The timing for starting braces does not depend on a specific number of lost baby teeth. Orthodontic treatment is determined by the patient’s stage of dental development. Braces can be applied while many baby teeth are still present if early intervention is needed, or they can be delayed until all permanent teeth have erupted. The decision relies on a professional assessment of the jaw structure, the bite relationship, and the readiness of permanent teeth to move.
The Significance of Dental Development Stages
Tooth development is categorized into three main stages central to orthodontic timing. The first stage is Primary Dentition, which includes the 20 baby teeth present in children, typically until around six years of age. During this period, the jaw grows while the underlying permanent teeth form.
The second stage is Mixed Dentition, beginning around age six with the eruption of the first permanent molars and incisors. This stage is characterized by a combination of baby and permanent teeth, lasting until ages 10 to 12 when the last baby tooth is lost. The presence of key permanent teeth, such as the first molars, is significant because they anchor the bite and help guide jaw growth.
Mixed Dentition is often the optimal time for the orthodontist to assess potential problems and begin early treatment. This timing allows the orthodontist to influence jaw development and create space for incoming permanent teeth. The final stage, Permanent Dentition, begins once all 28 adult teeth (excluding wisdom teeth) have erupted, which is the traditional time for comprehensive full-mouth braces.
Timing Orthodontic Intervention (Phase 1 and Phase 2)
Orthodontic treatment often follows a two-stage approach related to dental development. Phase 1, known as interceptive treatment, is typically initiated during the Mixed Dentition period, often between ages six and nine. This initial phase addresses significant problems best corrected while the jaw is growing, such as severe crossbites, harmful oral habits, or jaw discrepancies.
Phase 1 often involves partial braces or specialized appliances like palatal expanders, rather than a full set of braces. The goal is to guide jaw development and create sufficient room for permanent teeth to erupt correctly. This early intervention can help prevent the need for permanent tooth extractions later, and many baby teeth remain in place during this phase.
Comprehensive Phase 2 treatment is the traditional application of full braces or aligners. It usually begins once the majority of permanent teeth have erupted, typically around age 11 to 13. The focus is to align all permanent teeth for an optimal bite and aesthetic result. If Phase 1 successfully corrected skeletal and space issues, Phase 2 is often shorter and less complicated, but it relies on the loss of nearly all baby teeth.
When Permanent Teeth Must Be Removed for Braces
While the natural loss of baby teeth is a prerequisite for comprehensive Phase 2 treatment, permanent teeth sometimes must also be removed. This is a strategic necessity to create the required space for proper alignment in cases of severe dental crowding. If the jaw size is too small to accommodate the width of the permanent teeth, removing one or two teeth per arch allows the remaining teeth to move into a straight, functional position.
The teeth most often selected for extraction are the first premolars, located behind the canines. Extraction may also be necessary to correct significant bite issues, such as severe protrusion of the front teeth, which requires extra space to move the arch backward. Impacted teeth, like wisdom teeth or blocked canines, may also be removed if they interfere with the planned movement of other teeth. This decision is always made on a case-by-case basis after a detailed analysis of X-rays and facial structure.