Overcrowded teeth

Q:I am looking for information on orthodontic work with children. My interest is in overcrowded teeth and the need for, and efficacy of, braces. Can you help? JC, Hove.........

A:When a child has overcrowded teeth, orthodontics is standard medical practice. When teeth are overcrowded or misaligned, this can in turn lead to other problems ranging from embarrassment over appearance, chewing difficulties, jaw tension and a greater tendency towards gum disease and tooth decay. Teeth are meant to have small spaces between them making it easier to brush away food particles and plaque.

Braces have a good success rate in moving teeth into their correct position. Our panel member Jack Levenson, warns however that you should be aware of the possibility of metal allergy. "All metals corrode in the body whether it is hip replacements, knee replacements or braces and fillings, and you will find deposits of metal in the liver, spleen and lymph nodes of individuals who have metal in their bodies," he says. "What we don't know is what harm metals may be doing."

Some children will react badly to the nickel element of the stainless steel wiring used in orthodontic work. If your child is allergic or reacts to costume jewellry then it is also likely that he or she will also react to the metals in the brace.

Orthodontist Robert Hempelman advises that there is no alternative to braces when it comes to correcting overcrowded teeth. Happily there are different types of braces, some of which do not require much metal. Some of these only require four metal brackets on the back teeth and porcelain brackets attached to each tooth to hold the wires in place.

"Overcrowding occurs when the teeth are coming in more quickly than the jaw is developing. There are two schools of thought about how to handle this problem. Some orthodontists still advise waiting until the child is 13 or 14 and then extracting some of the teeth to make more room. This point of view, however, is giving way to another method, " says Hempelman.

"Ideally, you should begin correcting overcrowded teeth around the age of 8 to 10 by fitting a brace which encourages the jaw to stretch, thus giving the teeth more room. Then, around age 12-13 you would move on to a fixed brace.

While this may sound complex, it avoids the trauma and disfiguration of face and chin shape which can come from extracting teeth," he says.

Hempelman also advises that tooth extraction can lead to other problems later in life such as chronic headaches.

Not all orthodontists in the UK are trained in this method of correcting jaw alignment. To find one contact: OOO Dental Laboratories, Unit 1, 226 Shaftmoor Lane, Hall Green, Birmingham, B28 8SP. They will be able to advise you of a practitioner local to you.