When should a child first see an orthodontist?

Short answer: I recommend planning the first orthodontic check when a child turns 6. At this age the first permanent teeth come in, the jaws grow actively and the direction in which the bite is developing is already visible. The aim of the first visit is not to fit braces: most often the outcome is either "everything is fine, we will monitor" or "this problem is easier to solve during growth".

The question I hear most from parents is: "Isn’t it too early for braces?" In this article I explain why I chose age 6, what I look at during the check, when early treatment really helps and how habits affect the bite. The service side of the topic is on the orthodontics for children page.

Why age 6

At about age 6 the first permanent molars come in behind the baby teeth, and a little later the front incisors start to change. This period is called the mixed dentition: there are both baby and permanent teeth in the mouth. The jawbones are still growing at this age. That is why the orthodontist can see both the alignment of the teeth and the relationship between the jaws and, if needed, gain time to guide growth in the right direction.

There is another reason not to wait: some problems, such as a narrow upper jaw or teeth that bite the wrong way, are corrected with simpler tools during growth. Once growth is complete, the same problem may need longer treatment.

What I look at during the first check

• How the teeth meet: from the front, from the side, on the right and on the left
• The relationship between the upper and lower jaws, the profile
• The width of the upper jaw and the shape of the palate
• Whether baby teeth are changing on time and whether any tooth has been lost
• Habits such as thumb sucking, mouth breathing and tongue thrust
• How the child chews and whether the jaw shifts to the side

I talk to the child directly and show the instruments and models so that the child understands what is happening and is not afraid. When needed I order photographs and X-rays. At the end of the visit I explain what I found to the parent in plain words.

Three possible outcomes after the check

When early treatment really helps

Not every problem needs early treatment, and it is important to say this openly. But in some cases timely intervention makes a difference:

• The upper front teeth stick out far: according to a Cochrane review, early treatment reduces the risk of these teeth being injured. See also: the relationship between the jaws.
• The back teeth bite the wrong way and the jaw shifts to the side: a narrow upper jaw can be widened during growth. See: crossbite.
• The lower jaw sticks out: some appliances improve the relationship of the jaws during growth.
• The front teeth do not meet: this is often linked to a habit. See: open bite.
• A baby tooth was lost early and the space for the permanent tooth is closing. See: early loss of baby teeth.

How to prepare for the visit

• Explain to your child calmly beforehand that the doctor will just look at the teeth and take pictures
• Bring previous X-rays and dentist notes if you have them
• Mention bite problems in the family, for example a relative with a prominent lower jaw
• Write down what you have noticed about habits, sleep, snoring and breathing
• List the questions that worry you in advance

Make sure your child does not come tired or hungry. A visit planned in the morning or after a nap usually goes more smoothly.

What the science says

• Cochrane review (2018): in children with prominent upper front teeth, two-phase early treatment reduces the risk of trauma to the front teeth; for other outcomes no major difference was seen between early and later treatment.
• Cochrane review (2021): some expansion appliances are effective for posterior crossbite, with low to moderate certainty of evidence.
• Meta-analysis (2016): a long-lasting thumb or dummy sucking habit is associated with open bite, posterior crossbite and prominent upper teeth.
• Meta-analysis (2021): habitual mouth breathing in childhood is associated with changes in the development of the facial skeleton.

In other words, the evidence does not say "early braces for every child". It says that timely intervention helps with certain specific problems. And to see these problems, an early check is needed.

How habits affect the bite

If thumb or dummy sucking continues after age 3, it can lead to an open bite of the front teeth and a narrow upper jaw. Habitual mouth breathing keeps the tongue low and affects the width of the upper jaw. Stopping these habits in time often makes future treatment much simpler. More: thumb sucking and mouth breathing.

The first phase is short

Even when early treatment is needed, I do not keep young patients in braces until all the permanent teeth have come in. In the first phase we make only the necessary movements and the phase ends. Then we follow the eruption of the permanent teeth and, if needed, move on to a shorter and lighter final phase. Even after a good result we keep following how the bite develops.

What parents can watch for at home

• Look at the front teeth from the front and the side when your child smiles and bites together
• Check whether the lower teeth stay in front of the upper teeth
• Does the mouth stay open during sleep, is there snoring
• Does your child chew on one side only
• Does thumb or dummy sucking continue after age 3

If you see one of these signs or simply want to be sure, you can take the bite check quiz or book a visit.