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Orthodontic treatment for

Ideal age to begin orthodontic treatment of children

The American Association of Orthodontists recommends an assessment with a registered orthodontist no later than seven years of age, as early treatment may give the orthodontist the opportunity to:

  • Guide jaw growth
  • Lower the risk of trauma to protruding front teeth
  • Assist with stopping various habits such as thumb sucking
  • Improve appearance
  • Guide permanent teeth into a more favourable position
  • Improve the way the lips meet

For more information on the ideal time for the first orthodontic assessment, please see below the American Association of Orthodontists website.

https://www.aaoinfo.org/blog/parent-s-guide-post/understanding-early-check-ups/

https://www.aaoinfo.org/blog/parent-s-guide-post/what-parents-should-look-for/

In my opinion, the ideal age to begin orthodontic treatment for the majority of children is between 10-12 years old, once most of the adult teeth have erupted. This allows for all the teeth to be aligned and the bite to be corrected simultaneously. Whilst I recommend assessment of a child’s developing dentition by a specialist or a consultant in orthodontics from the age of seven, I recommend orthodontic treatment before the age 10 for only about 10 per cent of children. In my opinion, in the majority of cases, beginning treatment before 10-11 years of age confers few advantages, whilst prolonging unnecessarily the duration of the treatment as well as increasing the cost to the patient’s family.

For a small percentage of children, for whom early intervention can achieve results that are not possible once the growth of the jaw and face is complete, it may be desirable to start the orthodontic treatment sooner. Such cases include the delayed eruption of permanent teeth, suspicion of impacted teeth, and misalignment of the upper front teeth or bite. When there is a suspicion that permanent teeth are or are becoming impacted, a simple intervention such as widening of the upper dental arch to create space may assist in normalising the position of the adult teeth. In cases when the child has a narrow dental arch or smile, widening the upper dental arch minimises the likelihood of the child requiring extraction of teeth and can spontaneously improve the alignment of his/her teeth.

Below you will find some examples of what to look out for as a parent and what treatment modalities are available.

Narrow upper arch

Before
 
 
At 7 days
At 3 months
At 6 months
After
 
 

A 10-year-old girl presented with a narrow and V-shaped upper dental arch and palate, as well as significant disproportion between the size of the upper and lower jaws. This gave rise to crossbites and a misaligned bite of the front teeth. An expansion device was used to widen the upper dental arch to correct the bite and yield an aesthetically pleasing smile. Despite the upper dental arch being crowded,  the upper teeth were aligned without requiring the extraction of any teeth.

Severe misalignment of upper front teeth

Before
 
 
During Treatment
 
 
After
 
 

An 8-year-old boy was being teased at school about the misalignment of his upper front teeth. A fixed appliance was used to straighten the upper teeth, providing him with a confident smile and restoring his self-esteem. 

In cases where early fixed appliance treatmemt is carried out, it is preferable to keep the treatment duration to a minimum, usually six months, as a further comprehensive course of treatment at the age of 11 is usually advised. 

Thumb-, finger- or tongue-sucking habits causing an open bite

Persistent thumb, finger or tongue sucking at night and/or during the day beyond the age of 6 may cause protruding upper teeth and an open bite of the front teeth.

In my opinion the easiest and most cost-effective means to stop thumb or finger sucking is by educating a patient and encouraging him/her to stop. I find this method is simple yet effective for more than 90 per cent of my patients. Beyond this, if necessary, a comfortable removable appliance may be worn at night as a habit dissuader.

Before
 
 
During Treatment
 
 
After
 
 

An 8-year-old girl with a persistent thumb- and tongue-sucking habit presented with an open bite and protruding upper teeth. There was a well-defined step between the upper lateral incisors and the primary canine teeth. A removable appliance was worn at night time which prevented the tongue from coming forward. This allowed the teeth to grow, and the correct bite was achieved.

Misaligned bite of the front teeth

A misaligned or incorrect bite at the front teeth is also known as anterior crossbite. The upper front teeth should be ahead of the lower teeth throughout the dental development. Simple treatment with a removable appliance or fixed appliance may be carried out in young children to get the bite of the front teeth corrected.

Before
During
After

An 8-year-old boy presented with an anterior crossbite, whereby the two upper front teeth (upper central incisors) were biting behind the lower front teeth. Provision of an upper removable appliance with a screw and key mechanism pushed the upper front teeth forward to achieve the correct placement of the upper front teeth, creating space for the eruption of the side teeth (upper lateral incisors).

Lingual Crossbite Correction

A misaligned bite of the back teeth can be much easier to correct in young growing children. Beyond a certain age and at the end of the growth period, the back teeth may lock unfavourably, and the bite may be much more difficult to correct.

Before
During
After

A 9-year-old girl presented with a lingual crossbite on the upper right first molar.

In a normal bite, the upper first molar bites further inwards in relation to the lower molar.

Simple early treatment involving wearing elastics at night between two attachments/brackets corrected the bite. Postponing treatment would have been more difficult and time-consuming, as the upper molar tooth tends to travel downwards, locking the bite unfavourably even further. 

Space creation to align impacted and/or severely displaced teeth.

Creating space for displaced and/or impacted teeth allows for the impacted and/or severely displaced teeth to be aligned without loss of any permanent teeth. 

Before
 
 
After
 
 

A 12-year-old girl presented with a displaced upper right canine tooth. The space created allowed for the alignment of the upper right canine tooth as well as for the correction of the upper centreline.

Whilst I recommend assessment of a child's developing dentition by a specialist or a consultant in orthodontics, in my clinic I consider it to be desirable to start orthodontic treatment before age 10 for only 10% of chiildren. I believe that starting treatment before 10-11 years of age for 90% of children confers few advantages but on the contrary, if one starts too early one has to balance time off school, the possibility of treatment/burden fatigue due to the long treatment duration and the additional expense of orthodontic treatment that may not be necessary.