Mauricio Berco, DDS, DMSc, FRCD(C)

Stephelynn DeLuca, DDS, DMSc, FRCD(C)

Specialists in Orthodontics & Dentofacial Orthopedics


Your child’s first orthodontic check-up should be no later than Age 7

Most orthodontic problems in children are addressed between the ages of 10 and 14 and resolved in a single phase of treatment (comprehensive orthodontic treatment).  Some problems, however, are easier to address early, when some baby teeth are still present in the mouth around ages 7 to 9 (early or interceptive treatment).  The American Association of Orthodontists recommends a check-up with an orthodontic specialist no later than age 7 for this reason. 

At your initial complementary consultation Dr. Berco and Dr. DeLuca will evaluate your child’s dental development, occlusion (bite) and dentofacial esthetics to determine if or when active orthodontic treatment should be initiated for maximum improvement with the least time and expense.  Depending on your child’s individual needs, early or interceptive treatment, two-phase treatment, or full comprehensive orthodontic treatment may be recommended.

Interceptive treatment (Early treatment)

When indicated, early treatment is usually initiated after the four permanent upper and lower front teeth have erupted, around ages 7 to 9.  Early treatment is used to prevent a problem from developing, prevent a developing problem from becoming worse or guide the growth of the jaws (growth modification or dentofacial orthopedics).  The goal of early treatment is to create a more favourable environment for eruption of the permanent (adult) teeth or to address growth issues.  The appropriate use of early treatment may negate the need for later phase II treatment or reduce the complexity of second phase treatment.

Indications for early treatment include:

  1. An unbalanced facial profile - growth modification treatment (dentofacial orthopedics) with a headgear, functional appliance or facemask can improve the relationship between the upper and lower jaws and allow for more favourable skeletal growth and development.

  2. Posterior crossbite (top back teeth sit inside the bottom back teeth) or jaws that shift from side to side - an expanders can be used to widen the upper jaw and establish the proper function of the teeth.  If left untreated, posterior crossbites may cause the lower jaw to grow asymmetric.  When treated as an adult, correction of a posterior crossbite becomes more difficult and may require surgery.

  3. Early loss of baby teeth - baby teeth act as important space maintainers for the unerupted permanent (adult) teeth.  Use of a space maintainer when baby teeth are lost early can prevent unnecessary crowding or impaction of the permanent teeth.  This may negate the need to extract permanent teeth later during phase II treatment.

  4. Late loss of baby teeth - in some cases, the permanent (adult) teeth may not be developing properly.  Early screening and intervention for dental developmental problems can help prevent tooth impaction and subsequent exposure surgery.

  5. Speech impediments - In some cases, malocclusion (bad bite) can cause speech impediments.

  6. Biting and chewing difficulties -  Biting and chewing difficulties may be resolved with orthodontic treatment. 

  7. Deep bite or biting of the roof of the mouth - Early treatment can prevent traumatic biting into the gum tissue on the roof of the mouth.  Excessive wear of the front teeth may also be observed in a deep bite malocclusion when the upper front teeth overlap the lower front teeth too much.  

  8. Oral habits such thumb- or finger-sucking - Early correction of these habits with a habit reminder appliance may prevent or minimize the development of open bite (front teeth do not meet when biting down) and posterior crossbite (top back teeth sit inside the bottom back teeth) malocclusions.

  9. Mouth breathing - Habitual mouth breathing can affect skeletal and dental development in children.  Early screening and treatment for causes of habitual mouth breathing, including enlarged adenoids or tonsils and allergies, is important to prevent the development of more serious skeletal and dental consequences.

  10. Anterior crossbite or underbite malocclusion (top front teeth sit behind the bottom front teeth) - This type of bite may be due to the position of the jaws and/or the position of the teeth.  In either case, early treatment is required to prevent a more complicated malocclusion from developing.  If skeletal in nature (small upper jaw or large lower jaw), early treatment with a facemask may improve facial balance and encourage more favourable skeletal growth.  If dental in nature, early intervention with a removable or fixed appliance can prevent excessive wear of the front teeth and jaw problems.

  11. Crowding (overlapping and misaligned teeth) - Guiding the eruption of the permanent teeth into a more favourable position and preserving space during the transition form the primary (baby) to the permanent (adult) dentition may eliminate the need for permanent tooth extractions during later second phase treatment.

  12. Open bite (front teeth fail to meet when back teeth touch) - Open bite malocclusions are usually due to a thumb- or finger-sucking habit or habitual tongue thrust (tongue pushes against the teeth when swallowing).  Cessation of the habit is important.  This can be accomplished in both cases with a habit reminder appliance and tongue exercises.

  13. Protrusion - Interceptive treatment to retract protruding upper teeth can prevent accidental fracture of the front teeth.

Potential benefits of timely early treatment include:

  1. Eliminate harmful oral habits, such as thumb- or finger-sucking

  2. Lower the risk of trauma to protruded front teeth

  3. Improve the relationship between the upper and lower jaws and allow for more normal skeletal growth and development

  4. Guide permanent teeth into a more favourable position

  5. Reduce or eliminate the need to extract permanent teeth during phase II treatment

  6. Reduce or eliminate the need for later jaw surgery

  7. Simplify, shorten or eliminate the need for phase II treatment

  8. Eliminate a problem that may cause physical or psychological harm if left untreated

  9. Improve appearance and self-esteem

  10. Increase the stability of the final treatment result

  11. Reduce the likelihood of impacted permanent teeth

  12. Improve oral function and speech development

Two-phase treatment

Two-phase treatment consists of two separate phases of active orthodontic treatment.  The first phase

occurs when some primary (baby) teeth are still present in the mouth (early or interceptive treatment),

around ages 7 to 9. The goal of this early phase of treatment is to create a more favourable environment

for eruption of the permanent (adult) teeth or to address growth issues.  The second phase of

treatment occurs when all or nearly all of the permanent (adult) teeth are in the mouth, around ages

10 to 12.  The goal of this later phase of treatment is to align the permanent teeth, detail the

occlusion (bite) and establish optimal dentofacial esthetics and long-term dental stability.  Generally,

a maintenance period is required between phase I and phase II treatment to retain the corrections

obtained with phase I.  It is also important to continue to monitor your child’s dental and skeletal

development so that second phase treatment may be initiated at the most efficient time.

Comprehensive treatment (One phase treatment or Full treatment)

For most children, a delayed single-phase of treatment is the best approach.  In such a scenario,

comprehensive orthodontic treatment is initiated when most or all of the permanent teeth have

erupted, around ages 10 to 14.  Comprehensive treatment typically takes 18-30 months and is

completed in a single phase.  Treatment time depends on several factors, including the complexity

of the problem, age of the patient, appliances selected and patient cooperation.

Schedule your child’s complimentary orthodontic check-up today!