Growth Guidance. Monitoring. Observation. Recall.

The process of tracking a child’s dentofacial and skeletal growth as it relates to the current or future need for orthodontic treatment may be described with several terms, but they ultimately all mean something similar. This is the orthodontist’s way of keeping watch as your child develops, identifying orthodontic discrepancies that would benefit from interceptive treatment prior to braces, and targeting the perfect time to start orthodontic treatment when it is deemed necessary.

Today I’m shedding some light on this important step in your child’s growth.

Lucky 7

A poll taken in 2014 by mathematician Alex Bellos found that seven is people’s favorite number. There are lots of good associations with that particular number: seven days in a week, seven notes on a musical scale, seven continents, the seven wonders of the world, and let’s not forget James “007” Bond. Seven is a lucky number in orthodontics, too, for it is the age deemed ideal for your child to receive an initial orthodontic evaluation.

Prize wheel 1By age 7, your child has a good mix of adult and baby teeth and the bite is established. This provides a window into your child’s jaw growth that can reveal whether any problems exist that might benefit from interceptive treatment. No treatment is needed at this age in most cases. Instead, we place your child in our growth guidance program – called the Kids Club – for continued monitoring as he grows. Our growth guidance visits are complimentary. We will take pictures and X-rays periodically to help monitor growth and keep our records up to date.

In situations where I recommend some form of treatment, it is because doing so at this age gives me the chance to:

  • Guide jaw growth – some untreated dental problems can create an unhealthy environment for teeth, gums, bone and jaw development.
  • Intercept a developing problem – an example of this would be decreasing the risk of trauma to protruding front teeth.
  • Prevent a problem
  • Address harmful oral habits
  • Improve appearance
  • Guide permanent teeth into a more favorable position
  • Improve the way lips meet
  • Avoid the need for orthognathic surgery later in life

Fun=Effective Treatment

We have found that patients who are part of our growth guidance program and go on to require orthodontic treatment are excellent when it comes to compliance, and this is integral to successful treatment. It’s simple: kids who enjoy coming to the office are more compliant with treatment.

I attribute this to the rapport our entire staff builds with your child through the years. These periodic appointments truly seem to set them on the road to lifetime good oral health.

We establish this rapport by making treatment fun, and by getting kids excited about coming to their orthodontic appointments. Our reception area has a game room, so lots of our patients come early for their appointments to get in some game time before their checkup. We also give away an iPad every month. Each summer, we hold a “Where in the World is Dr. Sanders” photo contest, and prizes include a variety of Apple products.

Finally, your child earns a trip to the famed prize wheel after each appointment. Our patients can’t wait to spin for a Prize wheel 2prize at each visit, because there is an opportunity to win items ranging from ice cream to Toys R Us gift cards.

When Interceptive Treatment is Needed

There are some occasions when I will recommend interceptive treatment. Also known as Phase 1 treatment, this is recommended only for about 10 percent of cases, and usually involves a year of treatment followed by maintenance for a couple of years until Phase II treatment begins, which involves braces.

Appliances that may be used in Phase I treatment include:

  • Palatal expander – used to widen the upper arch so the upper and lower teeth fit together better.
  • Herbst appliance – used to address lower jaw deficiency, this appliance helps the lower jaw develop in a more forward position to correct overbite.
  • Hay rake/palatal crib/bluegrass – one of these appliances may be prescribed if your child has difficulty breaking his thumb-sucking habit.

Recheck appointments during Phase I treatment are similar to recheck appointments for patients who have braces. That means your child likely will be seen every four to six weeks. We may want to see your child every two weeks at first if a palatal expander is in place. This is so I can ensure the key on the expander is being turned as directed and we’re achieving the desired expansion.

Phase I treatment reduces the likelihood that your child will require tooth extraction prior to beginning Phase II treatment. It also reduces the risk of tooth trauma in instances where your child has severely protruding teeth. Periodontal trauma also is reduced because we can guide the erupting teeth so they don’t damage gum tissue.

Appointment Frequency

In the early stages of growth guidance where no obvious issues are present, we may only see your child once a year.

At about age 10, we typically increase the growth guidance recheck appointments to anywhere from three to six months if I see something I want to watch more closely. An example of this would be monitoring the eruption of the canine teeth, which happens between ages 10-12. These are among the last teeth to erupt, they are among the most noticeable when your child smiles, and consequently, they can be the most trouble. I monitor their eruption to ensure there remains enough space in the jaw for them to erupt normally.

The Practical Parts of Growth Management

The thought of taking your child to an orthodontist at such a young age and maintaining years of monitoring may sound like a daunting task, but it isn’t. We offer ways of making this important process manageable.

Members of our Kids Club receive reminders via text and email when it’s time for their next appointment.

For parents of children who must undergo Phase I treatment, they often are pleased with our financing approach. We combine Phase I and Phase II treatment into one fee so parents don’t have to have the finance conversation twice. We offer a variety of financing options, which we will discuss with you when we present our treatment plan.

Our quoted fee always includes the following:

  • All diagnostic records necessary for thorough treatment planning, such as X-rays, photographs, study models and a personalized growth study work up.
  • All orthodontic appliances, including dentofacial orthopedic appliances for Phase I patients and braces or Invisalign for comprehensive orthodontic treatment.
  • All follow-up office visits
  • All emergency visits
  • All procedures that are performed in our office
  • One set of final retainers
  • All retention visits for one year following treatment

More Information

I invite you to call our office today if your child has not yet received an initial orthodontic evaluation. We will conduct a thorough assessment, provide treatment recommendations and answer all of your questions. I look forward to meeting you soon.


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