The article "Early Orthodontic Treatment: What Are the Imperatives?" by Dr. G. Thomas Kluemper and colleagues (May JADA) plays a vague middle ground in defining if and when early treatment is indicated.
It seems intent on protecting current dogma, while signaling a coming shift—a shift that has been espoused by a growing number of progressive clinicians. A similar shift for similar reasons occurred in the past century, when extractions for orthodontics went from a high of 76 percent in 1968, and declined rapidly to 28 percent in 1993.
It is unreasonable to be vague about early treatment if one can escape from a "tooth moving" mentality into the bone-affecting reality of orthodontics—which in fact is functional jaw orthopedics.
In 1771, Hunter recorded that the anterior part of the dental arch did not increase in size after the emergence of all the deciduous teeth. That would be at about age 2. In 1986, Van der Linden recorded that the mandibular and maxillary structures reach about 80 percent of their ultimate growth by age 6.
So why should we wait until age 7 to recommend a first orthodontic examination? And why should we wait even longer, after over 80 percent of bone growth, to begin orthodontic and orthopedic treatment?
Why? Because it is the dogma. Furthermore, it is this dogma of late active treatment that promotes the need for outdated serial extractions and related "guided" arch collapse. Many cases of serial extractions and related intentional arch collapse could be prevented by early primary dentition treatment.
Fortunately, this dogma too will change, as we further understand the impact and lifelong effects of jaw formation and deformation. Remember, the jaws and related structures form the gateway to the human airway. Only earlier orthodontics and orthopedics can enlarge the airway gateway.
