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The question: I took my 12-year-old daughter to the dentist, and they recommended she get braces. I remember braces were awful and painful to have as a kid myself. I'm not sure if she really needs them, plus they're quite expensive for our budget. Are there any better alternatives to braces these days?

The answer: I frequently regale my children about the many hardships I had to face when I was their age. Their response is usually the obligate eye roll and stares of disbelief as I recount my desperate tales of walking to school and (gasp) no remote control for the TV. They counter with their own list of modern hardships such as computer crashes and patchy cellphone reception.

Fortunately, advances in technology have made modern dental care much more patient and child friendly than in my day. Although I never needed braces, the general consensus among my peers at the time was that braces were to be feared as a fate worse than death. This phobia was only reinforced by the kid (every class seemed to have one) who had to wear the dreaded headgear, a device that at the time seemed reminiscent of a medieval instrument of torture. How times have changed! I now see children who beg their parents to get them braces so that they will look like the other kids in their class.

In order to answer your question it is important to clarify why your child needs braces in the first place. For some, orthodontic work is purely cosmetic. In these situations, braces are optional and it is certainly reasonable to postpone the decision until your daughter can decide for herself whether she wants to remedy the problem with orthodontic work. This also gives you time to budget and save accordingly or even share the cost with her.

For many children and teens however, braces are recommended not only to enhance aesthetics, but also to improve jaw function. In these cases, there can be some urgency to get the work done before the jaw bones have finished growing. Expect your orthodontist to discuss the pros and cons of treatment and to suggest the optimal time to apply the braces in order to get the best functional result.

There is no question that orthodontic work is expensive, is not always covered by private health insurance, and may be beyond the means of many families. Expect the total cost for braces to be about $5000, sometimes more. Don't hesitate to ask your orthodontist about payment plans that spread the cost of the braces over several years.

On a positive note, modern braces are not nearly as uncomfortable or unsightly as they were in the past. When braces are first applied there will be mouth pain for a few days, but for most children regular doses of acetaminophen or ibuprofen, and soft food will be all that is required. With each adjustment of the braces there may be another day or two of discomfort, but this too is usually easily controlled. Bottom line, don't let your own negative experience deter you from getting braces for your child if she needs them.

Dr. Michael Dickinson is the head of pediatrics and chief of staff at the Miramichi Regional Hospital in New Brunswick. He's a staunch advocate for children's health in Atlantic Canada through his involvement with the Canadian Paediatric Society.

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