When is the Right Time for Braces?

Orthodontists recommend the first orthodontic checkup for each child to be around six to eight years old, which is about the time the adult first molars and adult incisors (front teeth) begin to come in. At that time, the orthodontist tries to assess three things:

  1. Are the upper and lower jaws growing normally, and is their growth harmonious with each other?
  2. Will the upper and lower jaws have space for the adult teeth that are about to erupt in the next few years?
  3. Is there a serious aesthetic problem which is affecting the child’s confidence and self-esteem?

All Phase I orthodontic treatment falls into one of those three categories. Now, let’s dive further into what each of these mean.

Are the upper and lower jaws growing normally and is their growth harmonious with each other?

“Normal” growth of the jaws usually means that the upper jaw is ahead in its development when compared to the lower jaw. This means that the upper jaw and posterior teeth (molars) are wider than the lower jaw and lower posterior teeth. Also, as the adult incisors grow in, the upper incisors should be in front of the lower incisors. This is termed “positive overjet.” In many patients, we see that the child has a slight “overbite” present. (For reference, severe or excessive overjet and overbite are not normal, and the effect of this is covered in another article.)

During puberty, however, the upper jaw stops growing and solidifies while the lower jaw (powered by the sex hormones) begins accelerated growth. During this stage, many children outgrow the overjet/overbite, and the size and position of the upper and lower jaws begin to match. At the first orthodontic checkup, the orthodontist reviews this. If, at the visit, the upper jaw is too narrow or the upper teeth do not lie outside the lower teeth, we know that during puberty the upper jaw will become even smaller in comparison to the lower jaw, resulting in “crossbite” and “underbite.” The negative effects of crossbite and underbite are covered in another article).

After puberty, this problem usually requires extensive therapy and even sometimes surgery and removal of teeth to correct the problem. A Phase I treatment has the awesome effect of preventing that problem with a relatively simple course of therapy.

Will the upper and lower jaws have space for the adult teeth that are about to erupt in the next few years?

As the adult teeth begin to emerge, it is extremely important to make sure that there is sufficient space for them to erupt into. Orthodontists and pediatric dentists can take a panoramic radiograph (pano) to identify where the remaining adult teeth are inside the upper and lower jaws. Taking a pano around the age of six to eight can reveal if certain adult teeth are missing, if the adult teeth are developing properly, and to make an early observation of whether the jaws will have the space to fit all the adult teeth. In a lot of patients, teeth take an incorrect eruption path, which can only be seen on an x-ray.

If these teeth continue on the incorrect path, the resulting position can be difficult (and sometimes impossible) to correct. Many children lose teeth too early and failure to save space for the adult teeth can result in some adult teeth being “blocked out.” The reason for this is that teeth have this funny phenomenon of moving into spaces so they can “be more comfortable.” Think of being in a crowded elevator. As someone gets off, people move around to have a little more space for themselves. The end result is that once space is lost, it is very difficult to gain back. By monitoring tooth development and space availability in the mouth, the orthodontist can help determine if all the adult teeth can fit in the child’s jaws.

If these problems continue without being addressed, extracting multiple teeth may be the only option to achieve proper alignment. The orthodontist has a number of tools at his or her disposal to see these issues, at ages six through eight, long before they become a serious problem. At age 11-13, when all the adult teeth should be present, he or she can install an appliance to save, regain, and even create space in the young, adolescent mouth.

Is there a serious aesthetic problem which is affecting the child’s confidence and self-esteem?

We all know how hard children can be on each other. A small difference can become the source of bullying and ridicule when children interact. As adults we try to teach our young ones to respect and love others no matter how they look, act or speak. Unfortunately, the playground can be a very judgmental place. Spacing between teeth, teeth that stick out too far, open-bite (when the front teeth are not overlapping at all), and crossbite are all conditions that children in early adolescence can experience. These problems can also lead to issues with speech, and many children are picked-on because of this. Parents can sense that their children are being affected by this if their child tries not to smile, is constantly looking at their teeth in the mirror or if they are overly critical of their own appearance. No child deserves to feel less-than because of the way their teeth look. A short Phase I orthodontic treatment with a limited number of brackets on adult teeth can align the front teeth, close spaces and provide the child with a sense of “normalcy” which can have profound effects on his or her self-confidence.

The benefit from a Phase I orthodontic treatment is really extraordinary. A small 1-year treatment can prevent the need for extensive orthodontic treatment, tooth extraction and even surgery. Most orthodontists perform consultations for free, providing parents with all the information covered in this post regarding their children. Please feel free to reach out to us if you have any questions on Phase I orthodontics!