When is the Best Time for my Child to start Braces Treatment?

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ABC Dental Education | By Dr Stanley Kok

Even though most people think of pre-teens and teens when they think of orthodontics, there are good reasons your child should get an orthodontic evaluation much sooner. The American Association of Orthodontists recommends a check-up with an orthodontic specialist no later than age 7.

Starting the process early doesn't mean a child will get braces right away. It just means the orthodontist will be able to detect any problems and decide the best time for your child to start braces treatment.

Orthodontists can spot subtle problems with jaw growth and emerging teeth. While your child’s teeth may appear to be straight, there could be a problem that only an orthodontist can detect. The check-up may reveal that your child’s bite is good, or the orthodontist may identify a developing problem. He may recommend monitoring the child’s growth and development, and if indicated, begin treatment at the appropriate time. In other cases, the orthodontist might find a problem that can benefit from early braces treatment.

In the list below, I shall briefly describe some of the commonly seen features of children requiring early orthodontic intervention or monitoring.

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1. Impacted Teeth

a. Unerupted Front teeth

A delay in eruption of greater than 6 months between the left and right upper front teeth is a cause of great concern. This is most commonly caused by the presence of extra teeth or over-retained baby teeth obstructing its eruption.

b. Impacted Canine

The upper canine fails to erupt in 2% of the population and orthodontic treatment may be required to pull those impacted canines into alignment. Typically, the upper canine should be felt in the gums by the age of 10. If not, a x-ray should be taken to investigate.

c. Impacted Molars

Impaction of the upper first molar has a high occurrence of 4% and is indicative of crowding in upper jaw. This is one of the earliest problems that require early orthodontic treatment at the age of 7.

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2. Missing Teeth

Congenital absence of one or more teeth is relatively common. Premolars or incisors are the most common types of teeth that are missing, with up to 8% of the population being affected. Orthodontic management of congenital tooth absence will involve either closing of the space or maintenance of the space for replacement using false teeth.

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3. Ankylosis

A tooth becomes ankylosed when the tooth becomes fused with the bone. This condition affects the baby molars in up to 9% of children. This can result in the affected tooth becoming shorter (infra-occluded) relative to the rest of the teeth. Your orthodontist may then indicate for the ankylosed baby tooth to be removed. If the ankylosed baby tooth has minimal infra-occlusion, and a permanent adult tooth is present and developing under it, the affected tooth can be left under observation.

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4. Supernumerary teeth

These are additional teeth present on top of the normal complement affecting around 4% of the population. The mesiodens, located near the upper 2 front teeth, is the most common form of supernumerary teeth and is often detected by x-rays. Removal is usually indicated if they interfere with the growth, position or proposed orthodontic movement of adjacent teeth.

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5. Reverse Overjet (“UnderBite”)

A single tooth in “underbite” position can cause gum recession of the lower incisors. Treatment should be rendered as early as possible to prevent further damages to the teeth and gum involved.

An underbite involving all the upper front teeth tends to worsen with age. Hence, treatment decisions are often delayed to monitor further growth to better determine the extent of the jaw discrepancy. In some cases, early treatment with functional appliances can be considered in patients whose jaw discrepancy is mild. This type of underbite can be treated to a high success rate.

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6. Increased Overjet (Bugs Bunny Teeth)

Class II malocclusions (protruding upper teeth) are amenable to early treatment using functional appliances; however, the timing of treatment is paramount for the success for such treatment. Early correction is warranted as an increased overjet is often a cause of teasing and bullying, and there is an increased risk of trauma to the upper front teeth.

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7. Traumatic Deep Bite

A traumatic deep bite occurs when the incisors have erupted past each other to the point that the lower front teeth starts biting into the gums of the upper teeth which often results in its recession. It is much easier to correct a overbite problem in a growing child as the growth facilitates the overbite reduction. Early correction is always required to prevent worsening recession which can eventually lead to increased mobility of the upper front teeth.

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8. Open Bite

Open bite occurs in around 2% of the population. When observed in a child, it is important to eliminate the cause of the open bite is due to bad habits such as digit sucking or mouth breathing. Eliminations of these poor habits with early orthodontics corrections will prevent worsening of such conditions which can be challenging to correct later in life.

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9. Cross Bite

A posterior crossbite is a reverse bite involving the back teeth. In children, a posterior crossbite can be an early indication of a discrepancy in the sizes of the upper and lower jaws. Alternatively, it may be due to a bad posturing or displacement of the lower jaw. This established lower jaw displacement can progress from the primary (baby) set of teeth into the adult set of dentition. Hence, it is often appropriate to correct a posterior crossbite and eliminate the jaw displacement as early as possible. This may be as early as the age of 7.

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In Summary

Early treatment of developing dental problems may prevent more serious problems from developing and may make braces treatment at a later age shorter and less complicated. In some cases, the orthodontist will be able to achieve results that may not be possible once the face and jaws have finished growing.

Through an early orthodontic evaluation, you’ll be giving your child the best opportunity for a healthy, beautiful smile. Because patients differ in both physiological development and treatment needs, the orthodontist’s goal is to provide each patient with the most appropriate treatment at the most appropriate time.

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