Some children as early
as 5 or 6 years of age may benefit from an orthodontic evaluation.
Although treatment is unusual at this early age, some preventative
treatment may be indicated.
By age 7, most children have a mix of baby (primary) and adult
(permanent) teeth. Some common orthodontic problems seen
in children can be traced to genetics, that is they may be inherited
from their parents. Children may experience dental crowding,
too much space between teeth, protruding teeth, and extra or
missing teeth and sometimes jaw growth problems.
Other malocclusions (literally, “bad bite”) are
acquired. In other words, they develop over time.
They can be caused by thumb or finger-sucking, mouth breathing,
dental disease, abnormal swallowing, poor dental hygiene, the
early or late loss of baby teeth, accidents or poor nutrition.
Trauma and other medical conditions such as birth defects may
contribute to orthodontic problems as well. Sometimes an inherited
malocclusion is complicated by an acquired problem. Whatever
the cause, the orthodontist is usually able to treat most conditions
Orthodontists are trained to spot subtle problems with jaw
growth and emerging teeth while some baby teeth are still present.
The advantage for patients of early detection of orthodontic
problems is that some problems may be easier to correct if they
are found and treated early. Waiting until all the permanent
teeth have come in, or until facial growth is nearly complete,
may make correction of some problems more difficult. For
these reasons, the AAO recommends that all children get a check-up
with an orthodontist no later than age 7. While your child’s
teeth may appear straight to you, there could be a problem that
only an orthodontist can detect. Of course, the check-up
may reveal that your child’s bite is fine, and that is
Even if a problem is detected, chances are your orthodontist
will take a “wait-and-see” approach, checking your
child from time to time as the permanent teeth come in and the
jaws and face continue to grow. For each patient who needs
treatment, there is an ideal time for it to begin in order to
achieve the best results. The orthodontist has the expertise
to determine when the treatment time is right. The orthodontist’s
goal is to provide each patient with the most appropriate treatment
at the most appropriate time.
In some cases, your orthodontist might find a problem that
can benefit from early treatment. Early treatment may
prevent more serious problems from developing and may make treatment
at a later age shorter and less complicated. For those
patients who have clear indications for early orthodontic intervention,
early treatment gives your orthodontist the chance to:
- Guide jaw growth
- Lower the risk
of trauma to protruded front teeth
- Correct harmful
- Improve appearance
- Guide permanent
teeth into a more favorable position
- Improve the way
It’s not always
easy for parents to tell if their child has an orthodontic problem.
Here are some signs or habits that may indicate the need for
an orthodontic examination:
- Early or late
loss of baby teeth
- Difficulty in
chewing or biting
- Mouth breathing
- Thumb sucking
- Finger sucking
- Crowding, misplaced
or blocked out teeth
- Jaws that shift
or make sounds
- Biting the cheek
or roof of the mouth
- Teeth that meet
abnormally or not at all
- Jaws and teeth
that are out of proportion to the rest of the face
If any of these problems
are noted by parents, regardless of age, it is advisable to
consult an orthodontist. It is not necessary to wait until
age 7 for an orthodontic check-up.
is preventive orthodontic treatment?
Preventive orthodontic treatment is intended to keep a
malocclusion (“bad bite” or crooked teeth) from developing
in an otherwise normal mouth. The goal is to provide adequate
space for permanent teeth to come in. Treatment may require
a space maintainer to hold space for a primary (baby) tooth lost
too early, or removal of primary teeth that do not come out on
their own so to create room for permanent teeth.
What is interceptive orthodontic
Interceptive orthodontic treatment is performed for problems
that, if left untreated, could lead to the development of more
serious dental problems over time. The goal is to reduce
the severity of a developing problem and eliminate the cause.
