The benefits of early orthodontic evaluation

An early orthodontic assessment is not the same thing as early orthodontic treatment. The point of seeing someone at seven or eight is mostly to find out whether anything needs doing — and for most children, the answer is not yet.

That distinction matters, because it is the difference between a useful check and being sold braces to a seven-year-old.

When should a child be assessed?

The Australian Society of Orthodontists recommends an orthodontic assessment at around age 8 to 10. By then the first adult molars and incisors have usually come through, which is enough for a practitioner to see how the bite is developing and how much room the remaining adult teeth will have.

Your general dentist monitors this at routine check-ups from a much younger age and will tell you if a referral is worth making earlier.

What is happening in the mouth, roughly by age

Wide variation is normal. A child a year either side of these is not behind.

What an early assessment can actually find

Some problems are genuinely easier to manage while a child is still growing, because the jaws can still be influenced:

• Crossbites, particularly a narrow upper jaw, where expansion during growth is far simpler than the alternatives later
• Severe crowding where creating or preserving space changes what treatment is needed later
• Significant overjet — upper front teeth protruding markedly, which carries a real increased risk of trauma to those teeth
• Underbite, where the lower jaw sits ahead of the upper
• Impacted or missing adult teeth, and teeth erupting in the wrong position
• Habits such as prolonged thumb-sucking or dummy use affecting how the teeth meet
• Retained baby teeth blocking adult teeth from coming through
• Early loss of a baby molar, where the adult tooth behind drifts forward and steals the space meant for another tooth

Finding these early does not always mean treating them early. Often the recommendation is simply to review in twelve months.

What actually happens at the appointment

Parents sometimes expect a decision and get a plan to watch instead. A first assessment usually involves:

1. Looking at how the teeth meet — front to back, side to side, and whether the jaw shifts to close
2. Counting what is present and what is still to come
3. Radiographs where clinically indicated — commonly an OPG, which shows unerupted teeth, missing teeth and anything sitting in the wrong path. We have an OPG on site
4. Photographs, and sometimes a digital scan or impressions for records
5. A conversation, which should cover what was found, whether anything needs doing now, what is likely later, and roughly what that would cost

Nothing is painful and nothing is fitted on the day. It is an information appointment.

Why growth matters

While a child is growing, the position and relationship of the jaws can be influenced by appliances. Once growth is complete, the teeth can still be moved — adults have orthodontic treatment routinely and successfully — but changing the underlying skeletal relationship becomes much harder, and in significant cases may need jaw surgery alongside braces.

This is the real argument for assessing early. It is not that children's bones are soft; it is that a growth spurt is an opportunity that does not come round again.

The appliances used in early treatment

Where early treatment is genuinely indicated, it usually means one targeted appliance rather than a full set of braces.

Expanders and functional appliances feel strange for the first week or two, affect speech briefly, and increase saliva. That settles. A child who cannot cope with an appliance is a real constraint on the plan, and worth raising honestly before it is fitted rather than after.

Thumb-sucking and dummies

This is the habit that comes up most.

Sucking is normal in babies and toddlers and usually stops by itself. It generally causes no lasting problem if it ends before the adult front teeth arrive, around age five to six. Beyond that, a persistent habit can push the front teeth forward, open a gap between them and narrow the upper arch.

What tends to work: positive reinforcement rather than shame, identifying the triggers (tiredness, screens, boredom), a reward chart, and a plaster or glove at night as a reminder rather than a punishment. Bitter-tasting nail preparations work for some children and backfire for others. If a genuine attempt has failed by about six or seven, a habit appliance is the next step, and it works well.

A dummy is generally easier to stop than a thumb, for the obvious reason that you can remove it.

Being straight about the benefits

The honest case for orthodontics is:

• A functional bite — teeth that meet properly, chew properly and wear evenly
• Reduced trauma risk where front teeth protrude significantly
• Easier cleaning — severely crowded and overlapped teeth are harder to clean, which can mean more decay and gum inflammation
• Appearance, which for many people is the main reason and is a perfectly legitimate one

What we would not claim: that mild crowding causes disease, or that straightening teeth prevents decay by itself. It does not — plaque control does. A child with straight teeth who never cleans between them will still get cavities.

Two-phase treatment, honestly

Early ("phase one") treatment for a young child, followed by braces in the teens, is genuinely valuable for particular problems — crossbites, severe overjet, impactions. For routine crowding, the evidence for two phases is weaker: it often means longer overall treatment, more appointments and more cost than simply waiting and doing one course of treatment in the early teens.

If early treatment is recommended for your child, fair questions to ask are: what specifically are we correcting, what happens if we wait, and will a second phase still be likely afterwards? A good practitioner will welcome all three.

Other questions worth asking

• Is the practitioner a registered orthodontist, or a general dentist providing orthodontics? Both are legitimate; you are entitled to know which
• What is the total fee, and what does it include — records, retainers, repairs, and review visits after the braces come off?
• How many appointments, and how long are they? This matters for school and work
• What happens if we move interstate mid-treatment?
• What is the retention plan, and what does a replacement retainer cost?

Looking after teeth during treatment

Braces make cleaning harder at exactly the age when cleaning is least reliable. Decalcification — permanent white marks around where the brackets sat — is the common and avoidable disappointment at the end of treatment.

• Brush after every meal during treatment, not twice a day
• An interdental brush for under the wire is not optional
• Fluoride toothpaste, and consider a fluoride mouthrinse if your dentist recommends one
• Keep the regular check-up and clean appointments with your general dentist running alongside the orthodontic visits
• Avoid hard and sticky food that breaks brackets — each breakage adds time

If your child plays contact sport, a custom mouthguard is important, and even more so where front teeth protrude. A boil-and-bite guard does not fit over braces properly. See mouthguards.

Costs and what to expect

Orthodontic treatment is a significant expense, usually paid over the course of treatment. Private health extras cover varies widely and often carries waiting periods and lifetime limits — check your policy before committing. The Child Dental Benefits Schedule does not cover orthodontics, which surprises many families.

Retainers are for life. Teeth move back if they are not retained. Anyone who tells you otherwise is not being straight with you. Budget for replacements — retainers get lost, stood on, and thrown out with lunch wrapping.

Questions we are asked

My child's front teeth came in crooked. Is that a problem? Often not. Newly erupted incisors frequently look crowded and settle as the jaw grows and the canines arrive. It is worth mentioning at the next check-up rather than worrying between visits.

There is a gap between the front teeth. Common and usually temporary — it often closes when the canines come through. A persistent large gap is worth assessing.

An adult tooth came through behind the baby tooth. Usually the baby tooth loosens and falls out shortly after. If it stays firm for several weeks, have it looked at.

Do teeth need to be removed for braces? Sometimes, for severe crowding. Less often than a generation ago. This is a decision for the treating practitioner after records.

Is it too late for me? No. Adults have orthodontic treatment routinely. What changes is that the jaw relationship can no longer be influenced by growth.

How we fit in

Victorian Dental Group is a general dental practice in Malvern East and holds no specialist registration. We monitor your child's dental development at their check-ups, take the radiographs where they are indicated, raise anything we see, and refer to a registered orthodontist when specialist assessment is warranted. We do not provide orthodontic treatment ourselves.

Read more about family and children's dentistry or your child's first dental visit.

Victorian Dental Group — 291 Wattletree Road, Malvern East VIC 3145 · (03) 9088 5808 · book online

General information only, not personal dental advice. See our disclaimer.