What You Need to Know About Kids and Braces

Kids are donning braces much sooner than most of us experienced in our own childhoods. In fact, dental health experts now say that most kids should see an orthodontist for an evaluation by age 6 ot 7.  We explore why early orthodonticsis more prevalent these days, and how to make the right decision regarding your child and braces.

By Courtney Drake-McDonough

Orthodontics at Age 8? Brace Yourself!

Girl with BracesI remember clearly the day my daughter’s dentist said it was time for her to get braces.

She was 9, and I was shocked. “Braces are for teenagers!” I objected.

“They start kids earlier now and usually do two phases of treatment,” the dentist said.

So I consulted with two orthodontists, and they confirmed that it was indeed time to get her started. Other parents I knew were getting the same news. And all of us associated getting braces with the teen years – certainly not the elementary school years.

I now have four children at various points in the orthodontic process and I can speak with some experience on this early-orthodontia concept. If you’re skeptical about kids and braces, or shell-shocked by the expense and time that needs to be invested in this treatment, these answers from dental health pros will help put things into perspective.

Why are orthodontics necessary?

There are three basic reasons behind a recommendation for orthodontic work:

Function – When our teeth are properly aligned, they fit together in a way that helps us chew adequately and doesn’t wear our teeth down unevenly;

Protection – Orthodontics can pull teeth that would otherwise protrude out of harm’s way; and

Appearance – Orthodontics can fix crooked or protruding teeth that may make people, particularly kids, feel self-conscious or reluctant to smile.
(See Signs that Orthodontia Might Be Necessary)

Why are braces being started much earlier these days?

Actually, orthodontists have been treating children under age 10 for a long time, but the practice has become more prevalent in the last 15 years as oral health professionals embrace the idea that earlier treatment can yield better results. The American Association of Orthodontists (AAO) now recommends that kids be evaluated by an orthodontist by age 6 or 7 to create a baseline for monitoring a child’s “dentofacial” growth and development.

“(This) is a time of exchange of baby teeth for permanent teeth, and is opportune for intervening to intercept problems that may worsen with age,” says Lee Graber, D. D.S., M.S., Ph.D., and president-elect of the AAO.

That doesn’t mean that all problems need treatment while a child is so young. “Most orthodontic problems respond nicely to treatment started around the time all the permanent teeth complete their eruption (usually 10 to 12 years),” notes William Berlocher, D.D.S., with the American Academy of Pediatric Dentistry. “However, there are several conditions – cross-bite, severe crowding and severe overbite – that benefit from early treatment.” It all boils down to the individual case.

“If there’s a [dental] growth problem involved, you would want to start as early as possible to channel that growth or inhibit the wrong direction of growth,” says Roshan Ghazinouri, D.M.D., an orthodontist with Dental Services in Cambridge, MA.

Martin Kaplan, D.M.D., a pediatric dentist with KidCare Dental and a pediatric dental instructor at Tufts University, has treated kids as young as 3 with serious cross-bite issues – when the upper jaw position is too narrow and, as the child closes his mouth, his upper teeth land inside the area of the lower teeth. This is best corrected early to avoid jaw and chewing problems later on. It can involve braces on, say, four teeth and the use of an expanding appliance (like a palate expander), Kaplan says. Early treatment can sometimes correct the problem entirely, making a second phase of treatment unnecessary.

What are the pros and cons of early orthodontia?

As Kaplan noted earlier, sometimes early treatment is curative by itself. A child won’t need further treatment down the road. Kaplan and Ghazinouri say early orthodontia helps with the:

• Correction of dental and skeletal problems that, if left untreated, could adversely affect facial growth and cause jaw problems;

• Creation of space between crowded baby teeth, so that new teeth are allowed to grow in; and

• Correction of protruding teeth, which might otherwise get hit and broken during sports or rough play.

Why are two phases of treatment sometimes necessary?

The first phase of treatment is often done to set the stage, correcting the position and shape of the upper and lower jaws to allow existing and incoming teeth to fit better in the mouth while doing some alignment.

The second stage is when refinement and final alignment typically takes place. Depending on the patient’s situation, there could be several months to several years between phases. Why can’t everything be done at once?

“When I see a child at 8, 9 or younger, that child still has lots of baby teeth. What we are going to be doing is correcting any functional or skeletal problems, such as anterior or posterior cross-bites or a habit like thumb sucking that can cause a lot of damage,” says Ghazinouri. “Once that is solved, we have to wait until the patient has all of her permanent teeth in order to address further problems if any.”

Still, Kaplan notes, “every case should be treated individually. There’s not a blanket answer. There are [orthodontists] starting a child on braces before it’s absolutely necessary because that means they’ll have a patient for life. I’ve seen cases where this was happening.”

Furthermore, one of the cons of early treatment that continues over several years is that “the kids are in braces too long,” Kaplan says. “A hygiene problem develops because it’s much more difficult for kids to take consistent care of their teeth and gums.”

So how can parents be sure that braces are really necessary – and not just a “nice to have”?

“Most braces are strictly cosmetic unless you really have a horrible occlusion where you can’t bite properly,” says Kaplan. “I’ll tell some parents, ‘Your child doesn’t have to have braces.’ It may be cosmetic; see your orthodontist and let him or her explain. And ask if it’s strictly cosmetic or something that has to be done to avoid problems down the line.”

Both he and Ghazinouri strongly recommend seeking second or third opinions from other orthodontists.

“Different orthodontists, like any other health professionals, have different philosophies,” says Ghazinouri. “Some like to get in and start treatment as early as possible. Some, like myself, try to avoid it unless we have to. So you get a second opinion; you get a third opinion to make an educated decision.”

What do you ask?

“Ask what the problem is, what’s the worst-case scenario, what happens if you don’t do the braces,” she says. “Parents are very good these days about asking good questions.”

Ultimately, cosmetic reasons can be as good as any if the child feels self-conscious about his teeth. “And some parents do want their children to have that very good, Hollywood smile,” Ghazinouri says. “Every case is different and each treatment plan should be custommade for each patient.”


Signs that Orthodontia Might Be Necessary

Additional Resources

Braces: A Consumer's Guide to Orthodontics by G. Ray Callahan, BS, DDS, MS 1st Books LIbrary, 2000. Clear descriptions and explanations on why children need orthodontics, what braces do, questions to ask the orthodontist and more.

Courtney Drake-McDonough is an associate editor at Colorado Parent, a  Dominion Parenting Media publication. National senior editor Deirdre Wilson also contributed to this article.