The length of later comprehensive orthodontic treatment may
be reduced. Examples of this kind of orthodontic treatment may
include correction of thumb- and finger-sucking habits; guiding
permanent teeth into desired positions through tooth removal
or tooth size adjustment; or gaining or holding space for permanent
teeth. Interceptive orthodontic treatment can take place
when patients have primary teeth or mixed dentition (baby and
permanent teeth). A patient may require more than one phase
of interceptive orthodontic treatment
What is comprehensive orthodontic
Comprehensive orthodontic treatment is undertaken for
problems that involve alignment of the teeth, how the jaws function
and how the top and bottom teeth fit together. The goal of comprehensive
orthodontic treatment is to correct the identified problem and
restore the occlusion (the bite) to its optimum. Treatment can
begin while patients have primary teeth, when they have a mix
of primary and permanent teeth, or when all permanent teeth
are in. Treatment may consist of one or more phases, depending
on the nature of the problem being corrected and the goals for
Orthodontic care may be coordinated with other types of dental
treatment that may include oral surgery (tooth extractions or
jaw surgery), periodontal (gum) care and restorative (fillings,
crowns, bridges, tooth size enhancement, implants) dental care.
When finished with comprehensive treatment, the patient must
wear retainers to keep teeth in their new positions.
What is a space maintainer?
Baby molar teeth, also known as primary molar teeth,
hold needed space for permanent teeth that will come in later.
When a baby molar tooth is lost, an orthodontic device with
a fixed wire is usually put between teeth to hold the space
for the permanent tooth.
Why do baby teeth sometimes need
to be removed?
Removing baby teeth may be necessary to allow severely crowded
permanent teeth to come in at a normal time in a reasonably
normal location. If the teeth are severely crowded, it may be
that some unerupted permanent teeth (usually the canine teeth)
will either remain impacted (teeth that should come in, but
do not), or come in to a highly undesirable position. To allow
severely crowded teeth to move on their own into much more desirable
positions, sequential removal of baby teeth and permanent teeth
(usually first premolars) can dramatically improve a severe
crowding problem. This sequential extraction of teeth, called
serial extraction, is typically followed by comprehensive orthodontic
treatment after eruption of permanent teeth has brought about
as much improvement as it can on its own.
After all the permanent teeth have come in, the extraction of
selected permanent teeth may be necessary to correct crowding
or to make space for necessary tooth movement to correct a bite
problem. Proper extraction of teeth during orthodontic treatment
should leave the patient with both excellent function and a
How can a child's growth affect
Orthodontic treatment and a child’s growth can complement
each other. A common orthodontic problem to treat is protrusion
of the upper front teeth. Quite often this problem is due in
part to the lower jaw being shorter than the upper jaw. Upper
teeth may also be the primary cause of the protrusion if they
stick out too far. While the upper and lower jaws are
growing, orthodontic appliances can be beneficial in reducing
these discrepancies. A severe jaw growth discrepancy may
require orthodontics and corrective surgery after jaw growth
has been completed, although this is rare.
The AAO recommends that all children have a check-up with an
orthodontist no later than age 7 so that growth-related problems
may be identified and so that treatment can be commenced at
the appropriate time for each patient.
What kinds of orthodontic appliances
are typically used to reduce the severity of jaw-growth problems?
A process of dentofacial orthopedics (guiding the growth of
the face and jaws) with orthodontic appliances may be used to
correct jaw-growth problems. The decision about when and which
appliances to use for this type of correction is based on each
individual patient's problem. Some of the more common orthopedic
Headgear: This appliance
applies pressure to the upper teeth and upper jaw to guide
the direction of upper jaw growth and tooth eruption. The
may be removed by the patient and is usually worn 10 to 12
hours per day.
A young patient wearing
- Fixed functional
appliance: The appliance is usually fixed (glued) to the upper
and lower molar teeth and may not be removed by the patient.
By holding the lower jaw forward, it reduces the protrusion
of the teeth while the patient is growing and helps bring
the teeth together. The appliance can help correct severe
protrusion of the upper teeth.
