I agree with the American Association of Orthodontists recommendation that all children have an orthodontic checkup no later than age 7. At this age, the permanent incisors(front teeth) have begun to erupt along with the first molars. Also, important facial features are beginning to take form. For a select few patients, treatment at this age will prevent the need for more invasive or unpredictable treatment in the future.
This is the best time to correct certain jaw growth problems including narrow maxilla or “upper jaw” (usually presenting as a posterior crossbite) and short maxilla (usually presenting as an anterior crossbite). It is also an excellent time to address open bites caused by habits such as thumbsucking and functional problems such as tongue-thrusting. Impaction (inability to erupt) of the permanent incisors and first molars should also be addressed at this time.
Other problems such as mandibular (lower jaw) deficiency and excess are usually not best addressed early. The same is true with spacing and crowding, except when social reasons are in play. Frequently incisor irregularity and incisor protrusion are disfiguring to the point that it would be cruel not to correct it early even though a good result could be achieved by starting later. This is determined in consultation with the child and parent.
It is important to remember that the first orthodontic examination usually does not result in immediate treatment. However, it does give parents greater peace of mind. It also gives me information to use in the future when the patient is ready for treatment. I much prefer to have a record of three or four annual observations prior to evaluating a 12 year old for treatment rather than observations at one single point in time.
After the initial evaluation, I will monitor facial growth and development with periodic checkups while the permanent teeth erupt and the face and jaws continue to grow. During this period of “watchful waiting”, small problems in growth or development can be noticed and corrected before they become bigger problems.
For some patients, it is best to delay orthodontic treatment until all of the primary teeth are lost. With severe mandibular prognathism, it may even be best to wait until the jaws are finished growing.
By beginning treatment at the ideal time, the best results can be achieved in the least amount of time.
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