The timing of orthodontic treatment is determined by the child’s stage of tooth and jaw development. There is no single right age for every child; an early check-up allows timely intervention when it is needed.

Developmental stages

• Primary dentition: Intervention may come up in a limited number of situations (e.g., marked crossbite) (Kanellis, 2001).
• Mixed dentition: Guidance treatments can be planned for space problems and jaw discrepancies (Graber, 2001).
• Permanent dentition: Comprehensive treatment is done with fixed appliances; there are approaches specific to Class I, II and III problems (Staley & Reske, 2001; Spalding, 2001).

First check-up

When you notice crowding, thumb sucking, open bite or jaw discrepancy, you can consult an orthodontist. Treatment steps and the follow-up process are planned by the dentist (Kuhlberg, 2001).

Why is the first examination important?

A child’s jaw and tooth development progresses quickly. An early examination makes it possible to see early the cause of crowding, tooth-jaw discrepancy and the effects of habits such as thumb sucking. This examination does not mean treatment will start immediately; in most children only monitoring is done (Kuhlberg, 2001).

Orthodontic approach in primary dentition

In the primary dentition period, intervention comes up only in special situations; for example in marked crossbites or conditions that lock the bite, the dentist may consider early intervention (Kanellis, 2001). In most cases monitoring development is enough.

What is done in the mixed dentition period?

In this period, when primary and permanent teeth are present together, approaches such as space management, jaw expansion or habit-breaking appliances can be considered. In some cases guidance programs including extractions (serial extraction) are planned (Graber, 2001). These decisions are made only after a specialist examination and X-ray review.

Comprehensive treatment in permanent dentition

After all permanent teeth have erupted, comprehensive treatment with fixed braces or clear aligners can be started. Treatment approaches for Class II and Class III bite problems differ from each other (Spalding, 2001; Staley & Reske, 2001). Treatment time and approach depend on the complexity of the case, the child’s stage of development and cooperation.

Tips for parents

• Pay attention to cavity care so as not to lose primary teeth early.
• Discuss thumb sucking and bottle habits with the dentist.
• Strengthen the child’s oral hygiene before orthodontic treatment.

Frequently asked questions

Is it always necessary to start early?

No; in some cases waiting for permanent dentition is more appropriate.

Are clear aligners used in children?

The dentist evaluates according to the situation.

How long does treatment take?

It varies with the case; the dentist gives information. Related article: braces and hygiene.

Does my child need braces?

Only an orthodontic examination can show this; not every crowding needs treatment.

Does early treatment take less time?

Not always; in some cases two-phase treatment may be needed.

At what age is a check-up recommended?

The pediatric dentist or orthodontist determines the check-up time for each child.

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References

• Bishara, S. E. (Ed.). (2001). Textbook of orthodontics. W. B. Saunders.
• Kanellis, M. J. (2001). Orthodontic treatment in the primary dentition (Chapter 17). In S. E. Bishara (Ed.), Textbook of orthodontics (pp. 248–256). W. B. Saunders.
• Graber, T. M. (2001). Mixed dentition guidance of occlusion: Serial extraction procedures (Chapter 18). In S. E. Bishara (Ed.), Textbook of orthodontics (pp. 257–289). W. B. Saunders.
• Staley, R. N., & Reske, N. T. (2001). Treatment of Class I nonextraction problems, principles of appliance construction, and retention appliances (Chapter 19). In S. E. Bishara (Ed.), Textbook of orthodontics (pp. 290–323). W. B. Saunders.
• Spalding, P. M. (2001). Treatment of Class II malocclusions (Chapter 20). In S. E. Bishara (Ed.), Textbook of orthodontics (pp. 324–374). W. B. Saunders.
• Kuhlberg, A. J. (2001). Steps in orthodontic treatment (Chapter 16). In S. E. Bishara (Ed.), Textbook of orthodontics (pp. 232–247). W. B. Saunders.

Note: Book chapter references follow the page ranges of the publisher’s edition; article links open the matching PubMed record.

This article is for information only and is not medical advice. See your dentist for diagnosis and treatment; no outcome is guaranteed.

This page was reviewed by Dr. Dt. Mehmet Fuat Bozaba, periodontist.