The American and Canadian Associations of Orthodontists recommend that a child receive a first orthodontic examination by no later than seven years of age. Why so young? Children should be assessed early for many reasons. Small problems can be found and treated sooner, avoiding larger problems later on in the teenage years. Parents may think their children need to wait until all the adult teeth have erupted before seeing an orthodontist. This can often be too late.
By age seven, the permanent incisor teeth have usually erupted into the mouth. This allows for a clearer assessment of the relationships developing among the teeth, jaws and the face. Finding problems sooner allows for early treatment and helps with normal facial and dental development.
The orthodontist will do a thorough examination of your child’s face, jaws and teeth. An x-ray may be taken. The type of x-ray favored by most orthodontists is a panorex radiograph. This x-ray allows the orthodontist to see all the teeth present in the upper and lower jaws as well as the developing permanent teeth in the jaw bones. It can be very helpful since the orthodontist can see if all permanent teeth are present and developing, if any are extra or missing, and whether teeth are developing in the right place. X-rays can also show abnormal bony patterns and some problems in the sinus area.
If problems are found, the orthodontist will discuss them, give treatment options, and advise how long it will take to make corrections. In some instances you may be referred back to your general dentist for treatment. Sometimes a simple appliance is all that is needed. In other situations the orthodontist may recommend simply waiting and watching your child’s development. In this case your child should be seen at regular intervals so dental and facial development can be monitored.
Thumb and finger sucking habits - Children who frequently suck their fingers or thumbs can move their teeth into a less favorable position. The number of hours the child sucks the fingers and the pressure applied are significant. More time and pressure usually cause more movement and deformity. Once the child’s permanent incisors have erupted, the habit should be broken to avoid further damage to the developing teeth and bite. Upper permanent incisors usually erupt between ages seven and eight. A crib appliance is often the best treatment option for thumb or finger habits. This appliance fits across the roof of the mouth. A fence in the front sticks down. The fence stops the finger or thumb from making contact with the roof of the mouth to break the habit. It is cemented to the permanent molars and is usually left in place for several months.
Speech problems - These should be evaluated and the cause of the problem found. If there is a true speech problem, your orthodontist can refer you to a speech therapist for help. If the problem is related to the position of the teeth or jaws, your orthodontist can work with the speech therapist to correct the problem.
Crossbites - Normally, top teeth bite in front of the lower teeth. In a crossbite the relationship is reversed. Crossbites can involve one tooth, many teeth or the entire jaw. Most crossbites should be corrected as soon as possible. Unnecessary wear and tear on the teeth and gums is prevented and normal development occurs. Some crossbites caused by large differences between the jaws may not be corrected until adolescence if they require full orthodontic treatment.
Missing or extra teeth - It is not uncommon for permanent teeth to be missing. This is often hereditary, but not always. The sooner the problem is found, the easier it will be over time to correct spacing. Extra teeth sometimes interfere with the normal eruption of neighbouring teeth. The extra tooth may need to be removed.
Delayed eruption or loss of primary teeth - If one or more teeth are very late in erupting, it is best to find the cause. Absence of a tooth or the presence of a small problem in the bone can contribute to the problem. A baby tooth may need to be removed early in order to assist in the normal eruption of the underlying permanent tooth.
Impacted teeth and crowding - Impacted teeth are teeth which will not erupt on their own. Occasionally permanent teeth can become impacted or ‘stuck’ under the baby teeth. Assistance with their eruption is often required. Sometimes it may be suggested that the child have one or more baby teeth removed early. Extracting baby teeth may assist with the normal eruption of the permanent teeth. In cases of severe crowding, removing baby teeth in a specific sequence can help, allowing for a normal eruption of permanent teeth. If crowding is severe, the eyeteeth may erupt in an irregular position giving the appearance of ‘fangs.’ With severe crowding, removal of some permanent teeth followed by braces may be necessary.
Space maintenance - If a baby tooth has been lost early due to trauma, decay or necessary removal, a space should be left for the developing permanent tooth. A space maintainer is a simple appliance used to hold this space open until the permanent tooth erupts. If space is not maintained the adjacent teeth can move, resulting in a much greater series of problems later on.
Difficulty in chewing, biting or swallowing - Different patterns of bites, such as open bites where the front teeth don’t overlap, can make it very difficult for children to eat. The cause of the open bite should be found and, if necessary, treated. In severe open bite cases, treatment may be delayed into late adolescence. Deep bites, where the front teeth overlap by 50 per cent or more, are also a problem. Deep bites can cause damage to the soft tissue of the roof of the mouth and the permanent incisors.
Mouth breathing or snoring - Many parents comment on how their children snore loudly while sleeping. Enlarged tonsils and adenoids can cause snoring. Enlarged adenoids can lead to difficulty in breathing through the nose and result in mouth breathing. This in turn can lead to the development of crossbites or open bites, and interfere with normal facial development. The child may be referred to an ear, nose and throat specialist for further evaluation.
Teeth and jaws that look out of proportion to the rest of the face - Some children have teeth that stick out (buck teeth). These teeth may be at risk of injury or damage, since they are not as well protected by the lips and cheeks. This can also be a social concern. Simple short-term treatment can often improve the position of the teeth, along with the child’s appearance and self-esteem.
An early orthodontic examination can ease your concerns about your child’s teeth and bite. Early treatment of certain conditions can help your child’s anxiety and improve self-esteem. Some problems are best treated early for social, biological or practical reasons. Early treatment can guide the growth of the developing teeth and jaws, and correct harmful habits. It can also improve appearance, lower the risk of injury or damage to teeth that stick out, and allow space for permanent teeth to come in.
The value of an attractive smile should not be underestimated. Often a child’s self-esteem improves as treatment progresses.