HOW KIDS GROW: AN ORTHODONTIC PERSPECTIVE

Using growth knowledge for non-extraction orthodontic treatment

If you know when a child will grow, you can use that knowledge to avoid extractions and complete orthodontic treatment in about fourteen to eighteen months.  It's a matter of timing treatment to coincide with maximum growth rate.

The idea is to treat the child during the maximum growth spurt.  The other factors are: knowing how to use natural spaces available in the bone as the last of the lower baby teeth are being lost; how to use the growth of the face to accomplish alignment; and most important when or if to use expansion techniques.

Being in orthodontic treatment before the last of the lower baby teeth are lost and before the major teenage growth spurt is the objective.

If you plot a graph of a child’s growth as a function of age vs. height, you will find they do not grow in a straight line. There are lags (horizontal lines of no growth) and spurts (vertical lines of growth) on the chart.  The graph will look like a set of steps until the final leveling out after the teen-age years. 

Functional aspects of the muscles and bone must be taken into consideration when evaluating growth.  Oral habits, lack of facial width, airway problems, and genetics are factors which greatly influence growth of the face.  The final 'look' of the facial features are directly related to the environment of the whole face.  This interrelated environment is call the 'functional matrix'.  

A tongue thrust or inadequate nasal volume due to constriction of the face can greatly alter the direction of and pattern of the face.  Long narrow faces, muscular faces, long lips, short lips, lack of chin growth, are all factors which can be influences on development.

The goal is to treat skeletal problems like retrusive jaws, constricted palates, and avoid extractions by treating the child during the maximum growth period from approximately age 11 to 14.

Kids grow for short periods and then go into a lag stage. The greatest growth rate occurs during the long days of summer. This apparently is due to pituitary gland factors related to length of the day and heat.  Girls will typically mature much earlier in the more southern climes and later in the northern latitudes. This factor is important as growth anticipation must begin earlier in the south and later up north.

Kids will have a massive growth spurt at about age eleven for girls and thirteen for boys.  During this growth spurt is the time to combine braces and the facial growth to achieve jaw relationship changes.  

If you are trying to avoid extractions, the child needs to be in braces before or during the growth spurt and before the loss of the last of the baby molars in the lower jaw.  Using the growth spurt is how we avoid extraction of permanent teeth. Extractions should only be an option if there are facial deformities, lack of bone room to align the teeth, or tooth size discrepancies. This is a tricky diagnosis, but with experience, you can tell when these kids are going to grow and start treatment at the best time to utilize growth and bone space.

Eliminating or dealing with crowding is part of the art and science of doing non-extraction orthodontics.  Gaining room for all the permanent teeth is done by expanding the width of the dental arch (expansion techniques), advancing the lower incisors forward against the muscles of the lower lip (myofunctional techniques), and utilizing the growth potential of the face in a positive manner.  If the major growth spurt has already occurred, as in a sixteen year old, you eliminate the possibility of early intervention that allows for non-extraction treatment or correction of facial features in most cases.

The last part of the face to grow is the back of the lower jaw (the part closest to the ear). This fact is usable in obtaining some jaw correction in boys as late as sixteen or seventeen. Girls will get their lower jaw growth much earlier and must have been in treatment prior to the final growth of the lower jaw. 

Girls tend to start their growth spurt before boys and usually are well under way about age eleven or twelve. Again, with girls it is often important to be in braces even before age eleven to use the natural bone space to gain alignment of all the permanent teeth.  Girls’ growth will end about a year to a year and a half after the on-set of puberty or the beginning of the menstrual period.   Boys on the other hand will grow into their late teens.

The bottom line: start orthodontic treatment before or during the maximum growth spurt and before the last of the baby teeth are lost.

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Orthodontics for Children and Adults

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