Early Treatment at H2O
"Everything should be made as simple as possible, but not simpler." ~ Albert Einstein
Drs. Handy & Handy have helped many parents save thousands of dollars & helped their children save many months of total treatment time in braces by avoiding unnecessary and expensive Early or Phase I Orthodontic treatment.
There is no area with more difference of opinion than the question of whether a patient needs early orthodontic treatment. Dentists and orthodontic specialists alike often hold strong & diametrically opposed views. it is not uncommon for a family to be told that their young 8 year-old child "badly needs early orthodontic treatment" by one orthodontist and then told that early treatment is "unnecessary" by the next orthodontist seen for a 2nd opinion. Drs. Handy & Handy believe strongly in helping patients and their families make good decisions based on upon orthodontic scientific evidence from quality research rather than on unsupported opinions and personal biases.
The Gold Standard in orthodontic treatment timing -- the most effective & efficient time to treat -- is during the adolescent growth spurt and during the late mixed or early permanent dentition. This is due to the leeway space picked up during the exchange from the primary molars to permanent premolars & due to growth potential remaining to assist orthodontic correction. Logical reasoning follows that the only reason to depart from this gold standard treatment time would be of 1) Earlier treatment would be more effective & work better, or 2) Early treatment would be more efficient & offer a better cost (time, money, energy) to benefit ratio, or 3) Both of the above.
So what does orthodontic research show? What are the facts?
Patients with Class I occlusions (good posterior bites) with crowding or with spacing & protrusive teeth do NOT need early treatment. They may need eruption guidance or extraction of some baby teeth over time to aid eruption of permanent teeth and/or reduce the risk of impaction of permanent teeth that could necessitate surgery in the future.
Patients with mild, moderate & even moderate-severe Class II malocclusions (excessive "overbites") do NOT need early orthodontic treatment. While early treatment does not lead to a reduction in overbite in 75% of cases, research has conclusively established that patients who receive early treatment do NOT finish with a better orthodontic treatment result at the end of normal full treatment as compared to patients who do not receive early intervention. The orthodontic results of the patients who receive early treatment are indistinguishable from patients who are only treated later at the normal adolescent time. The only difference if that patients who receive early treatment are in braces longer & their parent's bill is higher.
Patients with Class III malocclusions ("underbites") DO often need early orthodontic treatment. Orthodontic treatment for "underbite" is more effective at a younger age (between 7-10 years old most commonly) and can help protect a patient's teeth from wear & fracture, protect their gum tissue from recession and reduce the risk of needing orthognathic surgery to correct their bite later.
Patients with a posterior crossbite (narrow palate) and an associated shift or deflection of the lower jaw when biting down DO need early orthodontic treatment as correction of the crossbite & reduction or elimination of the mandibular shift has been shown to reduce the risk of asymmetrical lower jaw growth. Research as yet is not definitive regarding whether early expansion of the palate is critical in cases without an associated shift of the mandible though experienced orthodontist have long observed that early expansion seems to offer benefits in the form of greater stability & possibly less undesirable bite opening.
Patients with significant social concerns due to their bite or the alignment of their teeth MAY often times benefit from early orthodontic treatment. Kids can be tough on each other (and on themselves) and addressing smile esthetics through early treatment can benefit some patients with regard to their self-image and interactions with peers. In such cases, it is important that the orthodontist confirm that permanent tooth root development is sufficient & proximity of tooth roots to be moved relative to unerupted teeth is acceptable to allow safe orthodontic tooth movement.
Patients with severe Class III ("underbite") or severe, persistent anterior openbites do NOT* need early orthodontic treatment and may, in fact, be best advised to delay orthodontic treatment until later in adolescence. Such cases are most often due to substantial, adverse skeletal growth patterns and may require orthodontics in combination with surgery to achieve full correction.
* Special Note: Some patients with an anterior openbite have airway issues as an underlying problem. Such "mouth breathers" may benefit from our team approach to helping them achieve a normal breathing pattern and mouth/tongue/lip posture. Openbites with airways problems are serious cases that often require orthodontics plus major jaw surgery to correct. Early intervention & correction is NOT curative in all cases, but historical and ongoing research ha shown promise in some children of facilitating a more favorable facial growth pattern, reducing or closing the openbite, improving speech, improving sleep, reducing ADHD, improving self-esteem and, in some cases, reducing or eliminating the need for later jaw surgery.
Drs. Handy & Handy are highly trained in all forms of Early or Phase I Orthodontic Treatment. In fact, early treatment through growth modification was a strong focus & passion of Dr. Gordon's during his orthodontic residency and remains an area of diligent study for him to this day. But in the end, evidence trumps opinion.
