Generally, an orthodontist should be seen any time there is a question about the alignment of the teeth or bite. Sometimes, this may be quite obvious if significant crowding or rotated teeth are noticed. Other times, it may not be as obvious.
Even less obvious problems can have significant consequences if they are not addressed, which is why the American Association of Orthodontists (AAO) and most specialists recommend an evaluation by age 7. This recommendation is based on the fact that by this age, the permanent first molars and some of the permanent front teeth should be present in the mouth. If this is not the case, there may be a problem in normal tooth development or eruption.
There is a large variation in normal tooth development for different individuals. Therefore, an evaluation by an orthodontist is important to determine whether there is a problem or if it is just a normal variation in tooth development/eruption. If an orthodontist has not been consulted by age 7, an examination will still be valuable to determine what, if anything needs to be done. Although most patients will not need treatment at a very young age, catching problems early if they exist can potentially prevent more severe future problems.
Most orthodontists do not charge for an initial examination appointment, so it can be a valuable way to gain information about the bite and development of the teeth and jaws. Most times a referral is not needed to make an appointment with a specialist in orthodontics. However, there may be specific requirements by certain insurance companies that may necessitate a referral by the primary dental care provider. The insurance company should have that information available if that is the case.
The general dentist may also recommend seeing an orthodontist. Usually, the dentist will see patients every 6-12 months for cleaning and exams. They will have a good idea about the teeth and dental history. Since the alignment of the teeth many times can be a subjective and cosmetic decision, it may be difficult for the patient or dentist to discuss. If there are questions about the alignment of the teeth or bite, do not hesitate to ask the dentist or make an appointment to see an orthodontist.