The easy and quick answer to this is around age 7 all kids should be evaluated by an Orthodontist. It’s typically a quick and free consult. As Orthodontists we specialize not just in straightening crooked teeth, say what?! That’s right. Orthodontists are experts in so much more – everything surrounding the teeth: jaws, bone, the face, lips, airway, occlusion, TMJ. As you know, all the latter go through drastic changes from birth to adulthood. Being able to evaluate earlier allows Orthodontists to have better view of the child’s growth trajectory. Some kids need an early intervention to prevent a problem from worsening, and some kids can be monitored every 6-12 months to evaluate the changes in their growth and development.
Many parents ask why kids are starting orthodontics “earlier and earlier these days?” Being a parent myself, I completely understand the questioning of this, why would I put my little one through anything that could just wait until later, right? Actually, the opposite is true. The REASON we would do an earlier orthodontic treatment is because sometimes there are problems that are so much harder on the kid if we let it progressively worsen. There are a whole host of issues that present themselves early and are far easier and simpler to correct before they turn into a bigger problem. There are even some problems that if they are not addressed early, you lose the window of opportunity to correct them!
Here are a few examples of problems that present early on:
- Excessive crowding – this can cause impaction of adult teeth in the bone because they are trying to grow into the mouth but do not have the space so they stay buried in the bone and get stuck, or they press against the roots of the adjacent adult teeth and resorb (disintegrate) the roots, or they erupt in crazy locations causing irreversible gum issues
- Open bite – often this is caused by a narrow upper jaw, this can even be associated with other bigger underlying problems like airway disorders, habits, jaws that are developing poorly
- Deep bite/deep overbite – This kind of bite tends to make the upper teeth continue to protrude outwards and sometimes the lower front incisors are so close to the roof of the mouth they cause ulceration of the gum tissue or even recession. Because the lower teeth are so far stuck behind the upper teeth it causes the lower front teeth to get crowded and pushed backwards collapsing inward and preventing the lower adult teeth from having the room to erupt into the dental arch
- Crossbite (front teeth) – this commonly causes significant and quick gum recession on the lower teeth because they are being pushed out of the bone and gums, this can be irreversible if not treated as quickly as possible. Often we see these teeth starting to chip because they are locked into a position with the top teeth
- Crossbite (back teeth) – picture the top teeth like a lid going over the bottom teeth. If the lid is too small it is on the inside of the bottom teeth – a crossbite. This is often associated with a small upper jaw, which can cause narrowing airways leading to snoring, bed wetting, ADD, severe grinding, and a whole host of other medical issues. This is easier to fix earlier than later.
- Underbite (bull dog look)- Sometimes this is a true jaw problem and sometimes it is just a tooth problem. Whichever the cause, typically it needs to be addressed at a younger age. If it is a jaw problem you have a small window of growth to work with and once the child is outside that window there are not many options.
- Protrusion – kids with upper teeth that protrude out farther are at a much higher risk for trauma. Because the top teeth are angled more forward, if they fall, get hit in the face or teeth, it’s very common that they will chip their front tooth or teeth. Once a front tooth is chipped you can never grow more back, it’s deemed to have a restoration for forever. It’s also common for these kids to get teased at school, it’s unfortunate but we see it all the time and this can leave permanent harmful emotional trauma for some kids.
When a child needs early Orthodontic treatment (usually between 6-11), this is called a Phase I. Typically phase I treatments last on average 12-14 months and the child will often finish with a few baby teeth still needing to fall out before they will have their full set of adult teeth. Often we use night time retainers to hold the movements and allow the remaining adult teeth to come in without losing all that we gained during the phase I. Most kids will need a second phase (phase II) once the rest of the adult teeth erupt because there will be additional bite issues, rotations, crowding, and spacing that need to be fine-tuned.
Clear aligners (Invisalign) can sometimes be a great option for kids whether they’re needing a phase I or their full comprehensive treatment around 12. If Invisalign is the treatment of choice, kids who are still mastering their brushing skills (let’s be honest, that’s most kids) can take out their clear aligners when they eat and brush making that challenging skill much easier to master.
Here is a recap of the timeline for possible orthodontics for children:
~7 years old: find an Orthodontist you love, make sure they explain what is happening in a way that makes sense to you and someone who is comfortable for your child to be around.
6-11: If a child needs a Phase I this is the typical timeframe. Most children have their front 4 upper and front four lower adult teeth + their back 6 year molars (12 adult teeth), and everything in between are the baby teeth that will start falling out as the adult teeth grow in (~10-12 baby teeth)
~11+: Kids start losing their final baby teeth and have mostly adult teeth. Depending on their needs they might be ready for Phase II (if they had a phase I) or we just call this comprehensive orthodontic treatment if they did not have a phase I. Most kids who finish full comprehensive orthodontics and wear their retainers well do not need orthodontics again. However, if retainers are not worn well, stopped prematurely, or are not replaced once they get worn out, teeth will move back to where they came from! Teeth can still shift slightly even with good retainer wear just because they body is always changing, but usually these changes are minimal.
Adults: For most adults any problems that were present as a child tend to worsen as an adult. It’s a misconception that people “grow into their teeth” or their teeth fix themselves. In fact it’s the opposite. As the problems worsen, so does the wear and break down of the teeth. If you are an adult who never had orthodontics, it’s never too late to get improvement, but the longer you wait the worse the problems get, the longer it takes to fix, and typically there is some irreversible breakdown of your teeth. Because these problems continue to worsen as we age, even if you can achieve improvement as an adult, you will still be better off in the long run!
Lastly, I often hear that people are waiting for their general dentist to tell them when to see an Orthodontist, whether it’s for you or your child. It’s helpful to understand that general dentists are not experts in the field of orthodontics, and you do not have to wait to take your child to one.