In fact, the American Association of Orthodontists (AAO) recommends children be evaluated at age 7 to determine if braces or other types of appliances will be needed. It is also not that uncommon for kids to need some sort of corrective measure. “The [AAO] estimates that 50% to 75% of people can benefit from orthodontic treatment,” says Karen Conn, DMD, MS, a board-certified orthodontist in Philadelphia. “Sometimes the need for treatment is obvious; other times it’s more subtle. The only way to know for sure is to see an orthodontist.” If you are considering braces, you may have questions about the cost, the length of time required, and treatment options. Below you will find some answers from experts, allowing you to enter this process knowing what to expect.
How Do I Know if My Child Needs Braces?
Braces are dental tools orthodontists use to help correct problems such as crowded, crooked, and misaligned teeth. But there are other issues braces can address, such as overbites, underbites, and even sleep abnormalities. “Most of the time, a parent will get a referral from their pediatric dentist once a child needs to be seen for an orthodontic consultation,” says Marina Gonchar, DMD a board-certified orthodontist and founder of Skin to Smile. “But there are other signs a parent can recognize even without dental expertise. If your child has a habit such as thumb sucking, tongue thrusting, or teeth grinding, these are all good indications for an orthodontic consultation.”
Best Age for Braces
Braces actually do more than just straighten your child’s teeth and are sometimes needed well before they reach their teens. “By age 9, dental problems resulting from improper eruption of the permanent teeth can be seen on x-rays, so observation and interceptive treatment by an orthodontist is important,” says Howard A. Fine, DMD, director of orthodontics and clinical associate professor of dental medicine at Touro College of Dental Medicine. While you always have the option to delay or opt out of braces, this does come with some risks. For instance, it may be harder to fix dental issues at a later age. In addition, an existing issue may take longer to address—or may require more invasive procedures.
Types of Appliances
As mentioned earlier, orthodontics doesn’t just involve straightening the teeth, but also helps align them. According to Raphael R. Putrus, DMD, MPH, MHA, an orthodontic specialist, there are a number of devices that can be used for correction. Some of these include palate expanders, spacers, and separators. “[For instance], palate expanders can be used to widen the top palate if there is not enough space for the permanent teeth to come in,” Dr. Putrus says. “When baby teeth fall out prematurely, a space maintainer might be necessary to hold the spot open until the permanent teeth come in.” Separators are little rubber doughnuts that may be placed between teeth to push them apart so orthodontic bands can be applied during the next appointment, Dr. Putrus explains.
What Costs Are Associated With Braces?
The cost of braces is based on a number of factors, including case complexity, treatment modality, and geographical location, says Dr. Terrana. For this reason, it is never a bad idea to have a few consultations prior to starting treatment. Not only can you evaluate the recommended treatment plan, but you also can determine whether the office and the orthodontist are a good fit for your family. “On average, the cost of traditional metal braces can vary from $4,000 to $6,000, while the cost of lingual (behind the teeth braces) can range from $5,000 to $8,000,” says Dr. Gonchar, adding that the cost of clear aligners, such as Invisalign, can be between $4,500 and $8,000. Extra fees might be incurred for lost or broken appliances. It is a good idea to determine what is included in your fee so there are no surprises. “Dental insurance may cover a portion of the total cost, assuming orthodontic coverage is included within the dental policy,” Dr. Fine says. “If there is no dental coverage, patients can be treated in a dental school environment, for example, where fees will be toward the lower end of the scale. Regardless of the location, most orthodontic practices will offer a payment plan which allows payments to be spread out over a portion of the treatment time.”
How Long Will My Child Need Braces?
According to Dr. Gonchar, the length of time your child will require braces will vary depending on their initial needs. Kids who have worse bites and alignment typically will call for longer treatment compared to patients with minor issues. “Most patients have braces for a duration of 18 to 24 months,” she says. “Some complex cases can take a little longer than the projected two years.” Keep in mind every treatment plan is personalized to your child’s needs, which makes it difficult to generalize. Some of the guesswork on timing may be removed at the initial consultation. “During a patient’s consultation, we prepare a digital mockup that shows the final position of their teeth before they begin treatment and provide the approximate length of time to attain those results,” Dr. Conn adds.
Why Do Some Kids Need Two Phases of Braces?