- Removable functional
appliance: This removable appliance holds the lower jaw forward
and guides eruption of the teeth into a more desirable bite
while helping the upper and lower jaws to grow in proportion
to each other. Patient compliance in wearing this appliance
is essential for successful improvement; the appliance cannot
work unless the patient wears it.
- Palatal Expansion
Appliance: A child’s upper jaw may be too narrow for
the upper teeth to fit properly with the lower teeth (a crossbite).
When this occurs, a palatal expansion appliance can be fixed
to the upper back teeth. This appliance can markedly expand
the width of the upper jaw. For some patients, a wider
jaw may prevent the need for extraction of permanent teeth.
my child play sports while wearing braces?
Yes. But wearing a protective mouth guard is advised
while riding a bike, skating, or playing any contact sports,
whether organized sports or a neighborhood game. Your orthodontist
can recommend a specific mouth guard.
braces interfere with playing musical instruments?
Playing wind or brass instruments, such as the trumpet,
will clearly require some adaptation to braces. With practice
and a period of adjustment, braces typically do not interfere
with the playing of musical instruments.
does orthodontic treatment time sometimes last longer than anticipated?
Estimates of treatment time can only be that - estimates. Patients
grow at different rates and will respond in their own ways to
orthodontic treatment. The orthodontist has specific treatment
goals in mind, and will usually continue treatment until these
goals are achieved. Patient cooperation, however, is the single
best predictor of staying on time with treatment. Patients who
cooperate by wearing rubber bands, headgear or other needed
appliances as directed, while taking care not to damage appliances,
will most often lead to on-time and excellent treatment results.
is patient cooperation and how important is it during orthodontic
Good “patient cooperation” means that the patient
not only follows the orthodontist’s instructions on wearing
appliances as prescribed and tending to oral hygiene and diet,
but is also an active partner in orthodontic treatment.
treatment is a “two-way street” that requires a
consistent, cooperative effort by both the orthodontist and
patient. To successfully complete the treatment plan, the patient
must carefully clean his or her teeth, wear rubber bands, headgear
or other appliances as prescribed by the orthodontist, avoid
foods that might damage braces and keep appointments as scheduled.
Damaged appliances can lengthen the treatment time and may undesirably
affect the outcome of treatment. The teeth and jaws can only
move toward their desired positions if the patient consistently
wears the forces to the teeth, such as rubber bands, as prescribed.
Patients who do their part consistently make themselves look
good and their orthodontist look smart.
To keep teeth and gums healthy, regular visits to the family
dentist must continue during orthodontic treatment.
recently took my child to an orthodontist for an orthodontic
check-up. The orthodontist recommended treatment. Should I seek
a second opinion?
You should review the recommended treatment with your family
dentist. If you would like a second opinion, feel comfortable
in arranging for one. You may have already had more than one
orthodontist recommended to you by family, friends or your dentist.
Seeking out a member of the AAO assures that your second opinion
is from an educationally qualified orthodontic specialist. You
should feel confident in the orthodontist and his or her staff,
and trust their ability to provide you with the best possible
is two-phase treatment?
Two-phase treatment simply means that the treatment is
carried out in two stages. The first is the interceptive
orthodontic phase (see above) and the second is the comprehensive
orthodontic phase (see above).
of my children’s friends have already started treatment,
but our orthodontist says my child should wait a while.
Why is there a difference in treatment?
Each treatment plan is specific for that child and his/her
specific problem. In some cases, children mature early
(e.g.: get their permanent teeth early) and in some cases early
treatment is indicated to prevent a more severe problem from
occurring. Your orthodontist is the best person to decide
the most optimum treatment plan. If you have questions,
you should discuss them with your orthodontist.
child has an allergy to nickel. Can my child still have
Yes, there are appliances available which are nickel-free.
Please tell your orthodontist if your child has any allergies.
can I fit the orthodontist’s fee into my family budget?
Orthodontic costs and payment options can be discussed with
your treating orthodontist. Your orthodontist will be able
to provide you with information about insurance and other possible