A Skeptical Parent's Guide to Orthodonture

Don't be shocked if your first-grader is referred to an orthodontist. Here's a glossary of some common appliances and treatments.

Palatal Expander

What It's For: A severe crossbite. Patients whose upper jaw isn't wide enough for the lower jaw.

What It Does: Widens the upper jaw so upper teeth line up better with lower teeth. Also allows teeth to straighten out, with or without braces, keeping more of the adult teeth intact. Expanders are either permanently fixed in the mouth for several months, or they are removable. When turned with a key, a screw in the center of the expander puts gradual outward pressure on the upper jaw's left and right halves, causing more bone to grow between the two halves. Side effects may include pain if turned too aggressively, headache, excess saliva and temporary speech impediments, such as lisps and garbling.

Early Treatment? In some cases. Studies indicate there's a strong argument for early treatment when the desired shift in the jaw is lateral. When the desired shift isn't lateral, treatment can wait until closer to adolescence. Also, in many cases an expander to reduce crowding can wait. Braces may still be needed later; an orthodontist can't know until permanent teeth come in.

Cost: $1,100 to $3,000 (sometimes the fee includes braces if needed later)

Braces

What They're For: An anterior crossbite, when one or more teeth on top are behind teeth on the bottom (an underbite); buck teeth (an overbite); crooked teeth; spacing.

What They Do: Move teeth. Kids with baby teeth who get braces usually get what's called "two by four"—braces on the first permanent molars in the back and the four incisors in the front, resulting in two bands and four brackets. Sometimes additional teeth are included in the braces to give more support for tooth movement.

Early Treatment? In some cases. Studies indicate early treatment with braces is effective for anterior crossbites and helps prevent damage to teeth and supporting structures. But for overbites, early treatment is no more effective than waiting for the adult teeth tocome in and treating all at once. Orthodontists, though, say there may be psychological reasons for treating early.

Cost: $900 to $5,000

Headgear

What It's For: To correct an overbite or buck teeth.

What It Does: Pushes upper teeth back; prevents upper jaw from growing forward by holding upper teeth and jaw while lower jaw grows. It's usually worn 10 to 14 hours a day for one to 12 months.

Early Treatment? Not usually. Studies indicate no measurable benefit from early treatment of this type.

Cost: $2,000 to $4,000

Face Mask

What It's For: A severe anterior crossbite, or underbite with the lower jaw outgrowing the upper jaw

What It Does: Sometimes called a "reverse pull headgear," it pulls the jaw and teeth forward to encourage growth of the upper jaw. It looks a little like a catcher's mask, with a face frame and a head cap that are attached by rubber bands or elastics. It's usually worn 14 to 16 hours a day for 12 to 18 months.

Early Treatment? Yes. There is strong evidence that this can make the jaws more even when used while the patient's jaw is still growing and can help avoid surgery later.

Cost: $2,000 to $4,000

Extraction

What It's For: Severe crowding

What It Does: Serial extraction involves pulling baby teeth to speed up the eruption of permanent teeth, usually the pre-molars, which will ultimately be pulled out as well. It eases the entry of adult teeth and in most cases braces will be needed.

Early Treatment? Yes.

Cost: $200 to $500

Source: Cameron Jolley, WSJ reporting. Prices include care by the orthodontist and cost of appliances