Orthodontics for children
A first check from age 6, monitoring growth and a short first phase of treatment when needed.
Does this sound familiar
Patients most often come for this with these words:
My child’s lower teeth close in front of the upper teeth
The upper front teeth stick out a lot
When my child bites together, the front teeth do not meet
Thumb or dummy sucking continues after age 3
The mouth stays open in sleep and my child snores
A baby tooth has been lost early
My child is 6 and has never seen an orthodontist
In orthodontics for children, the key is to see the patient in time. I recommend planning the first orthodontic check from age 6. At this age we assess how the jaws are growing, how the teeth are changing and how the bite is forming. Some problems are corrected with simpler tools during growth, so seeing them early increases the options.
A first consultation does not always mean braces
Sometimes treatment is needed. Sometimes it is better to wait. And sometimes it is enough to follow the child’s growth at certain intervals. The key is to see a problem in time and make the right decision at the right moment. More: when should a child first see an orthodontist.
What I look at during the check
- How the teeth meet: from the front, from the side, right and left
- The relationship of the upper and lower jaws, the profile
- The width of the upper jaw and the shape of the palate
- How the baby teeth are changing and whether any tooth has been lost
- Habits such as thumb sucking, mouth breathing and tongue thrust
- Chewing and jaw movement
When early treatment may be needed
| Situation | Why early | More |
|---|---|---|
| The lower jaw sticks out, the front teeth bite the wrong way | The upper jaw is easier to influence during growth | When the lower jaw sticks out |
| The back teeth bite the wrong way, the jaw shifts | To prevent asymmetric growth | Crossbite |
| The upper front teeth stick out a lot | To reduce the risk of injury | The first check |
| The front teeth do not meet | To stop the habit in time | Open bite |
| A baby tooth was lost early | To protect the space for the permanent tooth | Early loss of baby teeth |
| Thumb sucking, mouth breathing | To stop their effect on the bite | Thumb sucking, mouth breathing |
The first phase is short
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 first phase ends. When all the permanent teeth are in, we move on, if needed, to a lighter and shorter final phase. Even after a good result we keep following how the bite develops.
The tools we use
- Appliances that widen the upper jaw. See: palatal expansion
- A face mask: helps bring the upper jaw forward
- Functional appliances
- Space maintainers
- Reminder appliances that help stop a habit
- A short phase of braces
Trust with the child
I talk to the child directly, explain each stage and give them time to get used to it. I show the instruments and models so that the child understands what is happening and is not afraid. Treatment continues outside the clinic too: the appliance has to be worn and hygiene looked after. When a child understands the meaning and feels heard, they take part in the process more easily.
What the science says
- Cochrane review (2018): in children with prominent upper front teeth, early treatment reduces the risk of trauma to the front teeth.
- Cochrane review (2024): in Class III bite, appliances such as a face mask improve the relationship of the jaws in the short term; long-term evidence is limited.
- Cochrane review (2014): evidence on treating open bite is weak; removing the cause is key.
- Meta-analysis (2016): a long-lasting sucking habit is associated with open bite and crossbite.
When parents need not worry
- If there are gaps between the baby teeth: this is a good sign for the permanent teeth
- If newly erupted permanent front teeth look a little crooked and spaced: they often straighten when the side teeth come in
- If the permanent teeth look more yellow than the baby teeth: this is a normal difference
- If there is a small gap between the front teeth: it is often natural until the canines come in
Even in these cases, a first orthodontic check gives parents peace of mind. At the visit I explain which changes are normal and what needs to be watched.
Frequently asked questions
When should we first bring our child?
At about age 6. Earlier if there is a clear sign such as a reverse bite, a jaw shift or a strong habit.
Does early treatment remove the need for braces later?
Not always. Some children need a short final phase later, others do not.
Is the first check painful?
No. It consists of an examination, a conversation and photographs if needed.
Will my child be able to put the appliance in themselves?
With removable appliances I teach the child and the parent how to put them in. Fixed appliances are attached to the teeth.
Can my child do sport during treatment?
Yes. I recommend a mouthguard for contact sports.
How long does early treatment take?
The first phase is usually short and covers only the necessary movements. The exact duration depends on the problem.
Read more
Scientific sources
The information in this article is based on the following peer-reviewed scientific articles and systematic reviews.
- Batista, K. B., Thiruvenkatachari, B., Harrison, J. E., & O’Brien, K. D. (2018). Orthodontic treatment for prominent upper front teeth (Class II malocclusion) in children and adolescents. Cochrane Database of Systematic Reviews, 3(3), CD003452. [PMID: 29534303] | [DOI: 10.1002/14651858.CD003452.pub4]
- Owens, D., Watkinson, S., Harrison, J. E., Turner, S., & Worthington, H. V. (2024). Orthodontic treatment for prominent lower front teeth (Class III malocclusion) in children. Cochrane Database of Systematic Reviews, 4(4), CD003451. [PMID: 38597341] | [DOI: 10.1002/14651858.CD003451.pub3]
- Lentini-Oliveira, D. A., Carvalho, F. R., Rodrigues, C. G., Ye, Q., Prado, L. B., Prado, G. F., & Hu, R. (2014). Orthodontic and orthopaedic treatment for anterior open bite in children. Cochrane Database of Systematic Reviews, 2014(9), CD005515. [PMID: 25247473] | [DOI: 10.1002/14651858.CD005515.pub3]
- Doğramacı, E. J., & Rossi-Fedele, G. (2016). Establishing the association between nonnutritive sucking behavior and malocclusions: A systematic review and meta-analysis. Journal of the American Dental Association, 147(12), 926-934.e6. [PMID: 27692622] | [DOI: 10.1016/j.adaj.2016.08.018]