Ten-year-old Richard Stewart had been irritable and quarrelsome for almost a year.
His grades had gone steadily downhill, and he had stopped bringing friends and classmates home from school.

Mr. and Mrs. Stewart were puzzled and concerned.
Then one day Dick's classmate Jimmy, from next door, let the cat out of the bag.
The youngsters in the boys' class had nicknamed Dick "Bugs Bunny" because his teeth protruded.

When Richard's parents told him they wanted to take him to an orthodontist -- a dentist who specializes in realigning teeth and jaws -- their young son was interested.
During the year that followed, Dick co-operated whole-heartedly with the dentist and was delighted with the final result achieved -- an upper row of strong straight teeth that completely changed his facial appearance.

Richard Stewart is no special case.
"The majority of children in the United States could benefit by some form of orthodontic treatment", says Dr. Allan G. Brodie, professor and head of the department of orthodontics at the University of Illinois and a nationally recognized authority in his field.

What do parents need to know about those "years of the braces" in order not to waste a child's time and their money?
How can they tell whether a child needs orthodontic treatment?
Why and when should tooth-straightening be undertaken?
What is it likely to cost?

Tooth fit explained

occlusion is the dentist's expression for the way teeth fit together when the jaws are closed.
Malocclusion, or a bad fit, is what parents need to look out for.
One main type of malocclusion is characterized by a receding chin and protruding upper front teeth.
A chin too prominent in relation to the rest of the face, a thrusting forward of the lower front teeth, an overdeveloped lower jawbone, and an underdeveloped upper jaw indicate the opposite type of malocclusion.

These two basic malformations have, of course, many variations.
A child probably requires some form of treatment if he has any of the following conditions:
A noticeable protrusion of the upper or lower jaw.

Crooked, overlapping, twisted, or widely spaced teeth.

Front teeth not meeting when the back teeth close.

Upper teeth completely covering the lowers when the back teeth close.

The eyeteeth (third from the middle on top, counting each front tooth as the first) beginning to protrude like fangs.

Second teeth that have come in before the first ones have fallen out, making a double row.

Contrary to the thinking of 30 to 40 years ago, when all malocclusion was blamed on some unfortunate habit, recent studies show that most tooth irregularity has at least its beginning in hereditary predisposition.
However, this does not mean that a child's teeth or jaws must necessarily resemble those of someone in his family.

Tooth deformity may be the result of excessive thumb- or finger-sucking, tongue-thrusting, or lip-sucking -- but it's important to remember that there's a difference between normal and excessive sucking habits.
It's perfectly normal for babies to suck their thumbs, and no mother need worry if a child continues this habit until he is two or three years old.
Occasional sucking up to the fifth year may not affect a youngster's teeth;
but after that, if thumb-sucking pressure is frequent, it will have an effect.

Malocclusion can also result if baby teeth are lost too soon or retained too long.
If a child loses a molar at the age of two, the adjoining teeth may shift toward the empty space, thus narrowing the place intended for the permanent ones and producing a jumble.
If baby teeth are retained too long, the incoming second teeth may be prevented from emerging at the normal time or may have to erupt in the wrong place.

Correction can save teeth

every orthodontist sees children who are embarrassed by their malformed teeth.
Some such youngsters rarely smile, or they try to speak with the mouth closed.
In certain cases, as in Dick Stewart's, a child's personality is affected.
Yet from the dentist's point of view, bad-fitting teeth should be corrected for physical reasons.

Bad alignment may result in early loss of teeth through a breakdown of the bony structure that supports their roots.
This serious condition, popularly known as pyorrhea, is one of the chief causes of tooth loss in adults.

Then, too, misplaced or jammed-together teeth are prone to trapping food particles, increasing the likelihood of rapid decay.
"For these and other reasons", says Dr. Brodie, "orthodontics can prolong the life of teeth".

The failure of teeth to fit together when closed interferes with normal chewing, so that a child may swallow food whole and put a burden on his digestive system.
Because of these chewing troubles, a child may avoid certain foods he needs for adequate nutrition.
Badly placed teeth can also cause such a speech handicap as lisping.

The when and how of straightening

"most orthodontic work is done on children between the ages of 10 and 14, though there have been patients as young as two and as old as 55", says Dr. Brodie.

In the period from 10 to 14 the permanent set of teeth is usually completed, yet the continuing growth of bony tissue makes moving badly placed teeth comparatively easy.
Orthodontic work is possible because teeth are held firmly but not rigidly, by a system of peridontal membrane with an involved nerve network, to the bone in the jaw;
they are not anchored directly to the bone.
Abnormal pressure, applied over a period of time, produces a change in the bony deposit, so a tooth functions normally in the new position into which it has been guided.

What can 10-year-old Susan expect when she enters the orthodontist's office?
On her first visit the orthodontist will take x-rays, photographs, tooth measurements, and "tooth prints" -- an impression of the mouth that permits him to study her teeth and jaws.

