Natalie Gainsborough had a great smile -- until her picture-perfect baby teeth fell out, leaving little room for larger permanent ones to move in. "Her mouth was crowded and her top two front teeth took up all of the space that four baby teeth previously occupied," says her mom, Loralisa, of San Diego. On the advice of Natalie's dentist, she took her 7-year-old to an orthodontist, who suggested that Natalie start treatment.
There was a time when only high-schoolers fretted about being a metal mouth, but the American Association of Orthodontists (AAO) now recommends that children see an orthodontist by age 7 at the latest in order to check for crowded, spaced, or crooked teeth and misaligned jaws and bite. "With kids this age, a orthodontist will begin monitoring teeth and bite changes," explains Peter Ngan, D.M.D., chair of the orthodontics department at West Virginia University's School of Dentistry, in Morgantown. "But only a select group of kids truly require treatment in the second or third grade." Figuring out the best course of action for your child can be tricky. Here's the drill.
Pinpoint the Problem
"The type and severity of a child's bite problem are key in determining the timing of treatment," says AAO president Michael B. Rogers, D.D.S., an orthodontist in Augusta, Georgia. For instance, the lower jaw of a kid with an underbite juts out farther than it should, causing the bottom teeth to sit in front of the upper teeth. This can interfere with chewing and speech and lead to jaw strain and gum damage. But fewer than 5 percent of kids with a bite issue have this problem. For those kids, research shows that early intervention is beneficial more than 75 percent of the time. "If a child waits too long to get the problem fixed, surgery may be needed," says Dr. Rogers. Phase-one treatment usually should begin by age 8 and involves a palatal expander (a metal device fixed to the roof of a child's mouth that's gradually made bigger with an instrument or key to widen the upper jaw) and a reverse-pull headgear to be worn 12 hours per day. During the second phase, when all of the permanent teeth are in, the child usually gets standard braces.
More commonly, kids have crowded, crooked teeth or teeth that don't align properly. Some estimate that as many as 25 percent have a bite problem where the teeth protrude, often called "buck teeth." Early treatment for this problem with braces or a palatal expander may improve a child's appearance and bolster his self-esteem, but except for extreme cases (in which jutting front teeth are at risk of being knocked out or chipped), there are few benefits to starting orthodontics early. "Children with prominent upper front teeth can get the same results from one course of treatment during the tween and teen years as they do from a two-phase plan started at a younger age," says Timothy Wheeler, D.M.D., Ph.D., chair of the orthodontics department at the University of Florida, Gainesville.