smile solutions.com and today we're going to talk about when is the right age to start phase one
treatment and how many teeth need to be erupted in order to have an adequate outcome and not have a
lot of time while you're waiting for teeth to come in so let's go ahead and I have a ton of videos
on phase one treatment of course I have I think over 200 videos I even have a 13 hour phase one
course so all of this is already covered within the course and within the existing videos I have
I just wanted to succinctly go over the specific age about how many teeth should be erupted and
also the age so let's recap first what is the goal of phase one because if you know the goal of phase
one this helps give you some guidance on timing and I think it's wonderful that patients come in
or parents come in and maybe the kid is five or six or even seven maybe only have three permanent
teeth in front ones and maybe some molars in the back and they're like hey I want to get
started and that is amazing and I don't want you to lose that start and I don't want you to lose
that enthusiasm but this is what I would tell a patient and a parent in this situation first
of all remember there's three different ages each patient has three different ages right and I have
a video about this if you want to learn more you can go into my YouTube channel and look up age by
keyword and it should pop up so remember there's a skeletal age a chronological age and a dental age
right patient might be 7 years 10 months that's their chronological age that's what their birth
certificate says that's one age that's one factor okay other thing I'd like to keep in
mind is what grade they're in because there's certain grades when starting Ortho treatment
you don't want to be the first one in your class to start it you want to be the fifth
or the sixth or the third or the seventh I never ever ever want them to be the first in
their class or the first family member that they know because if you have a first grade
teacher they're usually not equipped to handle things like this even second is not really a quit
third good age fourth good age fifth is getting a little old for phase one so second is a maybe
I usually like to ask do I show them pictures of like what an expander looks like be it fixed
or removable a lot of times they don't know and I say does anyone have in your class have like
a retainer or something that they take in and out or something that's in their mouth you know
that they wear and maybe or maybe they have some braces or maybe they have colors and usually the
sometimes the parents know but usually the kids like oh yeah you know Sally has it and Sarah has
it and Brandon has it and you know we don't want to be the first one because it is something new
and it is a little stressful and there's some responsibility and there's food rules and if
the teacher is not already trained and equipped and a first or second grade teacher may not be
a third and fourth usually they have tons of things going on in their class fourth of wise
they already know what happens if something gets loose or what the rules are and things like that
um remind the P you know that the patients to put their appliances back in if they're removable I
know when my daughter had expanders I believe she was either in second or third and I remember I was
able to email the teacher and just say hey I'm gonna let you know that you know Olivia's gonna
have some removable expanders um they need to be in her mouth all the time obviously it's not
the teacher's job to enforce that but you know if they're playing with them or something like
that or if they're talking funny or if they seem hesitant to give a speech it's important that the
teacher is aware of that because that is might affect their academic performance especially
if they're the first person in their class to get it I think you get the point so that's one
thing I can keep in mind I like to focus on grades that's an important time or if you're
going to get started during the summer we want to make sure they're not going to summer camp or
anything like that that's not a good time to go to daycare summer camp we really want things to
be consistent have a consistent schedule and not have a lot of variables going on in the patient's
psychosocial life okay so that's one factor um so that is has to do with grades that's also
has to do with chronological age the other thing we got to keep in mind is there's a skeletal age
and certainly if this was a very mature girl and some girls are fully grown by age eight well we
need the hustle with expansion because things that bones are bone related need to be done before they
finish growing so that case it really incentivizes me to get started earlier on this patient because
I'm gonna have a better outcome if they haven't finished growing and remember even though they're
eight they might be done growing you're probably going to have some idea when you see this girl
they might be five foot three or five foot four you know really big as compared to an average
third grader you know but that gives me more incentive to maybe start them in second grade
because they're more physically mature now emotionally mature is a whole other thing
I've had very very little luck with boys in first and second grade and even third better and fourth
they're just not emotionally ready for this for the most part now if they come into the office
they sit in the chair they have perfect hygiene mommy's not having to tell them to do things to
listen to sit to do this do that they're excited they're asking for it you know five people in my
class have them they seem mature they seem like they're following commands and they're not crying
up or tearing up I do not do phase one on any patients that are crying in my chair that's a no
so and it's usually the boys so um if they're not emotionally ready for this we're not going
to force it on them this is not required phase one is a benefit phase one is a something to
help the patient so that phase two will be easier later that life will be easier later we'll get a
better outcome it'll be less complicated but if they're emotionally immature if they're emotional
