When Is the Best Time to Start Orthodontic Treatment?
The timing of interceptive orthodontic treatment is important. If treatment begins too early, the total time in braces may take longer than if the starting time is delayed until a patient has all of their permanent teeth. Although there are exceptions, the best time to begin full braces is usually after the last of the baby (primary) teeth are gone, and all the 12-year-molars are at least starting to break through. (Exceptions include impactions, severe malocclusions, bullying, etc.) The most common age to get braces is 12 or 13.

Why Start Treatment When There Are Still Baby Teeth?
Another exception to this rule is when it is determined that the severity of an orthodontic problem can be reduced by interceptive care. This approach is known as early, interceptive, or two-phase treatment. Some conditions that warrant interceptive treatment include habits that create malocclusions (thumb sucking, for example), severe crowding that prevents normal eruption, excessive overbite or deep bite, posterior crossbite, or impactions. The ideal age for the first phase of a two-phase treatment is between 7 and 10 years old, when there is naturally a mix of baby and permanent teeth.

Why Are Braces Placed on Baby Teeth?
Orthodontists use braces attached to the teeth to create forces that move them apart for the eruption of other teeth, close spaces between them for esthetics or to create room elsewhere, make them straighter, or to create more or less “overbite.” To move a tooth, there must be other teeth in the immediate area to hold on to. These adjacent teeth provide what orthodontists refer to as “anchorage.” In 7 to 10-year-olds, many times the only teeth available for anchorage are primary ones. Although treatment objectives usually do not include straightening the baby teeth, braces must be placed on them to facilitate the movement of the adjacent permanent ones. Even if the target teeth are at the front of the mouth, brackets are placed on baby teeth in the back to hold the arch wires in the appropriate orientation (parallel to the biting surfaces of the teeth).

Will Attaching Braces to Primary Teeth Cause Problems?
Some parents, hygienists, and even dentists worry when they see braces attached to baby teeth. Their concerns arise from the misconception that putting braces on these teeth will prevent losing them on time or damage the underlying permanent ones. Neither situation is an issue, however. Baby teeth will get loose and fall out whether braces are attached to them or not. In fact, because many young patients have their braces on during this stage of their dental development, it is common for a few of the baby teeth to be lost when the braces are removed or soon after that. As for damaging the underlying teeth, the permanent ones have no way of knowing that there are braces on the teeth above them. They continue to develop and erupt as usual, dissolving the roots of the baby teeth as they do. Normal dental development proceeds in spite of the braces on the baby teeth.

What Should Be Done If a Baby Tooth with A Bracket Gets Loose or Hurts?
If a baby tooth with a bracket gets so loose that it hurts or feels like it needs to come out, contact your orthodontist and make an appointment to have the BRACKET removed from the tooth (not the tooth itself). Although straightening the teeth is easier with brackets on all the teeth, a baby tooth that is really loose isn’t providing support anyway. Once the bracket is removed, the patient can usually wiggle out the baby tooth within a few days, creating room for its permanent replacement. If the permanent tooth comes in before the end of the interceptive phase of treatment, the orthodontist may add a brace to it too.

NOTE: The author, Dr. Greg Jorgensen, is a board-certified orthodontist in the private practice of orthodontics in Rio Rancho and Albuquerque, New Mexico. He was trained at BYU, Washington University in St. Louis, and the University of Iowa. Dr. Jorgensen’s 30+ years of specialty practice and 10,000+ finished cases qualify him as an expert in two-phase treatment, extraction and non-extraction therapy, functional orthodontics, clear aligners (Invisalign), and multiple bracket systems (including conventional braces, Damon and other self-ligating brackets, Suresmile, and lingual braces). This blog is for informational purposes only and is designed to help consumers understand currently accepted orthodontic concepts. It is not a venue for debating alternative treatment theories. Dr. Jorgensen is licensed to diagnose and treat patients only in New Mexico. He cannot diagnose cases described in comments nor select treatment plans for readers. The opinions expressed here are protected by copyright laws and can only be used with the author’s permission.