Payton Morelli, 9, of West Ashley couldn't wait to get her braces last summer.

"She wanted them," said her mom, Lisa Morelli. "Her smile wasn't what she wanted it to be."

Payton also wanted have braces because her sister, Annalise, 12, also had them. Now Payton is asking her mom when they will come off.

Braces have changed a lot since the old-school days of metal wire, bulky headgear and painful adjustments. These days, braces are made with modern plastics, are less painful and allow children who wear them ways to express themselves in many different fashions, said Dr. Bradley Nirenblatt, a Charleston orthodontist.

The first visit

When should your child see an orthodontist? The best time to get an initial examination is age 7, Nirenblatt said.

"Parents consistently ask me when is the best time to get braces," he said. "I call that a peace-of-mind visit for parents because parents just don't know."

At a first appointment, a child is assessed for potential problems, he explained. It doesn't, however, mean that child is going to get braces at age 7.

"It takes the question out of the parent's mind," he said. "At that age, if we need to do something, we can correct the problem instead of waiting, or it may be such they need to have baby teeth out. We refer them back to their dentist for that."

Braces, defined

Nirenblatt said braces are relatively common in preteens and teens. Children need braces to correct different problems they have with their teeth such as bite problems, crowding or speech difficulties, he said.

"Sometimes there's two phases where an orthodontist starts to correct problems early and then puts braces on later," Nirenblatt said.

Denise Swasty, an orthodontist with The Smile Team, said some problems diagnosed early are easy to treat but if diagnosed late may require surgery. For example, a cross bite, which is when one or more teeth are reversed, can be treated with an expander when young, but in adults require surgery, she said.

"Another example is excessive overbite or when the top teeth are way ahead of the bottom teeth," she said. "That's pretty straightforward and easy to treat in children and in preteens, but when you're an adult that takes surgery or extraction."

In Payton's case, Morelli said her daughter's orthodontist recommended early treatment for crowded teeth.

Types of braces

The three main types of braces are metal brackets, porcelain clear braces and Invisalign, which are removable, Swasty said.

Metal brackets have changed tremendously over the years.

"The term metal mouth doesn't really apply anymore because we don't put bands on all of the teeth, just on some of the back molars and even then in a lot of cases we don't have to put bands on any of the teeth," she said.

Instead, the brackets are glued on to the front of the teeth. Wires are lighter and more flexible, and gently move the teeth, Swasty said. Installation is less painful now, too, she said.

Treatment times are shorter as well, she said. Children now typically wear braces from one to three years, and orthodontist visits are reduced.

To express their own personal styles, Swasty said many children choose specific colors for the ties that go around the brackets.

"That part is fun," she said.

Payton opted for Clemson-Carolina rubber bands to show off her personality. Annalise, who is an actress, decided to get clear braces for cosmetic reasons, her mom said.

"We had to make it look like she has braces as little as possible," Morelli explained.