How to tell if your child needs braces

How can I tell if my child needs braces and how soon?

There are many reasons why a child might need braces. Appearance is a concern of many parents. In a society that places a high premium on looks, it can be a legitimate worry. Even if appearance isn’t a major issue, mouth conditions like crowded, turned or misaligned teeth, which makes normal oral hygiene more difficult, can pose long-term oral health risks, like tooth decay and gum disease. A “bad bite” may also cause chewing, biting or speech problems. 

Some problems require braces at an early age, even when the child has mostly baby teeth (ages 5-9), although it may be best to start braces after most of the baby teeth have fallen out (ages 10-14). If your child has regular dental visits, your general or pediatric dentist will be able to determine when it is time for minor intervention or a full evaluation for braces.

Signs a child may benefit from braces

• Early, late or irregular loss of baby teeth
• Difficulty chewing or biting
• Crowding, misplaced, missing, blocked-out or misaligned teeth
• Abnormal enamel wear  
• Biting the cheek or roof of the mouth — deep overbite
• Teeth that meet abnormally or not at all — overbite, underbite, crossbite (e.g. top teeth inside lower teeth) or openbite
• Jaws and teeth that are out of proportion to the rest of the face

What causes the need for braces?

Most orthodontic problems are genetic. The size of your jaws and the shape of your teeth are inherited from your parents. When the jaws don’t have room to fit all teeth, you get crowded, crooked teeth or misaligned jaws. Other issues with spacing and bite develop over time, due to prolonged thumb or finger sucking, mouth breathing, dental decay, accidents or poor nutrition.

What are the possible benefits of braces for my child?

Early diagnosis and successful treatment of certain bite problems, called malocclusions, have both short- and long-term benefits. Short term, you can get correction of problems the child might have been experiencing like difficulty biting, chewing or speaking. Improved esthetics may help your child feel better about themselves physically and personally. Long term, correcting a poor bite lessens the risk for uneven or excess wear on the teeth, eating difficulties, or jaw joint problems. Short and long-term straight teeth are less susceptible to tooth decay and gum disease. The value of setting up the right conditions for a lifetime with a confident healthy smile is perhaps the biggest benefit.   

Types of bite problems

• Crooked or crowded teeth — teeth must compete with each other for limited space, leading to crowding, twisting or misalignment of teeth
• Missing or extra teeth
• A deep overbite, underbite, crossbite or openbite. Abnormal bites refer to the way that your child’s teeth look when their jaws are closed, and each type of abnormal bite can lead to specific issues for your child’s dental health.
• Incorrect jaw position — too far forward, backwards or skewed to one side

What problems could result from not treating an abnormal bite with braces?

• Crowded or poorly aligned teeth make it more difficult to keep them clean, increasing risk for tooth decay and gum disease
• Tooth loss
• Gum disease and periodontitis
• Abnormal wear on enamel
• Issues with speaking and eating

At what age should my child have an orthodontic exam?

Some dental growth and development problems are best treated early, even while all of the baby teeth are still present (ages 5-9). The most important thing to do is to take your child for regular dental check-ups. Your child’s general or pediatric dentist will be able to track any potential dental issues that arise, and they can decide if, and when, your child may need minor intervention or a full orthodontic screening. They can also help you determine the best time for evaluation and treatment by an orthodontic specialist, or if one is needed. The American Association of Orthodontists recommends a first evaluation visit to the orthodontist no later than age 7.

What is the best age to be fitted with braces?

The best age varies from patient to patient. Most children can wait to start orthodontic treatment until most, or all, of their baby teeth have fallen out and the permanent teeth are mostly in place (ages 10-14). At that age, the child is still growing, and the teeth and bone move more easily. However, some dental-facial growth and development problems are best addressed early, even while mostly baby teeth are present (ages 5-9). These early corrections are often only the first phase of treatment, and final corrections are made when the permanent teeth are in place. This is often referred to as two-phase treatment. Other developmental problems are not as critical. Even adults get successful orthodontic care, although success is usually more predictable in a growing jaw. Any problem classified as a “bad bite” may be minimized with the proper orthodontic treatment.

