"Does my child need braces?
When braces are necessary. How long the treatment takes. What costs are covered by the health insurance"
published in Eltern Ratgeber, issue 1/2002
Braces are on (almost) everyone's lips: every year, over a million children in Germany are fitted with braces.
There are several reasons why children are "wired" more often today than in the past: Parents attach great importance to healthy and straight teeth. In addition, the harmful consequences of misaligned teeth and jaws are better known today than in the past. And finally, most children today are more likely to accept braces because they are no longer a stigma among their peers.
Even adults can be treated orthodontically. There are invisible braces for you, called Aligner / Invisalign.
Go directly to our services for braces for children:
Tooth straightening - just for beauty?
Flawless teeth are a side effect for the orthodontist: he decides from a medical point of view whether the misalignment will affect health later on. But what works well and is healthy also looks good!
When do you really need braces?
If individual teeth are crooked in the jaw or the bite is not correct because the upper and lower jaws do not fit together properly, this can soon have consequences: for example, stomach and intestinal problems due to poor chewing. Or speech defects, such as a lisp.
If the teeth are crooked, this can also lead to increased tooth decay. Last but not least, the neck and jaw muscles, throat and airways are strained if the mouth is not closed properly at night when sleeping.
What are the most common reasons for treatment?
- Recessed lower jaw: The front teeth of the upper jaw are far in front of the front teeth of the lower jaw.
- Protruding lower jaw: The lower incisors bite in front of the upper teeth.
- Crowding: The teeth are not aligned in a neat arch, but closely interlocked.
- Frontal open bite: The posterior teeth bite on each other, but the anterior teeth do not - a hole is created at the front.
The reason for such misalignments is sometimes due to predisposition, but often the problems are homemade: thumb sucking, nail biting, but also sucking bottles or pacifiers as permanent comforters lead to deformations. The upper jaw bones, which are still soft, are pushed forward. This causes the front teeth to protrude later. It is also bad if the milk teeth fall out too early due to tooth decay. The neighboring teeth then tilt into the resulting gap and the permanent teeth grow out at an angle.
When should treatment begin?
Most children get their braces at the age of eight or nine. This is when the change of teeth begins. However, jaw growth is not yet complete and can therefore be specifically controlled by the orthodontist.
Correction is still possible during puberty, but is more difficult for psychological reasons. Now it's time to kiss! Many teenagers therefore detest the annoying braces and deal with them accordingly. Apart from the costs - negligence also jeopardizes the success of the treatment.
According to the Professional Association of German Orthodontists (BDK), many children could be spared a lengthy procedure if parents took their child to see an orthodontist at the age of five to six. Malocclusions detected at an early stage can often be treated with playful (myofunctional) muscle exercises or simple measures such as an oral vestibule plate or functional regulators.
If treatment is started late, there is a risk that braces will usually be unavoidable, teeth may have to be extracted or even surgery may be necessary.
How are clasp teeth cleaned?
Children with braces need intensive oral care:
Rinse thoroughly with water or a special solution before brushing your teeth. This removes coarse food debris. Then brush your teeth carefully and systematically with small, circular movements.
Take special care of the gum line below and above the braces. Use an oral irrigator and special small "interdental space toothbrushes" to clean under and between the braces. Particularly important: clean the interdental spaces with dental floss every evening.
Clean removable braces with a toothbrush under running water. With daily care, this is also possible without cleaning tablets.
The professional associations of orthodontists and pediatricians have therefore decided to work more closely together. According to an interdisciplinary program, the paediatrician also examines the children orthodontically in the 3rd, 5th and 7th year of life and searches for malpositioned teeth and jaws as a preventive measure.
How long does the treatment take on average?
The child usually has to wear the braces for several years. Even if it is possible to bring the teeth into the desired position soon, they will slip back again just as quickly.
Whether the child is given removable or fixed braces depends on the orthodontist's diagnosis. Only a few malocclusions can be corrected with both the one and the other brace system. Depending on the type of malocclusion, the child is given fixed brackets, removable braces or so-called non-compliance appliances, which move the teeth without the child's cooperation being necessary.
Why braces after braces?
Many children still have to wear a removable appliance for a while after their fixed braces have been removed. Unfortunately, the teeth cannot be tricked so quickly: the "retention phase" is the time after orthodontic treatment during which the teeth have been moved into the desired position. The aim now is to keep them in this position. How long this takes varies from patient to patient.
What costs are covered by health insurance?
If the treatment is medically justified, 80 percent of the treatment costs for the first child and 90 percent for subsequent children are covered immediately by the statutory health insurance fund. The ten or 20 percent is reimbursed after successful completion of the treatment.
