Does my child need braces?

„Braucht mein Kind eine Zahnspange?
Wann eine Klammer nötig ist. Wie lange die Behandlung dauert. Welche Kosten die Kasse übernimmt“

published in Eltern Ratgeber, issue 1/2002

Braces are on (almost) everyone’s lips: every year, over a million children in Germany get braces. You can find out everything about pediatric orthodontics here. To find out whether clear aligners are an option yet, check out our article “Can My Child Get Clear Aligners Yet?”

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 receive orthodontic treatment. For adults, there are invisible braces, known as aligners or Invisalign.

Go directly to our services for braces for children:

• Invisalign Aligners (Clear Braces)
• fixed braces
• removable braces

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 do not form a neat arch but are tightly packed together.
• Open bite:The back teeth touch, but the front teeth do not—leaving a gap at the front.

The cause of such misalignments is sometimes genetic, but often the problems are self-inflicted: thumb-sucking, nail-biting, and the use of a bottle or pacifier as a constant source of comfort can lead to deformities. The upper jaw bones, which are still soft, are pushed forward. As a result, the front teeth later protrude. It’s also problematic when baby teeth fall out too early due to cavities. Then the adjacent teeth tilt into the resulting gap, and the permanent teeth grow in crooked.

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.

Nach Ansicht des Berufsverbandes der Deutschen Kieferorthopäden (BDK) könnte vielen Kindern eine langwierige Prozedur erspart werden, wenn die Eltern mit ihrem Kind schon mit fünf bis sechs Jahren zu einem Facharzt für Kieferorthopädie gehen würden. Frühzeitig erkannte Fehlstellungen lassen sich nämlich oft schon mit spielerischen (myofunktionellen) Muskelübungen oder einfachen Maßnahmen wie einer Mundvorhofplatte oder Funktionsreglern behandeln.
Ein später Behandlungsbeginn birgt die Gefahr, dass man um eine Spange meist nicht mehr herumkommt, Manchmal müssen Zähne gezogen werden, oder es ist sogar ein operativer Eingriff nötig.

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, new guidelines have been in effect since January 2002: Before beginning treatment, the orthodontist assess the malocclusion using a rating system ranging from “1” to “5.” Health insurance companies only cover treatment starting at a rating of “3”; parents must pay out of pocket for milder cases rated “1” or “2.”

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 nearly invisible braces for adults, such as aligners or Invisalign. Depending on the diagnosis, treatment may involve 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:

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• Parents' Guide, Issue 1/2002
• AWMF Registry No.: 083-018 Guideline of the German Society of Orthodontics (DGKFO) and the German Society of Dentistry and Oral Medicine (DGZMK): Indications for Orthodontic Treatment. Available at: https://www.awmf.org/leitlinien/detail/ll/083-018.html
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