When should a child have a first orthodontic check?

Parents often wonder when a child's teeth should first be looked at by an orthodontist. Some hear that an early check is recommended, while others are told to wait until the adult teeth have come through. Both views reflect real guidance, because recommendations differ between countries and depend on the individual child. This article explains what US and UK orthodontic organisations say, which signs are worth mentioning, how childhood habits can affect the teeth and what usually happens at a first orthodontic appointment.

What US and UK guidance says

In the United States

The American Association of Orthodontists (AAO) recommends that children have their first check-up with an orthodontist by age 7. It stresses that this is the latest suggested age, not a reason to wait: if something seems wrong earlier, a child can be seen sooner. The AAO also notes that parents can contact an orthodontist directly, without a referral from a dentist.

In the United Kingdom

In the UK, children are usually referred to an orthodontist by their dentist. The NHS explains that braces are often recommended once all the adult teeth have come through, that the orthodontist may use X-rays, photos or scans to assess the teeth and jaws, and that NHS braces are usually only available to under-18s, with eligibility based on how much the problem affects everyday life, such as eating or cleaning the teeth. The British Orthodontic Society (BOS) says most children begin treatment around the age of 12 or 13, once all their permanent teeth have come through, but that in a few cases treatment is better started early and the dentist may refer a child sooner.

The two approaches differ mainly in who usually arranges the first look and when. Referral arrangements depend on the health system where you live, so ask your child's dentist how it works locally. In the UK, the NHS notes that waiting lists for orthodontic treatment can be long.

Why around age 7 is used as a marker

At about age 7, most children have a mix of baby teeth and permanent teeth. The AAO explains that this stage gives an orthodontist useful information about how the teeth and jaws are developing, and allows them to advise whether treatment might be needed, when it should start and how long it might take.

A check at this age does not commit a child to treatment. The orthodontist may conclude that no treatment is needed, that the teeth should be watched for now, or that treatment would be better at a later stage.

Signs worth mentioning to a dentist or orthodontist

The AAO lists several signs that may suggest a child would benefit from an orthodontic evaluation:

• losing baby teeth much earlier or much later than usual;
• pain when chewing or biting;
• breathing through the mouth;
• a jaw that shifts or makes clicking sounds;
• frequently biting the cheeks;
• a face that looks noticeably uneven.

An assessment can show whether signs like these are related to the teeth or bite. If you notice any of them, mention them at your child's next dental check-up or ask whether an orthodontic assessment would be helpful.

Thumb sucking, dummies and the developing bite

Sucking a thumb, finger or dummy is common in early childhood. BOS explains that it is normal for infants up to the age of 2 to want to suck, and that the habit often provides comfort and security. Whether it affects the teeth depends on how often and how hard a child sucks, and on the age at which the habit stops.

BOS notes that a long-standing habit can lead to:

• a vertical gap between the front teeth (an open bite), which can make biting some foods difficult;
• upper front teeth that stick out;
• a narrowing of the upper jaw, so that the back teeth do not meet correctly (a crossbite).

According to BOS, if the habit stops by about age 7, the teeth can often correct themselves with normal growth. If it continues beyond that age, the position of the adult teeth may be permanently affected, and orthodontic treatment cannot begin until the habit has completely stopped. Dummy habits tend to stop earlier and are generally easier to give up than thumb or finger sucking.

BOS suggests a positive approach to help a child stop: encouragement and praise, a reward chart, and gentle reminders such as a plaster or glove on the thumb. Nagging, teasing or punishment is not recommended, and the child needs to want to stop. Your dentist or orthodontist can offer further advice if the habit is hard to break.

What happens at a first orthodontic appointment

BOS describes a first visit as an assessment. The orthodontist will usually look at the mouth and teeth with a small mirror and a ruler. X-rays, photographs and moulds or a digital scan of the teeth may also be taken to help decide whether treatment is needed and, if so, which approach would suit your child.

BOS explains that there are usually four possible outcomes:

1. Your child is not yet ready for treatment and may need to be seen again when older.
2. Dental health needs to improve first, for example because of tooth decay or difficulty with brushing.
3. No treatment is needed, because the position of the teeth is acceptable or is expected to become so.
4. Your child is ready for treatment, and you can decide together whether to go ahead.

If your child is ready for treatment, BOS explains that the orthodontist will talk you through the treatment options, their pros and cons, how long treatment is likely to take, the commitment needed from your child and when treatment could begin. Any extractions or other dental work needed as part of the plan are usually carried out by your own dentist. BOS also says it is very unlikely that braces would be fitted at a first appointment. BOS suggests writing down any questions and bringing them with you, as it is important to understand what treatment involves before deciding to go ahead.

Why timing varies from child to child

There is no single right age to start orthodontic treatment. BOS explains that timing depends on several factors, including how many adult teeth have come through and the type of problem. Many treatments are left until most of the baby teeth have been lost. Some types of bite are ideally treated while a child is growing fast, and these may be given priority, whereas other treatment may need to wait until growth of the face has almost stopped.

When treatment is not needed straight away, the orthodontist may suggest observation visits. The AAO describes these as short appointments, often once or twice a year, used to check that baby teeth are being lost on schedule, that permanent teeth are coming through in the right order and position, that there is enough room for them and that the jaws are developing well. If a problem starts to develop, early action can sometimes be quite simple, such as removing a baby tooth that has not come out on its own at the right time.

Next steps

If you are unsure whether your child's teeth or bite need attention, an orthodontist can carry out an assessment and explain whether treatment, monitoring or no action is the right course for now. Our orthodontics page has more information, and Find my physician can help you choose a specialist for your child.