However, there have been new guidelines since January 2002: The orthodontist must assess the jaw misalignment using a kind of grading system from "1″ to "5″ before starting treatment. The health insurance companies only pay from "3″, parents have to pay for minor deviations with a grade of "1″ and "2″ themselves.
However, a degree "1″ or "2″ malocclusion does not mean that treatment of this disorder is unnecessary or even useless! It is simply not so urgent according to the new health insurance guidelines that it has to be financed by the health insurance companies.
This can lead to some downright bizarre decisions. One example: If the child's upper teeth protrude 6.5 millimetres beyond the lower row of teeth, the insurance company must pay for the entire treatment. If, on the other hand, the teeth protrude by 6 millimetres, the parents are stuck with the entire cost of the tooth alignment!
Summary:
Nowadays, braces are being used more and more frequently in children and adolescents to correct misaligned teeth and jaws and to promote healthy, straight teeth.
There are virtually invisible braces for adults, such as aligners or Invisalign. Depending on the diagnosis, treatment can include removable or fixed braces, such as self-ligating brackets.
The optimal time for braces treatment in children is as soon as the teeth begin to change, as jaw growth is not yet complete. An orthodontic indication group is used to determine the necessity of treatment and whether the costs will be covered by statutory health insurance companies.
Fixed braces for children and adults are attached to the teeth using self-ligating brackets. Intensive oral hygiene is important for patients with fixed braces to prevent tooth decay and other problems.
After treatment with fixed braces, removable braces may be necessary - the use of a retainer is recommended to keep the teeth in their corrected position.
Sources:
- Fleming P. S. (2017). Timing orthodontic treatment: early or late? Australian dental journal, 62 Suppl 1, 11-19. https://doi.org/10.1111/adj.12474
- DiBiase A. (2002). The timing of orthodontic treatment. Dental update, 29(9), 434-441. https://doi.org/10.12968/denu.2002.29.9.434
- Anne Mandall, N., Cousley, R., DiBiase, A., Dyer, F., Littlewood, S., Mattick, R., Nute, S., Doherty, B., Stivaros, N., McDowall, R., Shargill, I., Ahmad, A., Walsh, T., & Worthington, H. (2012). Is early Class III protraction facemask treatment effective? A multicentre, randomized, controlled trial: 3-year follow-up. Journal of orthodontics, 39(3), 176-185. https://doi.org/10.1179/1465312512Z.00000000028
- Kluemper, G. T., Beeman, C. S., & Hicks, E. P. (2000). Early orthodontic treatment: what are the imperatives?. Journal of the American Dental Association (1939), 131(5), 613-620. https://doi.org/10.14219/jada.archive.2000.0235
- Marques, L. S., Freitas Junior, N.d, Pereira, L. J., & Ramos-Jorge, M. L. (2012). Quality of orthodontic treatment performed by orthodontists and general dentists. The Angle orthodontist, 82(1), 102-106. https://doi.org/10.2319/061311-389.1
- Farret, M. M., Farret, M. M., & Farret, A. M. (2016). Orthodontic camouflage of skeletal Class III malocclusion with miniplate: a case report. Dental press journal of orthodontics, 21(4), 89-98. https://doi.org/10.1590/2177-6709.21.4.089-098.oar
- Brierley, C. A., DiBiase, A., & Sandler, P. J. (2017). Early Class II treatment. Australian dental journal, 62 Suppl 1, 4-10. https://doi.org/10.1111/adj.12478
- O'Brien, K., Wright, J., Conboy, F., Appelbe, P., Davies, L., Connolly, I., Mitchell, L., Littlewood, S., Mandall, N., Lewis, D., Sandler, J., Hammond, M., Chadwick, S., O'Neill, J., McDade, C., Oskouei, M., Thiruvenkatachari, B., Read, M., Robinson, S., Birnie, D., ... Worthington, H. (2009). Early treatment for Class II Division 1 malocclusion with the Twin-block appliance: a multi-center, randomized, controlled trial. American journal of orthodontics and dentofacial orthopedics : official publication of the American Association of Orthodontists, its constituent societies, and the American Board of Orthodontics, 135(5), 573-579. https://doi.org/10.1016/j.ajodo.2007.10.042
- Antoun, J. S., Mei, L., Gibbs, K., & Farella, M. (2017). Effect of orthodontic treatment on the periodontal tissues. Periodontology 2000, 74(1), 140-157. https://doi.org/10.1111/prd.12194
- Parents' Guide, Issue 1/2002
- AWMF Registry No.: 083-018 Guideline of the German Society for Orthodontics (DGKFO) and the German Society for Dental, Oral and Maxillofacial Medicine (DGZMK): Indications of orthodontic treatment. Available at: https://www.awmf.org/leitlinien/detail/ll/083-018.html
- Proffit W. R. & Fields H. W. (1993). Contemporary orthodontics (2nd ed.). Mosby-Year Book.
