Our family's orthodontist recommended early treatment for my daughter. What kinds of problems can be fixed with early treatment? Will having braces at an early age prevent the need for full braces later?

Orthodontic screening at age 7
The American Association of Orthodontists recommends that all children be seen at age 7 so that the growth and development of their smile can be evaluated. By age 7 most children have all four of their 6-year-molars and four central incisors too. With these teeth in place, your doctor can identify most of the orthodontic problems your child may have down the road and can counsel you on whether early treatment would be beneficial. What kinds of problems should be addressed at age 7 when your child still has lots of baby teeth?

Is there enough room for all of the teeth?
The first type of problem has to do with the amount of space available. Crowded teeth overlap each other and cannot be lined up straight. Teeth with too much space between them may actually be preventing other permanent teeth from coming into the mouth. Crowding in the front of the mouth is obvious. Crowding in the back of the mouth may not be visible without an x-ray. Moderate crowding and spacing problems should be addressed at an early age so that the remaining permanent teeth can come in correctly.

Is there an underbite or posterior crossbite?
The upper teeth are naturally wider because they lay on the outside of the bottom ones when lined up correctly. When the top back teeth are on the inside of the lower ones (crossed over), we call that a posterior crossbite. When the upper front teeth are behind the lower front teeth, we call this an anterior crossbite or an underbite. Teeth in cross bite may reveal an underlying jaw problem that is best addressed at a young age.

Is there an overbite?
The opposite of an underbite is an "overbite" (actually called excessive overjet). Mild overbites are common and not a concern until all the permanent teeth are in. Moderate to severe conditions can cause social problems for young patients and make them more susceptible to dental injuries because the teeth stick out. Although overbites cannot be totally eliminated until a child has finish growing, it is advisable to reduce their severity for reasons of safety and self-esteem.

Is there a deep bite or and open bite?
Ideally the top front teeth overlap the bottom front teeth about half way. If they overlap too much, we call this a deep overbite or deep bite. If they don't overlap at all, we call this an open bite. Both conditions may hint that there may be underlying jaw problems. An open bite may also be due to oral habits such as thumb-sucking that can harm your child's dental development. Orthodontists can help young patients break such harmful habits.

Early treatment does not usually prevent the need for braces
Will early treatment guarantee that a child will not need treatment later? The answer is almost always no. Early treatment is commonly called two-phase treatment because more than 90 percent of children who undergo treatment at age seven or eight must finish when the remaining permanent teeth are in place. The typical patient finishes his first phase of treatment with 12 primary teeth remaining. The second phase cannot begin until all 12 of the remaining primary teeth are gone and the remaining 16 permanent ones have come in fully (around age 13). If a child has problems so severe at age 7 that they need interceptive care, the chances are pretty good that he or she will need to have the second phase of treatment to finish their smile.

The best way to look at two-phase treatment is this. Instead of waiting until your child is 13 years old and then putting him or her through two to three years of difficult treatment, your orthodontist is recommending an easier approach. Why not let him help your child over some of the biggest hurdles now, so that when all the adult teeth are in (junior high and high school) treatment will be easier, better, and faster? That is the goal of early treatment.

NOTE: The author, Dr. Greg Jorgensen, is a board-certified orthodontist who is in the private practice of orthodontics in Rio Rancho, New Mexico (a suburb on the Westside of Albuquerque). He was trained at BYU, Washington University in St. Louis, and the University of Iowa in the United States. Dr. Jorgensen’s 25 years of specialty practice and nearly 10,000 finished cases qualify him 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 the state of New Mexico. He cannot diagnose cases described in comments nor can he select treatment plans for readers. Please understand that because he has tens of thousands of readers each month, IT IS IMPOSSIBLE FOR HIM TO RESPOND TO EVERY QUESTION. Please read all of the comments associated with each article as most of the questions he receives each week have been asked and answered previously. The opinions expressed here are protected by copyright laws and can only be used with written permission from the author.