intelligence is low for their age for their for their chronological age then it's a no will we
recall in six months until it seems like they're ready it's fine especially in boys it's really
not that urgent it just might mean the phase two it gets more complicated but you know what that's
not something I'm gonna put my staff through and I'm never gonna put a kid out through this
because it's never that much in an emergency it really just isn't I mean it's Ortho come on
um okay so all things to keep in mind Scuttle age chronological age grade as well as psychosocial
age emotional um maturity everything like that there's a lot of things I keep in mind how excited
are the parents is only the parents excited or is the kids super excited is only the kid excited or
is the parents not excited you know everyone needs to be super on board for me to consider doing
a phase one treatment on a second or third or fourth grader otherwise it's a no okay so that's
one thing to keep in mind now let's that's things that I can't control now let's talk about um also
how many teeth are in the reason why remember the goal of phase one is to fix the light we're going
to fix the transverse we're gonna get the byte integrated we're gonna grow Jaws as needed either
upper jaw or the lower jaw if needed if there's a sagittal issue or an AP issue we're also going to
fix the vertical if there's a or a habit if there's an open bite um or if there's mouth
breathing or if there's tongue thrusting we're gonna fix that there's a thumb sucking habit we're
gonna fix that we're gonna fix if there's Deep by cases we're going to open the bite if there's open
bite cases we're going to close the bite basically our goal is to make a perfect bite in all the
different planes of space as well as needed straight front teeth if needed you know obviously
if they're super crowded that means the Arches are constricted so we're gonna make the Arches
be the right size it's always a nice bonus if you straighten the front teeth too although it's not
that's quasi cosmetic at times now of course if you had crooked front teeth then they were spaced
out and after expansion they were blocking the eruption of the upper threes six and 11 well then
we need to consolidate the spaces and straighten them so there's a there's a health reason for that
so you got to figure out what is your goal of treatment always the goal is to fix the
bite eliminate habits and fix the bite into all the different plates of space straightening the
front teeth may or may not be the goal it might be a cosmetic thing if finances are an issue and
it's just a cosmetic thing that can be fixed in phase two maybe you're going to leave the crowding
but you need to make sure that the parents understand because I can't tell you how many times
it really wasn't necessary to put braces on it would have been an extra four to six months
um which is a tiny little crooked tooth on the bottom wasn't the health reason wasn't blocking
any canines and I'm like okay we're done with phase one we fixed the bite yay and all the
different planes of space and they're like where's my braces so you want to make sure that they know
so sometimes I'll even in these situations especially if it's not an insurance case
I'll say hey this is our goal phase one is to fix the bite and get you out of trouble you know with
bite issues with teeth issues um so that means we're going to do this Appliance we're gonna do
upper braces but we're not necessarily going to do lower braces are you cool with that sometimes
we're going to charge a little extra if they want cosmetic things if it's not Insurance case
if it's an insurance case you pretty much gotta I mean you gotta do whatever they want because
we don't want them complaining even if it's not necessary and could be done in phase two we just
want to make sure everybody's on the same page with what the goal is so for that reason since
most of the time it does involve either braces on top and bottom front teeth or Invisalign first or
phase one clear aligners you need to time things accordingly so that after we've fixed the bite
whether we had expanders or twin blocks or um I don't know bionators or whatever we're using to
fix by you know protraction face mask whatever we're using to fix the bite once we've done
that portion we're ready to put those eight front braces on and if all the teeth aren't
in at that point now we're just Dilly dallying we're we're wasting time for six months a year
this is this is where you get burnout so that's why we want it to consolidate it into the most
compact succinct timing so that everything's happening at the right time and it's just
streamlined we don't want this phase one to be going on two two and a half three years
that's a complete waste of everyone's time and a complete waste of chair time and overhead for you
patient parents gonna be like when are we done they get burnt out in phase one after one year you
really got to try to keep your phase once to less than a year if possible you know and there's no
reason you can't as long as you're timing things correctly now occasionally you're gonna have a
really complex phase one with habits and other stuff you know maybe they need ENT surgery I mean
it might take a little bit longer major trauma major growth issues okay that might take a little
bit longer or maybe we have to start things early just because skeletally they're it's a girl and
she's about to finish puberty so we have to hustle but maybe sometimes you get these girls that are
eight and and they're almost done growing but they have four permanent teeth then so I mean timing is
off so in this case it might be a two year because we got to get started with the expansion and the
growth modification component and we can do the phase one braces part after and there might be
a little delay it gets a little messy though when you do that with insurance when you don't when you
have nothing going on so that's why I just wanted to bring up the whole timing thing and you know
it doesn't always work out perfectly but yeah so these are all things so that for that reason if
I have my ways everything needs to align in terms of the timing the skeletal age the chronological
