Children's orthodontics: plates, trainers and orthodontic appliances

A child's jaws are still growing, and this growth gives the orthodontist an opportunity adults no longer have: to guide jaw development, make room for permanent teeth and correct the bite with gentler means. Children's orthodontics works with primary and mixed dentition (when a child has both baby and permanent teeth), and its main tools are removable plates, trainers and functional appliances. At UKRMED this is done by the orthodontists of UKRMED Dentistry.

Photo: Ian Furst, Wikimedia Commons, CC BY-SA 4.0

When to see an orthodontist

A first orthodontic check is usually recommended by the age of 7, when the first permanent teeth are in. Not every child needs treatment at this age, but the orthodontist will spot problems that are easier to fix during growth. Watch for:

• lower teeth overlapping the upper ones or a jaw shifted to one side;
• a gap between the front teeth when the child bites together;
• upper teeth sticking out strongly;
• crowded teeth with no room for permanent teeth;
• mouth breathing, snoring, thumb sucking after age 4-5;
• baby teeth falling out too early or too late.

Appliances used in children

A trainer is a soft silicone mouthpiece worn at home and at night. It trains the correct position of the tongue and lips and nose breathing, so it is used early, including as a pre-orthodontic trainer (preparing for the main orthodontic treatment).

A removable plate is an acrylic plate with wire elements and a screw. By gradually turning the screw, the orthodontist widens the dental arch and makes room for teeth. Plates come with one screw or with two or more for more complex movements.

Functional appliances - Twin Block (two plates that hold the lower jaw forward), Andresen activator, LM activator - influence the position of the lower jaw and muscle function. A systematic review of children with a Class II bite (lower jaw set back) found that removable functional appliances correct the bite mainly by moving teeth, while skeletal changes (changes in the jaw bones themselves) are moderate and most noticeable with the Twin Block.

Fixed orthodontic appliances are attached to the teeth and work all the time, without relying on the child's discipline. They include upper jaw expanders (Hyrax, HAAS - screw appliances that gradually widen the upper jaw), distalisers (Pendulum, bilateral and unilateral - they move back teeth backwards to make room), Forsus (a spring that helps bring the lower jaw forward) and palatal and lingual arches (metal wires on the inner side of the teeth that hold them in place).

A Delaire face mask is an extraoral appliance (fitted on the face and pulling the upper jaw forward) worn at home when the upper jaw is underdeveloped.

A space maintainer keeps room for a permanent tooth if a baby tooth is lost early.

Who treats children

Olena Fedoriv is an orthodontist with 12 years of experience who treats children and adults and works with braces, appliances and aligners. Karyna Skliarenko specialises in comprehensive orthodontic treatment for children and adults and bite correction.

How treatment works

1. Consultation. Examination of the bite, habits and breathing.
2. Diagnostics. If needed, a panoramic X-ray and lateral cephalogram (a side X-ray of the skull to measure how the jaws relate), impressions or a scan.
3. Making the appliance and explaining how to wear and clean it.
4. Check-ups. The orthodontist turns the screw (so the appliance keeps working), adjusts the appliance and monitors growth.
5. Next stage. After the teeth change, the child may move on to braces or aligners if needed.

Tips for parents

• the result of a removable appliance depends on how many hours a day it is worn;
• clean the plate with a brush every day and the teeth twice a day;
• with fixed appliances, thorough brushing and regular professional cleaning matter;
• do not repair a broken appliance yourself, see the orthodontist;
• keep up regular check-ups with a paediatric dentist: decay under an appliance is harder to treat.

Prices for children's orthodontic appliances

Sources

1. Koretsi V., Zymperdikas V. F., Papageorgiou S. N., Papadopoulos M. A. Treatment effects of removable functional appliances in patients with Class II malocclusion: a systematic review and meta-analysis. Eur J Orthod, 2015. https://doi.org/10.1093/ejo/cju071
2. NHS. Orthodontics. https://www.nhs.uk/tests-and-treatments/orthodontics/