Orthodontics for Children

The American Association of Orthodontists has recommended that a child’s first visit to the orthodontist should occur by the age of seven. Orthodontic treatment is usually associated with adolescence, but there are a few common problems that require limited orthodontic treatment at an earlier age. Although treatment will not necessarily begin at this early age, an examination is important to ensure maximum dental health for your child. If no treatment is needed, the examination will give you, the parent, peace of mind.

Why is age 7 considered the optimal time for screening?
By the age of 7, the first permanent molars have erupted, establishing the occlusion. During this time, an orthodontist can evaluate front-to-back and side-to-side tooth relationships. For example, the presence of erupting incisors can indicate possible overbite, underbite, open bite, crowding or gummy smiles. The erupting first molars can indicate jaw discrepancies such as cross bites, overbites, or underbites. Timely screening increases the chances for a beautiful smile.

The following early signs may indicate that your child should have an orthodontic examination:

• Early or late loss of teeth
• Early removal of a baby tooth
• Difficulty chewing or biting
• Mouth breathing
• Finger or thumb sucking
• Crowding, misplaced or blocked out teeth
• Jaws that shift or the teeth come together in a cross bite
• Speech difficulty
• Biting the cheek or into the roof of the mouth
• Facial imbalance
• If the upper or lower jaws protrude more than the other
• Upper front teeth (incisors) that are flared with spaces due to a habit such as a tongue thrust, lip habit, or finger habit

Early orthodontic treatment, known as Phase I, can help minimize the need for more lengthy and expensive treatment at a later date, such as extraction of permanent teeth and/or jaw surgery. Dr. Angle can diagnose subtle problems with jaw growth and emerging teeth while baby teeth are present.  At that time early treatment may be necessary to modify growth to help the jaw relationships. Early treatment also may have the benefit of improving a child’s self-esteem, which is so important in the early years. Other benefits of early treatment include:

• Creating room for crowded teeth to erupt into place
• Creating facial symmetry through influencing jaw growth
• Reducing the risk of trauma to protruding front teeth
• Preserving space for unerupted teeth
• Reducing the need for future extractions
• Reducing treatment time with full braces

This phase I treatment consists of techniques to guide or redirect facial growth. Treatment usually starts when the permanent incisors and first molars have erupted, but the severity of the problem dictates the timing of treatment. Some examples of early treatment include but are not limited to the following:

• Premature loss of a baby tooth may require a space maintainer to hold the space until the permanent tooth erupts into that space.
• Early extractions of baby teeth at this age may help alleviate crowding of the anterior teeth until the child is older. At that time, a decision must be made whether or not permanent teeth need to be extracted.
• Crossbites (scissor bite), if not corrected in the earlier years, may lead to future developmental and asymmetrical facial problems.  Once the upper jaw matures and the bone fuses, expansion of the upper jaw is no longer possible, so it is important not to miss the window of opportunity.
• Headgear or functional appliance treatment may be necessary if there is a discrepancy between upper and lower jaw positions.  These appliances can help the jaws better align with each other.
• A Habit Breaker may be indicated for a persistent thumb sucking or tongue thrusting habit that is keeping the teeth from touching (open bite).

When a first phase of treatment is initiated, a second phase of treatment (full braces) is almost always necessary to position all the teeth into their ideal position. In most cases, this second phase begins when the last permanent teeth are ready to come in, which is approximately at 12 years of age.

If Dr. Angle observes an orthodontic problem at an early age, it does not always result in early treatment. After evaluating your child, Dr. Angle may just want to check your child periodically while the permanent teeth are erupting and the jaws and face continue to grow. Dr. Angle’s initial examinations and follow-up recall visits are complimentary.