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Braces

Guiding teeth and #2 x-rays needed?

07/06/2006

Question:

My daughter is 10 y.o. and just getting her primary incisors (permanent) in. She already had the lateral incisor on the upper right come in first at a severe angle. Now the central one on the right is coming in at a severe angle...almost a right angle. We were told at the ortho consult to just let them all come in and then a plan for braces would begin.

Is there any prior `guidance` these teeth should be getting to come in better? The bottom lateral are tongue side and at an angle behind the bottom central incisors. There is alot of crowding obviously. She has had 3 panorexes in the last 40 months as she was so late getting her teeth in, they kept watching to see if they were coming down at all.My dentist was also worried they could have become anklyosed? as my older son had that problem undiagnosed with his upper canine and eventually had it drilled out of his pallet? Apparently in his case the pallatel expander was shortening roots and also hiding the later problem...so my dentist has been cautious with my daughter.

My daughter`s upper lateral incisors had (past history) on x-ray been trapping the central incisors on either side at an angle...like four people trying to get through a small doorway all at once. I guess I should rejoice they are coming in at all but wanted to get another opinion on whether there is more I should be doing at this point in time? Also, as she has already had so many x-rays, are there alternatives/exceptions to the ortho x-rays usually taken at the beginning of treatment? I believe when I had braces they just did a `mold`. Can braces be done without additional x-rays? THANKS!

Answer:

Let me address your concern about the radiographs (x-rays).  Your daughter is well within the safety zone and I would not want a member of my family not having this diagnostic tool available.  

The question of timing for her is one the orthodontist wants to be cost effective for you.  There are a number of possible issues which need to be determined such as the depth of bite, the progress of the growth of the lower jaw to mention just a couple. The orthodontist needs to sort this out as well as the eruption sequence.  

I would insist on re-evaluation on a six month observation schedule to monitor the progress.  It is likely that she will need to have braces.  In my mind this is being conservative but we certainly don't want damage to the adjacent teeth.  So stick with the specialist and don't miss recall visits. 

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Response by:

Walter C Buchsieb, DDS, MS Walter C Buchsieb, DDS, MS
Professor Emeritus - Clinical, Associate of Dentistry
College of Dentistry
The Ohio State University