Orthodontic treatment of young patients is initiated between 11 and 12 years of age almost all over the world. At this time the permanent dentition is most likely established and there are ideal conditions for a short and least stressful orthodontic treatment using only one fixed appliance.
By contrast, it’s common use in Germany to start with orthodontic treatment while children are of primary school age and still have many primary teeth. This is justified by means of being able to produce a more significant improvement of the skeletal pattern, reduce the treatment duration and get better results than postponing the treatment until adolescence. Because of systematic scientific research throughout the last twenty years these statements turned out to be wrong.
Recently British orthodontists have carried out a systematic search in scientific literature in order to clarify whether the merits of interceptive treatment prior to the age of 11 years have any advantages for the young patients. This systematic review was performed considering findings like the retrusion of the lower jaw, the lateral posterior crossbite, the anterior openbite and some other forms of malocclusion. The authors didn’t find any benefits of interventions prior to the age of 11 years for any of the findings in comparison to the orthodontic treatment undertaken between 11 and 12 years of age. In the contrary it could be proved for most of the findings that an early intervention was associated with a longer duration of treatment, an additional burden to the young patients and additional costs. According to the systematic review the authors conclude: „The additional cost and burden to the patient, parent and clinician may, therefore, generally negate early treatment.“ Therefore early intervention on mixed dentition shows a lack of evidence, in other words isn’t founded by scientific findings but is rather arbitrary and undisciplinded.
But why is the early treatment of the mixed dentition propagated by many orthodontists, professional associations and even professors in Germany? Exactly: not in spite of but because of the inefficiency of early orthodontic treatment. The unnecessary additional costs for the patients, parents and health insurance on the one hand are a welcome profit for the orthodontist on the other hand. This is the deeper secret why systematic reviews like this one are not taken note of in Germany.
A tip for patients and parents: Please refuse orthodontics prior to 11 years of age if your orthodontist can’t prove the merits of early intervention.
Reference: Sunnak R, Johal A, Fleming PS. Is orthodontics prior to 11 years of age evidence-based? A systematic review and meta-analysis. J Dent. 2015 May;43(5):477-86. doi: 10.1016/j.jdent.2015.02.003. Review. PubMed PMID: 25684602.