UPMC HealthBeat Podcast

Braces are important for more than just cosmetic reasons. They can also play a key role in your child’s health. Lindsay Shuster DMD, MS, UPMC Children’s Hospital of Pittsburgh answers commonly asked questions and explains when it’s time to see an orthodontist.

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– This podcast is for informational and educational purposes only. It is not medical care or advice. Clinicians should rely on their own medical judgments when advising their patients. Patients in need of medical care should consult their personal care provider.

– Beyond creating a nice smile, braces can also be particularly important to your child’s health. So, how do you know if and when your child should get braces? Hi, I’m Tonia Caruso. Welcome to this UPMC HealthBeat podcast. And joining us right now is Dr. Lindsay Schuster. She’s an orthodontist at UPMC Children’s Hospital of Pittsburgh. Thanks so much for joining us.

– Thanks for having me.

– Okay, so we do always think about a nice bright smile, but braces can also be important to a child’s health. And why?

– Absolutely. So, it’s not just about looks, it’s about the function of the teeth as well. So, if the bite is improper, sometimes it can actually damage the teeth or cause dental pain. And beyond the teeth, the gums and the bone that hold the teeth in can be damaged as well. So, those are important things. The cosmetics are real, though. The benefit of that is very real to someone. If they have increased confidence from treatment, it can affect their work relationships, their personal relationships, and how they carry themselves. Also, braces can affect someone’s ability to chew a course properly, breathe optimally, and clean their teeth the best they can.

– In general, it might sound like a silly question, but what do you say to people that braces are designed to do?

– So, they make small movements over time to align the teeth and correct the bites, and it can even affect the facial profile.

– OK. So, how do you know, what are some of the signs as a parent, if you’re noticing with your child that are signs that it might be time to think about getting braces?

– The American Orthodontic Association recommends every child be seen by age 7. So, that’s largely a screening visit. Sometimes, people need early correction of bite issues that affect the way the jaws fit together, if there’s severe dental crowding. But some signs might be if your child’s simply self-conscious and they want to have the option of treatment, sometimes dental pain, or other things.

– So, is it one of these things that if your child is regularly going to the dentist, is it the dentist who then turns to the parent and says —

– Sometimes.

– “It’s probably time”?

– Yeah, sometimes. So, I think at this point, some of the referral patterns have shifted, and patients self refer. So, I would just encourage a parent if their children reach age 7, to seek orthodontic consultation.

– OK, so you have the consultation. Is it automatically, then, that you would go right into treatment? Do things differ between boys and girls, and is there a typical age where you can say this is typically the time that someone gets braces?

– There are growth differences between boys and girls.

– By age 7 generally we have a number of adult teeth, so our back molars and our front teeth. So, for early treatment, certain things can affect that. Typically, patients will have all their adult teeth by age 12 or so, and then they’re really candidates for full care. So, there’s, we have kind of phase one care that not everyone is going to benefit from. And, then, phase two or comprehensive care when you have all the adult teeth.

– And when you talk about phase one, give folks a sense what might be involved in that.

– So, a lot of people are familiar with pallet expanders or things like that. Another example is if the teeth are severely crowded, some management around some limited braces, not full braces, other things like headgear. I know everyone’s familiar with that.

– It’s really all the pre-work that you do before the braces then go on. Can braces be covered by insurance? I guess that, you know, obviously depends upon someone’s insurance, but in some cases they can be covered.

– There’s a range. Some insurances have an orthodontic benefit where they’ll cover a portion of care regardless of the reason, whether it be for cosmetic benefit or dental health reasons. Some insurances fully cover medically necessary orthodontics as in the case at Children’s with our cleft care.

– Is there a difference between aligners and braces? We see more and more of those. We see commercials for them all the time.

– Right, right. So, I think one of the great things about the commercials is the awareness surrounding orthodontics. So, it’s way more than straight teeth. Both aligners and traditional braces are like tools in a tool belt, essentially. So, there are pros and cons to each. Certain types of bites are just better for aligners. I think aligners are really excellent for people who have a high aesthetic demand, perhaps an adult patient that don’t want people to necessarily be so aware that they’re having treatment. In some cases, braces might be better. So, orthodontists go to residency after dental school for an additional two to three years. And that’s to give us the expertise to be able to know and help guide our patients surrounding what their goals are. I would just say, discuss it with someone’s orthodontist and see because there really are a lot of subtleties to it.

