Braces: Normal for children, expensive for parents

Why braces are often so expensive for children

Only very few people have ideal dentures by nature. If the milk teeth fall out, the permanent teeth often grow back a little crooked: Incisors stand forward, the rows of teeth do not close properly, or a tooth does not have enough space.

Pronounced misalignments have been considered a disease in Germany since a ruling of the Federal Social Court in 1972. The health insurance funds therefore pay for a medically necessary correction up to the age of 18.

According to Barmer GEK, more than half of the children and adolescents of a given year wear braces today. But when does treatment really make sense?

Malocclusion can be a medical risk

“Of course you can also be healthy and happy with crooked teeth,” says Dirk Kropp of proDente, an initiative of the dental associations. However, malpositions are not always just an aesthetic problem.

According to Kropp, a malocclusion can also represent a medical risk: Some children cannot bite, chew or talk properly. Teeth that are tight can be harder to clean, and the wrong load can damage the teeth.

The fact that braces improve oral health has not yet been sufficiently proven, according to the consumer association. The 2016 Health Monitor published by Barmer GEK and the Bertelsmann Stiftung also points this out. According to the study, orthodontists still often argue with parents about possible long-term consequences if a malposition is not treated.

Orthodontist classifies malpositioning

In order to assess whether a child needs braces, the doctors orient themselves to orthodontic indication groups (KIG). Malpositions of severity grades 1 and 2 are considered so minor that the statutory health insurances do not cover the costs of braces. From grade 3 they pay the correction, even if the child has no problems at the moment.

If the parents decide to treat their child, she should start before the jaw growth is complete. “The ideal age is about 10 to 13 years,” says Dirk Kropp.

The milk teeth only need to be treated in rare cases, for example when the jaw is particularly narrow and the teeth need to be prepared for the actual braces. The treatment usually takes four years.

Fixed braces depend on the findings

Whether a patient needs removable or fixed braces depends on the findings. “Usually you do a combination of both,” says Hub van Rijt, a dentist from Bielefeld who specialises in orthodontics.

Loose clasps are used for minor misalignments or as preparation for a fixed clasp. The former consist of a plastic mould adapted to the teeth, which is held in place with wire clips. The child wears the braces at night and as long as possible during the day. It is removed for eating and sports.

In the case of fixed braces, the orthodontist sticks brackets – small metal, ceramic or plastic plates – onto the teeth. A wire bow, which connects the brackets, brings the teeth into the correct position.

Costs of 1000 Euro and more not infrequently

Once the treatment goal has been reached, the braces can be removed. In order to stabilize the result, the so-called retention phase follows. A wire – a retainer – is attached behind the front teeth and should remain there for one to two years. “If the wire does not bother you, you can leave it in your mouth for five or ten years,” says van Rijt.

Often the teeth move a little when the retainer is removed. The teeth want to go back to where they were before. However, this does not mean that the treatment was unsuccessful, van Rijt emphasises: “The functional result remains.

Even if there is a corresponding degree of severity, the health insurance companies often do not cover the complete costs for the treatment. In most cases the parents pay a lot more – amounts of 1000 Euro and more are not uncommon, the health monitor shows. Van Rijt explains this with medical progress: “Dentistry has evolved and the health insurance company does not always pay what works best.

Second opinion on additional services not wrong

Additional services are offered especially for fixed braces. More expensive materials for brackets and wires are less visible or promise better wearing comfort and shorter treatment times. Orthodontists often recommend regular professional tooth cleaning for fixed braces to prevent tooth decay, which is not paid for by the health insurance.

If parents are unsure whether the services offered make sense, van Rijt advises them to obtain a second opinion. Patients can seek advice from health insurance companies, dentists’ associations or consumer centres.

One should become skeptical, if an orthodontist does not offer the health insurance benefit in the first place: “The orthodontist is obliged to show the health insurance benefit and to justify why he proposes something different”, says dentist Driss Wartini of the Independent Patient Advisory Service Germany.

However, Wartini rarely hears that parents feel put under pressure by orthodontists. “Today, people are informed a lot and know that they have a free choice of doctor.

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Christina Cherry
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