It is Dr. Thom's & Dr. Gordon's commitment to recommend early orthodontic treatment when it would help achieve a better result for your child but to recommend against early treatment when all it would do is keep your child in braces unnecessarily long & cause your bill for treatment to be unnecessarily high.
One Important Note:
If your child is having social concerns and/or getting teased at school because of his or her teeth, please share this with Dr. Handy. We love kids & don't like to see them bullied or teased. Early treatment may be the most loving thing we can do for your child in this situation.
Drs. Handy & Handy hope this review of scientific research regarding early orthodontic treatment will help you and your family distinguish between opinion & fact and make the most wise decision for your child's care. If you have any other questions or concerns regarding early treatment, please do not hesitate to ask Dr Thom or Dr Gordon. They will be happy to talk with you & always recommend for your child only the treatment they would pursue for their own children & grandchildren.
Non-Extraction vs. Extraction
Extract or Not?
To extract or not to extract, that is THE question that has been most debated throughout the history of orthodontics. the father of modern orthodontics, Dr. Edward Angle, practiced 100% non-extraction treatment as he believed that God has given man 32 teeth and it is the orthodontist's job to straighten them all out regardless of all other considerations. Dr. Angle's most famous student, Dr. Charles Tweed, became disheartened with the exclusively non-extraction treatment philosophy because of the protrusive faces & unstable dentitions that he was creating. Dr. Tweed famously displayed 100 cases first treated without extractions and then treated with extractions at the 1940 American Association of Orthodontists meeting...and the pendulum began to swing from non-extraction to extraction therapy. And the pendulum has swung back & forth ever since.
Today the pendulum has swung more to the non-extraction side as contemporary orthodontists place primary emphasis on facial balance and fullness of smile rather that on Dr. Tweed's "plaster on the table" and teeth upright over basal bone. Dr. Handy puts facial balance & harmony and beautiful smiles at the tip of his priority list for his patients and treats the majority of his patients using non-extraction techniques. However, he is also careful to explain to patients & their families that there is a certain subset of cases that require extraction to achieve the very best orthodontic result: the most beautiful smile, excellent occlusion or bite and optimal long-term health & stability.
Orthodontic Problems often Treated by Non-Extraction
SPACING
MILD to MODERATE CROWDING
MILD to MODERATE CROWDING
MILD to MODERATE CROWDING
MILD to MODERATE CROWDING
MILD to MODERATE CROWDING
DEEP BITE (overbite)
MILD to MODERATE CROWDING
DEEP BITE (overbite)
OPEN BITE
UNDER BITE
DEEP BITE (overbite)
UNDER BITE
UNDER BITE
UNDER BITE
CROSS BITE
UNDER BITE
UNDER BITE
SEVERE OVERBITES/ UNDERBITES when Patient wants to preserve FUTURE SURGICAL OPTION
SEVERE OVERBITES/ UNDERBITES when Patient wants to preserve FUTURE SURGICAL OPTION
SEVERE OVERBITES/ UNDERBITES when Patient wants to preserve FUTURE SURGICAL OPTION
DEFICIENT LIP SUPPORT
SEVERE OVERBITES/ UNDERBITES when Patient wants to preserve FUTURE SURGICAL OPTION
SEVERE OVERBITES/ UNDERBITES when Patient wants to preserve FUTURE SURGICAL OPTION
DEFICIENT SMILE FULLNESS
SEVERE OVERBITES/ UNDERBITES when Patient wants to preserve FUTURE SURGICAL OPTION
CASES with COMPROMISING VARIABLES: Short tooth roots, History of Periodontal Disease, History of Drug Therapies that Affect Bone Healing
CASES with COMPROMISING VARIABLES: Short tooth roots, History of Periodontal Disease, History of Drug Therapies that Affect Bone Healing
CASES with COMPROMISING VARIABLES: Short tooth roots, History of Periodontal Disease, History of Drug Therapies that Affect Bone Healing
CASES with COMPROMISING VARIABLES: Short tooth roots, History of Periodontal Disease, History of Drug Therapies that Affect Bone Healing
Orthodontic Problems sometimes Treated by Extractions
SEVERE CROWDING
PROTRUSIVE TEETH
PROTRUSIVE TEETH
PROTRUSIVE TEETH
PROTRUSIVE TEETH
PROTRUSIVE TEETH
OPENBITE
PROTRUSIVE TEETH
EXCESSIVE LIP STRAIN
EXCESSIVE LIP STRAIN
HIGH RISK of GINGIVAL or GUM RECESSION
EXCESSIVE LIP STRAIN
MODERATE to SEVERE OVERBITE/UNDERBITE
HIGH RISK of GINGIVAL or GUM RECESSION
HIGH RISK of GINGIVAL or GUM RECESSION
HIGH RISK of GINGIVAL or GUM RECESSION
HIGH RISK of GINGIVAL or GUM RECESSION
HIGH RISK of GINGIVAL or GUM RECESSION
HIGH RISK of RELAPSE or LOSS of TREATMENT RESULT if PROBLEMS are CORRECTED USING NON-EXTRACTION
HIGH RISK of RELAPSE or LOSS of TREATMENT RESULT if PROBLEMS are CORRECTED USING NON-EXTRACTION
HIGH RISK of RELAPSE or LOSS of TREATMENT RESULT if PROBLEMS are CORRECTED USING NON-EXTRACTION
The Best Appliance
Many patients, parents & referring dentists alike are confused by the endless number of different appliances used by different orthodontic specialists today. "What is the best appliance?" Is it headgear or the Herbst appliance? The MARA or the Twin Block? The Pendulum or the Jones Jig? Or how about the Frankel, the Bionator or the Stockli-Teuscher combined with activator-headgear appliance? And what about TADs? No wonder everyone is so confused!
