The Basics of Braces

Why Kids Need Braces

Kids can need braces for any number of reasons, including crooked, overlapping, or overcrowded teeth, or a "bad bite" (known as malocclusion). Malocclusion is a discrepancy in the sizes of the top and bottom jaws. When the upper jaw is bigger than the lower jaw, it's called an overbite. When the lower jaw is bigger, it's called an underbite.

Sometimes tooth and jaw problems can be caused by tooth decay, losing baby teeth too soon, accidents, or habits like thumb sucking. But often they're inherited, so if you or someone in your family needed braces, it's likely that your kids will, too.

Often, your child's dentist will be the first to notice problems during a regular visit and recommend that you see an orthodontist (a dentist who specializes in correcting jaw and/or teeth alignment problems). The orthodontist can determine whether your child does indeed need braces and which types of devices would be best.

There's no set age for a child's first orthodontist visit — some kids go when they're 6, some kids go when they're 10, and some go while they're teens. Even adults can receive orthodontic treatment. Many orthodontists say kids should see an orthodontist once their permanent teeth start coming in, around age 7. At this age, issues such as uneven bite and overcrowding will become apparent.

Starting the process early doesn't mean a child will get braces right away. It just means the orthodontist will be able to determine which problems exist and assess the best time to start treatment.

The First Orthodontist Visit

At the first visit, the orthodontist will thoroughly examine your child's teeth, mouth, and jaw. He or she may ask your child to bite the teeth together and will also ask questions about whether your child has problems chewing or swallowing, or has ever had clicking or popping of the jaw.

The orthodontist may take X-rays of the mouth and teeth to see how the teeth are positioned and whether any permanent teeth still need to come in. He or she also may make a mold (or impression) of your child's teeth by pressing a tray of gooey material into the top and bottom teeth. When the mold is removed and the material hardens, the result is a replica of your child's teeth that will allow the orthodontist to decide which treatment options are best.

Type of Braces

Braces correct alignment problems by putting steady pressure on the teeth, which eventually moves them into a straighter position.

Most kids just need braces with wires and rubber bands. The wires help to move the teeth, and the rubber bands (which come in fun colors) help to correct alignment. Though metal braces are still used, so are clear or white ceramic braces, which are much less noticeable. Some even go behind the teeth (lingual braces).

In the last decade, clear removable braces that move teeth with plastic trays called aligners (rather than wires and rubber bands) have become available, but these are usually only for people without bite problems.

Some kids may need other devices, too, such as headgear (don't worry — this is usually worn only at night!). Headgear uses a horseshoe-shaped wire that attaches to the back teeth, pushing them back and allowing more room for teeth in the front of the mouth. The orthodontist also might recommend that your child have one or more teeth removed to create more space in his or her mouth.

Once the braces are on, your child will have to visit the orthodontist every few weeks for monitoring and adjustments.

How long your child will need to wear braces depends on the problems the orthodontist is trying to fix, but the average is about 2 years. After that, your child might wear a specially molded retainer, a small, hard piece of plastic with metal wires or a thin piece of plastic shaped like a mouthguard. Retainers keep the teeth from wandering back to their original places.

Caring for Braces

Because it's so easy for food to get stuck in wired braces, kids who wear them need to work extra hard to keep their teeth clean. Brushing after meals is essential, as is daily flossing (the orthodontist can give your child a special flosser to use in and around braces). Regular dental cleanings and checkups to look for cavities are also a must.

Your child should avoid certain foods, such as popcorn, hard and sticky candy, and gum, because they can damage braces. Sugary sodas and juices can be a problem, too, because they can contribute to tooth decay. A child with clear plastic aligners should always remove them when its time to eat.

Because braces put pressure on the teeth, they can feel uncomfortable once in a while, especially after the orthodontist makes adjustments. Over-the-counter pain relievers can help if this happens.

See the orthodontist right away if your child has a loose wire or bracket, or a wire that is poking his or her mouth. If the orthodontist can't find a problem, your child might use some soft wax to cover any sharp spots on the braces that are bothersome or rubbing against the inside of the mouth or gums.

Affording Braces

Braces create nice smiles, but that's not all they do. Good orthodontic care contributes greatly to oral health. Straight, aligned teeth can make it easier to chew food, and can even help prevent snoring.

But these benefits don't come cheap. Braces cost about $5,000 and even if your family has insurance, it may not cover much of the bill. Fortunately, there are ways to get braces at a reduced cost:

• Smiles Change Lives. This program serves kids and teens between the ages of 11 and 18 in all 50 states. If you apply and are accepted, your child will receive braces for only $250 to $500. To be eligible, your family can't earn more than roughly $10,000 per person (so a family of four can't make more than $40,000). In addition to the income requirements, your child's teeth must be moderately to severely crooked (but well cared for, thanks to plenty of brushing and flossing). For more information or to apply, visit the Smiles Change Lives website.
• Dental schools. After completing dental school, dentists who want to specialize in orthodontics must continue their training in specialized programs. At these dental schools, kids can often get braces at a reduced rate. These schools are especially interested in complicated cases. The orthodontists-in-training will be supervised by more experienced orthodontists during the treatment. One thing to remember is that the treatment may take longer to complete than it would in an established orthodontist's office. Appointments also may need to be scheduled during school hours. Search online for a list of dental schools to find one near you.
• Your dentist and dental societies. Some general dentists will do braces and may be willing to work with your family on the cost. Your dentist is also a great person to ask about orthodontists in the area who might accept lower payments. Again, being a good brusher and flosser will make your child a better candidate. In addition to your dentist, you can also request information from your state's dental society.
• Your community. Ask around your community (your place of worship, local clubs, and school organizations) to see if any orthodontists are also members or if anyone knows of a dentist who might take your child's case.
• Insurance programs in your state. State insurance programs, such as Medicaid, may cover braces, especially if the condition of your child's teeth interferes with talking, eating, or swallowing. Not all states make this easy. There's a lot of paperwork required and you might have trouble finding a dentist who works with the insurance program. But it's worth checking. Some states have taken steps to make this process easier for kids and parents.

If cost is an issue, it's worth the effort and patience it takes to find an orthodontist who will treat your child. Straight teeth are more than just attractive — they can help keep your child's mouth healthy for a lifetime.

Reviewed by: Lisa A. Goss, RDH, BS, Charlie J. Inga, DDS, and Frank R. Egan, DDS, PC
Date reviewed: October 2010