Avoid Years of Dental Work: How to Tell if Your Child Needs Braces Now

Young boy at a dentist visit

Getting braces is almost an adolescent rite of passage nowadays, with many kids getting them put on by their middle school years. And if you're like most moms, you want what's best for your kids' smiles. But while perfectly straight teeth are nice for anyone to have, not every kid needs to undergo the pain and stress of braces, experts say.

So how can you tell the difference between teeth that might not make it onto a toothpaste commercial but are otherwise perfectly normal and a severe dental problem that requires professional treatment? (And since dental insurance coverage is often spotty when it comes to braces, it's important to know whether any money you shell out to the orthodontist is worth the expense.) We consulted with two reputable orthodontists and a pediatric dentist to help you make the best decision for your kids' teeth.

1. Take your kids to the dentist from an early age.

The best way to determine whether your children will need braces is to take them to the dentist regularly, and make sure to ask a professional if anything you notice about their teeth or behavior troubles you. "The dentist should monitor for the normal eruption [appearance] of teeth," says Deborah DeCamps, DDS, MS, an orthodontist with practice locations in Baltimore and Bel Air, Maryland.

DeCamps stresses that all children should have their first visit to the dentist by around age two, and adds that most children should also have an initial consultation with an orthodontist by around age seven to see if they are showing early signs of common tooth or jaw misalignment problems.

You'll often be able to tell between the ages of five and eight whether your child's teeth are coming in normally, says Gregory A. Cumberford, DDS, GPR, a dentist in private practice in Calgary, Alberta who also volunteers to treat underprivileged children on a mobile dental bus, both at home and abroad. "In this age range, kids should be in early mixed dentition," which means they have both some permanent teeth and some baby teeth—usually the upper and lower incisors and the six-year molars, Cumberford explains. "If these teeth are in the jaw with minimal or no crowding on the lower, and with good bite placement on the upper, this is normal," he says. However, Cumberford cautions that parents are usually not able to determine what is normal and what might need correction on their own, so regular kids' dental checkups at this age are still important.

2. Check for crowding and abnormal tooth spacing.

Some types of orthodontic problems—called malocclusions—are obvious early on, while others might look innocuous in childhood but can cause severe dental problems later in life if left untreated, experts say. Warning signs to watch out for include tooth crowding (where the teeth bunch up against one another); excessive spacing (where large gaps form between teeth, which can indicate gum issues or missing teeth), and abnormal eruption (which occurs when one or more teeth appear in the wrong location).

All of these issues can cause dental complications beyond just having an unattractive smile, Cumberford explains. "Once teeth erupt out of position, they will never have the proper gum attachment," he explains—which means periodontal pockets can form around the misaligned teeth, among other problems. These pockets collect mouth bacteria that can cause tooth decay, periodontal disease, and even jawbone loss later in life.

Crowding and misplacement of either baby or permanent teeth can also cause other, developing permanent teeth to become trapped below the gumline, a condition called impaction. "[These] teeth can [then] compromise other healthy teeth," Cumberford explains. An overjet occurs when the top front teeth protrude far out, sometimes even over the lips. "In these cases, the incisor teeth are more prone to trauma (breaking or cracking), especially in active children," Cumberford notes.

If you notice one of these conditions developing in your child, don't panic, DeCamps stresses. "If a tooth is erupting into the wrong spot, parents should bring it up to [their kids'] dentist at their next six-month checkup," she says. "But it's not a reason to make an emergency appointment."

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3. Be on the lookout for unusual bite or jaw structure.

Problems can also develop in the jawline and in how the upper and lower teeth come together to form a bite. For example, a crossbite occurs when the lower teeth overlap the upper teeth, instead of vice versa as normally occurs. "If [the bite] is reversed, then it can lead to a shift in the bite, and gum problems in the involved teeth," DeCamps explains.

Meanwhile, an open bite is a condition where the upper and lower teeth don't meet at all, and instead form an oval shape, DeCamps notes. An underbite is a condition where the lower jaw is more forward than the upper jaw, and often requires expanders to be placed in the upper jaw, and braces on either or both jaws, depending on the child's age and the condition's severity, DeCamps explains.

"If your child's teeth don't meet when they bite down, braces are almost inevitable," stresses Claire Nightingale, a British orthodontist with Queens Gate Orthodontics in London's South Kensington neighborhood.

If left untreated, bite or jaw misalignments can have lifelong implications, Cumberford advises. "In a growing child, [these problems] can lead to growth asymmetries that are permanent." He adds that while these issues can often be easily corrected in a growing child, they are much more difficult to reverse in an adult.

Lastly, if your child is losing baby teeth considerably earlier or later than normal, it can be a warning sign that braces will be needed, Nightingale notes, because it's often an indication that permanent teeth are not coming in properly.

Our sources stress that when medically necessary, braces should go on kids in early adolescence—usually between ages 9 to 12 or so, while children are still growing at a rapid pace. If you wait much past that window, many orthodontic issues can become more difficult and expensive to treat as the facial and jaw bones settle into their adult sizes. So don't put it off if you can help it, experts say.

4. Pay attention your children's oral behaviors.

Some common early-childhood behaviors can cause dental problems later on, so pay attention to whether things like thumb- or finger-sucking or tongue-thrusting continue past the toddler stage, experts say—because this can lead to or aggravate orthodontic problems. (If you're concerned, talk to your pediatrician, dentist, or orthodontist about strategies for stopping or minimizing the behavior.)

If you notice that your child is having trouble biting or chewing, this can sometimes indicate a need for braces, Nightingale says. "If your child is struggling to chew, it could well be the case that their bite is off," she says.

Bite or jaw problems don't always interfere with how a child eats or chews, DeCamps notes—so don't rely on that to dismiss a dental professional's recommendation to correct one or more of these issues, she cautions.

5. Take note of any problems with your kids' speech or self-esteem.

Some speech problems are related to orthodontic issues, DeCamps points out—so even if your children's teeth appear relatively straight and normal to you, if they have a speech impediment, sometimes the only way to fix it is through orthodontics. "If the child is lisping, it can be dental-related," and orthodontic treatment may need to be done in coordination with a speech pathologist, DeCamps explains.

Not only that, some orthodontic issues might seem purely cosmetic in nature, but any dental problem that is causing severe damage to your child's emotional well-being and self-esteem deserves treatment from a psychological perspective, Cumberford argues. "Psychosocial considerations—especially getting teased at school— are a big issue," he says. "So much so that pretty much every state Medicaid program in the U.S. recognizes it as a medical indication to treat a child with braces."

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