The decision of when to begin orthodontic treatment is based on an individual’s unique dental and skeletal development, not a single age. Orthodontics is the specialized practice of correcting misaligned teeth and jaws to improve both function and appearance. The optimal moment for intervention ensures the most effective and efficient results. This timing is highly specific to each patient’s growth pattern.
The Critical First Orthodontic Assessment
The American Association of Orthodontists recommends that a child’s first screening occur by the age of seven. By this age, the first permanent molars and incisors have erupted, offering the orthodontist a clear view of the developing bite and jaw relationship. This early assessment is a proactive measure to identify developing problems, such as crossbites, severe crowding, or jaw irregularities that may benefit from early intervention.
If a problem is identified, the orthodontist advises whether to begin interceptive treatment or enter a “waiting and watching” period. Monitoring growth allows the specialist to time the start of treatment perfectly, taking advantage of natural growth spurts. This initial evaluation provides parents with a roadmap, potentially simplifying future care and reducing the complexity of later treatment.
Understanding Phase 1 and Phase 2 Treatment Timing
For growing patients, treatment is sometimes divided into two distinct periods, known as two-phase orthodontics. Phase 1, or interceptive treatment, typically occurs around ages six to ten while the child still has a mix of baby and permanent teeth. The goal of this initial phase is to correct major skeletal discrepancies or functional issues, such as a severe underbite or crossbite, using appliances like palatal expanders. This intervention guides jaw growth and creates adequate space for the incoming permanent teeth.
Following Phase 1, there is a resting period where the remaining permanent teeth erupt naturally while the child is monitored. Phase 2, the comprehensive stage, usually begins around ages 11 to 13, once most or all of the permanent teeth have emerged. This stage involves the placement of full braces or aligners to precisely align the teeth and perfect the bite relationship. Although recommended for only about 10% of children, the two-phase approach can significantly reduce the need for extractions or surgery later on.
Dental Development Factors Dictating the Start Date
The precise starting point for comprehensive treatment is determined by biological markers rather than chronological age alone. Orthodontists use the patient’s dentitional status, ensuring enough permanent teeth have erupted to anchor the full appliances effectively. For corrections that rely on modifying jaw growth, the patient’s skeletal maturity is a more important factor.
To assess skeletal maturity, the orthodontist analyzes the morphology of the cervical vertebrae (bones in the neck) seen on a lateral cephalometric X-ray. Shape changes in the second, third, and fourth cervical vertebrae correspond closely to the pubertal growth spurt. Identifying the peak period of mandibular growth allows for the most efficient use of growth-modifying appliances. Optimal timing ensures that remaining growth is maximized to achieve the desired skeletal correction.
Timing Considerations for Adult Orthodontics
For adults, the question of “when” shifts away from growth potential and focuses instead on overall dental health, as skeletal growth is complete. The primary constraint is the health of the periodontal tissues, including the gums and supporting bone. Orthodontic tooth movement should only begin after any active periodontal disease, such as periodontitis, has been completely treated and stabilized.
Before starting braces, existing dental issues like untreated decay, failing restorations, or necessary extractions must be addressed by the general dentist. Although adult treatment can start at any age, the lack of growth means that certain severe bite discrepancies may require longer treatment time or surgical assistance. Consistent oral hygiene is necessary throughout treatment, and a regular maintenance schedule with a periodontist is often recommended for long-term stability.