When Should Children See An Orthodontist? Earlier Than You Think | Dr. Emily Watson

When Should Children See An Orthodontist? Earlier Than You Think

By Dr. Emily Watson

If you suggest to parents that their child visit an orthodontist as early as age 2, you’ll likely get a startled reaction. Then come the questions. Or maybe just one question expressed in a single word: Why?

After all, in the view of many parents, the orthodontist is someone a child visits in late elementary school or middle school, when crooked teeth need to be straightened, and the soon-to-be teenager who refuses to smile can finally show their teeth without the self-consciousness that haunts young people at that age.

In contrast, small children still have all their baby teeth, and a full set of permanent teeth is years off. Parents often figure they will wait until the braces are needed — and then act.

But for so many children, early intervention by an orthodontist serves as a way to avoid problems that will surface later, taking care of them before they have the opportunity to worsen and potentially require more drastic steps.

Why the rush?

It is important to consider that more than half — 60% — of a child’s facial growth and development is accomplished by age 6. If the orthodontist can spot bad habits or improper growth before that development happens, then some problems may never occur at all.

What might those habits and unwelcome growth trends be? They include: thumb sucking, mouth breathing, tongue thrusting, anterior and posterior crossbites, and severe crowding. All of these can change a child’s growth pattern, whether they have all baby teeth, some baby teeth, and some permanent teeth, or all permanent teeth.

Children experience the best outcomes when the orthodontist can correct bad habits and misaligned teeth early on while the child is still in a phase of rapid growth. It is much easier to influence the more malleable bone in children rather than allow unfavorable growth to continue and try to correct when bones are harder and more “set.”

Believe me, I understand the hesitation about making an orthodontic appointment for children so young. I’m a parent myself who, at the time of my first daughter’s birth, would not have considered this as something to explore. And I’m also an orthodontist who at one time questioned this as well, especially since while in residency, we never saw children when they only had primary (baby) teeth present.

Orthodontists, frankly, are not trained to see children before age 7, which is the age that the American Association of Orthodontists recommends for the first visit. The association cites that age because most children will have enough permanent teeth for the orthodontist to spot a problem. As a result of that general guideline, orthodontists don’t have the pediatric training for examining and treating patients before they reach that age.

When I started my practice, I also followed this recommendation. I would wait until these young patients were older (out of ease for myself because younger patients require a different set of tools and training to manage). A general dentist or pediatric dentist could handle their needs in the meantime.

Then one day, a dentist told me she had heard a pediatric dentist lecture on the topic of much younger orthodontic visits, and she told me she had patients who were about 2 and 3 years old whom she thought could use the orthodontic help I could provide.

Listening to her, I battled my own reluctance and version of “why” questions. Still, I became intrigued and explored the idea, taking a number of courses and even enrolling in a mini-residency in California. Around this time, one of my daughters, Grace, was developing an underbite, which led me to get further training so I could help her. After I treated Grace when she was 4, I became more comfortable working with younger patients and became an advocate for earlier orthodontic visits.

Within the profession, though, disagreement still exists. Many orthodontists continue to abide by the age 7 association guideline, and if you Google anything about the age to start orthodontic treatment, 7 is the most likely age to pop up.

If we don’t see a child until age 7, we have lost a valuable window of time. But if we act when we have the most opportune conditions, then we can maximize the long-term benefit to the child.