It's best for the orthodontist to see children by age 7 to advise if orthodontic treatment is required and the best time for that patient to be treated. The first permanent molars and incisors have usually come in by that time and crossbites, crowding and other problems can be evaluated.

When treatment is begun early, the orthodontist can guide the growth of the jaw and guide incoming permanent teeth. Early treatment can also regulate the width of the upper and lower dental arches, gain space for permanent teeth, avoid the need for permanent tooth extractions and reduce likelihood of impacted permanent teeth. It will also correct habits such as thumb-sucking and eliminate abnormal swallowing functions such as a tongue thrusting on swallowing or speech problems. Early treatment is almost always orthopedic and will in most cases simplify later comprehensive orthodontic treatment if indicated. 

Orthodontic appliances can be made of plastic, metal, ceramic. Appliances are mainly orthopedic at this early age but may also be dental. They may be removable or fixed and may involve orthodontic brackets bonded to the teeth. By placing a constant, gentle force in a carefully controlled direction, braces slowly move teeth to a corrected position. At this early age, it is a great time to wear braces! Gone are the days when a metal band with a bracket was placed around each tooth. You can choose brackets that are clear or metallic colour with coloured O-rings that are inter-changable. Orthodontic wires are also less noticeable than they used to be and the latest materials move teeth faster with less discomfort experienced.

Comprehensive orthodontic treatment during adolescence typically ranges from eighteen to twenty-four months, depending on the growth of the facial bones, the eruption status of the teeth and the severity of the problem. Patients grow at different rates and teeth and facial bones may respond differently to orthodontic treatment, therefore, the time until case completion may differ slightly from the original estimate. Diligent use of any prescribed rubber bands and good oral hygiene is an important  factor in achieving the best result in the shortest period of time. Early orthopaedic treatment (ages 6-10) may take as little as 6-8 months to complete and these growing patients will be reviewed annually thereafter to assess their growth and development.

The Twin Block appliance is an orthopedic appliance aimed at aligning the jaws in the transverse, sagittal and vertical dimensions.  This appliance consists of separate upper and lower plates. The upper plate includes an expansion screw for lateral development and plastic pads to cover the molars. The lower plate includes plastic pads to cover the lower premolars. These plates interface at 70 degree angles to advance the lower jaw and lock it in to the desired forward position, thus improving the deep overbite (vertical overlap of top over bottom teeth), eliminating the overjet (horizontal overlap of top over bottom teeth), correcting any crossbites on the back teeth and improving the lower facial balance and profile. The Twin Block appliance is worn full-time (even when eating) and only removed when brushing teeth.  Treatment time is approximately 12 months and it is usually followed by an orthodontic phase of fixed braces to correct tooth alignment, co-ordinate the upper and lower arches and lock the bite into the correct position.    

Recessive Mandible	Straight Profile

Maxillary and Mandibular expansion appliances are used to expand narrow or constricted dental arches. This creates the necessary space for blocked out, erupting or crowded teeth. Expansion also corrects crossbites and other bite problems. Usually with a narrow upper jaw, the relationship of the back teeth is reversed, with the upper teeth biting inside of the lower teeth (crossbite). Expansion may also improve the nasal airway eg. A narrow or deep upper jaw may make it more difficult for one to breathe through their nose. When the upper jaw is expanded,  the air passages also widen, in most cases improving the nasal respiration. Once the upper jaw has been expanded, new bone fills the space created by bony separation, thus maintaining the increased width for long term stability.

A Herbst Appliance is a functional device similar to the Twin Block  that helps improve the way your upper and lower jaws fit together. It moves the lower jaw forward while pushing the upper jaw backward. The Herbst incorporates steel crowns, which are cemented on the permanent molars. Telescopic arms connect the upper and lower jaws. Lengthening the arms propels the lower jaw forward into the desired position. Once the jaw is positioned properly, the Herbst is left in place for 10 months and the growth is modified to reposition the lower jaw forwards to align the jaws, correct the profile and create a better facial balance.  Once this functional orthopaedic phase is complete, braces are fitted to lock the teeth into an ideal occlusion. 

A lingual bar is a form of retention using a very thin wire that is cemented in behind the teeth after treatment. This helps to retain the teeth and minimise any further movement after orthodontic treatment. It often eliminates wearing a removable retention plate for long periods after orthodontic treatment is completed.

Removable retainers are used after orthodontic treatment to keep the teeth in place whilst the dental soft tissue fibres around the teeth re-orientate themselves to accept the new tooth position. They are generally worn full-time for 6 months and nights only there after for another 12-18 months.

 Mouthguards are recommended when you are actively involved in a contact sport. They can be instantly moulded in hot water or custom made in a laboratory and come in a range of different colours and patterns.  With braces fitted, a mouldable mouthguard can be made chair-side and issued immediately. It is brought to your adjustment appointments and it can be remoulded each time to ensure it is fitting well. Once treatment is complete, a custom-made mouthguard can be made to last. This requires an impression and is senr off to a laboratory.

This requires a short appointment at which separating elastics are placed between the teeth to aid in the banding procedure (fitting expanders or tooth bands). This procedure can be done at the consultation appointment or at a separate appointment if desired. Separating teeth makes fitting stainless steel bands around the molars and premolars possible and they are in place for 4-7 days. Normal eating and brushing is encouraged, but no flossing of teeth whilst the separators are in place.  

Reverse Headgear is utilized to help correct an under-developed or small upper jaw. Usually only worn 12-14 hours per day at home only. The headgear requires rubber bands which attach it to an upper fixed expander or a holding arch in the mouth. The rubber bands create a forward pull on the upper teeth and jaw. Because the reverse headgear rests on the chin and forehead, a reciprocal or backward directed force is placed on the lower jaw. The overall effect is forward pressure on the upper jaw and backward pressure on the lower jaw. This helps to correct the jaw imbalance by modifying the growth thus improving the facial balance and allowing the teeth to meet properly. The ideal age for this type of treatment is earlier (ages 7-11) rather than later (ages 11-14) as the facial sutures are still soft and malleable and separate easier to mobilise the upper jaw and help correct the jaw discrepancy. This younger age group is also more accepting of treatment and far more compliant.

The Fixed Tongue/Habit Guard acts as a reminder by making it difficult to fit the thumb in the mouth. It maintains and protects the arch width. It is intended to keep the tongue back so that the front teeth can complete normal eruption. This appliance can be used in conjunction with a palatal expander, which widens a constricted palate to a normal shape.

Thumb and finger sucking habits, tongue thrusting, and mouth breathing must be stopped (after age 6) to ensure the success of any future orthodontic treatment. Duration, intensity, and frequency of the habit will determine the actual effects of the habit. The resulting malocclusion may affect speech, facial aesthetics, and the ability to chew food correctly. Mouth breathing can also have similar effects on the teeth and jaws and needs to be addressed appropriately. This may be caused by allergies or enlarged adenoids and may need to be addressed on conjunction with your physician.

The incidence of Bruxism (tooth grinding)and Temporomandibular Joint Dysfunction (TMD) is quite prevalent in today’s society. A wide variety of treatment approaches and appliance designs are available for the treatment of these disorders. Splints come in a variety of designs. Traditionally they have been made from hard acrylic or a soft polyvinyl material. Splints are generally classified according to their intended function as disengaging splints or occlusion correcting splints.  They can be designed for the upper or lower jaws, worn full-time or nights only wear and are regularly checked and adjusted by the specialist orthodontist.