Most parents expect orthodontics to be a teenage thing — braces, school photos, the whole rite of passage. So it surprises people when we say the first orthodontic check-up should happen a good deal earlier than that.
The American Association of Orthodontists recommends that children see an orthodontist as early as age seven. That doesn’t mean braces at seven. It means a look, at the point where a look is most useful.
Why seven?
By around seven, most children have a mix of baby teeth and adult teeth. That mix is exactly what makes the visit worthwhile: there is enough permanent dentition to see where things are heading, and enough growth left to influence it.
At that age we can diagnose and correct tooth and jaw problems sooner, and often without surgery. An upper jaw that is growing too much, or is too narrow, can be recognised early. If a child over the age of six has that kind of jaw discrepancy, they are a candidate for early treatment.
Most children lose all their baby teeth by age 13, and by the end of the teen years the jaw bones harden and stop growing. Orthodontic work in adulthood often takes more time and can involve tooth extraction or oral surgery. Getting a look in early is how you keep the easier options on the table.
Signs worth mentioning to us
You don’t need to diagnose anything. But if you notice any of these, they’re worth raising:
- Early or late loss of baby teeth — children typically start losing teeth around age five and have all their permanent teeth by about 13
- Difficulty chewing or biting
- Mouth breathing
- Thumb sucking that continues past age five
- Speech impediments
- Protruding teeth, where the top and bottom teeth extend away from each other
- Teeth that don’t come together normally, or don’t come together at all
- Shifting of the jaw when your child opens or closes their mouth — a crossbite
- Crowded front teeth around age seven or eight
Crowding, extra spacing, jaw growth problems and bad bites can be inherited, or they can be caused by injury to the mouth, early or late loss of baby teeth, or thumb-sucking habits.
What early treatment actually involves
Early treatment — often called Phase One — typically begins around age eight or nine. Its goal is to guide jaw growth and correct certain bite problems, such as an underbite, and to make room for permanent teeth to come in properly. That last part matters: creating space early lessens the chance of extractions later.
Phase One is followed by a resting period, where the remaining permanent teeth are left alone to erupt. We check in roughly every six months during this stretch. Teeth are not in their final positions at the end of Phase One, and they’re not meant to be.
Phase Two usually begins around age 11 or older, once all the permanent teeth have come in. It normally involves full upper and lower braces for an average of 24 months, followed by retainers.
Not every child needs two phases. Plenty need nothing at all at seven, and we simply keep an eye on things. The point of the early visit is to find out which situation you’re in.
What happens at the first visit
Your initial consultation is where we review your dental and medical history, do a complete oral exam with X-rays to determine whether treatment is necessary, help build a treatment plan if one is needed, and go through the financial side — insurance options and payment plans included.
We’ll answer whatever you want to ask. Nothing gets decided in the chair that day.
If your child is around seven or eight and showing any of the signs above, or your family dentist has suggested a look, request an appointment or call us on (212) 966-9628. We’re happy to tell you that nothing needs doing yet — that’s a perfectly good outcome.