Imagine taking your beautiful daughter to see an orthodontist because she doesn’t like the little gap between her front teeth. You’ve check out her teeth yourself and while there are admittedly a few uneven ones, things don’t look that bad. Surprisingly the doctor announces that her treatment will be much longer than you expected and several thousand dollars more. How could such seemingly “simple” treatment take so long?

Orthodontic treatment is more than just straight teeth
Having examined more than 10,000 patients over the past 20 years, I know that I’ve surprised more than a few parents with treatment estimates longer than they expected. I can imagine the thoughts that run through the minds of parents that don’t know me very well: Is he just trying to make more money? Is he being too picky? She’s only got a little space for heaven’s sake! Understanding my three primary objectives for your children will help you understand why quality treatment takes as long as it does. My goals are to give your child a smile that is 1) attractive, 2) healthy, and 3) stable.

Orthodontic treatment should results in beautiful smiles
First, while most parents do want a healthy smile, the main reason they seek care for their children is that they want them to look great. Straight teeth, no spacing or overlapping, and no overbite are standard expectations. There is a misconception however that all doctors with a license will produce the same results. A lot of what I do with braces is artwork and not all orthodontists are artists. Being able to visualize how a patient’s smile should look at the end of treatment and then coordinate all of the variables that go into achieving that outcome is complex. Some orthodontists choose treatment plans simply because they like using a certain device that makes their job easier. Others shy away from removing teeth because it makes treatment harder to sell and it takes a little longer. Achieving a great result does take a little more time than just doing an average job.

Healthy teeth, gums, and bone are just as important as appearance
Second, a healthy smile is one where the jaws are coordinated, the bite comes together evenly so that there is less enamel wear, the teeth nicely aligned so they can be easily brushed and flossed, the incisors are positioned so that the lips close completely and naturally, and the roots of the teeth are anchored in healthy gums and bone. Treatment that addresses only the appearance of the front teeth may ignore the bite, the face, and the health of supporting tissues. It is possible to create a smile that looks good but is actually unhealthy. An experienced clinician will look past the alignment of the front teeth to address underlying factors that determine if the smile is healthy.

The results of orthodontic treatment need to last
Last but not least, quality orthodontic care leaves your child with a result that will be stable after the braces come off. What a shame it is when braces are removed and the teeth are allowed to move back to where they were before. While orthodontic retainers are necessary in all patients, producing a stable outcome actually begins with the original diagnosis. Even though expanding the arches with straight wires is the quickest and easiest route to straight front teeth, doing so when there is not enough supporting gum tissue or bone is not only unhealthy, it is unstable. While aligning only the top front teeth may be in vogue right now (i.e. Six Month Smiles), it may not produce a “set” of teeth that work together and support each other. Even trained orthodontists who do not fully correct an existing overbite may be leaving the teeth in an unstable position. Long term stability is probably the most commonly ignored aspect of orthodontic treatment.

So when your orthodontist tells you that your little girl’s “simple” treatment may take 18 months, you can now keep all three of these objectives in mind. You will undoubtedly be happy with the improved appearance of the teeth in the first six to nine months. At that point however, your mindset should shift to the other two objectives, making the smile healthy and stable. A good orthodontist will keep his eye on all three objectives for you. If you are on board with him throughout treatment, your children will also be more likely to be patient until the job is done right. An extra few months is not a big sacrifice for a smile that she’ll have for a lifetime!

NOTE: The author, Dr. Greg Jorgensen, is a board-certified orthodontist who is in the private practice of orthodontics in Rio Rancho, New Mexico (a suburb on the westside of Albuquerque). He was trained at BYU, Washington University in St. Louis, and the University of Iowa in the United States. Dr. Jorgensen’s 25 years of specialty practice and 10,000 finished cases qualify him an expert in two-phase treatment, extraction and non-extraction therapy, functional orthodontics, clear aligners (Invisalign), and multiple bracket systems (including conventional braces, Damon and other self-ligating brackets, Suresmile, and lingual braces). This blog for informational purposes only and is designed to help consumers understand currently accepted orthodontic concepts. It is not a venue for debating alternative treatment theories. Dr. Jorgensen is licensed to diagnose and treat patients only in the state of New Mexico. He cannot diagnose cases described in comments nor can he select treatment plans for readers. Because he has over 25,000 readers each month, it is impossible for him respond to all questions. Please read all of the comments associated with each article as most of the questions he receives each week have been asked and answered previously. The opinions expressed here are protected by copyright laws and can only be used with written permission from the author.