I get a lot of questions about Phase I or early treatment and thought a quick review might be good. I BELIEVE in early treatment. I also believe it is overdone. There are certain things that should be treated early. Those include:
Thumb and Finger Habits (these often result in a tongue habit as well)
Class III Growth Problems – most of which are maxillary deficiencies. Ideal time to try and advance the maxilla is generally as the permanent incisors are erupting. Little advancement can be gained at a later age. Advancement involves an expansion appliance and a reverse headgear.
Crossbites – Many posterior crossbites cause a functional shift of the mandible which is a growth concern as it can contribute to a mandibular asymmetry. The narrow maxilla can also contribute to poor eruption of the upper permanent teeth. Usually, a maxillary crossbite is treated with a palatal expander, and possibly partial upper braces (2×4).
Posterior crossbites may be due to finger and thumb habits, tongue habits and airway deficiencies.
Anterior crossbites are usually treated early. These can also cause a functional shift, as well as lower gingival recession.
Enlarged Tonsils and Adenoids should be referred to an ENT for an airway evaluation.
Class II problems do not need early treatment according to many growth studies. There is no orthodontic benefit to treating a moderate Class II problem early. However, there are mixed opinions as far as treating protrusive incisors (to avoid fracture) and severe class II growth patterns. For a severe problem, we may want to expand early or if it’s a Class II, Division II we may want to open the bite early to allow the mandible to advance.
Often young patients with a severe Class II problem are self-conscious. This is not something that is necessary to treat orthodontically -but if a child is being bullied or teased because of their teeth it is certainly important and I always explain to the parents that treatment is not needed from an orthodontic standpoint but we will be happy to provide treatment if it is an issue and their child is self-conscious.
Crowding – in the past we extracted deciduous cuspids to alleviate crowding. This almost assured the removal of permanent teeth in the future. I do remove deciduous cupids if the crowding is causing tissue recession but place a space maintainer. Occasionally we do serial extraction when we know the facial structure and growth will not support expansion. This serial removal of teeth allows the permanent cuspids to erupt into attached gingiva and saves the child time in braces.
As I said, I believe in early treatment. I also believe it is overdone. Probably 15 to 20 percent of patients we see are candidates for early intervention.