The practice of orthodontics has changed somewhat since I wore braces in the eighties. In those days, the Orthodontist usually waited until all deciduous teeth were absent before beginning orthodontic treatment, which is around age thirteen. Parents are always asking why we are referring their five-year-old to the Orthodontist. Their biggest concern may be why they would spend money now versus waiting until all the baby teeth are gone thus needing treatment only once. This type of misconception can be detrimental. Today, we see children as young as five with some type of orthodontic appliance in their mouth. Why is this happening? There are many different reasons for committing to multiple phases of orthodontics. Suggesting Phase One results when the child has a mixture of primary and permanent teeth. Phase Two occurs when all permanent teeth are present.

Many orthodontic issues can be corrected efficiently when the permanent dentition is in place, but there are some conditions which would be better served with Phase One intervention while the child is younger. These include crossbite, open bite, overbite, underbite, tooth eruption difficulties, and malocclusion due to damaging habits. Delaying treatment until all the permanent teeth have erupted can cause increased complications in correcting the original problem, atypical jaw growth, unstable results, and abnormal tooth wear. Let’s review the different malocclusions you may encounter on a daily basis.

A crossbite occurs when the mandibular teeth rest outside of the maxillary teeth in one or more areas. An open bite/overjet transpires when the maxillary and mandibular front teeth are protruding so greatly externally, they don’t touch even upon closing the mouth. An overbite exists when there is a significant horizontal overlap of the maxillary incisors over the mandibular incisors. An underbite develops when the mandibular incisors rest outside of the maxillary incisors. Tooth eruption difficulties arise when a permanent tooth erupts in the wrong position or fails to enter the dentition due to blockage by a primary tooth. Additionally, a child may possess a habit such as sucking the thumb, pacifier usage, or mouth breathing in which they create a dysfunctional bite.

Perhaps the most important reason for an initial consultation is age itself. Evaluation before age seven is imperative for guiding tooth eruption, improving facial symmetry, and influencing jaw growth. Many innovative appliances used today are extremely beneficial in taking advantage of growth spurts and may prevent the need for more involved and extensive treatment in the future.

In summary, reassure the parent that the referral is key to optimal health and proper development of their child. Many Orthodontic offices offer an initial exam free of charge which may encourage the parent to make an appointment. It’s not just about aesthetics. Proper occlusion prevents a myriad of issues such as TMD, headaches, and chewing difficulties. Guiding the teeth into proper alignment will ensure not only a beautiful smile but also a healthy dentition. Conversely, an initial examination doesn’t always result in mandatory intervention. The Orthodontist may simply recommend a six month or yearly exam until treatment is necessary, if at all. Working together as a team, (You, the parent, and the Orthodontist) with open communication and commitment will ensure the best possible outcome for the welfare of the child.