Orthodontic Treatment for Children in Ukraine

The fundamental difference between children's and adults' orthodontics is that a child's jaws are still growing. While the bone is forming, the doctor can influence not only the position of individual teeth but also the width of the palate, the length of the dental arch and how the jaws relate to each other. In adults the same problems can be solved only by moving the teeth or by surgery, so childhood is a window of opportunity that closes with time.

Treatment is most often needed in a few situations. A crossbite, where the lower jaw shifts to the side as the teeth close, is a reason to treat without delay, because asymmetric loading affects growth. A narrow upper jaw with a high palate often goes hand in hand with difficulty breathing through the nose. A pronounced distal bite (Class II malocclusion), where the upper incisors stick out noticeably, raises the risk of injuring them in a fall. Early loss of a baby tooth calls for a space maintainer; otherwise the neighbouring teeth tilt into the gap and the permanent tooth does not have enough room.

It is just as important to know when there is no need to rush. At 7–9 years many children have upper incisors that fan out with a gap between them. This stage is called the "ugly duckling" stage, and it passes on its own when the canines come through. Gaps between baby teeth are also normal: they are needed so that the permanent teeth, which are wider than the baby teeth, fit into the row. Slight unevenness of the incisors in the mixed dentition without functional problems often lessens as the jaws grow, and in that case an appliance would be an unnecessary burden for both the child and the family budget.

The method also has its limits. Removable appliances work only for as long as they are worn, so without the cooperation of both child and parents there will be no result; this is the main reason treatment fails. Where there is a marked skeletal mismatch between the jaws, children's appliances reduce the problem but do not always remove it completely: once growth has finished, treatment with braces may be needed and, in some cases, orthognathic surgery.

MediUkraine is a service that finds and coordinates treatment; it is not a clinic. We find the clinic and a doctor with the right specialism, agree the dates and support your family, including if you are travelling from abroad; our partners include the Vidnova Dental Clinic in Lviv. The diagnosis and treatment approach are decided by the doctor after examining your child in person.

The first orthodontic examination is recommended at around 6–7 years. That is when the first permanent molars and central incisors come through, and the doctor can assess for the first time how the jaws close and whether there will be enough room for the rest of the permanent teeth. This does not mean treatment will start straight away: most children are simply monitored, with a check-up every six months. The point of an early visit is to catch the few conditions where timing really does decide the outcome.

Expansion of the upper jaw is the clearest example of an intervention tied to age. The upper jaw consists of two halves joined by the midpalatal suture; while the suture is still pliable, the appliance separates the bone itself rather than just tilting the teeth. The fixed Hyrax appliance is attached by bands to the molars, and the parents activate the screw in the centre at home with a special key: one quarter turn gives about 0.2 mm, and two quarter turns a day are usually prescribed. The active phase lasts two to four weeks, after which the appliance stays in the mouth for another 4–6 months as a retainer; without this retention phase the jaw narrows again. The gap that appears between the upper central incisors as the suture opens is an expected sign, not a problem: it closes on its own within a few weeks.

Removable plates are made of acrylic from models of the jaws, with a screw, springs, a labial bow or bite planes built in as needed. The screw is activated less often than on the Hyrax, usually once every 7–10 days. What matters most is wearing time: the appliance must be in the mouth 20–22 hours a day and is taken out only for meals and toothbrushing. A plate expands the dental arch and tilts individual teeth well, but it can barely move a tooth bodily or change the relationship between the jaws.

A myofunctional trainer is a ready-made silicone or polyurethane tray in standard sizes, which the child wears for one to two hours during the day and all night. Its job is not to push the teeth mechanically but to train the tongue to rest against the palate, the lips to stay closed and the child to breathe through the nose. The evidence should be stated plainly: systematic reviews of myofunctional appliances rest on small studies with a high risk of bias, so the trainer is regarded as an addition to work on the cause, not a stand-alone replacement for appliance treatment or braces.

