Am I too late?
Pictured above: Dr. Pfister’s latest visit to Blossom, featuring Styx and Foreigner.
Wow, has this not been a super June after a wetter-than-normal Spring?!
Camping, hiking, outdoor concerts…
All the great events that are the hallmark of Summer are now possible.
Speaking of concerts, have you checked your favorite artist’s touring schedule lately?
I’m finishing the edit of this blog on Thursday night because, last night, I was at Blossom with probably 20,000+ fans (the lawn has been extended in all directions) to experience an opening act by John Waite, followed by Styx and Foreigner.
Yes, it was one of the best concerts I have seen in a long time! And no, it was not titled, “Are You Still Alive Tour.”
And Saturday Night, Cleveland plays host to the Stones Tour at Cleveland Browns Stadium for Mick’s 80th birthday, which will be on July 26th (and yes, Mick is still alive).
Next month, Progressive Field rocks with a visit by Def Leppard and Journey. (And yes, I will be there… I never miss a Journey Concert! They are still amazing, even without Steve Perry.)
In September, Browns Stadium hosts the Billy Joel and Rod Stewart Tour. I saw Rod last Fall and he is still struttin’ the stage quite well at 79. Billy Joel can captivate an audience better than ever, as he tickles the ivories at 75! Easier on your ears is the Rock Hall’s entire floor presentation of life on-the-road with Bon Jovi. Jon’s new album, Forever (his 16th album), just came out June 7th this year and will secure his name forever on the musical highway of life.
Cleveland is truly the home of Rock-and-Roll… and letting the good times roll…
Summer also brings out other events that increase in frequency when school is out — getting athletic physicals, getting wisdom teeth out, and beginning your child’s orthodontic journey.
I have been asked many times, “When is it the best time to start looking at a child’s teeth?” In other words, when can we evaluate the ability of their teeth to come in and whether or not the teeth will need help fitting together?
There’s a line in Styx’s song, The Grand Illusion, that states, “Deep inside we are all the same.” While it’s true that parts of us may be the same, it’s the gazillion differences inside that make each of us unique and that give us so many answers to this simple orthodontic question.
Twenty years ago, in the orthodontic world, we pretty much had one phase of orthodontic treatment (namely, braces)…
And it usually started in 7th or 8th grade for females and 8th or 9th grade for males.
It lasted roughly 2-4 years, many teeth were pulled, and only the teeth and betterment of the bite were taken into diagnostic consideration.
It took a while (another 10-15 years) until research began to show that we needed an earlier phase to develop a better skeletal foundation on which to arrange all of our teeth.
The new and developing concept was that, instead of pulling teeth to fit the small, inadequate-sized jaw bones, why not expand the jaws (by stimulating the growth of both upper and lower jaws) and pull less teeth?
Europe was way ahead of us (by at least 10 years) because in the U.S. this was viewed as a more holistic approach due to the insignificant number of clinical orthodontists in Europe.
Run the dental research clock to the 90s… and orthodontic schools were now teaching the benefits of Early Interceptive Orthodontic Techniques… and the results were very impressive when analyzed by our 2-D analog radiographic equipment of the times.
These same procedures… when implemented with newer expanders and techniques (and viewed after 2008 with 3-D digital x-rays) showed amazing results in areas we had never thought possible for orthodontists!
Expanding the upper jaw increased the size and space available for the erupting permanent teeth, especially the upper canines, where one or both canines become impacted in nearly 25-30 percent of children today. When coupled with partial bracing of the upper permanent anterior teeth, the spaces produced by the expander can be selectively given to these canines to aid in their eruption.
Some upper front teeth come in with a backward path of eruption and actually push on the lower anterior teeth, causing sensitivity to temperature and chewing. Bracing the upper anterior teeth, after expanding, eliminated this issue and gave the patient another “unknown” prior to 2005 — the benefit of releasing the lower jaw and allowing it to grow properly to its genetic potential.
This is a major benefit to many young people! It is not cosmetic and therefore has not always been held in such high esteem until 3-D imaging could show the benefits of the lower jaw growing forward.
This natural growth of the lower jaw could go on uninhibited by the wider upper jaw and properly positioned upper anterior teeth!
This growth of the lower jaw could now be shown, through the use of 3-D imaging, to aid in the freeing up of the tight and painful TMJs (temporomandibular joints), but, more importantly, increasing the actual volume of the patient’s airway.
I participated in a two-year airway fellowship before purchasing my current 3-D digital machine.
The anatomy that we can show — tonsils, adenoids, and how their position and shape can affect an individual’s breathing — is truly exciting!
Only through the use of a very expensive MRI scan (read as insurance won’t cover it), could one depict any higher resolution to the image.
