Time for Treatment by Elvira Maricic Sometimes, parents are the last to know that their children need braces print article      send to a friend

"To make the situation worse, he told me that if Kate's teeth were left uncorrected, her chin would end up looking like mine. I keep looking in the mirror, and I still don't see anything wrong with my chin," she adds. "He recommended that I take her to an orthodontist, and I will, but I really can't see why."

Does She or Doesn't She?

Plonski, like other parents of children whose dental problems are not obvious, is understandably confused. While there are some early symptoms of orthodontic problems, very often parents can't tell that their children need orthodontic treatment until the permanent teeth come in.

Sometimes, the need for treatment is as obvious as the smile on a child's face.  The most noticeable symptom is crowded teeth, notes George Souris, DDS, MSD, a Cleveland-area orthodontist.  "Everyone can see crowded teeth," he says.  "When a child smiles, if you can see teeth that just don't seem to be fitting, that's possibly a sign of jaws that are too narrow or too small.

"The other thing is overbites, of course. If your child's teeth are sticking out, or they smile and you see these teeth sticking out or this jaw that's way back, that's another sign," Souris adds.

Some symptoms, while still visible to the untrained eye, are less easily noticed. "If the lower front teeth are out in front of the upper teeth, that's known as an underbite, and that's a very difficult situation that needs to be treated when children are young," says Souris. He notes that the underbite is a condition that isn't as readily noticed in children, as is the overbite.

Another less visible condition is the open bite, commonly seen in thumb suckers. The open bite--the improper positioning of the teeth and jaws-can also occur during the transition from primary to permanent teeth or from lip and tongue habits, airway obstruction, and skeletal growth abnormalities. According to Souris, open bites are not easy to see because parents are used to seeing their children smiling and talking, and don't really have their children put their teeth together to smile. If they did, however, they might be in for a surprise. "Unless you put your teeth together and show somebody, you can't see [the open bite]," says Souris. "If the teeth are apart, you don't realize that there's a big hole there where the thumb fits in, and that's not a good thing," he adds

Only the Doctor Knows for Sure

Certain conditions, such as cross bites, are best left to the professionals to detect. "This one is the one where the dentist really would see it because the parents aren't equipped to look in there," says Souris.  With a cross bite, "the upper jaw is really narrow and you're biting on the wrong side of your lower teeth. Your upper jaw is very skinny and the teeth are biting on the opposite side of what they should to the lower jaw," Souris explains. 

Some conditions are not only difficult to detect, they may even be deceptive. Souris offers the example of a child who goes to the dentist and, although she's got a few spaces, her teeth look fine. However, when the dentist examines and starts counting teeth, it's discovered that she doesn't really have space. "It's so severely crowded that her second or third tooth is trapped, so since [the tooth] hasn't come in, it looks as though the teeth are spaced, instead of crowded to the point where they don't even fit," he says. "You can't always tell from appearance. If somebody smiles at you, they don't always have to look horrid to know that something needs to be done."

Since parents won't pick up on the above conditions, as well as many other potentially serious ones, it's important to take children to a general dentist, who can then refer them to an orthodontist if necessary. "Think about it, you're not going to pull your child's cheek back and start examining their teeth," notes Souris.  "Other than the obvious, the best way to know is to have your child evaluated by your dentist, and most dentists are aware of how important it is to have these problems corrected at a young age," he says. "Without the dentist's help in evaluating it, you really don't know what's going on.

"If you, as a parent, look into the mouth and are concerned, there's about a 99% chance your child needs something. But, even if you think everything is fine, that's not necessarily true. If you're concerned, definitely go to your dentist or orthodontist. And even if you think that everything is ok, your child still should have their teeth cleaned and evaluated every six months by your general dentist, who will then decide whether or not to refer him or her," Souris concludes