An Orthodontist's Complete Guide To Braces For Children (2020)

When should my child put on braces?

What does my child need braces for?

Is there anything that can be done to prevent my child from needing braces?

I often receive these questions from concerned parents. In this guide, I answer all your most common questions about braces in children.

When should my child put on braces?

child smiling outdoors with braces

The American Association of Orthodontists recommends that you should bring your child to have a check-up with an orthodontist no later than age 7.

Your child's baby teeth will start to be replaced by their permanent teeth around the age of seven years old.

At the check-up, an orthodontist can detect disturbances to:

  • Eruption of permanent teeth
  • Abnormal jaw growth 

This allows them to recommend early brace treatment as necessary.

Some reasons for which your child may need braces

Your child may need braces for the following reasons:

1. Impacted tooth/teeth

When a tooth is obstructed from erupting properly, it is known as an "impacted" tooth (Fig. 1).

Braces may be used to tract or "fish" the tooth out to the correct position (Fig. 3).

Fig. 1 X-ray showing an impacted upper right central incisor in a 9y/o child as highlighted by the arrow
Fig. 1: X-ray of an impacted upper right central incisor in a 9y/o child.
(highlighted by the arrow)

Fig. 2 An un-erupted upper right central incisor. These need braces

Fig. 2 An un-erupted upper right central incisor. These need braces.

Fig. 3 Braces have been placed to tract the upper right central incisor out.

Fig. 3 Braces have been placed to tract the upper right central incisor out.


Fig. 4 Braces have successfully tracted the upper right central incisor out into position.

Fig. 4 The upper right central incisor has been successfully tracted out into position. 

2. Bite problems eg. Cross-bite, deep bite, open bite

Sometimes when your child's teeth are not biting in the correct position, there may be damage to the gums and bone, which results in shaky teeth.

An open bite may also cause problems with speech and eating.

While not all bite problems require immediate attention, some of these abnormal bites may have permanent consequences.

An orthodontist may recommend early intervention using partial braces or removable braces if necessary.

Fig. 5 Cross-bite: The upper right central incisor in cross-bite with the lower right central incisor.

Fig. 5 Cross-bite: The upper right central incisor in cross-bite with the lower right central incisor.

Fig. 6 Deep bite: where the lower incisors are biting on the upper gums.

Fig. 6 Deep bite: where the lower incisors are biting on the upper gums.

Fig. 7 An open bite where the upper and lower front teeth do not meet.

Fig. 7 An open bite where the upper and lower front teeth do not meet. 

3. Abnormal jaw growth e.g. small lower jaw or small upper jaw

A small lower jaw may cause the upper teeth to stick out, making them more prone to injury.

If abnormal jaw growth is allowed to progress, your child may require jaw surgery in future to improve the jaw relationship.

For a growing child, it is possible to carry out early orthodontic treatment that attempts to modify the growth of the jaws.

In a child with a small lower jaw, we can use removable functional applicances to encourage jaw growth during the pubertal age. (Fig. 8.1 to 8.3).

Fig. 8.1 Before treatment: a case of a small lower jaw in a child.

Fig. 8.1 Before treatment: a case of a small lower jaw in a child.

Fig. 8.2 During treatment: Braces and a functional appliance help to advance the lower jaw.

Fig. 8.2 During treatment: Braces and a functional appliance help to advance the lower jaw.

Fig. 8.3 After treatment: it's a success!

Fig. 8.3 After treatment: it's a success!

In a child with a small upper jaw, a facemask may be used to facilitate growth of the upper jaw and restrict further growth of the lower jaw. (Fig. 9.1 and 9.2).

Fig. 9.1 Before treatment: a case of a small upper jaw and a long lower jaw in a child.

Fig. 9.1 Before treatment: a case of a small upper jaw and a long lower jaw in a child.

Fig. 9.2 After treatment with a functional applicance (facemask) to advance the upper jaw and prevent excessive growth of the lower jaw.

Fig. 9.2 After treatment with a functional applicance (face mask) to advance the upper jaw and prevent excessive growth of the lower jaw.

Is there a way to prevent my child from needing braces in the future?

a teenager with braces

I get this question a lot when I inform parents that it’s not time for their child to start braces yet.

The answer: no and yes

There is nothing we can do to prevent a child from needing braces. It's all down to a matter of space: an inherent lack of space is the primary cause of crooked teeth.

Some parents may blame their child for not brushing their teeth well or not taking care of their teeth.

Others will blame themselves for not bringing their child to the dental clinic for an early extraction.

The truth is, it doesn't actually matter how well your child cleans or takes care of their teeth (though they should!).

Even giving your child supplements (such as calcium pills), or taking them to get their baby teeth extracted early does not help much. If your child has a small jaw, their teeth may still come out crooked.

There is nothing we can do to completely prevent a child from needing braces. However, it is possible to reduce the need for future treatment if interceptive or early treatment is used.

Interceptive/early treatment

Early treatment can help reduce the need for further treatment before a child's permanent teeth have fully erupted. Impacted teeth can be "fished" out with braces.

In addition, jaw positions can be corrected, and abnormal jaw growth can be reduced with the use of functional applicances.

It is important to note that the success of interceptive treatment ultimately depends on your child's growth and genetics. 

For instance:

  1. If someone is genetically predisposed to be short, no matter how much skipping they do, they will not grow taller than he or she is built to be.
  2. Conversely, if someone has the genes to be tall, even if we try to restrain them, they will still grow tall (though they will probably not reach their full height potential).

Therefore depending on the way your child's jaw grows, early treatment may not be as effective.

However, it may still be worth trying to normalise jaw growth using interceptive treatment. This can simplify future treatment or even save your child from going through jaw surgery in future.

Are there instances where my child can avoid braces?

a teenager girl wearing braces

Yes. Sometimes it is a case of "wait and see first" before treatment is advised.

An "ugly duckling" phase usually starts from age 7-9 when a child's baby front teeth start to fall out, and permanent front teeth erupt to take their place. This results in obvious spaces and gaps in their front teeth.

Although it may appear unsightly to parents, this is an absolutely normal phase and there is nothing to worry about. Your child is unlikely to be bothered as most of his friends will be going through the same thing!

If your child's permanent front teeth are crooked, I usually recommend waiting until their full set of permanent teeth have completely erupted before advising on braces treatment. This is because straightening crooked front teeth too early may cause the back teeth to be impacted or blocked from erupting. This only transfers a problem from one site to another, and doesn't help your child at all.

In some instances of impacted teeth in children, I may also choose to closely monitor if the tooth will erupt on its own over time. You’d be surprised how “smart” a tooth can be as it sometimes finds a way out on its own without needing any surgery or braces.


Get your child checked by the age of seven

It is recommended to bring your child to see an orthodontist early – no later than seven years old. This will allow the orthodontist to assess, diagnose, and recommend the best treatment options for your child.

Article contributed by:

Dr Elaine Tan
Consultant
Department of Orthodontics
National Dental Centre Singapore


References:

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Medically reviewed by National Dental Centre on 27/02/2018.
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