The purpose of braces is to correct malocclusions, or misalignments of the teeth and bite, which can affect oral health and function. These orthodontic appliances apply continuous, gentle pressure to gradually shift teeth into their correct positions within the jawbone. The timing of when this process begins is often as important as the mechanics of the braces themselves. While many people associate braces with adolescence, the optimal time to start is highly individualized and depends on the patient’s unique dental and skeletal development.
When Should the Orthodontic Assessment Occur?
The American Association of Orthodontists (AAO) recommends that children have their initial orthodontic check-up no later than age seven. This early assessment is not about immediately applying braces, but rather a diagnostic measure to identify potential problems in their earliest stages. At this age, children have a mix of primary (baby) and permanent teeth, a stage known as mixed dentition.
An orthodontist uses this developmental window to evaluate jaw growth and the eruption path of permanent teeth. They look for specific issues like crossbites, severe crowding, or functional problems involving the jaw or breathing. This check-up allows the specialist to either confirm healthy development or identify a need for future intervention.
Determining the Optimal Age for Treatment Initiation
The initial assessment determines if the patient should be monitored or requires immediate intervention, often leading to a two-phase treatment plan. The first phase, known as Phase I or Early Interceptive Treatment, generally occurs between the ages of six and ten. This early phase is reserved for complex issues that benefit significantly from correction while the jaw is still actively growing.
Criteria for starting Phase I include severe skeletal discrepancies, such as an underbite or significant crossbite, which affect facial growth symmetry. Appliances like palatal expanders or partial braces may be used for about 9 to 18 months to guide jaw development or create space for erupting permanent teeth. After Phase I, there is typically a resting period where the remaining permanent teeth erupt naturally, and the patient is monitored until Phase II.
Comprehensive Treatment, often called Phase II or Adolescent Treatment, is the stage where full braces are typically applied, usually beginning between the ages of 11 and 14. This timing is optimal because most or all permanent teeth have fully erupted, and the body’s growth rate has slowed. The goal of this phase is to achieve the final, precise alignment of the teeth and correct the bite relationship. For many patients who only require alignment, this Comprehensive Treatment is the first and only phase they undergo.
Factors That Influence the Waiting Period
The period between the initial assessment and the start of active treatment is highly variable, depending on dental and logistical factors. One significant dental factor is waiting for the complete eruption of specific permanent teeth, such as the second molars, which can take years. The orthodontist monitors growth patterns, especially in younger patients, to ensure treatment starts at the most biologically advantageous moment.
The waiting period sometimes involves preparatory procedures, such as the surgical removal of teeth to alleviate severe crowding before braces are placed. Non-dental variables also influence the timeline, including scheduling appointments or obtaining necessary financial approvals. For adult patients, the wait is generally shorter, involving immediate preparatory work like treating existing dental issues.
Understanding the Treatment Duration
Once braces are placed, the active treatment duration varies significantly based on the complexity of the malocclusion. For most individuals, active treatment lasts between 18 and 36 months, though the average is closer to 18 to 24 months. Cases involving minor spacing or crowding may take as little as 6 to 12 months, while severe bite problems often require two years or more.
The patient’s compliance plays a major role in keeping treatment on schedule, as consistent wearing of prescribed elastics or avoiding damaging foods prevents delays. After the removal of braces, the retention phase begins, requiring the use of a retainer to hold the teeth in their new positions. This final stage allows the bone and soft tissues to stabilize around the newly aligned teeth.