How early should a kid get braces?

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Posted on August 15, 2014
What every parent should be asking: How early should a kid get braces?

Hi, my name is Greg Evans, I am a (board certified) pediatric dentist practicing in Fort Collins Colorado.

The question you asked is a very good one and one every parent and dentist should ask. Surprisingly, many dentists don’t know the answer to this important question and by the time a kid sees an orthodontist valuable time and growth potential is lost. Sometimes they have to sacrifice permanent teeth and a full smile as well.

Everyone in dentistry agrees that a child should be screened for braces by age seven. At age seven the first permanent molars are in full bite and we have a good clue as to potential crowding of the upper and lower front teeth. The American Association of Orthodontists recommends this age and I agree. The funny thing is, a competent pediatric dentist can likely give you an accurate growth assessment for your child by age four!

Children fall into categories for braces issues, but almost universally, Dads are to blame for crooked teeth, especially if Mom is the one driving back and forth to the dentist!

First, is the growth of the jaws ideal? About 30% of the population has a growth discrepancy between the upper and lower jaws. In other words, about one third of kids have an upper jaw that outgrows the lower jaw. In this case, if a CLASS II jaw growth is accompanied by front teeth crowding, it is a good idea to consult and orthodontist who may suggest early treatment. Early in this case means limited braces on the molars and front teeth about age 8-9 years. For kids who don’t have crowding, you can start to treat this problem now or wait until later. The dental literature clearly shows either way you skin the cat is fine.

In about 1% of Caucasians and 9% of Asians, the lower jaw grows faster than the upper jaw. Often these children will definitely benefit from early orthodontic treatment to align the jaws. If you child has an underbite, you may have a CLASS III grower. Treatment may start at 6-7 years old.

In about 70% of kids, the jaws are growing together but the teeth are crowded. How crowded is the question to ask. Kids with more that 6-10mm (the width of a canine) of crowding may well benefit from early treatment around age 8 to 9 years. At this age, 3-4 mm of crowding is considered normal and a good pediatric dentist has a few tricks in the toolbox to guide the teeth in satisfactorily without braces.

Some controversy exists among orthodontists and pediatric dentists about doing braces twice or only once on a child. I have my opinions as well.

Kids don’t get braces twice. If you think of a two and a half year treatment being broke up into a first phase and a second phase to take advantage of the natural growth of a child, you may see some advantages. Cost is spread out, you treat a younger easy to handle kid versus a teenager, and you take advantage of growth and time to get what you need.

But sometimes, a kid doesn’t need to worry about jaw growth or it can be compensated for and a one phase braces stint is more convenient and overall faster treatment. In my town, it also seems to be the less expensive way to go, even if the result is sometimes not quite as perfect.

Your local pediatric dentist can give you an objective view of a child’s growth; most have had more training than even orthodontists in the growth and development of a child’s mouth and face. And, shop around, you will find a range of treatment styles, fees, and treatment times between orthodontists. If you don’t believe what is too good to be true and listen to your gut, your kid will be just fine. Don’t short change the retainers, either!

For more details or to find out what other questions you may need the answers too, log on to my website at or email me. I love what I do and I would love to help you raise beautiful healthy children!