For parents, the question of whether a child can undergo orthodontic treatment while they still have some baby teeth is very common. The answer is yes; a child can absolutely receive orthodontic intervention, often referred to as “early treatment,” before all their permanent teeth have erupted. This proactive approach is designed to guide jaw development and address certain problems that are easier to correct at a young age, laying the foundation for a healthier smile.
Understanding the Mixed Dentition Stage
The period when a child has a combination of primary (baby) teeth and permanent teeth is known as the mixed dentition stage. This transitional phase typically begins around age six with the eruption of the first permanent molars and incisors, and continues until about age 12 or 13. The presence of both tooth types makes this a dynamic and significant time for dental development, which is why an orthodontist often recommends an initial evaluation no later than age seven. Monitoring the eruption sequence and jaw growth during these years allows for the interceptive management of potential issues.
Goals of Early Orthodontic Intervention
Early orthodontic treatment, also known as Phase I, focuses on correcting significant skeletal or dental problems rather than perfectly aligning every tooth. One primary aim is to address severe bite issues, such as posterior crossbites, where the upper back teeth bite inside the lower back teeth. Correcting a crossbite early prevents an asymmetrical shift in the lower jaw and promotes balanced growth. Another major objective is managing space to ensure enough room for the permanent teeth to erupt without severe crowding. Guiding the growth of the jawbones can potentially reduce the need for permanent tooth extractions later. Intercepting harmful oral habits, like persistent thumb-sucking or pacifier use past age five, is also a common goal, as these habits affect jaw growth and the position of the front teeth. Early intervention can also improve the alignment of the upper and lower jaws while a child is still growing rapidly.
Appliances Used in Phase I Treatment
Traditional full-mouth fixed braces are not the typical appliance for Phase I treatment. Instead, orthodontists use specific devices tailored to skeletal growth and limited tooth movement. A common appliance is the palatal expander, a fixed device used to gently widen a narrow upper jaw, correct a crossbite, and create space for permanent teeth. This expansion is most effective during the mixed dentition stage because the jaw bones have not fully fused.
Another frequently used tool is the space maintainer, which holds the space open when a baby tooth is lost prematurely. Maintaining this space prevents adjacent teeth from drifting and blocking the path of the underlying permanent tooth. Limited or partial braces may also be applied, typically bonded only to the front four permanent incisors or the permanent molars. These partial braces are used for limited goals, such as correcting severe tipping of the front teeth or closing a specific gap.
The Two-Phase Treatment Model
Early orthodontic intervention is the first part of the two-phase treatment model. Phase I is the initial, limited treatment that occurs while the child still has baby teeth, focusing on jaw and bite correction. This phase typically lasts about nine to 18 months and is designed to simplify or shorten later treatment.
Following Phase I, there is a “resting period” where the child is closely monitored as the remaining permanent teeth erupt. This allows for natural dental development before the second, comprehensive phase begins. Phase II typically starts once most or all of the permanent teeth are in place, usually around age 11 to 13. This second phase uses full braces or clear aligners to achieve the final, precise alignment of all the permanent teeth and establish the best possible bite relationship.