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The ABCs of Braces

Portrait of girl in braces smiling, close up, close-up, portrait
Photograph by Getty Images

The Tooth Fairy may leave a few bucks for your child, but if she were a really good fairy, she’d leave a few thousand bucks for parents, who may soon be paying for braces. Next to college, orthodontic treatment may be one of the biggest expenses you’ll face; here’s what you need to know.

Who needs braces?

In many cases, it’s clear from a child’s jack-o'-lantern smile that braces are a must. But only an orthodontist will be able to spot bite or jaw issues that require treatment, says Dr. John F. Buzzatto, president of the American Association of Orthodontists (AAO) and a practicing orthodontist in the Pittsburgh area.

Bite or jaw issues "can include protrusive teeth [aka overbites] and ‘underbites’ [the lower jaw and/or teeth are forward of the upper teeth/jaw],” says Dr. Gayle Glenn, president-elect of the AAO and an orthodontist in Dallas. Other problems orthodontics can fix include narrow palates, recessive lower jaws and open bites (when back teeth are closed, there is a gap between the top and bottom teeth).

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Ignoring these problems can lead to short- and long-term dental problems, including uneven wear and a greater risk for tooth fractures, she explains. “It can also create difficulties in biting, chewing and speaking. And there can be psychosocial consequences for children who are teased about the appearance of their teeth.”

At what age should treatment start?

You’re never too old to get braces, but most kids are 9 to 14 when they start orthodontic treatment, says Buzzatto. But don’t wait until they’ve lost their last baby teeth to be evaluated by an orthodontist; in fact, the AAO recommends that children be evaluated by an orthodontist by age 7.

“There are 7- and 8-year-olds who require early treatment, because there are things an orthodontist can do to minimize problems,” he says. “For instance, if you can break thumb-sucking and finger habits (such as nail biting) when kids are 7 or 8, the bite will spontaneously correct itself in many cases. Early interventions start at $200 and can save you money later.”

Another reason to take action early is that “you are working with children who are still growing, so they are [physiologically] more responsive to treatment,” Buzzatto says.

What does treatment entail?

There are two components of braces: brackets or bands, which are attached directly to teeth, and wires, which are threaded through the brackets. The orthodontist will adjust the wires, and that is what moves teeth to the new position. Rubber bands or headgear may be a part of treatment.

“Some problems may be improved within six to nine months,” says Glenn. “But comprehensive treatment is usually about 18 to 24 months.” More complicated treatments take longer. “In my practice, the patient whose treatment lasted the longest was 42 months,” she says.

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What kids need to do

Another issue affecting length of treatment is how cooperative children are. “Orthodontic treatment can be prolonged if the patient fails to follow the orthodontist’s instructions,” says Glenn. “It’s important for patients to brush and floss as instructed—and to see their dentists for checkups and professional cleanings at least every six months during active treatment.”

This also means avoiding eating anything “hard, sticky, crunchy or chewy,” she says. “If a bracket comes loose, the wire attached to the bracket cannot deliver the force necessary to move that tooth. Movement comes to a standstill until that bracket is re-attached.”

Kids wearing braces can still participate in normal childhood activities, including sports, says Glenn. Often, though, an orthodontist will recommend a mouth guard be worn to protect teeth and braces.

How to find an orthodontist

You can search for an orthodontist in your area at the AAO’s website, mylifemysmile.org. Many parents also rely on personal recommendations when choosing a practitioner. And parents stress it’s also important to take location into consideration; you’ll have numerous office appointments during the course of treatment, so you’ll want to minimize travel time.

How much it costs

The average fee, depending on treatment and the region of the country is $5,000 to $6,000, estimates Buzzatto. “In urban areas, it’s going to be in the higher end of the range.”

Most orthodontists will describe what treatment entails and the costs up front, Buzzatto says. Usually the fee will cover study models, X-rays, treatment fees and retainers. “The orthodontist will let you know if there are additional costs, like tooth extraction or periodontal (gum) treatment or jaw surgery. But you should always ask if there will be any other costs."

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How to make it more affordable

You can keep costs down by sticking to stainless-steel braces, which are usually the least expensive, says Glenn. Tooth-colored brackets, gold-colored braces and clear aligners may carry a higher price tag. Let your orthodontist know you’re on budget, so you can work together to keep costs down.

“Most orthodontists offer a variety of payment plans so that the family budget can accommodate orthodontic treatment,” she says. “Some require a down payment, with the remainder amortized over the estimated treatment time—and often with no interest charged. Other payment plans are done through outside finance companies.” Check the small print, however, to make sure you don’t end up paying much more due to high interest rates.

If you have dental insurance, it may cover part of the cost for orthodontic treatment. You may also want to set up a Medical Flexible Spending Account, which allows you to pay for treatment with your dollars before taxes.

Where to go for discounted treatment

Glenn recommends these programs for lower-cost or pro bono treatment:

Orthodontic residency programs offer lower-cost treatment.

Two nonprofits, Smiles Change Lives and Smile for a Lifetime Foundation, match people in need of treatment with orthodontists.

An American Association of Orthodontists program called Donated Orthodontic Services provides pro bono service in Illinois, Indiana, Kansas, New Jersey and Rhode Island. Call 866-572-9390 for eligibility information.

A similar program called Advantage Smiles for Kids is available in Washington, Oregon and Idaho, while KIND (Kids in Need of Dentistry) Smiles helps residents in Colorado.

“School nurses can be good resources as well, regarding programs and providers who may be able to offer assistance,” says Glenn.

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