What exactly should be addressed in early orthodontic treatment for children? When is the optimal time for intervention? And who should perform the treatment? By briefly outlining children's growth and development patterns, we guide you in self-assessing your child's dental and bite issues, highlighting which problems warrant early intervention.
Growth Patterns of Children's Jawbones and Teeth:
Children typically begin teething around 6 months with the first primary incisors. By approximately 2.5 years, all 20 primary teeth (10 in each jaw) have erupted, marking the primary dentition stage.
Around age 6, the first permanent molars (six-year molars) begin erupting at the back of the lower jaw. Concurrently, the upper and lower front teeth start gradually replacing their deciduous counterparts. This mixed dentition stage typically spans from age 6 to approximately 12.
Once both maxillary canines fully erupt and all deciduous teeth are replaced, the permanent dentition stage begins, after which teeth no longer change. Growth and development of the maxillofacial region correlates with tooth eruption, featuring two rapid growth spurts around ages 6 and 12.
How to identify misaligned teeth and malocclusion in children:
A normal primary dentition and permanent dentition feature evenly spaced teeth. The cusps and fossae of the upper and lower posterior teeth interlock. The upper front teeth cover the lower front teeth by no more than 3mm, while the lower front teeth may be exposed by approximately two-thirds. The posterior teeth exhibit even occlusion and function well.Any deviation from this pattern—such as crooked teeth, diastema (gap) between central incisors, "buck teeth," "chibi teeth," "underbite," or "protruding teeth"—is collectively termed malocclusion (see Figure 1).
Not all malocclusions require early intervention:Malocclusions (see Figure 1) involve both dental arch and jawbone development. At this stage, it is crucial neither to miss the optimal treatment window nor to proceed too hastily. Since jawbone and dental arch development spans a prolonged period, frequent regular check-ups for children between ages 6 and 12 are impractical. Additionally, the child's cooperation must be comprehensively assessed.For most malocclusions (see Figure 1), the permanent dentition around age 12 represents the optimal treatment window. Orthodontic intervention at this stage constitutes comprehensive systemic orthodontic treatment, where the orthodontist develops a full-mouth correction plan considering tooth alignment, occlusal relationships, and facial profile.Although many dental issues may become apparent during the mixed dentition phase—such as crowding of the lower front teeth after tooth replacement or a slight diastema in the upper front teeth—these are often temporary manifestations of the tooth replacement process and may resolve later. Even if the issues persist, addressing multiple problems simultaneously during the permanent dentition phase is not too late.Therefore, orthodontic treatment requires consideration of "timing (growth and development stage), conditions (tooth eruption environment), and cooperation (the child's willingness to participate)."
The following situations warrant early intervention:
Premature loss of primary teeth
If a primary tooth is lost prematurely due to severe decay or extraction before its natural shedding time, and the permanent tooth is not expected to erupt within six months, a removable space maintainer is often needed. This device "holds the seat" for the permanent tooth, preventing space collapse that could lead to crowding, misalignment, or even impaction. Without intervention, severe crowding and malocclusion may occur during the permanent dentition phase.Sometimes, when too many primary molars are lost prematurely due to severe decay, space maintainers are also needed to preserve space and restore chewing function, achieving both goals simultaneously. These issues can generally be addressed by a pediatric dentist.
Underbite
Also known as "buck teeth" or medically termed "anterior crossbite" (see Figure 1), this condition occurs when the lower teeth cover the upper teeth during mid-bite. Beyond compromising chewing function, it may restrict maxillary bone development, affect facial appearance, and even impact psychological well-being, necessitating proactive early intervention.We typically choose to correct dental and jaw misalignment during early intervention when children are cooperative (ages 3–5) or after complete front tooth replacement (ages 8–11). Children aged 6–8 are in the front tooth replacement phase, which complicates assessment. Additionally, some primary tooth underbites may self-correct after front tooth replacement, eliminating the need for intervention.Therefore, we generally avoid treating underbites during this period. We recommend consulting a professional orthodontist, who will comprehensively evaluate the severity of the dental reversal (see Figure 1), whether parents have underbite issues, and other factors to provide the optimal treatment recommendation.
Unilateral Chewing
Under normal circumstances, people utilize both sides of their posterior teeth when chewing food.However, some children develop a long-term habit of chewing on one side due to factors like tooth decay or misaligned eruption on the opposite side. Over time, this leads to a unilateral bite, causing facial asymmetry such as "uneven cheekbones." Early intervention is necessary. Orthodontists use appliances to correct the incorrect bite pattern and guide normal jawbone development.
Unhealthy Habits
Young children naturally go through an oral stage during growth, but this phase is typically brief and not a cause for concern. Persistent habits like thumb-sucking or biting the lower lip, however, can cause the upper teeth to protrude and the lower jaw to recede, resulting in buck teeth and a receding chin.For children unable to overcome these habits through education or persuasion alone, orthodontic intervention is necessary. This addresses the habit while simultaneously guiding proper tooth and jaw development.In reality, mouth breathing requires both prolonged mouth opening and oral respiration. It often arises as a passive choice due to nasal airway obstruction. Therefore, the first step should be consulting an ENT specialist to identify and treat nasal issues like enlarged adenoids or tonsils before considering orthodontic treatment.
Final note:
Parents should be aware that many currently harbor excessive anxiety about their children's dental and facial appearance, fearing delays in treatment.The market offers various ready-made or semi-custom "aligners" for children, some even available without a doctor's prescription. These products often exaggerate their scope and effectiveness, failing to reduce the complexity of future orthodontic treatment or avoid comprehensive correction during the permanent dentition stage. This leads to unnecessary early intervention for children who don't require it, wasting time, effort, and money.
Professional orthodontists provide optimal treatment recommendations based on the developmental stage of a child's teeth and jaws. Sometimes, their reassurance alone can alleviate parental anxiety. Therefore, the wisest choice is to help children develop good habits like thorough brushing and regular dental check-ups, while consulting an orthodontic specialist to determine the best timing for any necessary treatment.