– And that really speaks to the way that you treat all of your patients. There is no one-size-fits-all solution, that every patient is individual, and there’s always a conversation. And the parents and the patients are a part of this. When it comes to braces, again, individual by patient, is there a typical length of time that a child will be in braces?

– Right, right. Great question. So, that all varies as well. So, if someone’s having the phase one early care, sometimes treatment can be up to a year or so. If someone’s having comprehensive care, age 12, 13, two years is pretty typical. But it can be a year and a half. It can be four years, even, in some cases. It just depends.

– What can be would you say the most challenging thing for a child with braces?

– Right. So, there are some habit things that we really need to enforce. Good brushing and flossing are always important for anyone, but especially more so with braces on because food can get stuck more easily, plaque can get stuck more easily. So, it can actually make someone more susceptible to getting cavities and gum problems if the good habits aren’t already there. Other things are food; so sticky, chewy food, toffee, taffy, corn on the cob, gum. Things like that, we really have to put a pause on during orthodontic treatment because we don’t want to break anything or bend anything. And then it requires additional time in treatment to recover from that.

– Right, and so your work extends way beyond the regular braces. Tell me about the work that you do there.

– Oh, thank you. Yes, so I’m with the cleft-craniofacial team at Children’s Hospital of Pittsburgh. So, we work with a comprehensive team treating children who have birth differences with their face related to cleft lip and palate, other facial differences, car accidents, things like that. So, we work with a team of speech therapists, surgeons, social support services, and many more. So, the concept is that instead of the child having to seek care separately on multiple different visits, we’re all in one spot to treat, treat all of their needs.

– And so, how did you, how did you choose? Did you know starting school this is where you wanted to end up? Walk me through your path of how you ended up there.

– In undergraduate, I knew I wanted to be an orthodontist. I spent, it was one afternoon with an orthodontist, and he just seemed like he was having a lot of fun with his patients, joking around and everything. And seeing the results was really cool. And then, again, it was one single day in dental school I was with a pediatric dental faculty member, and we had a rotation with the cleft team. And just seeing some of the patients and how grateful they were, seeing just the the level of care provided, it was just really inspirational. I was in private practice for several years, and then I decided to go back to school for specific training.

– What’s it like to work in a place like Children’s?

– It’s great. It’s such a positive environment. It’s just fun. I think orthodontists, we do see younger children, but with the Cleft-Craniofacial center, we see, some of our patients are 1 week old. So, it’s really rewarding to see them grow and the families grow throughout their whole lifespan.

– What would you say is the best thing about your job? What’s a good day on the job?

– Often, when patients get done with treatment, they’re just very grateful. They’re very relieved to be done with the course of care. They’re very grateful. So, all of the little notes and things that we get over the years, I definitely keep those. I really enjoy working with my orthodontic team and the relationships I have with them. I’d like to specifically thank them during this time because they really, we couldn’t do it without them. They really render a lot of the care under our guidance. And also, just being in academics, I get to travel and teach. So that’s, that’s pretty exciting for me.

– The whole idea of the population that you’re working with are children. Do you think that it just in general makes everybody happier there?

– I think so, right. Kids are so honest. Just some of the things they say sometimes cracks you up, and it’s just fun. I feel like it, it makes you younger to work with younger people.

– Yeah. And so, to wrap up, what do you say to parents about things they should be thinking about and when it really is time to see if your child should get braces?

– So, first things first. By the time a child has even their first baby teeth, that’s the time to start seeing a pediatric dentist or family dentist and see them every six months to make sure that any basic dental health things are taken care of. And then, again, age 7 most orthodontists will do a complimentary exam to ensure that there aren’t any early care needs.

– Yeah. Well, Dr. Lindsay Schuster, we thank you so much. Thank you for coming in and spending time with us today. Some great information. Thank you for your time.

– Appreciate it; thank you.

– I’m Tonia Caruso. Thank you for joining us. This is UPMC HealthBeat.

About UPMC

Headquartered in Pittsburgh, UPMC is a world-renowned health care provider and insurer. We operate 40 hospitals and 800 doctors’ offices and outpatient centers, with locations throughout Pennsylvania, Maryland, New York, West Virginia, and internationally. We employ 4,900 physicians, and we are leaders in clinical care, groundbreaking research, and treatment breakthroughs. U.S. News & World Report consistently ranks UPMC Presbyterian Shadyside as one of the nation’s best hospitals in many specialties and ranks UPMC Children’s Hospital of Pittsburgh on its Honor Roll of America’s Best Children’s Hospitals. We are dedicated to providing Life Changing Medicine to our communities.