If he decides to proceed, he will custom-make for Susie an appliance consisting of bands, plastic plates, fine wires, and tiny springs.
This appliance will exert a gentle and continuous or intermittent pressure on the bone.
As the tooth moves, bone cells on the pressure side of it will dissolve, and new ones will form on the side from which the tooth has moved.
This must be done at the rate at which new bony tissue grows, and no faster.

"If teeth are moved too rapidly, serious injury can be done to their roots as well as to the surrounding bone holding them in place", explains Dr. Brodie.
"Moving one or two teeth can affect the whole system, and an ill-conceived plan of treatment can disrupt the growth pattern of a child's face".

During the first few days of wearing the appliance and immediately following each adjustment, Susan may have a slight discomfort or soreness, but after a short time this will disappear.
Parents are often concerned that orthodontic appliances may cause teeth to decay.
When in place, a well-cemented band actually protects the part of the tooth that is covered.

Next Susie will enter the treatment stage and visit the orthodontist once or twice a month, depending on the severity of her condition.
During these visits the dentist will adjust the braces to increase the pressure on her teeth.

Last comes the retention stage.
Susie's teeth have now been guided into a desirable new position.
But because teeth sometimes may drift back to their original position, a retaining appliance is used to lock them in place.
Usually this is a thin band of wire attached to the molars and stretching across the teeth.
Susie may wear this only at night or for a few hours during the day.

Then comes the time when the last wire is removed and Susie walks out a healthier and more attractive girl than when she first went to the orthodontist.

How long will this take?
Straightening one tooth that has come in wrong may take only a few months.
Aligning all the teeth may take a year or more.
An added complication such as a malformed jaw may take two or three years to correct.

What is the cost?

The charge for a complete full-banded job differs in various parts of the country.
Work that might cost $500 to $750 in the South could cost $750 to $1,200 in New York City or Chicago.
An average national figure for two to three years of treatment would be $650 to $1,000.

"Factors in the cost of treatment are the length of time involved and the skill and education of the practitioner", says Dr. Brodie.

To become an orthodontist, a man must first be licensed by his state as a dentist, then he must spend at least two years in additional training to acquire a license as a specialist.

"Costs may seem high, but they used to be even higher", says Dr. Brodie.
"Fees are about half to a third of what they were 25 years ago".

The reason?
People today are aware of the value of orthodontics, and as a result there are more practitioners in the field.

Most orthodontists require an initial payment to cover the cost of diagnostic materials and construction of the appliances, but usually the remainder of the cost may be spread over a period of months or years.
In many cities in the United States clinics associated with dental schools will take patients at a nominal fee.
Some municipal agencies will pay for orthodontic treatment for children of needy parents.

Research helps families

growth studies have been carried on consistently by orthodontists.
Dr. Brodie has 30-year records of head growth, started 20 minutes after children's births.

"In the past anyone who said that 90% of all malocclusion is hereditary was scoffed at;
now we know that family characteristics do affect tooth formation to a large extent", he says.
"Fortunately through our growth studies we have been able to see what nature does, and that helps us know what we can do".

This knowledge both modifies and dictates diagnosis and treatment.
For example, a boy may inherit a small jaw from one ancestor and large teeth from another.
In the past an orthodontist might have tried, over four or five years, to straighten and fit the boy's large teeth into a jaw that, despite some growth, would never accommodate them.
Now a dentist can recommend extraction immediately.

In other cases, in view of present-day knowledge of head growth, orthodontists will recommend waiting four or five years before treatment.
The child is kept on call, and the orthodontist watches the growth.
"Nature often takes care of the problem", says Dr. Brodie.
"A child with a certain type of head and teeth will outgrow tooth deformity".

That is why Dr. Brodie asks parents not to insist, against their dentist's advice, that their child have orthodontic work done too early.
"Both because of our culture's stress on beauty and our improved economic conditions, some parents demand that the dentist try to correct a problem before it is wise to do so.
Let the orthodontist decide the proper time to start treatment", he urges.

Superior new material for orthodontic work is another result of research.
Plastics are easier to handle than the vulcanized rubber formerly used, and they save time and money.
Plaster of Paris, once utilized in making impressions of teeth, has been replaced by alginates (gelatin-like material) that work quickly and accurately and with least discomfort to a child.

Prevention is best

as a rule, the earlier general dental treatment is started, the less expensive and more satisfactory it is likely to be.

"After your child's baby teeth are all in -- usually at the age of two and one half to three -- it's time for that first dental appointment", Dr. Brodie advises.
"Then see that your youngster has a routine checkup once a year".

To help prevent orthodontic problems from arising, your dentist can do these things:
He can correct decay, thus preventing early loss of teeth.
If a child does lose his first teeth prematurely because of decay -- and if no preventive steps are taken -- the other teeth may shift out of position, become overcrowded and malformed.
In turn the other teeth are likely to decay because food particles may become impacted in them.