Not many people have a naturally flawless set of teeth. When the baby teeth fall out, the permanent ones that come in are often somewhat crooked.

Dental braces can straighten them, of course, but when are they truly needed for a child or adolescent – versus just for appearances?

“Children with crooked teeth can be healthy and happy too, of course,” notes Dirk Kropp, managing director of proDente, an information programme funded by five large German dental-sector associations.

He added, however, that misaligned teeth can be a medical risk. Some children with them can’t chew or speak properly, and crowded teeth are more difficult to clean.

According to German consumer organisations, however, there is insufficient proof that braces improve dental health. A 2016 health report by the Barmer GEK public health insurance company and Bertelsmann Foundation concludes this as well.

Nevertheless, orthodontists often warn of possible complications later on if any teeth misalignments aren’t corrected.

In determining whether a child needs braces, German orthodontists use a rating system of five “orthodontic indication groups.”

Public health insurance pays, at least in part, for correction of a misalignment with a severity of 3 or more on the scale, even if it isn’t yet causing the child any problems.

If parents opt for braces, it’s best that the child get them while his or her facial bones are still growing and the teeth are easier to move. “The ideal age is between 10 and 13 years,” Kropp says.

Full braces are generally worn for about four years, and there’s a choice between removable and fixed ones, depending on the nature of the problem.

“Usually it’s a combination of both,” says Dr Hub van Rijt, a Germany-based orthodontist.

Removable braces consist of a plastic plate secured to the teeth with wires and clips. The child wears the braces at night and as long as possible during the day. They’re taken out before meals and sports.

In the case of fixed braces, the orthodontist attaches brackets made of metal, ceramic or plastic to the teeth. A flexible wire connects all of the brackets, controlling movement of the teeth.

The braces are removed when the desired result has been achieved.

To keep the newly straightened teeth from shifting back to their original position, a wire retainer is attached to the back of the front teeth, where it should remain for a year or two.

“If the wire isn’t uncomfortable, it can be left in the mouth for five or 10 years,” van Rijt says.

He advises parents to get a medical second opinion if they’re unsure of an orthodontist’s recommendation. – dpa/Caroline Mayer