Early orthodontic treatment, often called Phase One, refers to interceptive care that occurs while a child still has a combination of primary (baby) and permanent teeth. This approach usually begins when children are between the ages of six and ten, before the jaw and facial structures are fully mature. Parents frequently wonder if this early intervention is truly necessary or if it is better to wait until all the permanent teeth have erupted. The necessity of Phase One treatment depends entirely on the specific dental and skeletal issues present, as early correction can prevent more severe complications later in life.
Why Orthodontic Evaluation Should Occur by Age Seven
The American Association of Orthodontists (AAO) recommends that all children have an initial orthodontic checkup no later than age seven. By this age, the child has typically developed their permanent first molars, which establish the back bite, and their permanent incisors have begun to emerge. This mix of teeth allows the orthodontist to accurately assess a child’s developing bite and jaw relationship in all three dimensions: front-to-back, side-to-side, and vertically.
The evaluation is a means of assessment and monitoring, often referred to as interceptive care, and is not a commitment to immediate treatment. The orthodontist looks for subtle problems that may not be obvious to the untrained eye, such as potential crowding, misaligned teeth, or irregularities in jaw growth. In many cases, the assessment reveals that the child’s development is on track, and they simply enter a monitoring period. This early assessment ensures that if an issue is developing, the most effective time for intervention is not missed.
Specific Dental Issues That Require Early Intervention
Early treatment becomes necessary when specific dental or skeletal conditions are present where waiting would be detrimental to the child’s long-term oral health or facial development. One such condition is a posterior crossbite, where the upper back teeth bite inside the lower back teeth. If left uncorrected, a crossbite can cause the lower jaw to shift unnaturally to one side when closing, leading to asymmetrical jaw growth over time.
Severe protrusion of the upper front teeth, known as severe overjet, is another condition that warrants early intervention. Protruding teeth are significantly more vulnerable to traumatic injury, such as chipping or fracture, and early treatment can bring them into a safer alignment. Similarly, severe crowding that impacts the eruption path of permanent teeth may require early action. Early treatment can create necessary space, helping to guide the permanent teeth into better positions and potentially avoiding the need for future tooth extractions.
Functional shifts, where the lower jaw moves into an unnatural position to achieve a stable bite, must also be corrected early to prevent uneven wear on the teeth and potential jaw joint problems. Furthermore, persistent oral habits like prolonged thumb or finger sucking beyond the age of five can alter the development of the jaw and the alignment of the front teeth. Addressing these skeletal and habit-related problems during Phase One prevents them from becoming more complex and difficult to treat in adolescence.
The Role of Growth Modification in Phased Treatment
The core value of Phase One treatment lies in its ability to modify a child’s active skeletal growth, an opportunity that diminishes as a child ages. Growth modification, also called dentofacial orthopedics, uses specialized appliances to change the size, shape, or position of the jawbones to create symmetry and harmony. This interceptive treatment is most effective when timed to coincide with a child’s natural growth spurts.
For instance, if a child has a small lower jaw contributing to a significant overbite, an appliance like a Herbst device can be used to encourage the lower jaw to grow forward into a more favorable position. Conversely, a palatal expander can widen an upper jaw that is too narrow, correcting a crossbite by stretching the mid-palatal suture before it fully fuses. By guiding the jawbones during this period of flexibility, early treatment can simplify or shorten the subsequent Phase Two treatment, which focuses on the precise alignment of all the permanent teeth. Ignoring major skeletal discrepancies until all permanent teeth have erupted often means that the only remaining option for correction is more invasive procedures, such as orthognathic surgery.
Monitoring and Transitioning After Phase One Treatment
Following the completion of Phase One, which typically lasts between 9 and 18 months, the child enters a resting period. The goal of this phase is to allow the remaining permanent teeth to erupt naturally while the orthodontist monitors the child’s dental development and jaw growth. During this time, the child may be instructed to wear a retainer, which helps to maintain the foundational corrections achieved during the initial treatment.
This resting phase stabilizes the gains made in jaw position and ensures that the newly created space is preserved for the erupting permanent teeth. Monitoring appointments continue periodically until most or all of the permanent teeth have emerged, usually between the ages of 11 and 13. The orthodontist then assesses the final position of the permanent teeth to determine if a comprehensive Phase Two treatment, typically involving full braces or aligners, is needed to achieve the final, precise alignment and bite.