What Is the Best Age to Begin Orthodontic Treatment?
Two-Phase Orthodontic Treatment
Orthodontic treatment in children is sometimes performed in two phases with phase 1 occurringbetween ages 7 and 10, sometimes earlier or later, depending on dental development. Phase 2 is then typically started after all of the permanent teeth have erupted. Phase 1 treatment, often called early treatment, is indicated in situations where delaying treatment would likely cause jaw growth problems, facial asymmetry, permanent damage to teeth or gums, or when delaying treatment would make future correction significantly more difficult.
Common Examples of Cases Requiring Phase 1 Orthodontic Treatment:
1
Narrow upper jaw (the maxilla)
A narrow maxilla is very common among children and adults and causes a broad range of problems from dental crowding, incisor flaring and crossbites, to obstructive sleep apnea and facial asymmetry. The maxilla can be very easily expanded in early childhood with a palatal expansion appliance. Starting as early as age 12, the growth plate in the center of the upper jaw (mid-palatal suture) can begin to fuse. Expanding the maxilla after this has occurred requires significantly more extensive treatment like MARPE, SARPE or full jaw surgery. We see many teenagers and adults who could have avoided complex orthodontic treatment or jaw surgery with a simple palatal expander in early childhood.
2
Maxillary Hypoplasia and Maxillary Retrognathism (underdeveloped upper jaw)
The maxilla is often not only narrow, but also can have insufficient forward growth (retrognathic) as well. The most common cause of an underbite (crossbite of all of the front teeth) is maxillary hypoplasia / retrognathism. This condition or predisposition to this condition usually becomes evident to an orthodontist at a very young age but is not obvious to others until the child gets older since the upper and lower jaw growth discrepancy increases with age. Drs. Carroll and Sutton have treatment options to provide significant non-surgical advancement of the upper jaw, if done at an early age (typically prior to age 10).
3
Functional shift
A functional or mandibular shift occurs when a child’s lower jaw (mandible) shifts sideways or forward as they bite down due to how their teeth fit together. Most of these shifts are caused by an underdeveloped upper jaw. If not corrected early, it can cause the lower jaw to grow more forward (in forward shifts), or it can cause the lower jaw to grow to the side and the upper jaw to develop a cant (one side lower than the other), requiring jaw surgery to correct.
4
Impacted teeth
While most people have heard of impacted wisdom teeth, other teeth can also become impacted. Orthodontists can identify teeth that are or are at risk of becoming impacted by monitoring their development with x-rays, and then recommend treatment options for correcting the impaction. Dental crowding and failure to lose primary teeth are common causes of tooth impaction.
5
Deep impinging overbite
Mild (2-3mm) of overbite (vertical overlap of the front teeth) is ideal. In some people, overbites can be so deep that the lower front teeth contact the soft tissues of the roof of the mouth. Not only is this often painful, it can cause loss of bone on the back of the upper front teeth. Deep overbites tend to get deeper over time. Orthodontists can use the natural eruption tendency of teeth in early childhood to allow the back teeth to erupt further, helping to correct deep overbites.
6
Anterior openbite
The opposite of a deep overbite is an openbite, when the upper and lower front teeth do not overlap each other. In an openbite, the front teeth are usually not functional making eating more difficult and causing additional stress on the back teeth. Openbites can be caused by thumb-sucking habits, tongue thrust, incisor flaring, jaw growth issues and mouth-breathing habits. Many of these issues are best addressed at an early age.
7
Anterior crossbite
A condition where an upper front tooth fits behind a lower front tooth. This can cause excessive wearing or chipping of the upper tooth and gum recession and bone loss on the front of the lower tooth. Anterior crossbites should usually be corrected immediately since damage can occur rapidly.
8
Missing teeth
Many children and adults have congenitally missing teeth. These are permanent teeth that never developed. This should be planned for starting at an early age to simplify treatment later.
9
Speech problems
Some children with speech issues do not achieve complete success with speech therapy. Problems related to tooth position are sometimes the cause of speech issues in these situations.
10
Psychosocial issues
Although misalignment of the front teeth can usually be postponed until after all of the permanent teeth have erupted, some children may feel self-conscious about the appearance of their teeth. Elective early treatment for esthetic purposes can almost always be done if a parent chooses.
For parents, it’s not always easy to know if your child may need orthodontic treatment.
Here are a few things to look for that may mean your child needs to see an orthodontist:
- Early or late loss of baby teeth
- A hard time chewing or biting food
- Mouth breathing
- Finger or thumb-sucking
- Crowded, misplaced, or blocked teeth
- Jaws that pop or make sounds when opening and closing
- Teeth that come together abnormally or do not come together at all
- Jaws and teeth that are not proportionate to the rest of the face
- Crowded front teeth around age seven or eight
Even the most observant parent cannot identify every potential need for early orthodontic intervention. Only an orthodontist with x-rays can determine whether or not your child needs early treatment. Although most children do not need early treatment, we do recommend that every child have an initial evaluation by an orthodontist to ensure that they do not. Please contact our office to schedule an appointment for a complimentary orthodontic evaluation. Dr. Carroll or Dr. Sutton will listen to your concerns, and if any treatment is recommended, they will discuss treatment timing and options with you. Early evaluation now will give your child a healthy, beautiful smile for the future.
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