Like so many thing in life, the answer to which appliance is best is...it depends. It depends on what the appliance needs to do, which in turn depends upon what is the underlying problem needing correction in the first place. Excellence in treatment always comes back to careful diagnosis of a patient's orthodontic problems at the beginning.
All appliances that produce orthodontic forces on a patient's teeth produce tooth movement. Each appliance has its associated risks & benefits, its desirable effects and undesirable side effects, its action and equal & opposite reaction (Newton's 3rd law). In some cases, vertical control of the teeth and/or jaws is critical, in others, not; sometimes flaring of the incisors is good, while in other cases retraction is desired; sometimes skeletal or growth effect is paramount while sometimes producing substantial dentoalveolar compensation is OK. Achieving the best orthodontic treatment result in each individual case comes back to the time, care, skill & judgement of the orthodontist in accurately diagnosing and setting appropriate treatment goals for the patient's case much more than it depends upon what their favorite appliance happens to be. This is why in all but the simplest orthodontic cases, Dr. Handy strongly believes in both and initial exam and review of records with a patient, and then a follow-up treatment planning consultation after he has taken time to carefully diagnose, set goals and weigh all options for a case. Dr. Handy believes that he must thoroughly understand the nature of a patient's orthodontic problem before he can counsel the patient regarding the best way to fix it.
Beware of the orthodontic practice that tells you what you need before they have even looked carefully into what is wrong, or the practice that never uses " *** " or always uses " *** ". You are a one-of-a-kind and special individual with a unique combination of orthodontic concerns & problems. Excellence requires customization.
You deserve it. Don't settle for less.
The Inside Scoop on H2O
Patients & Parents often ask their dentist a hard but very fair question: "Doctor, you have kids. Which orthodontist did you send your children to?"
-- Drs, Handy & Handy have treated 10 dentists & 85 immediate family members of dentists in our area.
-- They have also treated hundreds & hundreds of dental hygienists, dental assistants & other dental staff members and their children.
--The dental experts overwhelmingly choose to entrust the orthodontic care of their families to Drs. Handy & Handy!
In 2014, Drs. Handy & Handy surveyed all the dentists in our area asking for feedback & constructive criticism in order that they might keep improving H2O. Their dental colleagues time & again praised their communication & treatment philosophy as excellent. Below you will find many of the dentist's exact responses to the following question:
What do you like best about Drs. Handy & Handy Orthodontic Specialists?
- "We love everything about your office."
- "The personal approach."
- "Honest & trustworthy. Professional."
- "Treatment based on sound research & data."
- "Do an excellent job & keep patients happy."
- "Our patients love you guys!"
- "Caring attitude."
- "The final results & my peace of mind that each patient is receiving the best treatment."
- "My patients love your locations & you!"
- "Very friendly; great result!"
- "Great communication with Doctors & staff on cases."
- "Being able to communicate with them as needed & the excellent care given to referred patients."
- "Parents come back to my office & tell me how nice everyone was at H2O and how nice it was to have the doctor take time to explain everything."
- "I think you are giving my patients your best. I know enough to see when others have done cases incorrectly. The doctors & team are great people--and it takes great people to do great ortho."
- "Outstanding care all the way around--first class facilities, excellent staff & a genuine concern for the highest level of care for our patients. The only reason I don't send every patient to the Handy's is for insurance purposes. More patients are demanding to stay in network. I don't question anyone's decision when it comes to finances but I do stress that you guys are worth every penny & I hope they will consider your office."