3 April, 2018


When Should My Child Get Braces?

When Should My Child Get Braces?

This is a very common questions asked at an orthodontic office and it is difficult to give one catch all answer. What you should really be asking yourself is ‘When should my child see an Orthodontist?’ The American Association of Orthodontics (AAO) recommends that children should have an initial exam at an orthodontist’s office by age 7. One main point is that even though you may see an orthodontist for a consultation it does not mean your child will need orthodontic treatment at that time. In my office I recommend early treatment to less than 25% of the young patients we see. Seven years old may not seem like an appropriate age for orthodontic treatment because ‘only teenagers need braces’. You may even ask yourself if age 7 is recommended do I then see a pediatric orthodontist?

First there are no orthodontists who are only trained to treat children. All orthodontists receive specialized training in all forms of orthodontic treatment. This includes adult, adolescent, and children’s orthodontic treatment. All three age groups come with different considerations and in this post I will highlight some points of children’s orthodontic treatment.

Seven years old is the age recommend by the AAO because there will be permanent teeth in both the front and back of your child’s mouth. These teeth establish the bite in the back as well as show us potential for crowding or spacing in the front. Adult teeth erupt in a regular sequence and deviation from that sequence is potentially a sign of problems to come. At an initial exam for a young child the main focus is to prevent larger and more complex problems from happening in the future. Some complications that can be noted early on are:

  • Crossbites (in front or in back)
  • Improper tooth eruption patterns
  • Space Loss
  • Jaw growth discrepancies
  • Increased risk of trauma
  • Improper habits
  • Social concerns

At a younger age, when the body is more adaptable, many problems can be addressed and the results are often more stable and can be performed quickly. One of the most common types of early treatment is palatal expansion. Palatal expanders are used when a there is a crossbite of the back teeth or the upper jaw (maxilla) is narrow. The reason expansion is so effective early on is due to the anatomy of the maxilla. There are two palatal bones that fuse together as you get older – in fact by the time you are a teenager these bones have already fused. This means to get the most stable skeletal expansion we have to use an expander before the bones have fused. In addition to expansion being more stable early on another problem that can arise from a crossbite of the back teeth is improper jaw growth. Your body adapts to the crossbite position and it has been shown that your jaws actually grow asymmetrically in the presence of certain types of crossbite. What I described is a crossbite of the back teeth. There can also be a crossbite of the front teeth. This is very effectively treated early on because of the maxillary anatomy I mentioned earlier. There is so much to talk about here – maybe I will write another blog post dedicated specifically to crossbites!

Less commonly seen are issues with tooth eruption. This group includes missing teeth, space loss, and improper eruption patterns. Taking a panoramic x-ray screens for all of these issues in a quick, minimally invasive, way. From that x-ray I can either recommend early treatment or, more commonly, no early treatment at al! Space loss is an issue that we really want to fix early. Space loss results from the premature loss of a baby tooth without a space maintainer placed. With no space maintainer the adjacent teeth commonly ‘drift’ and then block the permanent tooth from coming into the mouth. A space regaining appliance followed by some type of retainer are usually quick and easy to fix these problems. However, left untreated, the space loss can lead to impacted permanent teeth and other problems that we certainly want to avoid.

At a child’s first consultation I can also examine jaw growth. When we look at jaw growth the main idea is to determine where the lower jaw is in relation to the upper jaw. If the lower teeth are in front of the upper, commonly called an underbite, early treatment is almost always recommended. This type of early treatment has been proven to be extremely effective. If the lower teeth are significantly behind the upper teeth, commonly called an overbite, early treatment is more controversial. A lot of research has gone into this area because it so much more common than underbites. I will certainly write another blog post about early treatment for young children who have their upper jaws very far ahead of their lower jaws.

With the upper jaw forward other problems, such as protruding front teeth, may also be present. Protruding upper front teeth carry an increased risk for trauma but also can lead to some children being more self-conscious. If your child is concerned about their teeth and do not want to smile I would most certainly recommend a limited course of treatment to address this. In about 6 months the teeth can be brought back and your child can be confident in their smile!

The last type of early treatment I will discuss is habit intervention. The most common habit seen in children is thumb sucking. Almost all normal children engage in some sort of non-nutritive sucking habits of thumb or pacifier. As a general rule, these habits have no long-term effect if done while all the baby teeth are in. However, if this habit persists past the eruption of adult teeth problems such as flared front teeth, front teeth not touching when you bite together, and a narrow upper jaw can result. All of these problems can be corrected but there is no point in addressing them until the habit has stopped. If at home remedies and positive reinforcement have not worked there are ‘reminder’ appliances that can be placed so the child will likely stop their habit.

Everyone is different and there is no answer to ‘When is the best age to get braces’. The most common age for orthodontic treatment is when a child has lost all or close to all of their baby teeth. However, an early orthodontic visit will assure you have not missed an opportunity to correct larger problems. Through an early orthodontic evaluation, you’ll be giving your child the best opportunity for a healthy, beautiful smile. Everyone is unique and it is my goal to provide individual treatment options to all our patients. When you visit our office we will take into account both the physical and psychological development to recommend the most appropriate treatment at the most appropriate time. At the end of the day our goal is to work with you and your family to give everyone a beautiful confident smile!