POS Instructor Dr. Ben Villalon came to POS headquarters for Update 2017 so we took the opportunity to ask him questions about his area of expertise: mixed dentition orthodontics.
Click below to play the video or scroll down to read the full transcript.
GABY CASTILLO: Hi I'm Gaby and we're here today asking Dr. Villalon some questions on mixed-dentition. So how early should we start evaluating and treating patients?
DR. BEN VILLALON: Evaluating can be done as early as 3 or 4, as soon as the baby teeth are in. There are more things to consider in terms of when to start treating, mainly cooperation levels of kids. I think most general dentists are comfortable treating patients beginning at age 8. As a pediatric dentist we start a little bit earlier, but probably somewhere between 3 and 8 is a good range.
GABY: Okay, what kind of cases or what types of cases should you start?
DR. VILLALON: That's an interesting question. I think most people, parents, tend to see crooked teeth at around 6 or 7 and that tends to be the focus of what people want to treat, but actually the crowding that we see early on can be treated preferably in the permanent dentition. So the things that we look for are things that would make treatment in the permanent dentition go smoother for the patient and the family. So usually were looking for little discrepancies, severe class II overbites, severe class III under bites, open bites, which in kids usually is an indicator of some type of habit which needs to get under control as early as possible. And severe deep bites believe it or not can cause many problems in the permanent dentition. So if those can be resolved prior to the permanent dentition than the case is going to go much smoother in phase 2 treatment.
GABY: What do you tell parents when they ask you if their kids need braces?
DR. VILLALON: Yes. Pretty much. There's really, you know, there’s one situation at 3 or 4 years of age that if you see it you can comfortably tell a parent that their child is not gonna need braces. Or I'll typically say I don't see braces in your future. And that's basically when the primary cuspids are in a good class I relationship and you have plenty of spacing throughout the primary dentition called primate space. If you see those 2 things and the bite is not deep or open, then I will actually look at the parent and say I do not see braces in your future. They're usually not asking until the age of 6 but it can be a big confidence builder to give that type of information to the family.
GABY: What steps can doctors take to get better results?
DR. VILLALON: Get more training. I mean that's the easiest answer. The more training you have in orthodontics, the more issues that you see complicate your cases in permanent dentition or in adult treatment, the more you'll start to realize that some of these things could have been prevented and that will make diagnosing and treatment planning in mixed dentition much easier. I think I lot of people think that mixed dentition is a place they want to get started and that might be the easier way to go, but I think it's the other way around. The more permanent dentition treatment you do in orthodontics the better you're able to see the issues that cause problems and then want to get more into mixed dentition because you see the value of preventing those issues.
GABY: What are the risks, if any, involved in mixed dentition?
DR. VILLALON: Very little risk. I think fewer risks than doing permanent dentition treatment or adult treatment. The biggest risk is not getting results due to compliance issues. Many of the appliances that were recommending for kids rely on them being compliant with wearing them and if they don't then the risk is that you get a bad result.
GABY: How do you deal with non-compliant patients?
DR. VILLALON: Well you have to care for the kid in front of you and you have to consider the family situation, how well they're doing in school, do they take the trash out, do they bring good grades home? These are all things that I will talk to parents about before I start making recommendations as to doing early treatment. If they're having issues with compliance in other areas of their lives then this may not be the way to go. You don't have to really do mixed dentition treatment. That's probably one of the misconceptions as people learn more and more orthodontics they feel that they need to do mixed dentition. But in reality it's not the standard of care in the orthodontic community, so if you're gonna do it, you're doing something that a lot of people in your community are not doing. So if you're gonna do it, do it well and pick the right cases. And care about the family that you're treating. That's the best way that the kids are gonna listen and understand what it is you're trying to do.
GABY: What is the most challenging part of mixed dentition treatment?
DR. VILLALON: The most challenging part is getting the cooperation. That's probably the most challenging part. Other than that, if you do have a child that you know is going to cooperate because you're going to recommend some headgear or something that they have to wear at night then sequencing the treatment and deciding what to treat are the other challenges. You don't have to fix it all, there will be a phase 2. The idea is not to prevent them from needing braces in the future but to create a situation where you can get a better result in phase 2. I think sometimes doctors want to try to fix all the problems before they get to phase 2 and it can be overwhelming and this can lead to you know burning out the patient, so to speak, and you can have cooperation problems because of that. So sequencing the treatment in a way that the child can tolerate it well and spreading this out. Phase 1 or mixed dentition treatment typically takes 2 to 4 years. There are no quick fixes and so there's no reason to put all the appliances in the mouth at one time.
GABY: What about the rewards?
DR. VILLALON: The rewards are great. When you get to phase 2 and the family is expecting another 2 years of braces and you can be done in 12 months because the occlusion is good and you're just closing up a few spaces, that's really rewarding.
GABY: Thanks Dr. Villalon. Thanks for answering our questions I hope you enjoyed it.
DR. VILLALON: Yeah, my pleasure.