When Should My Child See an Orthodontist?

By Dr. Mohsen Alozaibi, Tiny Teeth Dental Center, Abu Dhabi

"Her front teeth are coming in crooked. Does she need braces now?" Many parents ask this as soon as the first adult teeth appear. The short answer is that most children do not need braces early, but an early check can be very useful. Here is how the timing usually works.

The age-7 check

The American Association of Orthodontists suggests that children have an orthodontic check by about age 7. At this age, the first adult molars and front teeth are usually coming in, so a dentist or orthodontist can already see how the jaws are growing and whether there is likely to be enough space.

An early check does not mean early treatment. For most children, the result is simply "everything looks on track, let's keep watching."

When do braces usually start?

Most orthodontic treatment with braces or aligners starts between about 9 and 14 years of age, once most of the adult teeth have come in. Every child is different, and the right time depends on how the teeth and jaws are developing, not only on age.

When early treatment may help

Sometimes treatment is started earlier, while the child still has some baby teeth. This is often called early or interceptive treatment, and it is usually reserved for specific problems, such as:

• Crossbite, where upper teeth bite inside the lower teeth, sometimes shifting the jaw to one side.
• Severe crowding, where there is clearly not enough room for the adult teeth.
• An underbite, where the lower teeth sit in front of the upper teeth.
• Front teeth that stick out a lot, which can be more likely to get injured in a fall.
• Habits such as long-term thumb or finger sucking that are changing the shape of the bite.

The aim of early treatment is to guide growth or remove a problem, which may make later treatment simpler. Many children will still need a second phase with braces later. Your dentist or orthodontist can explain whether early treatment is worth it for your child, or whether waiting is the better choice.

Signs worth mentioning to your dentist

• Crowded, overlapping or very rotated teeth
• Large gaps between teeth
• Upper teeth that bite behind the lower teeth, or a jaw that shifts when your child closes
• A deep overbite, or front teeth that do not meet at all (open bite)
• Mouth breathing, snoring or lips that do not close comfortably at rest
• Losing baby teeth very early (for example from decay or injury) or very late
• Thumb, finger or dummy sucking that continues past about age 4
• Difficulty biting or chewing, or a jaw that clicks or hurts

What you can do now

1. Keep baby teeth healthy. Baby teeth hold space for the adult teeth. Losing one early to decay can let neighboring teeth drift and cause crowding. 2. Ask about a space maintainer if a back baby tooth has to be removed early. Your dentist will tell you if one is needed. 3. Help your child let go of sucking habits gently, with praise and reminders rather than pressure. 4. Mention snoring or mouth breathing to your pediatrician as well as your dentist, as it can have several causes. 5. Keep up regular check-ups. At each visit, your pediatric dentist looks at how the teeth and jaws are developing and will refer you to an orthodontist when the timing is right.