What Happens Between Early Treatment and Adult Dentition?

Written by: Dr. Natalia Hodge

Find out when adult teeth usually erupt and why not everybody who has early treatment needs retainers.

Last week Dr. Tatum discussed Early Orthodontic Treatment (Phase I). Today I am going to talk about the development of the permanent dentition (adult dentition) and what happens between the end of Phase I treatment and the adult dentition.

The transition between baby teeth and adult teeth does not happen all at once. As previously discussed, around the age of 6, most kids get their first adult molars. Around the same time (between the ages of 6 and 8), they lose their upper and lower front baby teeth, which are replaced by adult teeth. During that first moment of transition, there is always something new happening. There is frequent excitement with multiple loose baby teeth and new teeth coming in. Needless to say, the tooth fairy works hard during that time! The doctors at Westrock Orthodontics follow the recommendations of the American Association of Orthodontists and like to see kids at this stage, usually at age 7. Most kids will not need treatment at this time, but some will highly benefit from early detection and treatment of problems that only get worse and more complicated to treat as the child continues to develop.

When Phase I treatment is needed, the orthodontist has several specific goals that typically require treatment lasting anywhere between 6 and 12 months. It is hard to develop comprehensive goals and treat everything at this stage because of all the changes that are still happening. Once the specific goals are achieved, the braces and/or appliances are removed. Not every patient who has Phase I treatment needs a retainer. Sometimes, the new position of the teeth is enough to hold the results of treatment. Other times, the orthodontist will determine that a retainer is necessary to maintain the teeth in the new position until the remaining adult teeth come in.

Examples of orthodontic problems.

After the anterior teeth are replaced by adult teeth, most kids go through a period of time of usually 1 to 2 years where not much seems to be happening. The changes are not obvious because the remaining baby teeth are not getting loose as frequently and not many adult teeth are coming in. But inside the jaws, where only the x-rays can see, there are many cells working hard to make many more adult teeth. When those teeth are ready to come in, a second “wave” of change happens. That is when the rest of the baby teeth, those on the sides, start getting loose and being replaced by more adult teeth. Time for more work for the tooth fairy! This usually happens between the ages of 10 and 12. Those who have had Phase I treatment and have retainers may find that their retainers no longer fit when this starts to happen. That is usually of little concern. The retainers are not fitting simply because the teeth are changing as part of a natural and expected process. When almost all the baby teeth are gone, the orthodontist can have a better idea of what the adult teeth and facial development looks like. At that time, they can plan a more comprehensive treatment, or Phase II treatment.

During the “gap” between the first and the second “waves” of changes, the orthodontists at Westrock Orthodontics usually like to see their patients every 6 to 12 months. That is true whether or not they have had Phase I treatment and whether or not they have retainers. Those appointments may involve taking a new radiograph that the doctor evaluates to determine how everything is developing and the best time for treatment of the permanent dentition (Phase II).