When should I bring my child to see the orthodontist?

kids and braces

One of the most common questions people ask me is when they should bring their child for an orthodontic consultation.  The American Association of Orthodontists recommends that children should be seen for a consultation at age 7.  The reason for this is that most children begin to get their first few permanent teeth by age 7, and so should be seen at that time to make sure they are coming in properly.

Having said that, I do not believe that most children need to be seen by an orthodontist at age 7 unless either a parent or the general dentist suspects a problem exists.  I generally recommend that kids be seen by age 9.  Frankly, there are few orthodontic problems that cannot be treated as effectively at age 9 as age 7, and there is generally a big difference in psychological and emotional maturity between those ages.

Now, the fact that I recommend children be seen at age 9 does not mean that I generally treat most kids at that age.  Many orthodontic problems are best treated once all of the permanent teeth have come in, which may not be until age 12-14.  However, there are some problems that are best treated early so as to avoid worse problems down the road.  These include crossbites, underbites, and habits damaging to the teeth (such as thumb sucking).

I generally tell parents that our consultation appointments are free of charge, so bringing their child to see me won’t cost them anything.  I may tell them that no work needs to be done and that they should return in a year, or I may identify a problem that requires immediate attention.  Either way, it is to the child’s benefit to know.

It is never too late for orthodontic treatment – I treat many mature adults in my practice.  But treating at earlier ages often makes the treatment faster and easier.  So bring your child for a consultation by age 9, or even as early as age 7 if you or your dentist suspect something might be wrong.

My Child is a Thumb-Sucker. Should I Worry?

When people find out that I’m an orthodontist, they often ask me questions about their children’s habits – and specifically about thumb sucking.

Thumb sucking is common among children.  In fact, fetuses are often seen sucking their thumbs when ultrasounds are performed during pregnancy.  At a young age, thumb sucking does not pose a threat to the teeth. However, if thumb sucking continues into later childhood it can lead to orthodontic problems – namely, it can cause the teeth to become crooked, it can affect the growth of the jaws, and can cause severe problems with the bite.  The longer the habit continues, the worse the problems become and the more difficult they are to correct.  So, depending on your child’s age, thumb sucking may be more or less of a concern.

What can thumb sucking do to the teeth?  THIS:

The bite of a 14 year-old thumb sucker – note the extreme mal-alignment and lack of proper bite

So, should you be worried about your child’s thumb sucking habit?

Here is an algorithm to help you decide:

Don’t worry about it. Thumb sucking is perfectly normal at this age, and will not likely result in damage to the teeth or bite

Don’t worry about it.  Thumb sucking is perfectly normal at this age, and will not likely result in damage to the teeth or bite

thumbsucking-ages-_ages 3 - 5

Don’t be overly alarmed, but gently encourage your child to stop the habit, without shaming or pressuring.  If the habit is stopped before age 5, there will likely be no permanent effects on the teeth and bite.  Consider a sour-tasting nailpolish to help the child stop the habit.

thumbsucking-ages-_ages 6 - 9

Thumb sucking at this age will likely affect the teeth and bite, and the habit should be stopped as soon as possible.  Visit the orthodontist to consider a habit-breaking device (see below).

thumbsucking-ages-_ages 9 +

Thumb sucking will lead to severe problems that will require braces, tooth extractions, or even jaw surgery to repair.  Prompt action is required.

What will the orthodontist do?

If your child is over 6 years old and is having trouble stopping the habit (or sucks while sleeping), the best course of action is for the orthodontist to make a thumb-crib appliance.  This appliance consists of a metal mesh which spans the roof of the mouth and is cemented in place.  It is invisible (hidden on the inside of the mouth), and is not sharp or painful.  With it in place, if the child attempts to suck his thumb, it no longer fits comfortably in place.  And because it no longer feels soothing, the thumb sucking habit will stop. The appliance is cemented in place for at least 6-8 months to prevent the habit from recurring.  If the habit is stopped early enough, the damage that it caused to the teeth and bite should largely reverse itself, or be correctable with braces.

Thumb sucking thumb crib appliance
Example shows a Thumb Crib Appliance which is used to help children who habitually suck their thumbs to break the habit.

So whether or not you should worry about your child’s thumb habit largely depends on the age of the child.  Please use the algorithm I’ve provided, and share it with your friends.  The more parents are aware of how and when to treat thumb habits, the better the outcomes will be for their children.

So what makes your teeth crooked anyway?

We see a large number of patients who complain that their teeth are crooked and they want to have  better smiles.  Naturally they come to see an orthodontist such as myself to help correct this issue, and when they visit they often ask “so why are my teeth crooked in the first place?  What caused this to happen?  Is it genetic?”
While it’s true that genetics do play a role in the development of your teeth and if your parents had an overbite or an underbite you might very well inherit the same trait, genetics are certainly not the only contributing factor.  Some bad habits such as clenching your teeth (stress) or tooth grinding or even thumb sucking in small children can lead to tooth alignment issues.  Here are some examples:

When a child sucks their thumb: 

This tends to make the top jaw narrow and even push out the top front teeth causing them to stick out (often referred to as buck teeth).
When a child pushes their tongue against their front teeth: Referred to as tongue thrusting, this can cause pressures behind the teeth which ultimately can lead to pushing the them forward causing them to stick out.  A similar issue can arise from extended pacifier use in very small children , if not caught in time and corrected this can certainly lead to undo pressures on the jaw leading to tooth problems.

Knocked out teeth: 

Accidental tooth loss in children as may occur while playing sports, can easily lead to crooked teeth if the underlying adult teeth fail to come in properly.  This is one of the reasons why it’s so important to be seen by your dentist regularly so they can catch these things early enough to correct them and if an Orthodontist is needed, they will refer you to the office so a custom plan can be devised for you or your child.

Not flossing:

In adults, something as simple as not properly flossing can cause teeth to become crooked over time!  When deposits harden on your teeth (known as tarter buildup) this has the effect of pushing the gums away from the teeth which would be otherwise closely in contact with the teeth.  Over time, this can loosen the teeth and cause shifting.  That’s another reason why you absolutely should be regularly seen by a dentist.  Bone loss beneath the gumline (which is a serious issue) greatly contributes to this same problem because the teeth simply have less material holding them in place and they become loose and then eventually will shift.  In this case, an adult patient is likely looking at an underlying Periodontal issue and should be assessed immediately.

In summary, Prevention is key!

All these examples point to prevention being one of your biggest assets when maintaining a healthy smile.  There are daily steps you can take to ensure you have the best chances of avoiding crooked teeth.  Here’s a brief guideline that you can follow, but remember, you may just be in that camp of people that has underlying genetic predisposition to certain alignment issues that really require the assistance of an orthodontist to properly correct.

Steps to take to help reduce the risk of crooked teeth

  1. See your dentist or independent dental hygienist for regularly scheduled cleanings  and checkups.  Knowing, really is half the battle!
  2. Make sure you are flossing!  If you have children, instil in them this critically important oral care habit.  Learning it early can help save them much grief later in life.
  3. Invest in a mouthguard, for you and your child while playing sports!
  4. See the orthodontist by age 8 for a consultation in case any preventive work is needed.  Remember, catching potential issues early can help save you both time and money down the road.