Guides · Children
Orthodontics for children: when should the first assessment be?
Why a check at age 7, conditions that need early intervention, the effect of habits and treatment timing.
A first orthodontic assessment is recommended at around age 7: by then the front incisors and first molars have erupted and jaw-growth problems can be spotted early. In most children treatment does not start immediately; only in cases such as crossbite, a marked mismatch between the jaws, thumb-sucking effects and severe crowding is a short early intervention done at 7–10, with the main treatment at 11–14 once the permanent teeth are in.
Waiting until "all the teeth have changed" is not always right for orthodontic treatment. Some jaw and alignment problems are far easier to guide during growth; that is why a first orthodontic assessment is recommended at around age 7.
Why age 7?
By this age the first permanent molars and the front incisors have erupted; the relationship of the jaws and whether the teeth will fit can be predicted. For most children the early assessment ends with "let's watch for now" — but in the few cases that need intervention, it starts on time.
Conditions that may need early intervention
- Crossbite (upper teeth closing inside the lower), especially one-sided
- A narrow upper jaw, mouth breathing
- A forward lower jaw (Class III)
- Markedly protruding upper incisors — risk of falls and fracture
- Open bite, prolonged thumb-sucking or dummy use
- Early loss of a primary tooth and space loss
- A permanent tooth failing to erupt or erupting in the wrong place
Early-phase treatments
The aim at this stage is not to straighten individual teeth but to guide growth: palatal expanders, functional appliances, space maintainers and habit-breaking appliances are used. Duration is usually 6–12 months; growth is then monitored.
The main treatment period
Ages 11–13, when most teeth have changed, is the commonest time for fixed braces or clear aligners. The growth spurt in this period makes correcting the jaw relationship easier. In children who had early intervention, this stage is shorter and simpler.
Habits
Thumb-sucking and dummies continuing beyond age 3–4 push the upper incisors forward and create an open bite. Mouth breathing (enlarged adenoids, allergy) narrows the palate; an ENT assessment may be needed. Tongue thrusting and lip biting also affect alignment.
What can parents do?
- Book an orthodontic assessment at around age 7
- Guide the child to give up the dummy and thumb-sucking by age 3
- Investigate nasal obstruction in a child whose mouth is always open
- Prevent early loss of primary teeth to decay
How is early treatment done?
- Rapid maxillary expansion: For a narrow upper jaw and crossbite, an appliance fitted to the palate is turned once a day and widens the jaw in 2–4 weeks; it stays in place for 4–6 months.
- Functional appliances: When the lower jaw is behind, a removable appliance timed with growth (Twin Block etc.), 12–16 hours a day for 9–12 months.
- Headgear / face mask: When the upper jaw is behind or ahead, external growth-guiding appliances; usually worn in the evening and at night.
- Space maintainers and habit appliances: To keep space after early loss of a primary tooth; to stop thumb-sucking and tongue thrusting.
- Partial braces: On the front teeth only ("2×4"), for marked crowding or protruding front teeth at risk of trauma.
Treatment in adolescence
Once all permanent teeth are in (11–14), full treatment is done with brackets or clear aligners; it takes 12–24 months. The growth spurt in this period is the last chance to correct the jaw relationship; in adulthood the same problem may need surgery. In children who had early intervention this phase is shorter and less complex.
Compliance in children
- Removable appliances need the child's responsibility; wear time is tracked
- Gingivitis and white-spot lesions are the commonest problems with braces: interdental brushes, fluoride toothpaste and cleaning every 3 months
- An orthodontic mouthguard for children who play sport
- Sticky and hard foods break brackets; a broken bracket prolongs treatment
Parents' frequent questions
The primary teeth are uneven — should I worry? Gaps between primary teeth are normal and mean room for the permanent ones; a gap-free, tight primary dentition can herald crowding later.
The permanent front teeth came in behind and the baby tooth hasn't fallen out. Common; if the primary tooth does not fall out within 2–3 months the dentist assesses it and removes it if necessary.
Is treatment painful? Tenderness for 2–3 days after adjustments; painkillers are rarely needed.
Braces or aligners? Depends on the child's compliance and the need for growth guidance; many adolescent cases can be treated with aligners.
Related: Who is suitable for clear aligners? · Impacted canines · Orthodontics
This article is for general information only; diagnosis and treatment tailored to you require a dental examination.
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