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At what age should children see the orthodontist?

This is one of the most common questions we’re asked from parents and dentists. The American Association of Orthodontists recommends all children have their first orthodontic consultation around age 7. Many of the permanent teeth haven’t erupted at that age, but there may be an underlying issue that isn’t obviously apparent. The goal of these early visits is to identify problems before they develop into something more serious.
Orthodontists will evaluate how your child is growing and check for any potential risks to the bone, gums, teeth, or jaws. Some of the things we need to evaluate are crowding, tooth loss, spacing, and the type of bite your child has.

Crowding is a common dental problem and concern for both parents and dentists. It develops when the jaws are too small or the teeth are too big, and can exist simultaneously. If a child loses a baby tooth prematurely, other teeth may shift into the vacant space, resulting in not enough room for the permanent teeth to erupt. The gums and bone around crowded teeth could become thin and recede in more severe cases of crowding. In these severe cases, the arches need to be expanded or teeth may need to be removed to create the needed space. On the other hand, large spacing occurs if teeth are small or missing, or if the arches have developed too wide.

The period of development during which the baby teeth are lost and permanent teeth erupt is extremely important. The placement of the primary teeth and when they fall out is also crucial. Permanent teeth should erupt in a fairly specific order. By the age of 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 either an appliance that maintains the space where a tooth was, or the removal of a primary tooth to help minimize issues down the road.

Although teeth can be aligned when patients are older, crooked teeth in children can 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 negative 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.

If the top jaw is too narrow, kids often shift the lower jaw side to side to “find” a functional bite. This lateral shifting (crossbite) 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 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.

Early evaluation by an orthodontist can also identify an overbite, which is when 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.

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.

While not every orthodontic problem can (or should) be treated at this age, an early screening at the age of 7 allows us to identify serious issues and correct them before they worsen. Many times, the best treatment decision is deciding to do nothing! The majority of kids are simply seen annually so we can monitor their progress if or until they are 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.

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