Most of my patients ask me when to start braces for their kids. I have been practicing orthodontics in Oregon since 1995 and so I have seen many of my pediatric dental patients grow up from infancy through their teens.
Some orthodontists recommend treating crooked teeth or teeth that do not occlude (bite together properly) in two phases or treatment steps. The first phase usually starts around second or third grade and a second phase around sixth grade.
Treating jaw problems early has not been well supported with excellent randomized controlled clinical trials. These studies show that equivalent results are achieved with either one or two phases of treatment but that two treatment phases usually costs more and takes longer.
I believe that there ARE tooth alignment or spacing problems that are best treated early; before the back primary teeth come out.
Reasons to treat early:
Congenital problems such as cleft lips are best treated very early, then off and on for many years.
Thumb or finger sucking, pacificer use or tongue thrusting all can move teeth and even bend the jaw bones.
Appliances to treat these problems early are very appropriate if other methods fail.
Upper teeth that stick out very far risk being broken in an accident so braces can help pull these back to safety.
Upper teeth that bite inside lower teeth are called crossbite teeth and should be treated early.
Narrow upper jaws are best treated early when the bones are most flexible.
Very crowded teeth may need to be extracted to make room for the others to straighten up.
Holding space is always a good idea with primary tooth loss.
Because the lower primary molars are usually much larger than the permanent premolars that replace them, holding this space with a metal wire appliance can usually save space for alignment without extractions.
Reasons to wait until later for orthodontic appliances:
Two sets of braces costs more than one set.
The novelty of braces wears off quickly so they are not so fun to wear any longer than necessary.
Putting braces on, getting straight, taking off, wearing retainers, putting braces on, getting straight, taking off, wearing retainers: just takes longer.
The longer braces are on, the more difficult it is to keep them clean and avoid cavities.
Braces come off when the second molars are straight, usually after age 12.
Retainers for life follow orthodontic appliances so the sooner you start, the longer you will need to have retainers.
As you can see, there are some reasons to start early but if your child has crowded teeth and can wait until middle school, you and your child will be better off for waiting.
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