Crooked Teeth in Children: When Is the Right Time for a First Orthodontic Check-up?

A new front tooth comes in at an angle, or appears behind a baby tooth that has not fallen out yet, and for a moment your child seems to have two rows of teeth. Most parents then hear the same advice: wait, it will sort itself out.

Sometimes it really does. But whether it will in your child's case is not something a neighbour, a forum or a parent with a mirror can judge. My rule is simple: as soon as something looks crooked, let an orthodontist take a look.

If there is no visible problem, the best time for a first check-up is around the age of 7, when the baby teeth start to change. Come earlier only when the problem is visible even to an untrained eye, for example when the position of the jaw, the lips or the profile of the face is changing.

Why is the first orthodontic check-up best around the age of 7?

Around the age of seven the change of teeth is in full swing. The first baby incisors fall out and permanent ones take their place, while the first permanent molars have already come in behind the baby molars. The jaws grow quickly during this period. That is exactly why this is the first time you can clearly see where the permanent teeth are heading and whether they will have enough room.

Most of this happens below the gums. The permanent teeth that are still to come are in the bone, and without an X-ray and orthodontic knowledge there is no way to tell how they are positioned. At home a parent sees only what has already grown in, and that is just part of the picture.

At the check-up we talk, I examine the teeth, the bite and the position of the jaws, and when needed we take an X-ray and impressions. The parent stays with the child the whole time. When we finish, you know where you stand: whether everything is fine, whether treatment is needed, or whether it is better to wait until the change of teeth has moved further along.

When should a child see an orthodontist before the age of 7?

Before the age of seven, come in when the problem is so obvious that you notice it without anyone's help: the lower jaw sits in front of the upper one, the jaw is shifted to one side, or the position of the lips or the profile of the face is changing. In that case there is no reason to wait until seven.

Can crooked teeth in children straighten on their own?

They can. After a check-up I sometimes tell a parent that the situation is not ideal, but that it is physiological, a normal part of development, and that in a few years the teeth will settle into place on their own. Then there is no need for a brace or for worry.

What parents find hard to accept is that two children can look the same from the outside, while for one of them everything sorts itself out and for the other it does not. That difference cannot be seen in a photo, in a description or in a text on the internet. At check-ups I often hear diagnoses parents have found online, and they usually have little to do with what I actually see in the child. So the advice stays the same: if something looks crooked to you, let an orthodontist take a look.

Baby teeth hold the place for permanent teeth

The idea that baby teeth are temporary and not worth fixing because they will fall out anyway is still widespread. In recent years parents have been taking more care of baby teeth, and I am glad about that, but this misconception has not gone away.

Baby teeth keep the space for the permanent teeth, which are considerably larger. If a baby tooth falls out too early, or sits with a severe infection for a long time, the permanent tooth growing beneath it is put at risk in every way, both its health and its position. That is why a decayed baby tooth is not only a question of a cavity, but also of how the permanent teeth will one day stand.

Signs in a child that are a reason for an orthodontic check-up

Parents often ask me which of these matters most. There is no order of importance, because anything that is crooked matters equally, whether it is the teeth, the jaws or the profile. Book a check-up if you notice that:

• A permanent tooth is coming in at an angle, rotated or behind a baby tooth.
• The lower jaw sits in front of the upper one.
• The bite shifts to one side.
• The lips or the profile of the face are changing.
• Your child breathes through the mouth all the time, during the day or while sleeping.

Are gaps between a child's front teeth normal?

They can be completely normal. Gaps between teeth in children are often physiological, roughly from the age of three to twelve. Whether that is the case for your child depends on the stage of the change of teeth, on what has happened with the teeth so far and on heredity. There is no rule that applies to every child, so a gap is also something an orthodontist should assess.

Why should a child who breathes through the mouth also see an ENT doctor?

Breathing properly through the nose is extremely important for the development of the jaws and teeth, and for the child's overall health. When a child breathes through the mouth for a long time, the upper jaw can stay narrow, leaving the permanent teeth without enough room. That is why I always also refer a child who constantly breathes through the mouth to an ENT doctor, to check the cause: tonsils, allergies, a deviated septum or something else. Unfortunately, mouth breathing often does not get enough attention, and it is not a habit a child simply grows out of.

Are crooked teeth hereditary, or are habits to blame?

Parents who wore braces themselves ask this most often. The answer is roughly fifty-fifty: genetics matter, but they are not decisive. The rest depends on habits and on how the jaws grow.

Among habits, the most questions are about dummies, bottles and thumb sucking. Ideally they should stop by the age of two. The good news is that habits, unlike heredity, can be changed.

How to prepare your child for their first orthodontic check-up

The check-up does not hurt, but it is a new situation for a child, and the unknown can be scary. So start preparing well before the visit, not the night before.

Talk about the check-up as something completely normal. Explain that doctors are there to help, that the health of our teeth matters just like any other health, and that today a lot is done without pain. A child who arrives relaxed cooperates more easily, and the check-up goes more smoothly too.

A removable brace for children only works if the child wears it

When a check-up shows that treatment is needed, for children I work exclusively with Myobrace, a removable appliance that corrects the position of the teeth, guides the growth of the jaws and changes bad habits. I have described the phases, duration and price on the page about the removable brace for children.

This has to be clear from day one. If the child does not wear the appliance, there will be no results, however good the appliance is. That is why I explain it at the very first check-up, to both the parent and the child. Motivation is mostly up to the parent, because a child does not think about how their teeth will look in ten years.

The position of the teeth determines their health, appearance and durability

I am glad that parents increasingly understand how important healthy teeth, their position and the bite are. It is something a child carries for life. If something about your child's teeth does not look right, or you suspect something is wrong, book a check-up. Sometimes the best outcome of a check-up is exactly this sentence: everything is fine, just wait.