All of my readers are well-aware of the adult sleep apnea research and the results of lack of REM sleep, but the research on adolescent sleep apnea and its patients’ effects have only emerged in the last 10 years.
Children suffer with attention deficit and ADHD from the lack of proper sleep… and constricted airway, many times, is never investigated. Pills and behavior modification procedures usually rule as the order of the day. This is too great a topic to cover in its entirety in this blog, but we will address it later.
The point to be made here is that orthodontics is now diagnosing and treating more areas than ever before, thanks in no small part to 3-D imaging and the ability to see what we are doing.
That may sound odd, that in my first 20+ years in practice we moved the teeth and created great smiles but never treated the whole person; and that is what makes orthodontics so exciting today!
By now I’m sure you are saying, “Dr. Pfister, you haven’t spoken on the topic… when do we come in?!”
I truly felt I had to explain the benefits of the procedures and the way we would go about them by educating the parent on the background.
Together, we could pick the proper age and timing for early intervention of orthodontics to begin.
Pictured: The grandchildren of Dr. Pfister’s sister, Suzan, enjoy a Memorial Day swim. (These two beautiful young girls are in the range of early orthodontic intervention.)
Let me state a fact that all parents know — boys mature differently than girls… and usually slower!
The literature will substantiate that biologically and emotionally, to muddy the waters further, all boys and all girls do not mature at the same rate.
Environment, home life, number of siblings, birth order — all seem to play a part in this interesting journey of maturation.
Just for the record, biological maturity is pretty easy to guess the stage or level through x-rays, questions, and examination.
The emotional maturity of an individual is the difficult factor to determine… and is often the basis of success or failure in terms of a child’s complying and “putting up with” early orthodontic procedures.
Expanders put pressure on the bone, but at a very micro-ounce level. The anterior braces can be felt with tongues and lips, but that is about it for the most part.
Total time in treatment for Interceptive Orthodontics does vary, but should be around 14 months in duration, unless you have a strong lower jaw that begins growing too early (at which point treatment may go two years or more!).
Therefore, five years of age is usually too early in my estimation. And all of my five-to-seven-year-old candidates usually have concurred and liked the idea of waiting ‘til next year.
There are some unique cases that should at least be monitored — if not started — due to accidents, trauma, and birth defects by six years of age.
Most people today get their upper and lower teeth in by nine years of age. And most orthodontists today will see your child at any time, but the initiation of treatment works best when you can put the expander in one month… and the anterior braces on the next month.
Expanding the jaw and then waiting six months before putting the braces on doesn’t do anyone any favors!
Personally, I love to start when the patient wants to start and is most excited about doing so. It is all-the-better if this is around eight-to-nine years of age and, for some males, I have stretched it out to ten or eleven years of age. (This assumes the initial first teeth began erupting into the mouth around five months, the national average according to the ADA. For every month beyond five, I tend to see six months added to the age when permanent teeth erupt.) Yes, I have done some “early treatment” at 12 years of age.
While we are talking about baby teeth, please dump the urban myth that all baby teeth naturally fall out on their own!
Granted some do, but I have 20 - 30 baby teeth a month being extracted as part of the early treatment in our practice, now that the 3-D imaging can show if the baby teeth’s roots are going to dissolve and the crown is going to fall out or not. (Again, Europe has been way ahead of us on the early extraction of non-dissolving baby teeth to facilitate the eruption of the permanent tooth.) It really is the cheapest way to straighten up some orthodontic cases, but needs to be initiated early on, usually before eleven years of age.
A person’s upper jaw grows in concert with their brain, cerebral, and cranial complexes; but their lower jaw grows maximally with the onset of puberty… and then continues on for 12 to 24 months for most individuals.
The major exception is under-slung or Jay Leno-sized lower jaws. This is a very genetic pattern for families with growth in the lower jaw continuing into their mid-twenties! I did my graduating thesis from grad school on this type of growing individual and they truly are the toughest to treat due to their prolonged growth phase.
Long story short (too late!), you want to start your child early enough in their growing that, through the expansion of the upper jaw and realigning of the front teeth, their lower jaw has the longest possible time to take advantage of the hormones of pubertal growth.
The growth of the lower jaw forward keeps the TMJ in proper position with the skull, with an increased volume of one’s airway, to fuel the rest of the body’s growth during puberty!
These are the best of times for young orthodontic patients!
The advent of 3-D digital x-rays and techniques to capitalize on what we see amiss… and then the ability to track our successes in creating not only a beautiful smile, but a beautiful life through better breathing and TMJ functions… these are the ingredients of great times for early intervention!
To all my readers out there, enjoy this Northern Ohio Summer with your families.
In paraphrasing Styx:
Your memories of yesterday and today will last a lifetime,
Go for the best, forget the rest,
And someday we’ll find that yes, these were the best of times.
All the best,
Dr. Pfister