Yes, orthodontics is about achieving straight teeth and a beautiful smile, but there’s so much more to it than that, as orthodontist Dr Catherine Lee can attest. A set of strong, healthy, properly functioning teeth is the basis not only of an attractive appearance, but also of optimal physical health and emotional wellbeing. In her varied career, Dr Lee works with children and adults of all ages and with a wide range of orthodontic needs, including philanthropic work among underprivileged “cleft” children in remote parts of Indonesia. Read on to find out more.
When should parents bring their children to an orthodontist for initial orthodontic assessment?
No later than the age of seven is the recommendation of the American Association of Orthodontists. This applies to all children, because even apparently straight teeth may not be properly functional. For example, the child may have a “bad bite”, or occlusion. In this Phase 1 stage, the orthodontist will detect and evaluate any problems, advise whether treatment will be necessary, and determine the best time for treatment.
The first permanent molars and incisors have usually come in by then, and cross-bites, crowding and injury-prone dental protrusions can be evaluated. Any other oral habits such as thumb-sucking or finger-sucking can also be assessed at this time.
Why is early treatment advantageous?
It’s all about working with the child’s growth: orthodontic treatment and a child’s growth can complement each other. For example, a common orthodontic problem is when the upper front teeth protrude ahead of the lower ones, often due to the lower jaw being shorter than the upper jaw. While the upper and lower jaws are still growing, orthodontic appliances can be used to help the growth of the lower jaw catch up to that of the upper jaw.
We can treat a severe discrepancy in jaw length quite well in a growing child. But if left untreated until the jaws have stopped growing, or are growing only slowly, he or she might very well require corrective surgery. Children who may have problems with the width or length of their jaws should be evaluated for treatment no later than age 10 for girls and age 12 for boys.
Can you tell us more about jaw-growth problems?
Correcting jaw-growth problems is called dento-facial orthopaedics. We use various appliances to improve the compatibility of the length of the upper and lower jaws, including:
- a palatal expansion appliance, fitted to the upper back teeth to expand the width of the upper jaw in cases of cross-bite, where the upper jaw is too narrow for the upper teeth to inter-fit properly with the lower teeth;
- orthodontic headgear, an appliance worn from ten to 12 hours a day (overnight) that applies pressure to the upper teeth and jaw to guide the rate and direction of upper jaw growth and upper tooth eruption.
When the time comes for corrective braces, which do you usually recommend?
That depends on the individual and his or her needs and preferences. Although braces are most often prescribed as Phase II treatment for teenagers, it’s interesting to note that over 30 percent of our patients are adult.
Whatever your age, modern orthodontic treatment offers many more options and is more comfortable than it used to be. For example, patients no longer have to undergo the discomfort of messy dental impressions used for making dental moulds; instead, we now use the Itero 3D intra-oral laser scanner, which quickly gives us an accurate image of your gums and teeth.
With the use of advanced technology and materials, and working with the natural forces of your body, we gently guide your teeth to their ideal position.
Fortunately, it’s never too late to correct crooked or crowded teeth. Timeous treatment can help avoid gum disease and early tooth loss, not to mention jaw and facial pain associated with malocclusion (a bad bite). For those who prefer more discreet treatment, technology such as Invisalign is a literally invisible, using a series of aligners that can be taken out when necessary – during teeth-cleaning and eating, for example.
Tell us a little about your work as the Patron and Health Director of the Cleft Care Indonesia Foundation.
We are a non-profit charity organisation in Surabaya, Indonesia, that provides care to underprivileged cleft children. My job as a healthcare adviser is to establish the programmes, work the protocols and ensure that each child is well taken care of.
In a first-world country such as Singapore, treatment can start as soon as the child is born. In the pre-surgery stage, an orthodontist such as myself who has specialised in cleft treatment, helps the surgeon to move the displaced lip, gum and nose tissues into the correct position before the first round of surgery at the age of about three months. This is just the start of the child’s surgical journey, which will continue through to adulthood.
In third-world countries, however, where orthodontists are not available, a healthy baby may receive surgery at the age of three months. But if he or she is sick, malnourished or has any other medical condition such as TB or a heart condition, surgery may be delayed to the age of a year or older, or even never be done at all.
As an estimated 85 to 90 percent of cleft infants are born into the lowest socio-economic level, our core aim is to ensure that the child survives in order to have the necessary surgery. I believe this outreach work is so important that it is well worth taking time off from my busy practice to do it.