We're using growth guidance instead of braces to give our kids beautiful smiles with plenty of space for all of their teeth.
Two Very Different Orthodontic Philosophies
When it comes to orthodontics, there are two main schools of thought:
Braces - The mainstream approach is to wait until most of the adult teeth are present (~10-14 years old) and then straighten the teeth with braces. With this method, sometimes healthy teeth will be surgically removed in order to allow the remaining teeth to be straightened.
Growth Guidance - The alternative approach is to get started early (~6-10 years old) in order to encourage the palate and jaw to widen and grow to accommodate all of the teeth. With this method, there is emphasis on airway development and oral habits in addition to creating space for the teeth.
Downsides to Braces
Our family has chosen not to use braces because:
Braces do not work in the long term. My husband had braces as an adolescent. At the end of using braces, his teeth were straight. However, now as an adult, his teeth are slowly moving back to their original positions. So the braces made them look better for a time, but in the end they are reverting back to being crooked. This is a well-known phenomena, known as orthodontic relapse. Nowadays it is a common recommendation that retainers need to be used for the rest of life after braces, to prevent relapse of the teeth into their original positions.
Braces do not go to the root of the problem, which is that the jaw is not large enough to accommodate the teeth. Rather, braces just seek to straighten the teeth to make them look better. When there is not enough room for all of the teeth, perfectly sound teeth are often removed prior to the installation of the braces. We wanted our children to be able to keep all of their teeth!
With braces, we would have needed to wait until our children were nearly done growing to get started. That means that we would have missed out on many opportunities for jaw growth.
Benefits of Growth Guidance
Our family has chosen to use growth guidance instead of braces because:
Growth guidance is more holistic. Instead of just focusing on straight teeth, growth guidance also works to ensure that the airway is open and that good oral habits (including tongue placement and musculature) are established.
Jaw and palate size can have a large effect on brain development. An interesting case study by Weston Price found that developmental delays were rapidly corrected with the use of palate-expanding orthodontics. We want to give our kids every opportunity to grow into their fullest potential by growing their jaws and palates to accommodate their teeth, and in doing so also increase the space for brain development.
Growth guidance can have many other benefits, including improved sleep and moods. Besides straight teeth, some of the other benefits attributed to growth guidance include improvements in mouth breathing, snoring, restless sleep, teeth grinding, bedwetting, allergies, and defiance/aggression.
Growth guidance appliances aren't readily visible to others. Both of our kids have used orthodontic appliances that are removable and mostly used at night in bed. These appliances don't get in the way of eating or alter the appearance like braces do.
Why We Use Plastic Myofunctional Appliances
We've chosen to use plastic myofunctional appliances for both of our kids' orthodontic treatments. There are other growth guidance options (including Crozat and lightwire), but plastic myofunctional appliances have worked well for us.
These removable appliances have no wires or adjustments. Progressively larger appliances are used as the child's jaw and palate grow larger. With this type of appliance, visits to the dental provider can be infrequent. This was especially important for us when we started out since the closest provider was 200+ miles away.
The specific type of appliance we are using is called Healthy Start. (When my daughter started her treatment 9+ years ago, the company was called Ortho-Tain. They have since changed their name.)
Finding a Provider
It can be difficult to find a provider who is knowledgeable about the use of growth guidance appliances instead of braces. Orthodontists are generally entrenched in the use of braces, and in our experience, orthodontists have not been the ones who could provide this type of care for our family.
Instead, we have found that general and pediatric dentists who also specialize in the use of growth guidance appliances have been the best. When our daughter started her orthodontic treatment 9+ years ago, we traveled 200+ miles to Albuquerque in order to find a provider for her. Now we have a local provider for our son's treatment.
A couple resources for finding a local provider include:
My Daughter's Orthodontic Journey - Beautifully Done
Our daughter Alina began her orthodontic treatment at 7 years old, when it became clear that there would not be enough space to accommodate her permanent teeth. As soon as Alina lost her first baby teeth, her teeth were coming in crowded and crooked.
Because she started her treatment early, Alina only ever had to use her orthodontic appliance while she was in bed at night. Alina is now 16 years old and her orthodontic treatment has worked beautifully.
Alina's minor cross-bite was quickly corrected with her appliance, and her palate and jaw grew to accommodate all of her permanent teeth well. Alina grew into her final appliance by ~11 years old. She got so used to using her orthodontic appliance that she chooses to still sleep with it in place most nights.
My Son's New Orthodontic Journey - A Work In Progress
Unlike Alina, it was not clear to me that my son Ian would need orthodontics until he was older. He had plenty of space between his baby teeth and I didn't realize until he was around 9-10 years old that anything was amiss. At that time, some of his upper permanent teeth came in incorrectly, sticking out because there was not enough space for them.
Ian didn't start his orthodontic treatment until late last year, at age 12. We should have gotten started years earlier, but between several years of COVID lockdowns and mask mandates in New Mexico 😝, time slipped away from us and we just didn't get Ian's orthodontics going until he was 12 years old.
Note that 12 years old will probably be too late for most kids to begin with the Healthy Start system. However, puberty and dental development run late in our family, so even though Ian was 12 years old when he started his orthodontic treatment, he still had quite a few baby teeth and therefore some good potential for guiding growth to accommodate his teeth.
Because Ian was older when starting treatment, in addition to nighttime wear he also needs to wear his appliance for a few hours during the daytime. We've had a hard time building these habits, and Ian still unconsciously takes his appliance out in the middle of the night in his sleep.
As a result, Ian's results have not been as quick as Alina's were. He's now 13 years old and has had some widening of his upper palate with straightening of the two teeth that were protruding in the front. His strong overbite has also been somewhat corrected. Ian will probably have several more years' of treatment for maximum results.