What are the types of braces?

Braces are much less noticeable than in past years. Advances in dental materials have provided more options to help the brackets and wires blend in with the teeth. In addition, techniques are available to place the braces on the backs of the teeth or to move the teeth by wearing a series of thin, barely noticeable mouthguard-like trays. Of course, these more esthetic options have greater cost and often are not available for more difficult orthodontic corrections.

• Stainless steel braces: Traditional braces using metal brackets and wires to align teeth are the most visible of all braces. These are the least expensive type of braces and allow children to customize with colored bands.
• Ceramic braces: Ceramic brackets are clear or tooth-colored and work the same as traditional braces. They can include clear wires. Ceramic brackets are less noticeable than metal brackets but are more expensive and can stain, if not properly cleaned.
• Lingual braces: Theses metal braces are placed on the back, or lingual side of your teeth. They are invisible to outside view but are harder to clean, more expensive, and more uncomfortable than traditional braces.
• Invisalign and other tray aligner devices: Custom-made, clear plastic aligners resemble mouthguards. Aligners require a series of 18 to 30 sets, which are exchanged every two weeks. They are nearly invisible but can be more expensive than traditional braces. Invisalign is inappropriate for young children and those with serious bite (malocclusion) problems. These have become a popular option for adults.

How much do braces cost?

The overall cost of braces depends upon the type of braces you select. Traditional metal braces cost between $3,000-$7,000, Invisalign ranges from $4,000-$7,400 (other aligners may be considerably less expensive but may not be covered by your insurance), ceramic braces span $4,000-$8,000, and lingual braces are $8,000-$10,000. Dental insurance often covers some of the cost of braces. Many orthodontists offer payment plans to make payment manageable.

Caring for children’s braces

Braces can create opportunities for bacteria to thrive, when not cared for properly. Food stuck in wired braces feeds bacteria, leading to tooth decay and gum disease. Children with braces should brush after every meal and floss daily to remove food particles and to prevent infections and cavities. Depending on the child’s oral hygiene and diet, professionally applied fluoride treatments 2-4 times per year may be beneficial. Certain foods can damage braces, like gum, sticky candy and popcorn, and should be avoided. Children with plastic aligners should remove them during meals. Caring for braces can prevent dental issues down the line.

Some final thoughts — Braces are expensive; there is some discomfort and pain involved; it can be a long process, especially if the treatment is done in two phases; the child must be cooperative and practice good oral hygiene or they could end up with straight teeth but cavities and gum problems. Overall though, braces can be a great long-term investment in a child’s health and well-being.

“AAO – A Beautiful Smile For Everyone” American Association of Orthodontists. www.youtube.com/watch?v=D41oX_PnAvA Accessed July 2018.

“Braces.” Mouth Healthy, American Dental Association. www.mouthhealthy.org/en/az-topics/b/braces Accessed July 2018.

Guideline on Management of the Developing Dentition and Occlusion in Pediatric Dentistry - 2014. American Academy of Pediatric Dentistry. http://www.aapd.org/media/Policies_Guidelines/BP_DevelopDentition.pdf  Accessed July 2018.  

Outcomes in a 2-phase randomized clinical trial of early Class II treatment. Tulloch JF, Proffit WR, Phillips C.  Am J Orthod Dentofacial Orthop. 2004 Jun;125(6):657-67.

Assessment of orthodontic treatment outcomes: early treatment versus late treatment. Hsieh TJ, Pinskaya Y, Roberts WE.  Angle Orthod. 2005 Mar;75(2):162-70.

Two Phase Orthodontics: There are Two Sides to Every Story. Dental Products Report. 2016 http://www.dentalproductsreport.com/dental/article/two-phase-orthodontics-there-are-two-sides-every-story?page=0,1 Accessed July 2018.