Orthodontia: Start saving now.

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For those who are early on the parenting journey (say with children five or younger), a word or so of advice: If it is at all possible, begin saving for the expense of braces now.

Even if you and/or your partner have a job with an orthodontia benefit, the maximum allowance is generally for an amount well below the actual cost of braces. For example, ours is currently $1,500. (It was $1,200 when our son was being treated.)

I certainly understand when folks indicate that budgeting for this expense is simply impossible. What is less clear to me are assertions that much of orthodontia is "cosmetic" and therefore optional or that even "real" concerns can be addressed in adulthood (presumably, when the patient can pay for treatment himself). While I'd prefer neither to enter nor to begin a debate about the need for braces, I must ask, If one trusts his child's dentist, and the orthodontists with whom he consults have no affiliation with said dentist, then why would he doubt their recommendations? As for attending to dental concerns in adulthood, well, it's even costlier then, particularly given that unaddressed issues create wear and decay that may otherwise have been avoided.

On the subject of whether or not braces are required, I would say this: If your regular family dentist recommends a consult, take it seriously. A mouth that seems utterly fine may have a bite pattern that will haunt the patient later. For example, it was always abundantly apparent that my oldest and youngest would need braces, but our middle child appeared to "luck out": Year after year, she was told, "Looking great!" In fact, she was with her younger sister when the latter had her ortho consult, and the orthodontist declared the middle child "Lucky, indeed!" Then subtle changes in her mouth and bite occurred, which our dentist began tracking a year ago and finally decided, "Get this looked at," and -- Voilà! -- she's in braces.

When this subject arises, many people ask, "How much?" and "Where do you live?" The cost for my oldest was about $4,200 for conventional braces. This did not include the extractions that were prescribed. The results were B+. At the time, the children saw a pediatric dentist. The orthodontist we chose after three consults was not part of her practice, but both were agreed that extractions were required.

In the seven or so years between our son's treatment and the youngest's we moved out of the city (although remained in Chicagoland) and moved the children to the dental practice at which my husband and I were patients. Not only do they not favor extractions, the ortho we chose once our youngest received her "It's time for the ortho consult" mandate avoided them like a large lollipop. My youngest enjoys an A+ outcome. Treatment crested $5,100, although she did not get "conventional" braces but rather the Damon system with the significantly smaller brackets (to say nothing of the significantly shorter treatment time!). Again, since people often wonder about cost, I'll add that we received two other cost-of-treatment projections, $4,500 and $4,800, from other reputable orthodontics practices, one of which insisted extractions were necessary.

We returned to the practice for our middle child. They were surprised to see us, but one look in her mouth told them the story. Fortunately, we were offered a 5% family discount. They also offered the same 7% PIF bookkeeping discount that was offered when our youngest was being treated.Such discounts are both common and significant and help explain why I'd urge parents of young children to begin saving now. An HSA is one way to develop this savings, as is the old-fashioned envelope system.

You know, since I'm on the subject of dental expenses for which you should begin saving now, I will also urge you to put money away for wisdom tooth extraction. Although there are a few dentists who think it's an unnecessary procedure, extraction is often prescribed because of crowding concerns and potential decay. Better to be prepared, right?

Related advice: Once your children have finished treatment, urge your teens and young adults to use their retainers! Most orthodontists are now quite direct about the lifelong need to use retainers, so impress upon your college students how important it is to keep using the night retainer and encourage care habits and savings habits that will help them keep up this maintenance when they are on their own.

Remember: Proactive, preventive health care is far easier and less expensive than remedying problems. When we invest in habits of care (annual physicals, regular dental cleanings and exams, common health screenings, etc.), we serve as models to our children.