This is one of the most common questions we’re asked from parents and dentists. When most people think about braces, the last thing that comes to mind is kids with baby teeth. However, the American Association of Orthodontists recommends all children have their first orthodontic consultation around age 7. Even though most of the permanent teeth haven’t erupted at that age, there may be an underlying issue that isn’t readily apparent. The goal of these early visits is to identify problems BEFORE they develop into something more serious.

What age should my child see the orthodontist?

Now the big question—what are we looking for during a typical orthodontic consultation? Orthodontists are dentists who specialize in tooth movement and the growth and development of the jaws, teeth, and face. We’ll evaluate how your child is growing and check for any potential risks to the bone, gums, teeth, or jaws. Things we’ll be looking for include:

CROWDING/SPACING: This is the most common dental problem found in kids and the #1 concern from parents and dentists. Crowding results when the jaws are too small and/or the teeth are too big. If a child loses a baby tooth prematurely, other teeth may shift into the vacant space, resulting in too little room for the permanent teeth to erupt. The gums and bone around crowded teeth could become thin and recede as a result of severe crowding, necessitating the arches be expanded or that teeth be removed to create the needed space. On the other hand, spacing occurs if teeth are small or missing, or the arches are too wide.

TOOTH LOSS AND ERUPTION: The transition from baby teeth to permanent teeth is extremely important. Where primary teeth are and when they fall out is also a big deal. Did you know that adult teeth erupt in a fairly specific order? By age 7, children should have four permanent molars and two-to-four permanent incisors. Any significant deviation from the normal sequence could indicate crowded, missing, or extra teeth. If primary teeth were lost prematurely, patients may benefit from 1) an appliance that maintains the space where a tooth was, or 2) the removal of a primary tooth to help minimize issues down the road.

ALIGNMENT: Although teeth can be aligned when patients are older, crooked teeth in children often lead to problems with chewing and function. Poorly positioned teeth are more susceptible to uneven wear or trauma, and can lead to periodontal (gum) and/or speech issues. Crooked teeth can also have major social implications in children. Correcting maligned teeth at an earlier age not only improves chewing, but can also have a large impact on a child’s self-esteem.

POSTERIOR CROSSBITES: If the top jaw is too narrow, kids often shift the lower jaw laterally (side-to-side) to “find” a functional bite. This lateral shifting can lead to early tooth wear or asymmetric jaw growth. Early expansion of the upper jaw around the ages of 7-11 can eliminate crowding or shifting and improve irregular jaw growth.

UNDERBITES: Underbites occur when the lower jaw “juts out” ahead of the upper jaw, often making eating, swallowing, and speaking difficult. The condition is often hereditary, meaning that parents with underbites tend to have children with underbites. While we typically have to wait until the patient has finished growing to complete treatment, early detection is important so that the bite can be normalized to avoid any “bite-shifting” or damage to the front teeth. Patients with underbites who receive early treatment (between the ages of 7 and 10) are much less likely to need corrective jaw surgery later in life.

PROTRUDING TEETH (OVERJET): By age 7, it’s also easy to tell if a child’s upper teeth extend too far forward or the lower teeth don’t extend forward enough. The clinical term for this condition is “overjet”, and often indicates a poor bite and/or poor jaw growth. Thumb sucking in children is a common cause, creating “flared” teeth susceptible to being chipped or knocked out. While it isn’t always possible to completely correct the problem at a young age, early treatment can greatly reduce the severity of the problem and improve dental function and patient self-esteem.

ANTERIOR OPENBITES/DEEPBITES: It’s possible to detect vertical bite issues as early as age 7. Openbites occur when the top and bottom front teeth are unable to make contact when the jaws are closed. Often caused by a finger, thumb, or tongue habit, openbites can cause accelerated wear of the back teeth, speech impairments, and make eating and drinking difficult. Deep-bites occur when the top teeth completely cover the bottom teeth, potentially causing damage to the teeth and gums. Vertical problems normally worsen as the patient grows, making early detection and correction important.

WE RECOMMEND ALL CHILDREN HAVE A GROWTH AND DEVELOPMENT SCREENING BY AGE 7. While not every orthodontic problem can (or should) be treated at this age, an early screening allows us to identify serious issues and correct them before they worsen. Many times, the best treatment decision is deciding to do nothing – no treatment! The majority of kids are simply seen annually so we can monitor their progress until they’re ready for treatment. If we see a situation that could benefit from early treatment, we’ll discuss the benefits of interceptive treatment. But most importantly, these visits allow us to launch into a fun, relaxed, and trusting doctor/patient relationship.

**We would like to thank Dr. Silas Dudley for his contribution to this blog. Portions of this article appeared first at http://www.dudleysmiles.com/when-should-my-child-see-an-orthodontist/

About the Author: Dr. Jeff Lenius is an Orthodontic Specialist at Bankhead Orthodontics in St. Louis. He completed dental school at The University of Iowa and his orthodontic specialty training at The University of Colorado. His private practice is limited to orthodontics, including traditional and two-phase treatment, clear and metal braces, Invisalign™, lingual braces, self-ligation appliances, SureSmile™, and functional appliances. He is licensed to treat patients in Illinois, Iowa, and Missouri. The information in this article is for educational purposes only. It is designed to inform current and prospective patients and parents about currently accepted orthodontic principles and is not intended to debate alternative treatment theories. The views and opinions expressed in this article are protected by copyright laws and may not be used without written permission from the author.

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