Written by: Dr. AnnaKate Tatum

When should my child see an orthodontist? The answer may surprise you.

I am an orthodontist and soon-to-be mother of 2.  At dance, gymnastics, preschool, I hear all the time, “My kid’s teeth are straight so we don’t need to see an orthodontist” and “we still have baby teeth so there’s no reason to see you yet.”  While this may seem to make sense, there are actually quite a few reasons you should see an orthodontist early- not doing so can have big implications. The American Association of Orthodontics recommends that all children see an orthodontist at age 7.  Westrock Orthodontics agrees!Early care, or phase I care, is orthodontic care when children still have baby teeth.  I like to tell my patients that every child needs to be seen by age 7. Most of those children will not need early care, but for those who do need it, getting started at the appropriate age is vitally important.  Even if early care is not needed, we get a baseline to monitor their growth and development over the next 3-5 years until it is time for care. We can also give mom and dad peace of mind and education about what may be needed in the future. In certain situations, which I explore below, there is a reason to start early or phase 1 treatment while a child still has baby teeth and is growing.  In those cases, it is paramount that they be seen early so their growth and development can occur with the guidance of an orthodontist. Orthodontists are trained in craniofacial development as well as tooth development. We take into account skeletal growth patterns, muscle and soft tissue development, airway, and other issues as we consider the best treatment for our patients.  While your child’s teeth may appear straight, a trained orthodontist can determine if the best treatment involves starting treatment at a younger age. Here are some of the reasons we may recommend early treatment for children ages 7-10.

Making room for the eruption of permanent teeth

Baby teeth are lost in a very specific order.  Between ages 6-8, it is normal for a child to lose his/her front 8 baby teeth. Those are immediately replaced by the 8 permanent front teeth (4 upper front teeth and 4 lower front teeth). During this time, children should also get their first molars (sometimes called 6-year molars) in the very back of their mouth. If there are more or less teeth than this, it may mean something out of the ordinary is happening.  If permanent teeth don’t have room to come in, the extraction of a baby tooth might prevent bigger problems later on.  Also, if baby teeth are lost too soon, space maintainers may be needed to hold space until it is the normal time for a permanent tooth to erupt.

Traumatic occlusion

Although alignment issues can be corrected when patients are 11 or 12 and have all of their adult teeth, some alignment issues need to be corrected early.  Crooked teeth can cause uneven wear to other teeth or even gum and bone loss due to trauma to the tooth when a child bites together. These are issues that need to be resolved immediately to prevent further damage.

Protrusive front teeth

Sometimes children have front teeth that stick out. Often times called “buck teeth,” this is neither safe nor attractive. Children with protruding front teeth are much more likely to break teeth and/or have teeth go through their lips if they were to fall or get hit in the mouth. In addition, it can also be a major self-esteem issue if children are being bullied or teased at school about their teeth.  For these reasons, we treat protrusive teeth at an early age to manage their smile and their confidence as they go through elementary and middle school.

Crossbites

Children can have crossbites in which the normal relationship of the top and bottom teeth is reversed. This can happen in the front (anterior crossbite), the back (posterior crossbite) or both.  In either case, it needs to be resolved immediately to prevent problems in the future. Let’s talk about a few different types of crossbites and how to treat each. The first is a dental crossbite in which a child’s jaws line up normally, but for whatever reason one or more teeth have not erupted into the correct relationship.  This can cause traumatic occlusion or bite which, as we have said, can lead to bone and gum damage to those teeth involved.  Thus, it needs to be treated immediately. Another issue that can happen with a dental crossbite is a functional shift. If a child bites down and their front teeth hit edge to edge and don’t allow the back teeth to come together, a child will subconsciously shift the lower jaw forward to make their back teeth come together.  The same thing can happen if a tooth hits edge to edge and a child shifts left or right to make their bite more comfortable.  Both of these shifts will actually alter the way that the lower jaw develops and can lead to drastic asymmetry, such that the top and bottom jaws no longer fit together correctly.  These must be corrected at a young age to eliminate the functional shift and prevent abnormal growth of the lower jaw. The final crossbite we will discuss is a skeletal difference between the top and bottom jaw.  For a number of reasons the top and bottom jaw can grow in different amounts.  The lower jaw will continue to grow past puberty, however, the top jaw completes the majority of its growth by age 9 for girls and age 10 for boys.  For this reason, if we have a need to alter the growth of the top jaw, we need to see the patient by age 7 so we can initiate care before the top jaw completes its growth and we are no longer able to manipulate it.  For example, seen at a young age, a child can wear a simple expansion appliance for a year which allows the top jaw to develop wider. This eliminates crowding of the teeth and allows top teeth to fit correctly with bottom teeth.  If the same patient is not seen at an early age, what could have been simple may become more complicated treatment involving removing permanent teeth or even orthognathic surgery in the future.

Deepbite and Openbite

This is the last major reason we like to see patients by age 7.  If a child’s front teeth overlap so much that you cannot see the lower teeth, we call this a deepbite.  It can mean that the jaws are not developing correctly and could mean the patient is traumatizing the tissue behind their top front teeth when they bite together.  The opposite of too much overlap of the front teeth is no overlap of the front teeth or an open bite.  This can indicate a thumb or finger sucking habit, a tongue thrust habit, or again a skeletal discrepancy (the top and bottom jaws are growing away from each other instead of growing together). In any of these cases, again, we need to see the patient so we can address the issue and correct it so that normal development can occur. Personally, I love to see 7-year-olds in my practice.  Our orthodontic consultations are complimentary, so it costs nothing to come see our excellently trained orthodontists.  The exams are quick and easy, and they help familiarize the child with our office which makes them more comfortable. In the majority of exams, we show mom and dad what’s going on and then ask the patient to return in 9-12 months for the same exam so we can monitor their growth and development. For those children who have any of the issues listed above, it is vital that they are seen so their conditions can be identified and corrected as early as possible.  Early care, or phase 1 care, can make the final result easier and faster, as well as give a child 3-5 years to enjoy a great smile during the critical years their self-image is developing.  If you have a child 7 or older who has not been seen by an orthodontist, please call to set up a complimentary exam today!