In a distal bite, where the lower jaw lags behind and the upper incisors stick out, functional appliances are used: the two-piece Twin Block, the activator, removable appliances with inclined planes. They hold the lower jaw in a forward position and make use of the child's own growth, so they are prescribed during the pubertal growth spurt: in girls this is roughly 10–12 years, in boys 12–14. Timing is based not on the child's age in years but on skeletal maturity, assessed from the cervical vertebrae on the cephalogram or from a hand X-ray.

A reverse overjet, where the lower front teeth overlap the upper ones, calls for even earlier intervention. To bring the upper jaw forward, a face mask resting on the forehead and chin is used together with an expansion appliance. The skeletal response to such treatment is noticeably better while the child is under 8–10 years old; after that the effect increasingly comes down to tilting the teeth, so delay is costly.

No appliance will hold the result if the cause that deformed the bite keeps acting. Constant mouth breathing because of adenoids, enlarged tonsils, a deviated septum or allergic rhinitis changes the position of the tongue and the tone of the facial muscles, so a child with a narrow palate is first referred to an ENT specialist. A short tongue frenulum stops the tongue from rising to the palate; where indicated it is released, and exercises are needed afterwards, otherwise the tongue keeps its habitual position. Sucking a finger or a dummy after the age of three or four creates an open bite, and until the habit is broken the appliance is treating the effect, not the cause.

Early loss of a baby tooth through decay or injury is a separate case. Baby teeth hold the space for the permanent ones, and if a tooth is lost a year or two before its natural time, the neighbouring teeth tilt into the gap. In that case a space maintainer is fitted: a simple fixed device made of a band and a loop, which costs less than creating space later with an appliance or braces.

Braces are a tool for the permanent dentition, so they are fitted once almost all the teeth have changed, usually at 11–13 years; teenagers are also offered aligners if they are willing to wear the aligners for the required number of hours. Whether it is worth treating in two stages, first an appliance at 7–9 years and then braces, has been studied in randomised trials: with protruding upper incisors the early phase above all reduces the risk of injury to those teeth, while the final state of the bite in the two-phase and one-phase groups turned out to be comparable. That is why early treatment is recommended for a specific purpose, not just in case.

There are also things that children's orthodontics does not do. It does not speed up the eruption of teeth, does not change the genetically determined shape of the face and does not automatically spare the child braces in the future. The doctor gives a prognosis for each child after the examination, X-rays and analysis, and reviews it as the child grows, which is why any plan covering several years must stay flexible.

The first few days with a new appliance are a period of adjustment. The appliance feels foreign, the child produces more saliva, may lisp and complain of pressure on the teeth. Speech usually returns to normal within 3–7 days, and the drooling passes even sooner; reading aloud for 10–15 minutes a day helps.

After each activation of the screw the feeling of pressure returns for a few hours. With upper jaw expansion there may also be pressure around the nose and the bridge of the nose, an expected reaction to the opening of the suture. If the pain is sharp, the child cannot bite together, or the anchor molars have become loose, stop activating the screw and contact the doctor without waiting for the scheduled visit.

Progress is checked every 4–8 weeks, and a meaningful assessment is possible only after 3–6 months. During expansion the width of the dental arch changes within weeks, but stability can be judged only after the retention period, once the bone in the suture has matured.

Relapse is a real risk, not a rare exception. It most often happens when the retention stage was shortened, when the child wore the removable appliance for less time than prescribed, or when the underlying cause was not addressed: the child still breathes through the mouth or rests the tongue between the teeth. That is why the doctor checks breathing and habits at every visit.

Some children still need braces in their teens after a successful first phase, and that is not a failure of treatment but a planned second stage. It is equally normal for the child to stay under monitoring after the appliance is removed until growth is complete: the bite changes together with the jaws. No one can predict exactly how an individual child will respond, so the doctor gives a range of timeframes rather than an exact date.

For families from abroad, part of the monitoring stage can be done remotely: standardised photos of the dental arches give the doctor enough to spot worrying changes between visits. The report, the X-rays and the activation instructions stay with you, and MediUkraine arranges a video consultation with the same doctor if needed and plans the next trip.