age the grade the psychosocial age the emotional maturity as well as I like to have at least six
to eight front teeth in before I get started as well as the first molders need to be fully fully
erupted my I prefer if I'm gonna do fix to ban the E's which is your your a your J your K and your T
it just is way more comfortable if you try to ban the sixes or you're three you're 14 excuse me your
um your 3 or 14 you're 19 and you're 31 you can see I'm thinking with ortho brain and not general
dentist American brain but uh it's really Pinchy to try to bend those so I don't recommend that but
if you wait too long You Can't Ban your a or J and all that because they're going to start getting
loose during treatment so timing is really really critical if you do that then you might as well I
don't know as soon as I just do removable in that case but yeah keep all those things in mind so
that everything could just be streamlined boom bang bang do the growth modification component
um or fix the bite and then boom go straight on to your two by fours which should only take a few
months if you already created enough space pull baby teeth as needed and then go into some type of
retention as needed and you're done less than one year that's the ultimate goal all right thanks so
much and just to oh one other tip if you have one of those parents that's just like desperate to get
started and occasionally you have someone there like my kids getting teased I really really really
really really want to get started you know and it seems like they're emotionally ready if maybe it's
a girl we need to get started a little earlier not too many teeth are in you can always start with
something and I call this pre-phase one therapy and you don't even have to officially start phase
one you could just do fees pre-phase one therapy um usually I charge between 300 and 500 I don't go
through insurance for this I kind of made up that term but I know a lot of other people are doing it
um you could build phase one and get started but now it's a two to two and a half year
thing and I just feel like sometimes it's a huge commitment especially if they're non-compliant
it gets really messy at that point so the previous phase one therapy there's three
companies that offer this that I know of there might be more um there there's Healthy Start
by orthotine you can get a habit corrector it's a good Appliance to get started with
um I like to use that for six to 12 months in these early mix dentition cases and then move
on to my expanders and my growth modification appliances that are worth 24 7 because you can't
wear something like a healthy start to school it's not going to work it's a one piece they can't talk
with it and it's just not realistic it's like wearing a bionator to school I had a friend who
wore one of those in I don't know why she was in seventh grade wearing it now that I think about it
because I know she was already done growing at the time it makes zero sense now that I think about it
but the poor thing she had to wear this bionator to school you probably have heard me tell stories
um all the time um in school and you know she'd have to take it out every time she had to talk
in class it was nasty you would sit on the desk right next door and I was like 12 or 13 and I was
like what the heck this is disgusting it really left quite an impression on me so um and by the
way her I still a friend of mine over just still there didn't get fixed of course because she was
done growing I could have told you that wasn't gonna work but um yeah that's not gonna happen
that's not gonna work that was terrible timing in terms of whoever created that treatment plan
um but yeah it's not gonna happen you know they're not gonna wear one piece appliances at school in
seventh grade or sixth grade or fifth grader maybe in second grade because they might think it's
fun but I mean it's probably not gonna happen so stick with two-piece appliances that they
can easily take in and out that they could easily navigate and talk and if they're looking hesitant
in the chair to wear appliances at school that are removable when they're not gonna wear them
I I have kids they're not going to wear them they're just going to come out of their mouth
that they're just going to go back in on the bus on the way home and then it's not going to
work because they're not wearing them as directed and the parents are not gonna know so and they're
going to wonder why you're getting a bad outcome well because you picked the wrong Appliance for
this patient or you time the timing wrong so let's keep these things all in mind as you're picking
the treatment plan um making sure that Appliance works for the patient I like to when I describe it
and show them what it looks like I like to have samples that they could touch and feel you can
call your lab and you can order sample appliances you know you can just send one demo they have all
kind of demo models you know that they can make on Old Scan they can make things off and say Hey
I want an example of a fixed expander a Schwartz a twin block a bionator I mean whatever the most
sagittal whatever the most common appliances that you use um and you need to have ones that sounds
sometimes there's ones that maybe people returned or never picked up um that they can send you they
shouldn't hopefully charge you full price if you're making a whole bunch of ones I mean
I've had really good deals that I've made with different labs and at one point I had samples
of everything you know in a little kit with my name on it and even cooler if you could make
all different colors and things so that they get really inspired if you make them all pink it just
there's no motivation so because I mean their eyes will light up they'll be like oh that's tie-dye
that's so cool this has glitter that's so cool you know this has my team decal they get really really
motivated we want when we show them the appliance for their eyes to light up and for them to be
super excited both the patient I want to be like Christmas day you know like they open the present
and they look excited about wearing this if they're not lighting up and if Mom's not lighting
up it's not a good fit so just things to keep in mind don't force the trip all right thanks so much