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Preventative & Cost Saving Orthodontics

Does a two-stage treatment help save time or money?

A Consultation with Dr. Richard G. Rosenbloom


Dear Doctor,
I recently saw an orthodontist because I was concerned about my 7 year old son's under-bite. The recommendation was for treatment in two phases. The first phase is to use a retainer type appliance and possibly a second treatment phase when he is older. Can you help me understand why?

Dear Simon,
Thank you for your question. At first this might seem perplexing; what you're probably wondering is why can't he wait until he's older and get it done all at once? But if I am reading the facts right, the treatment suggestion is right on target.

Here's why. When you say under-bite, we are assuming that you are referring to the lower front teeth biting in front of the upper front teeth instead of behind them. This is also referred to as a cross-bite. It can affect any number of the six upper and six lower front teeth.

A first phase of orthodontic treatment may prevent, intercept or minimize future orthodontic treatment.

If your orthodontist thinks it is correctable now with a simple type of retainer, it will more than likely be quite an easy treatment and won't take more than a matter of months. This will allow simple correction of the cross-bite to put the front teeth in normal relationship to each other.

A first phase of treatment can: prevent a problem from developing (called preventive treatment); intercept a developing problem (interceptive treatment) or guide the growth of the jawbones that support the teeth (growth modification). In your son's case it seems like this first phase of treatment could just accomplish all three, and is therefore definitely worth the early phase one treatment.

Sometimes it is more difficult, if not impossible, to correct some orthodontic malocclusions (mal-bad, occlusion-bite) when all the permanent (adult) teeth have erupted, and jaw growth is complete. It may also result in an unhealthy environment for the growth and development of the teeth, gums, jaws and even face. Treatment can be timed in concert with predictable stages of growth and development. Taking advantage of growth and development can provide the greatest potential for improvement and final correction, resulting in an optimal bite, esthetics, and facial profile.

Questions to ask your dentist

  • Ask your general dentist if orthodontic treatment will be necessary, as your child gets older?
  • Ask your general dentist when you should see an orthodontist for a consultation?

Also implied in your question is cost; does it mean twice the cost for two phases of treatment? The answer is generally no; in fact if the first phase of treatment is successful and corrects an underlying problem, no further treatment may be necessary. On the other hand, phase one treatment may indeed set the conditions up to make the second phase of treatment easier and less costly. But these are questions you will need your child's orthodontist to address directly, because they will be specific to his condition and the specifics of his malocclusion. More than likely if second phase treatment is necessary it will require “braces,” the tiny little appliances that are bonded to the teeth to allow movement by small wires that are connected to them. Clear aligners, the clear “trays” that fit on the teeth, may also be a possibility to discuss with your orthodontist.

Your orthodontist is a specialist in the diagnosis and treatment of malocclusion and has taken special education and training in the study of growth, development and correction of these problems. Seems like he/she is right on track, but don't be bashful — ask the right questions so that you feel comfortable with the proposed solutions.

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