Kids who still get Tooth Fairy visits are getting braces. The number of children under 17 getting orthodontic treatment grew 46 percent in ten years to 3.8 million in 2008, according to the American Association of Orthodontists. The orthodontist association president estimates that in his practice 15 to 20 percent of his patients seven to ten years olds get treatment.

Some parents have the idea that, the earlier the orthodontics treatment before all adult teeth are in place, the less treatment the child needs later. The orthodontist association says this idea does not comprehend that for some common orthodontic problems early treatment is no guarantee against more treatment in the teenage years and may not save time or money.

Some parents recalling the metal mouths of their teenage years want to spare their children the experience. Not long ago, braces on eight-year-olds were rare. Public health services, particularly in Scandinavia, have studied the efficacy of early orthodontic treatment extensively with inconclusive findings. In the USA, the movement to childhood treatment dates back to around 1990, the year the orthodontists association started to encourage the screening of seven-year-olds in magazine ads and videos. Better diagnostic technology has encouraged, and increased insurance coverage has been another factor.

Early orthodontics makes sense for an under-bite or a narrow upper arch, problems easier to solve while the immature jaw is still growing. Treating patients as young as seven or eight with a palatal expander to widen the upper jaw so the upper teeth align better with the lower may make the second round of treatment when the patient is a teenager, quicker and easier. Kids with cross-bites also may benefit from such early treatment, but they too may need a second round.

For one of the most common conditions, a Class II Malocclusion or overbite, studies find no measurable benefits from early treatment. A second treatment is no easier than the first. For this condition, early treatment usually means longer treatment time and higher costs. Three randomized clinical trials at the University of Florida with 261, at the University of North Carolina with 166, and at the University of Manchester, UK with 174 children found the early treatment of Class II Malocclusions less effective than treatment begun in adolescence.

Children treated early spent less time on average in the second treatment, but their total time in treatment was much longer. At the end, there were only small differences in front-to-back jaw position between the two groups. “There is no doubt,” says a University of Washington professor of orthodontics, that it is no more effective to do it earlier than later.

Most orthodontists recommend early intervention only when they think the patient will benefit. For parents, the difficult part is figuring out when early treatment is worthwhile.

A patient with crowding and an overbite that caused her teeth to protrude slightly had teeth lined up perfectly after ten months in braces and treatment with a semi-permanent wire at a cost of about $3,500, but the orthodontist says she probably will need braces again in adolescence. The patient’s parents now have second thoughts and wonder whether “it’s crazy to make them go through it twice.”

Orthodontists say they feel pressure from both parents and kids to treat early, that it is in the culture now that kids want to look like celebrities.

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