A question had been raised in a forum for dentistry and orthodontics – “Almost every teenager seems to be walking around with braces. Is this medically necessary or is it for other reasons?” In the forum, experts answer health questions from readers on a weekly basis. This question had been answered by Dental professionals at Phoenix Dental and by Sjoerd Henneman of the Dutch Association of Orthodontists (NVvO).
“If there are medical reasons for having braces fitted, that’s fine. But given the large scale at which children go to the orthodontist, I suspect there are also cosmetic reasons for this.”
In the past, there were fewer children with braces. Parents feel that the procedure is costly and doesn’t really correct any major health issues. So today, with more and more children and teens wearing braces, the question arises – is it really necessary?
“No one dies from crooked teeth or any other orthodontic defect”, admits Sjoerd Henneman, orthodontist, and chairman of the Dutch Association of Orthodontists (NVvO). But the ‘need’ for braces depends on several factors, not least the wishes of the wearer or their parents, he says.
Braces are not medically necessary
According to Henneman, the percentage of children who wear braces for a while until they are eighteen is about 45 percent. He thinks this is advisable for the vast majority of these young people. Henneman estimates that one in ten braces wearers in his practice wear them without a medical reason, ie for reasons of beauty. But according to him, psychological well-being also belongs to health.
After all, professor of general dentistry Albert Feilzer thinks the reader has a point. According to him, the aesthetic reason for getting braces plays an important role for many children and parents, but that does not necessarily make braces unnecessary. Because according to Feilzer, psychological well-being is part of health and braces can therefore also be considered a medical necessity.
NVvO chairman Henneman thinks that the difficulty of the discussion lies in the term ‘medical necessity. The basic insurance only covers extreme oral abnormalities, such as missing teeth, or when someone breaks the palate with his/her bite. But for less extreme cases, braces can still help. As an example, he mentions someone who has a large overbite where the upper teeth fall over the lower lip. Then the person runs an above-average risk of damage in the event of a fall from the bicycle, and even eating an apple is time-consuming. Braces may not be medically necessary, but the braces do make it more comfortable.
An overbite can also be treated with braces as long as a child is growing. At a later age, according to Henneman, something as drastic as jaw surgery is needed for this. And even if the teeth are only slightly crooked, braces can be desirable: to prevent tooth wear, or to better deal with any later problems, simply because the foundations are already in place.
The patient remains in charge
But if someone prefers a ‘more authentic face’, he/she is of course free not to opt for braces, says professor Feilzer. “Orthodontists try to propose an appropriate, scientifically based treatment, but the patient is always in charge”.
Sjoerd Henneman advises parents who want to make a critical assessment for their children to ask the orthodontist for information. He or she can estimate the risk of problems if the child in question does not wear braces now. Everyone has to decide for themselves whether they think the chance is worth the 1,800 to 2,500 euros.
According to Henneman, many people want braces themselves. They come to the orthodontist themselves, whether that is for functional or cosmetic reasons. And above all: changing the teeth will only be a success if someone wants to. Because it’s also a bit of a stretch.