I have many patients who are brought in for their initial consultation by their parents, and I always get questions regarding when the right time to start treatment would be. I don’t have a universal answer for every case, but rather it all depends on each individual patient. Let’s talk about it. When we start Early Treatment, which we also call “Phase I,” we explain why orthodontic treatment can either be postponed or should be started immediately.
According to AOA, the very first time that a child needs to see an orthodontist is at age 7. Why age 7? Can we treat patients at that age and achieve a lot? The most important factor is that we can identify most future problems at that age, and even treat some of these early. What is it precisely that I, as a specialist, look for during the first orthodontic visit for my youngest patients?
Crowding and Spacing
By age 7, we can clearly tell if the patient will have very crowded dental arches or even problems with teeth erupting into the arches. A crowding case will require some expansion of these arches or even extractions of some of the primary (baby) teeth.
Premature Tooth Loss
This can lead to space collapsing and a lack of erupting space for permanent teeth. It is important for orthodontists or pediatric dentists to recognize these problems early. We can preserve spacing by placing appliances known as “space maintainers.”
Should we align teeth now or wait until the patients have all of their adult teeth? Crooked teeth are more susceptible to the wearing down of enamel edges, trauma, or gum recession. Anterior crossbites of even one individual tooth can lead to severe bone loss, gingival recession, and root resorption at that particular tooth, and these are generally problems that I want to correct. An anterior crossbite with a few teeth involved may cause skeletal problems, leading to mandibular overgrowth (Class 3 Skeletal).
This not only creates crowding but also causes the jaw to shift to the side, which leads to facial asymmetry. Expanding the upper jaw at age 7 to 8 reduces the crowding and the risk of potential skeletal problems.
In general, this type of malocclusion requires early intervention. Orthodontists can distinguish whether it is a true skeletal problem or related to some dental eruption problems (i.e. upper incisor erupted in the palatal position of the lower incisors). Generally, I treat these patients with a Palatal expander and face mask therapy (with partial braces as well).
Protrusive Front Teeth
By age 7, it is obvious whether or not the front teeth stick out forward more than is safe or attractive. We cannot fully correct this problem at such an early age, but can help reduce the severity of the problem and make it much easier for the patient socially and dentally.
Anterior Open Bite or Deep Impinging Bite
We can detect this problem by age 7, and correct it as needed. Usually, an open bite can be caused by two distinct factors: thumb/finger sucking or tongue thrust (or a large tongue). I like to eliminate these habits early so that normal development can occur. I recommend screening all young patients at the age of 7, so as to identify some of these conditions and possibly correct them. In many cases, we put the patient under observation, to treat them later when all adult teeth erupt. But in some cases, interceptive treatment can prevent future larger dental and skeletal malocclusions.