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Usually patients in orthodontic treatment already have their permanent teeth – they are pre-teens, teens and adults. But in some cases we have to start treatment earlier, even before the patient’s permanent teeth come in. We call this “two-phase treatment.”

When we have patients with clear developmental problems at an early age, it’s best to start work when they are young, before the problems get bigger and more difficult to treat.

Examples include:
• An upper or lower jaw that is not growing correctly
• A mouth growing in a way that doesn’t leave enough room for all the permanent teeth to come in
• A severe malocclusion, or bad bite, which means the jaw doesn’t fit together correctly

In these cases we will start early and do one round of treatment – phase one – while the patient still has their baby teeth. Phase one usually does not involve braces, but can include a different type of appliance that helps the jaw grow into place properly. We’ll follow up with phase two usually a few years later, when permanent teeth are in place. Generally phase two involves braces.

In order to catch early problems, we recommend that children have an orthodontic check-up no later than age seven (and so does the American Association of Orthodontists). However, if your dentist or pediatrician sees any sign that early treatment might be necessary, he or she may recommend your child visit our office even sooner.

Are you thinking about orthodontic treatment to straighten teeth or correct jaw alignment? Consider making your first step an orthodontic consultation. During the consultation we will address your questions, concerns, and talk about a treatment plan that would best suit your situation.

We want you to feel prepared and in charge of your orthodontic treatment decisions, so keep these questions in mind when you come in for your appointment.

• If I do need some adjustments to my teeth, what options will I have besides braces?
(This will help you determine what approaches we use to straighten your teeth.)

• What kind of preparation is needed to get braces? How many visits will it take?
(It’s important to know how many appointments may be needed and what you will need to do between appointments to be ready for braces.)

• Can I expect any pain when getting braces?
(Ask about the ways we address pain management.)

• What determines how long I have to wear braces?
(The length of treatment will vary from patient to patient. During your consultation we can evaluate your teeth and jaw alignment to determine the correct course and length of treatment.)

• How will braces affect my lifestyle? Foods I can eat? Activities I can do?
(You may find that little needs to change in your daily routine to have a successful orthodontic outcome. We can discuss and address any changes so you can be prepared before you get your braces.)

• Who will be involved in the orthodontic work? Whom can I expect to see during my adjustment visits?

• What will my orthodontic work cost? What is the ”average” cost and what could be the maximum?
(Make sure you are clear about what your insurance covers, who contacts the insurance company for pre-authorization, who files the insurance forms, and what flexibility there is to pay the remaining amount not covered.)

Your initial orthodontic consultation may just be the first step in relieving a lot of pain and discomfort in your life. Going in with the right questions will help you to understand the entire process and prepare you to do your part for your own dental health. Be sure to bring a list of your questions!

Visibly crooked teeth are not the only reason to take your child into the orthodontist. There are some subtle things to look for as well, which may indicate the onset of more serious orthodontic issues. Many orthodontic issues are much easier to address if treated and corrected during a child's development.

Waiting until facial development is complete or until the permanent teeth have come in can make correction of many orthodontic issues more challenging. Both children and adults can benefit from orthodontic care at any age, but addressing issues early is almost always the ideal choice.

If you're wondering if you or your child might have need for orthodontic care, there are some things you can be on the lookout for. Here are some of the most common warning signs of orthodontic issues:

• Difficulty when chewing or biting
• Chronic mouth-breathing
• Sucking the thumb, the fingers, or any other oral sucking habits that continue after the age of six
• Overbite - when the upper teeth overlap the lower teeth by more than 5mm
• Top front teeth that cover more than 25% of the bottom teeth while biting
• Underbite - when the top front teeth go behind the bottom row of teeth when biting
• Crowded, crooked, overlapped, misshapen, misplaced teeth or extra teeth of any size
• Crossbite - when one or more teeth tilt toward the cheek or toward the tongue causing excessive stress on the jawbone
• The center of the top and bottom teeth don't line up
• Uneven teeth-wearing
• Baby teeth coming out too early for the child's age
• Pain in jaws
• Clicking in the jaw joints
• The jaw shifts off-center while chewing or biting
• A jaw that protrudes, or recedes, too much
• Difficulty speaking or enunciating clearly
• Chronic biting of the inner cheek or roof of the mouth
• Asymmetrical facial structure
• Grinding or clenching of the teeth

If you notice that either you or your child has one or more of these conditions, they could be signs that there is a risk of orthodontic or health problems. The sooner these problems are addressed, the wider and brighter you will be able to smile going forward!

Orthodontic treatments vary from dental treatment, in that they primarily address malocclusions, jaw spacing and tooth alignment, rather than the actual health of the teeth. That is why it is often more difficult for parents to determine when a child needs orthodontic treatment than dental treatment. So how can you know it is time to take your child to the orthodontist?

• Bad Bite - As the adult teeth begin to replace primary teeth, bite occlusions can develop. These often become visible to parents between middle childhood and the pre-teen years, although an orthodontist can identify a bad bite with early evaluation.
• Visible Tooth Crowding - If your child's newly emerging teeth are already crowded, you should make an appointment with our office to discuss braces.
• Tooth Grinding (Bruxism) - Children who grind their teeth at night may do so unconsciously, but the condition requires treatment to prevent the development of headaches, TMJ, and tooth damage. Oral appliances are available to correct nighttime tooth grinding.
• Difficulty Chewing, Biting, or Speaking - If your child is displaying difficulty speaking or eating, or if he or she often experiences cheek biting, schedule an orthodontic consultation.
• Asymmetry - If your child's face is asymmetrical, or if his or her teeth do not meet together in a natural way, orthodontic treatment may be necessary.

Evaluation and Preventive Care

Even if your child has no visible tooth or jaw alignment problems, the American Association of Orthodontics recommends that every child visit the orthodontist for an initial examination no later than age seven. The reason for early evaluation is because orthodontists are capable of finding subtle problems with the jaw and teeth growth and spacing before they become more pronounced and also more difficult to treat. By bringing your child in for an evaluation, you may be able to treat orthodontic conditions with shorter and more simplified treatments that are also more affordable than treatment during the teenage and adult years.