Parents may be surprised and skeptical if a dentist recommends seeing an orthodontist when their child still has as many baby teeth as permanent teeth. Having your child seen by an orthodontist by age 7 – a recommendation supported by the American Association of Orthodontists – can help uncover possible dental and jaw growth issues like crowding, crossbites, and other more serious concerns. Treating these problems early can prevent them from worsening as your child grows, possibly reducing time in full braces or Invisalign as a teenager and potentially preventing the need for more invasive treatments such as tooth extractions or surgery.
This early orthodontic intervention is called Interceptive or Phase 1 Treatment. Because it’s only indicated for certain problems, not every child who comes to our office will end up needing early treatment. We definitely will let you know if we feel a single phase of comprehensive treatment at an older age is best. If your child would benefit from early interceptive treatment, we will discuss the options and help you decide on the most optimal path, taking into consideration your child’s emotional readiness and weighing the costs, in both time and money, relative to the benefits. There is no charge for our initial evaluation.
What is involved?
Depending on whether the problem is dental or jaw-growth related, early treatment may involve partial braces or an orthopedic (growth guidance) device like an expander. Sometimes it can even be as simple as an active retainer.
Our goal is to address the identified problems with as little intervention as possible, knowing that we’re trying to head something off before it worsens, but we’re not aiming for perfection since so many permanent teeth still need to grow in. Our guiding principle is to have targeted goals and to accomplish them as quickly and efficiently as possible to save you time and money. This early phase of treatment can take anywhere from 6 to 18 months, ideally no more than 12.
One thing parents must be aware of is that interceptive care is typically the first of two phases of treatment, which is why it is also called Phase 1. Phase 2 (comprehensive) treatment will occur after the rest of the permanent teeth have grown in. Phase 2 is likely to be simpler and shorter than a single round of full braces would have been because of the progress made in Phase 1.
When is it needed?
One of the reasons we aim to keep interceptive treatment relatively short is that we like to give children at least a 1-year break between phases, preferably 2-3 years. This usually means that Phase 1 treatment is most appropriate in 7 to 10-year-olds. Also, there are growth conditions that respond to treatment much better before age 10, such as underdevelopment of the upper jaw (an underbite tendency).
There are a number of reasons why interceptive orthodontic treatment is recommended. Some examples include:
- Expanding the upper jaw to eliminate crossbites, reduce upper crowding, and improve airway and breathing.
- Developing upper and lower arches to create room for crowded teeth that are blocked out and may become “impacted”.
- Restricting or promoting upper or lower jaw growth to correct a bad bite (“malocclusion”) caused by an unfavorable growth pattern.
- Preserving or regaining space for permanent teeth if baby teeth have been lost prematurely.
- Retracting protruded upper front teeth to reduce “overjet” and the risk of dental trauma.
- Placing a “habit appliance” to help eliminate thumb/finger habits or tongue habits that are negatively influencing jaw growth and bite development.
How does it help?
Some parents ask why their child should undergo early treatment – won’t the problems improve on their own over time? When appropriately recommended, Phase I treatment targets problems that don’t get better with growth or that are harder to correct in a single round of treatment later.
For example, the lower jaw continues growing after the upper jaw has stopped, so the adolescent growth spurt may help a child with a small lower jaw, but it will worsen the situation for a child with a large lower jaw or small upper jaw. That’s why underbites are best corrected before age 10.
In crowded situations, we know that the space available for permanent teeth decreases over time because the permanent molars migrate forward in the mouth as baby teeth are lost. Unless it’s clear that the crowding is so severe that permanent-tooth extractions are inevitable, it’s helpful to develop the dental arches early to try fitting all the teeth in. This is especially true for children who struggle with airway and breathing issues since the size of the dental arches determines the space available for the tongue. Our low-dose 3D X-ray technology allows us to measure airway volume to help with that decision.
Studies have shown that improving a child’s self-esteem is also a very valid reason for doing early orthodontic treatment. Often the teeth aren’t ready for full braces until late middle school or early high school. Children who are self-conscious about their teeth being crooked or protruded benefit significantly from getting their front teeth straight before the sensitive middle school years start.
What happens next?
Following Phase I interceptive treatment, we recommend periodic visits to monitor your child’s dental development and jaw growth. This allows us to anticipate whether Phase 2 treatment will be needed and what the ideal timing would be. Occasionally, Phase 2 treatment is not necessary because of the correction accomplished in Phase I, but we can’t guarantee that. In any case, Phase 2 treatment should be shorter than single-round comprehensive treatment would have been. We do not charge for these observation visits between phases.
See the evolution of two of our patients below:
One of our cases was my son, Mitch, who had 6 months of partial upper braces to correct his upper protrusion and make room for his blocked-out upper canines. He also had his upper baby canines removed and currently wears a retainer at night.
Another great case was our patient Ella. You can see her Phase 1 and Phase 2 evolution: