially announced the news: It’s time for braces—the dental appliances that have given generations of children perfect smiles. But the exact path is not necessarily clear. Today, parents and their children have options, usually choosing between traditional wire and metal braces and newer clear aligners.
“It’s patient-specific,” says Mark DeMaria, DMD, of DeMaria Family Orthodontics in Murrysville and Greensburg.
The American Association of Orthodontists (AAO) recommends that children as young as age 7 see an orthodontist who can identify problems — such as overcrowding or crowded teeth — and suggest next steps.
“Very rarely do we need to do anything (this early),” says Dr. DeMaria. But it’s important to start learning about what’s going on with your child’s teeth so you can make choices about what they need as they grow.
Braces of any kind are a big investment, and not every option is right for everyone — especially children and teens. How do parents choose?
Learning what is available
Removable aligners or “dental adjusters” are actually not a new concept. They have been around since the 1940s and until the 1960s plastic braces were used to correct minor teeth problems. As research progressed, aligners became more common in the 1990s. Invisalign, invented in 1997 by students at Stanford University, was originally aimed at adults to subtly straighten their teeth.
Customized, removable clear Invisalign aligners are becoming increasingly popular with children and teenagers these days. Made of FDA-approved medical-grade plastic, aligners are designed to move teeth bit by bit. The wearer puts on a new set of aligners (usually weekly) that move their teeth a little farther in the right direction over a period of months.
“One of the nice things is that we can straighten your teeth without interrupting your life too much,” says Dr. DeMaria.
Then there are traditional braces, which are now more comfortable and smaller than in previous decades. They remain a popular choice, especially now that they don’t cause bleeding gums, Marcia Brady-like embarrassment.
“Many children, in my experience over the past two years, choose braces over Invisalign,” says Dr. DeMaria. This may be because they like the fun of choosing colored braces, or they see braces as a status symbol. Some teenagers, he says, have even asked for extra time with their golden smiles.
Facts to consider
• The success rate is similar with both braces and aligners, but may be slightly higher—as in 1 percent—with braces, says Dr. DeMaria, because there is no temptation to remove them and “take a break” like with aligners.
Teens and tweens may assume they won’t take their aligners off at school except at lunch, but it’s tempting to just leave them in the case. A student may think “I’ll take it off today…” and then not wearing the grams soon becomes a habit. While braces aren’t fun, the fact that they can’t be removed means they do their job every day and teeth are straightened on schedule.
• Aligners require accountability. Kids have to wear them at least 22 hours a day or they’re not going to work. Although clear, aligners are not invisible. And while you’re wearing them, they create a very slight change in how a person might sound when they speak — not a lot of fat, but a little muffled sound. If there is any doubt that your child will not wear them, then braces are the way to go.
Aligners can also be lost. “The biggest concern is that they will throw it away,” says Dr. DeMaria. If the aligners end up wrapped in a paper towel in the cafeteria trash, the child can use the previous week’s set or start the next set. But if not, replacements will need to be ordered, delaying treatment and adding another visit to the dentist.
• There are no food restrictions with aligners as they can be removed for meals. With braces, children should avoid hard, sticky and crunchy foods that can cause an arm to break or a wire to come out of the brace.
• For athletes, mouth guards can be worn over aligners. But if your child feels like this scenario is holding them back from performing at their best, Dr. DeMaria says they can get the lineup out for the game. (“I don’t recommend it,” he says. “Just make sure you put it on right away when you’re done.”)
For those with traditional braces, your orthodontist will recommend or provide a mouth guard that is not the typical “boil and bite” guard.
• School musicians don’t have to worry about cut lips. Aligners can be removed for band practice, as long as they are put back on immediately after practice is over.
• Sugary or acidic drinks can seep into aligners, causing stains or rot. According to the AAO, “it is critical to avoid consuming sodas, flavored waters, or sports drinks of any kind with alignment.”
• Aligners can be used if baby teeth are still present and, in some cases, can actually be helpful. For example, if an adult tooth is not directly below the baby tooth, aligners can help loosen the baby tooth, helping it fall out on its own – ultimately preventing extraction.
Also, aligners over baby teeth can help with some bites — something that’s hard to correct with braces, Dr. DeMaria says.
• If a tooth is truly out of place, braces will be able to bring it into alignment a little more quickly, before correcting any bite problems. But with aligners, both issues can be achieved simultaneously.
“From a comprehensive standpoint — correcting your bite, correcting that tooth — Invisalign might be a little faster,” says Dr. DeMaria.
• Pain can occur with and without braces, but may go away faster with braces because, unlike braces, your child cannot take a break from wearing them by simply taking them off. Children are “forced” to get used to them.
• Insurance is starting to cover both aligners and braces. The price is office specific, with braces usually costing a little less than aligners. In some offices, the initial down payment for aligners may be higher.
• Retainers are for life – for both traditional braces and aligners. So neither option will help kids skip this step.
• Don’t be afraid to ask questions!
“I would be honored if someone came just to get the information,” says Dr. DeMaria. “They can go elsewhere. It’s always nice to talk to people about it.”
