Treatment Timing
The timing of orthodontic treatment can sometimes be obvious, and other times it can be somewhat unclear. As was mentioned previously, the American Association of Orthodontists and most practicing orthodontists recommend an orthodontic examination by age 7. In most cases, treatment may not be needed at that time. However, there are times when serious eruption and crowding problems can be addressed early to prevent worse problems later on.
On average, girls will get their teeth before boys. Even considering this difference, the loss of baby teeth and eruption of the permanent teeth can be quite variable from one child to another. In spite of the variation, there is a general pattern of eruption, which is shown below:
|
Age (yrs) |
Range (yrs) |
Upper |
Lower |
|
6 |
6-7 |
|
First Molar |
|
6 |
6-7 |
First Molar |
|
|
6 |
6-7 |
|
Central Incisor |
|
7 |
7-8 |
Central Incisor |
|
|
7 |
7-8 |
|
Lateral Incisor |
|
8 |
8-9 |
Lateral Incisor |
|
|
10 |
9-10 |
|
Canine |
|
10 |
10-12 |
First Premolar |
First Premolar |
|
11 |
10-12 |
Second Premolar |
Second Premolar |
|
11 |
11-12 |
Canine |
|
|
12 |
11-13 |
|
Second Molar |
|
12 |
12-13 |
Second Molar |
|
|
20 |
17-21 |
Third Molar |
Third Molar |
Approximate ages for permanent tooth eruption.
The eruption pattern illustrates why most orthodontists recommend the examination by age 7. At this age, the upper and lower permanent first molars should be in, and the front four upper and lower incisors should be in or erupting soon. Tooth eruption problems, missing teeth, crowding, and the bite can all be accurately assessed.
The best time to begin orthodontic treatment will depend on the problems a patient has. If there is a significant issue with eruption of permanent teeth, severe crowding, missing or extra teeth, and bite problems before the permanent teeth have all erupted, treatment may be needed at a younger age. Sometimes, there are limitations on when certain treatment options can be effectively accomplished. For example, a headgear, Herbst, and other appliances will rely heavily on an actively growing patient for successful correction. Or, expansion of the upper jaw is limited by when the palate fuses together (ages 14-16).
There is a very simple appliance available that can sometimes be used to lessen a crowding problem at a young age. The appliance is called a Lower Lingual Arch (LLA), and functions as a space maintainer. It is most effective while some baby teeth are still present, since some of the baby teeth are wider than the permanent teeth that erupt behind them. The appliance is useful to preserve space that would otherwise have been lost when the permanent molars shift forward. Generally, braces are used to complete the treatment using the preserved space once all of the teeth have erupted. A study showed that the crowding problem of 60-70% of patients was successfully treated with this appliance and braces.
On the other hand, there may be problems that cannot be fully resolved with early treatment. Or, sometimes the severity of the problem does not warrant treatment right away. In those cases, treatment could be delayed until permanent tooth eruption has occurred.
Ultimately, there is no easy answer about the best timing for orthodontic treatment, since every patient will have a different set of circumstances. What may be appropriate for one patient may not necessarily be recommended for another. The best advice would be to seek consultation by an orthodontist, and get a second opinion if there is a question about the need and/or timing.