Most orthodontic problems can be treated in one phase of comprehensive treatment, says Michelle Kelman, DDS, a pediatric dentist and founder of the Pediatric Dental Center at Cedars-Sinai Medical Center in Los Angeles, California. However, there are a few exceptions. “Two-phase treatment is usually prescribed to ensure adequate space for all of the permanent teeth, especially the permanent canines,” Dr. Kelman says. “It may reduce the need to extract teeth in the future, and it can normalize the relationship of the upper jaw to the lower jaw, especially in the case of an underbite.” If your orthodontist recommends two phases, the first phase typically occurs prior to full eruption of permanent teeth. “At this time, overbites or underbites, which are skeletal problems, can be corrected while the patient is growing, regardless if all the permanent teeth have erupted,” Dr. Fine says.
What to Expect at the First Appointment
You can expect the braces application process to last between 90 and 120 minutes. During the visit, the surfaces of your child’s teeth will be brushed with a mild solution. Then, an adhesive will be placed on each tooth, and the bracket will be added atop that. After the excess adhesive is removed, the rest will be cured with a special light. Then, the orthodontic wire will be threaded through the slots in the brackets. Depending on the type of braces your child is getting, the wire will be held to the tooth using a clip that is built into the bracket, or by a series of a tiny rubber bands that come in a variety of colors. Dr. Putrus recommends that patients eat a good meal before their treatment, because they may not feel like eating afterward. “After orthodontic appliances are placed, there is usually minimal discomfort that lasts for two to three days and can be easily managed with over-the-counter pain relief medications and soft foods such as macaroni and cheese, eggs, mashed potatoes, and ice cream,” Dr. Gonchar adds. Sipping on cold water also can be helpful. It temporarily deactivates the wire in the mouth and gives the patient relief. Saltwater rinses can also assist with any gum discomfort that may be experienced initially. “Most children and teens adjust to their appliances in a matter of one to three days,” Dr. Gonchar says. “The older the patient is at the time of treatment, the longer it takes for them to adjust to their appliances and discomfort.”
How Often Will My Child Need to See the Orthodontist?
The average follow-up appointment is around 20 to 30 minutes long, says Dr. Conn. Kids should expect to see their orthodontist every eight to 12 weeks, depending on the stage of their treatment. During those appointments, the orthodontist will look to see if your child’s teeth are moving as they should be, or if further adjustment is needed. They also will check for any broken or missing brackets and will look to see if there are teeth erupting that could impact the treatment plan. “The orthodontist will also monitor oral hygiene,” says Parul D. Makkar, DDS a family dentist at PDM Family Dental. “This is key to effective treatment. If there is decay noticed, the orthodontist will have to pause treatment to have decay treated by the dentist.” You also should plan to have your child’s teeth cleaned more frequently while they are in orthodontia. How often will depend on how well your child does with brushing and flossing, as well as what your child’s dentist and orthodontist suggest. “I recommend cleanings every six weeks to at least every three months when a patient is in orthodontia,” says Dr. Kelman.
What Happens After the Braces Are Removed?
All patients should receive retainers at the conclusion of their orthodontic treatment, says Dr. Gonchar. The instructions on how the retainers should be worn will vary based on your child’s treatment plan and the type of problems that were addressed. “Retainers should be worn at least several nights a week for the remainder of your life to avoid shifting,” she adds. “An orthodontist’s favorite saying…is ‘nighttime for a lifetime.’” Retainers can be either removable or cemented to the back of the teeth, depending on the potential for relapse, says Dr. Fine. Both options come with pros and cons. For instance, removable retainers should be worn nightly in order to maintain the correction. Meanwhile, cemented retainers require the patient to be diligent with oral hygiene, he says. “Most orthodontists recommend replacing clear retainers every two to three years as they do wear and break,” says Dr. Gonchar. “Other types of retainers last longer, but are often perceived as less comfortable.”
A Word From Verywell
If your child’s dentist recommends they get evaluated for braces, it can feel overwhelming at first. The good news is there are options for getting your kid the treatment they need, including utilizing college orthodontics programs, payment plans, and even financing methods. The key is to get your child evaluated early. Not only will the treatment likely be less invasive, but it also could be less expensive than waiting until the problem progresses. Be upfront with the orthodontist about your concerns, and look for a practice where both you and your child feel comfortable. Doing so will help you find treatment for your child that you both can smile about.
