Children's Orthodontics: Does My Child Need an Assessment?

Why seven?

By about seven the first adult molars and the adult front teeth are usually in, which gives an orthodontist enough information to see how the bite is developing without waiting for every adult tooth. It is also early enough that growth can be used where it helps. The check is short, typically with photographs and, if there is a reason, a panoramic radiograph. At Guildford Orthodontic Centre the first visit is complimentary and includes a digital scan.

Signs that may warrant an assessment

None of these means treatment is needed. Each is a reason to have someone look.

Signs worth a visit before the teen yearsScreenshot this list for the dentist

A crossbite: one or more upper teeth biting inside the lower teeth, at the front or the side, especially if the lower jaw shifts to one side when closing.
Upper front teeth that stick out well beyond the lower teeth, particularly if the child has had a fall or a chipped tooth.
Front teeth that do not meet when the back teeth are together (an open bite), often alongside a thumb or finger habit or a tongue-forward swallow.
Baby teeth lost very early or very late, or an adult tooth coming through in an odd place, or one side well ahead of the other.
Crowding severe enough that adult teeth are erupting behind or in front of the arch.
A dentist has mentioned it. General dentists see children far more often than orthodontists do and refer for good reasons.

What an assessment involves

Expect a conversation about habits, breathing, snoring, previous dental injuries and family history; a look at the face and profile; a look at the bite from the front and each side; photographs; and often a digital scan. Radiographs are taken when they will change the decision, not by default. The visit ends with one of three outcomes: nothing needed now, come back in a set number of months to watch a specific thing, or a proposal for early treatment with a stated goal. A written summary is reasonable to ask for. For what an assessment should include in more detail, see what an orthodontic assessment involves.

What early treatment is actually like

Weeks 0 to 2: records and fittingScan or impressions, photographs, sometimes a radiograph. An expander or partial braces is fitted a week or two later. Fitting is usually not painful; the mouth feels crowded and speech is thick for a few days.
The turning weeksExpanders are turned at home by a parent with a small key, on a schedule set for your child and given to you in writing. A gap may open between the front teeth; this is expected and closes later. Eating soft food for the first week helps.
Months 2 to 9: active phaseVisits every 6 to 10 weeks. Partial braces get wire changes; expanders are left in place to hold the new width. Brushing around an expander takes a water flosser or a syringe to clear food from under the plate.
Months 9 to 18: holding and removalThe appliance is removed in a short visit. A simple retainer or the appliance itself may be worn at night to hold the change.
The rest periodNothing active happens while the remaining adult teeth come through. Check-ups every 6 to 12 months. Many children then need shorter or simpler full treatment; some need none; some still need full braces. A good Phase 1 plan says at the start which of these is likely.

Why this matters clinically

Some corrections use growth that will not be available later. A posterior crossbite with a jaw shift, for example, can be addressed with expansion while the upper jaw's midline suture is still open; after growth the same correction may need more complex treatment. The Cochrane review of early treatment for prominent upper front teeth found that treating early reduced the chance of injury to those teeth, while final results after full treatment were similar whether treatment was done in one or two phases. That is the honest case for early treatment: specific benefits in specific situations, not a universal head start.

Good reasons and weak reasons to treat early

Reasons an orthodontist may give for early treatment
Reason given	How to read it
Crossbite with a jaw shift	A well-supported reason; expansion in a growing child is predictable.
Very prominent front teeth in a child who plays contact sports or has already had a knock	Well supported for injury reduction; ask whether a second phase will still be needed.
Habit (thumb, finger, tongue) that is holding an open bite	Reasonable; often a habit appliance and coaching rather than braces.
A tooth erupting in the wrong place or blocked out	Reasonable; sometimes a simple space maintainer or a baby-tooth extraction rather than an appliance.
"It will avoid extractions later"	Possible in some crowding cases, not guaranteed. Ask how likely, and what happens if it does not.
"It will avoid surgery later"	Rarely a safe promise. Growth is not fully predictable. Treat this as a hope, not a plan.
"It will fix breathing or sleep"	Not an orthodontic outcome to promise. Ask for a medical referral if breathing is the concern.

A note on airway and sleep. Orthodontists assess growth, jaws, bite, arches and habits. Physicians diagnose medical sleep and airway disorders, and orthodontic treatment is not a treatment for sleep apnea, snoring, mouth breathing or attention difficulties. Where a growth pattern or habit may be relevant to breathing, a good assessment says so and suggests a medical referral rather than promising an outcome. For the national evidence summary, see AirwayOrthodontics.ca.

Planning around school and family life

Early treatment visits are short and roughly every six to ten weeks; most families book them for after school. Expander turns happen at home. The first week of any appliance is the hardest for eating and speech, so avoid fitting it the week of a school presentation or a birthday party if you can. For the day-to-day, see braces at school and eating with braces.

Questions people ask

Is age seven too early for braces?

Seven is an age for a check, not usually for braces. Most children seen at seven are monitored. Full braces are far more often fitted between about 11 and 14, once most adult teeth are in.

Does every child who has Phase 1 need Phase 2?

No, but many do. Phase 1 addresses a specific problem while the child is growing; Phase 2 aligns all the adult teeth. Ask at the start how likely a second phase is and what it would involve.

Can a general dentist do the early check?

Yes. General dentists monitor development at routine visits and refer when something needs a specialist look. Both general dentists and orthodontists provide orthodontic care in BC.

References

American Association of Orthodontists. Your child's first check-up with the orthodontist: no later than age 7. Consumer guidance. https://aaoinfo.org/
Canadian Association of Orthodontists. Consumer information on orthodontic treatment and specialist care. https://www.cao-aco.org/
Batista KBSL, Thiruvenkatachari B, Harrison JE, O'Brien KD. Orthodontic treatment for prominent upper front teeth (Class II malocclusion) in children and adolescents. Cochrane Database of Systematic Reviews 2018;(3):CD003452. https://doi.org/10.1002/14651858.CD003452.pub4
Thiruvenkatachari B, Harrison J, Worthington H, O'Brien K. Early orthodontic treatment for Class II malocclusion reduces the chance of incisal trauma: Results of a Cochrane systematic review. American Journal of Orthodontics and Dentofacial Orthopedics 2015;148(1):47-59. https://doi.org/10.1016/j.ajodo.2015.01.030
Agostino P, Ugolini A, Signori A, Silvestrini-Biavati A, Harrison JE, Riley P. Orthodontic treatment for posterior crossbites. Cochrane Database of Systematic Reviews 2014;(8):CD000979. https://doi.org/10.1002/14651858.CD000979.pub2
Behrents RG, Shelgikar AV, Conley RS, et al. Obstructive sleep apnea and orthodontics: An American Association of Orthodontists White Paper. American Journal of Orthodontics and Dentofacial Orthopedics 2019;156(1):13-28.e1. https://doi.org/10.1016/j.ajodo.2019.04.009

Children's orthodontics: does my child need an assessment, and what is early treatment like?

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