When Should My Child Have Orthodontic Treatment?

            The age at which a child needs orthodontic treatment depends on the type and severity of the orthodontic problems that are present.  Some orthodontic problems are more effectively treated at an early age, while others are best treated once the majority of permanent teeth have erupted.  Disproportional growth between the upper and lower jaws is one type of orthodontic problem that is best treated at an early age (8 to 9 years old).  Orthodontic appliances can redirect growth so that the upper and lower jaws grow in better proportions.  As a result of treatment, a better skeletal balance is achieved, the teeth fit together more properly and facial esthetics are improved.  Mild growth discrepancies between the jaws may still be corrected in older children (10 to 13 years old), but more severe problems may not be able to be corrected totally with orthodontics alone.  Growth of the jaws is largely completed by age 13.5 in girls and age 14.5 in boys.  After these ages, skeletal imbalances can be treated, but different techniques are used.  Teeth can be moved to compensate for the skeletal problem or a combination of orthodontics and jaw surgery may be necessary. 

            Severely crowded (crooked) teeth is another type of orthodontic problem that is best treated at an early age (8 to 9 years old). Orthodontic appliances can align the crowded teeth and can develop more space in your child’s mouth so that the rest of the permanent teeth can erupt in better alignment  and in better position. 

         On the other hand, not every child needs orthodontic treatment at an early age.  Mildly crowded teeth is one orthodontic problem that is better treated once the majority of permanent teeth have erupted.  Mild tooth crowding can be corrected in young children without causing any harmful effects to the unerupted permanent teeth.  However, this sometimes necessitates wearing retainers for an extended time period (years) in order to hold the tooth alignment while other permanent teeth erupt.  For most children with mild tooth crowding, waiting to start orthodontic treatment until the majority of permanent teeth erupt, is a more practical option.

        Children should have their first orthodontic evaluation by age 7 to determine if any orthodontic problems are present and to determine the best timing of treatment.


Phase I and II Treatment

            Children with significant orthodontic problems at an early age (6 to 9 years old) may require two phases of orthodontic treatment.  The goals of phase I (interceptive) treatment are to improve growth discrepancies between the upper and lower jaws, to correct immediate dental problems that may be present (crossbites, open bites, severe crowding, etc.) and to minimize the severity of the developing malocclusion.  After phase I treatment, a child may need a second phase of treatment at a later time once the majority of permanent teeth have erupted.  Phase II usually involves a full set of braces (upper and lower) to align the teeth and perfect the bite (occlusion).  Whether or not a child needs a second phase of orthodontic treatment depends on the size and position of the teeth that erupt, the manner in which the teeth fit together, the effectiveness of phase I treatment and the dental expectations of the child and the parents.  Successful completion of phase I treatment does not guarantee that teeth will erupt in perfect alignment and good occlusion, but it may make phase II optional.  However, if the child and parents desire perfect tooth alignment and an ideal bite, a second phase of orthodontic treatment is usually necessary.  Not every child requires two phases of orthodontic treatment.  Mild orthodontic problems can be treated with a single phase of orthodontic treatment.  Severe orthodontic problems that are treated with two phases of orthodontic treatment may produce more esthetic and more stable orthodontic results than if only one phase of treatment is done. 


Thumb Sucking Habits

            Thumb or finger sucking in young children (under the age of 4 years) is a normal occurrence and usually should not be a cause for concern.  However, thumb sucking in older children can lead to significant orthodontic problems.  Most children will stop thumb sucking on their own before dental problems develop.  Older children will frequently stop sucking after they begin school as a result of peer pressure.  Thumb sucking after the permanent teeth have started to erupt (ages 5 to 6 years) frequently causes dental problems.  Insufficient vertical overlap of the front teeth (an open bite) is the most frequent dental problem associated with thumb sucking.  Placing the thumb in the mouth prevents the upper (and sometimes the lower) front teeth from fully erupting and thus produces an open bite.  Thumb sucking can also result in forward movement of the upper front teeth and distortion of the bone supporting the teeth, which results in an increase in the horizontal overlap of the front teeth.  Crossbite of the back teeth (when the upper teeth abnormally fit inside the lower teeth) is yet another problem caused by thumb sucking.  Cheek pressure placed on the back teeth during sucking moves the upper teeth inward and leads to a narrowing of the upper jaw.  The extent of the dental problems caused by thumb or finger sucking depends on the frequency and intensity of the sucking and at what age the thumb sucking is discontinued.  Some dental problems may self-correct once the sucking has stopped, while others require orthodontic treatment for correction.  Orthodontic appliances can assist your child in stopping a thumb sucking habit.  Most habits can be stopped within 2 weeks.  Correction of dental problems caused by sucking habits are more effectively treated at an early age before all of the permanent teeth have erupted.

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