Pamela Winegrad reader Pamela Winegrad sent us this photo of 9-year-old Sabreena and her metallic smile.
updated 10/23/2009 7:47:49 AM ET 2009-10-23T11:47:49

Nadia Czekajewski got braces on her teeth when she was 8. Now she's in third grade, turning 9, and "she'll be done before she begins fourth grade," said her father, Tomasz Czekajewski.

"It was a wise decision to start young," said Czekajewski, whose family lives in the Lakeview section of Chicago. "Kids are not as self-conscious at this age."

Braces used to be another miserable part of being a teenager, but now some kids, like Nadia, start and finish orthodontic treatment long before adolescence.

But despite the allure of getting it over with young, starting early is not right for every child. Experts say it strongly depends on the treatment required.

Some children who start early end up in a second phase of treatment, with braces into the early teenage years despite having started young, according to Dr. Flavio Uribe from the University of Connecticut School of Dental Medicine in Farmington, Conn.

"That's one of the criticisms of early treatment: Kids in braces for a long time," Uribe said. "It's controversial."

For children with Class II malocclusion, commonly referred to as an overbite or buck teeth, "there is no advantage to starting early," according to Dr. William Proffit, a professor at the University of North Carolina's School of Dentistry in Chapel Hill.

Proffit said that was the conclusion of "three major, randomized clinical trials comparing the outcomes of treatment" for younger versus older children.

"Early treatment is more costly both in terms of the amount of money you have to pay and the number of visits you make, and there is a greater burden of treatment with no benefit for most children," he said.

‘Window of opportunity’
Proffit was the author of one of the three studies that looked at early treatment for Class II malocclusion, with the other two done by researchers at the University of Florida and in the United Kingdom.

But Proffit emphasized that early treatment is beneficial for other conditions, such as a Class III malocclusion, commonly referred to as an underbite, where the lower jaw is too big or the upper jaw is too small. "You're trying to change growth and your window of opportunity has run out by age 10. The ideal time to start would be as early as age 7," Proffit said.

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The largest group of children getting orthodontic treatment in the U.S. are those with Class I malocclusion, with crowded teeth that are either crooked or protrude. For this group, Proffit said, "early treatment works, but you have to do two phases of treatment. So they're going to be in treatment for four years — a first phase, then a vacation, and a second phase."

Proffit said there is one overarching reason to start early no matter what type of treatment the child will need, and that's when teeth are so crooked or unattractive that "the child is really being teased and harassed and has psychosocial problems," he said. "Most preadolescent kids shrug it off, but some kids are really bothered by it."

Assessment at age 7
The American Association of Orthodontists says most treatment begins between ages 9 and 14, but there are no detailed statistics on preadolescents versus teenagers. The AAO also said most orthodontic treatment lasts from one to three years, with two years being the average, but it had no statistics correlating length of treatment with age at which treatment began.

Some family dentists offer orthodontic treatment. But parents should be aware that "an orthodontist has an additional two to three years training after dental school, just to learn how to move teeth properly," said Dr. Robert Bray, president of the American Association of Orthodontists, and an orthodontist in private practice in Atlantic City, N.J.

The AAO recommends having children screened no later than age 7 to assess what the best age for treatment is. Bray said prices for treatment in his practice range between $4,000 and $7,000, but many orthodontists will do an initial screening for free. Often the price quoted for treatment will not change regardless of how long the child's treatment takes.

Meanwhile, Nadia, who had top and bottom expanders in her jaws to make room for her permanent teeth to grow in straight, is looking forward to a perfect smile before she even hits middle school.

"Sometimes I even forget that I have braces," she said. "And I'm almost done. I'm really happy that they're going to be taking them off."

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