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