According to the international gold standard it’s common to start orthodontic treatment when the patients’ early permanent dentition is present. The young patients are at the age of 11 to 12 then and all permanent teeth have erupted. At this time most of the patients can be treated with a single fixed appliance in about 18 months. If you start earlier the dentition is partly primary and partly permanent. Moreover, some of the permanent teeth haven’t erupted yet. Regarding the latter: You can’t move teeth which haven’t emerged from the bone. That’s the reason why it’s questionable to start an early orthodontic treatment in the mixed dentition. Furthermore, orthodontics at the age of 11 to 12 is absolutely favorable because the adolescent growth spurt approaches and during this phase of rapid growth you can reduce the treatment duration in contrast to orthodontics for younger children.
There are hardly good reasons for starting with orthodontics when the children are of primary school age. Unfortunately, in Germany early treatment is of common use contrary to the current state of science: a great number of early treatments are started during primary school phase when children, aged 6 to 10 years, still have a lot of baby teeth. It’s even worse because most of the early treatments are conducted with outdated removable appliances. Most of the times, removable appliances can’t be worn efficiently so that 30 to 50 percent of treatments end up in failure. Even if there are any treatment results they are negligible and so poor that treatment has to be continued with fixed appliances.
It’s interesting that in most other developed countries early treatment with removable appliances isn’t of common use any more. This also applies to most of the removable appliances which aren’t used any more in other countries. Moreover, it’s a special German feature that orthodontists run their own in-office-laboratory where removable appliances are produced. In-office-labs aren’t common in other countries – no wonder, as foreign orthodontists don’t need such a huge amount of removable appliances. Patients and parents have to pay dearly for early treatment with removable appliances regarding overlong treatment duration, many failures and discontinuation of treatments, and last but not least the unnecessary high costs. This is exactly the reason why the German orthodontists continue this outdated way of treatment. The German reimbursement system for dental care pays nearly twice as much for the treatment with removable appliances than for those with fixed ones.
Treatment with removable appliances asks for such a little knowledge, expertise and effort that it is close to the old human dream of earning an income without having to work. No wonder why German orthodontists want children to start with treatments at the age of six. ”The earlier the better” is the common motto and “starting early would make later treatment less costly”. There will be a few years of early and afterwards a few years of “proper” treatment. It would be easier to wait wisely and only treat once, wouldn’t it? Such statements by orthodontitsts abozt early treatments are usually easy to see through as being guided by economic interests.
Therefore, it is no wonder that the professional associations in German orthodontics speak out in favour of early treatment. Both the Professional Association of German Orthodontists (BDK), the German Board of Orthodontics, and the German Society of Orthodontics regularly advocate early orthodontic treatment – the guild is simply fighting for its usual easy income. When interpreting such statements, one should always bear in mind the economic interests of the authors behind them.
There are only a few exceptions: the retruded mandible with extreme incisor overjet or a narrow maxilla with a total lateral crossbite. In these cases and some other rare findings early treatment may be exceptionally justified. In our orthodontic practice in Mannheim, however, this affects at most every 20th child, so that we hardly ever have 10 early treatments a year. Above all, we usually carry out the treatment with fixed appliances, which lead safely and quickly to success.
Tip for parents: If an early orhtodontic treatment is recommended for your child, it is better to get a second or third opinion beforehand. If you are in doubt, simply wait until your child is at least 10 years old – waiting has rarely done any harm. But pointless and aimless early treatments have already caused a lot of unnecessary trouble and avoidable costs.