Early Orthodontics

Early interceptive treatment, also commonly called Phase I treatment (Phase-One treatment), may be recommended for your child. We set limited treatment goals for early interceptive treatment and we try to keep the treatment time as short as possible. Some children can benefit tremendously from early interceptive treatment, such as by decreasing the probability that they will need jaw surgery in the future. There is a relatively small window of opportunity to make certain orthopedic changes to the jaws easily. It is very important that your child is evaluated for any need for early interceptive treatment.

At what age should a child first visit the orthodontist?

The American Association of Orthodontists recommends that a child be orthodontically evaluated by age 7. Early interceptive treatment typically takes place in early mixed dentition, when there are more baby teeth than the adult teeth. Dental development wise, I usually like to have the 4 front adult teeth in on the top and the 4 front adult teeth in on the bottom. Age wise, my typical early interceptive patients are about 6- to 8-years-old. However, timing is critical for early interceptive treatment and I will be evaluating the dental development, skeletal development and maturity, among other things, in assessing whether the timing is right for any early interceptive treatment for your child. Please bring your child in for our complementary screening exam, so I can evaluate if your child needs any early interceptive treatment.  Many dentists have been trained to identify orthodontic problems early, and may refer you to our office earlier than age 7.

Why are children being evaluated at such an early age?

Early diagnosis and treatment can guide erupting teeth into a more favorable position, preserve space for permanent teeth, and reduce the likelihood of fracturing protruded front teeth.

If early treatment is indicated, Dr. Marshall can guide the growth of the jaw and incoming permanent teeth. Early treatment can also regulate the width of the upper and lower dental arches, gain space for permanent teeth, decrease the likelihood of need for permanent tooth extractions, reduce the likelihood of impacted permanent teeth, help correct thumb sucking, and eliminate abnormal swallowing or speech problems. In other words, early treatment can simplify later treatment, after all the permanent teeth erupt.

Who Needs Early Interceptive Treatment (Phase I Treatment)?

I strongly recommend early interceptive treatment for any child who falls into either of the two categories below:

  • Early orthodontic treatment will result in strong benefits.  These benefits will typically be difficult to achieve (and usually more costly and/or invasive) or impossible to achieve, if the child were to wait to obtain orthodontic treatment when their older.
  • Early orthodontic treatment will result in damage prevention or decreasing the risk of potential damage.

I will usually give the options of either doing early interceptive treatment or to place patient on recall (with no plan for early interceptive treatment), in the following type of case:

  • Early orthodontic treatment will result in benefit(s).  These benefits may be achievable, even if you were to wait to just do one round of treatment later (as comprehensive orthodontic treatment).

In my opinion, most children do not absolutely need early interceptive treatment.  However, it is important to have your child be evaluated by an orthodontist, to make sure that your child does not need early interceptive treatment.  Would I do interceptive treatment on my own kids?  Yes!  I did for both of my kids, even though they didn’t need it per se.  I think there are advantages to having straighter teeth, even at that young age, from a psychosocial aspect, perception aspect and from an oral hygiene aspect.  So while I don’t think most kids need early treatment, it is nice to get the teeth and jaws into better positions early, in preparation for future comprehensive orthodontic treatment (the last treatment in which you try to get the best possible bite & straightness). But don’t worry, at the exam, I should tell you how important or how not important it is to do early interceptive treatment in your child’s case, and you make the decision from there.  If I forget, please just ask right then & there.  I’m honest, so just straight up ask me “How important is it to do this treatment?” and I’ll tell you what I think.

Typical Cases in Which I Recommend Early Interceptive Treatment

  • Posterior crossbite
  • Anterior crossbite
  • Adult teeth are stuck somewhere (impacted) and unable to come into the mouth without orthodontic intervention
  • Severe overjet (upper front teeth stick out much much farther than the lower front teeth)
  • Moderate to severe crowding
  • Child being teased or psychologically affected, due to positioning of teeth
  • Child unable to quit oral habits (finger sucking, thumb sucking, lip sucking, etc.)

Goals of Early Interceptive Treatment

Goals of early interceptive treatment are limited.  I do not attempt to correct all the orthodontic problems at this stage because it is not possible.  Not all the adult teeth are in the mouth, so I cannot straighten all the adult teeth yet and cannot fully correct the bite.  Unfortunately, straightening out the baby teeth does not result in the adult teeth coming in straight.  It is important to understand that most patients, who received early interceptive treatment, will need another round of orthodontic treatment later (usually in the pre-teen or teen years) to address all orthodontic problems.

What is Involved in Early Interceptive Treatment?

There are various orthodontic appliances I use, when I do early interceptive treatment, and what I recommend will mostly depend on the treatment goals.  I don’t necessarily do braces (brackets & wires) on all early interceptive patients and I may only recommend treating just the top or just the bottom jaw or teeth.  I do require that an adult brush and floss our early interceptive treatment patient’s teeth every night, if they have any traditional appliances on, so that our young patient does not end up with damaged teeth and gum disease.

How Long is Early Interceptive Treatment?

This will vary widely depending on the patient, but it is typically 9 to 15 months in my cases.

Does early treatment benefit all children?

Early treatment does not necessarily benefit all children. Certain types of orthodontic problems can be more easily and efficiently corrected in the teen years when all the permanent teeth have erupted. Some skeletal orthodontic problems should not be addressed until growth is more advanced or completed. The doctors develop a plan for treatment based on each individual child’s needs. If the doctor decides the patient is not ready for treatment, they are placed on our orthodontic recall program.

What Happens After Early Interceptive Treatment?

The patient will usually receive retainers or other types of appliances (either glued in the mouth or removable, depends on the patient) to wear.  The patient will come in periodically (usually every 3-, 6-, or 12-months) for retainer check appointments.  During these appointments, I will check the fit of any retainers, adjust the retainers as needed, and will be monitoring the dental (and when needed, the skeletal) development.  I will also be checking to see, if the patient is ready for the next and usually final round of orthodontic treatment.  Almost every patient that received early interceptive treatment will need another round of orthodontic treatment later.  This second round of orthodontic treatment is often called Phase II treatment (Phase-Two treatment).

What is the Orthodontic Recall Program?

The orthodontic recall program is for patients who are not ready for treatment and have been placed on recall. This program enables us to monitor the eruptive pattern of the permanent teeth. Sometimes, poor erupted patterns of permanent teeth may be eliminated with early removal of baby teeth and reduce the treatment time required for orthodontic treatment in the future. This program allows Dr. Marshall to determine the optimum time to begin treatment and achieve the best possible result for your child.

In addition to a beautiful new smile, what are some other benefits of orthodontic treatment?

Braces can improve function of the bite and teeth, improve ability to clean the teeth, prevent wear on the teeth, and increase the longevity of natural teeth over a lifetime.

If a child has treatment early, will this prevent the need for braces as an adolescent?

Early treatment can begin the correction of significant problems, prevent more severe problems from developing, and simplify future treatment. Because all of the permanent teeth have not yet erupted when early treatment is performed, their final alignment may not have been corrected. Phase II treatment is comprehensive orthodontic treatment with treatment goals usually addressing both bite and alignment. Usually, all the adult teeth (except the wisdom teeth) or almost all the adult teeth are in the mouth. Age of phase II treatment will depend on the patient’s skeletal and dental development. Typically, a shortened comprehensive treatment (Phase II), after all the permanent teeth have erupted, completes the correction. However, in rare circumstances, further orthodontic treatment may not be indicated.

Do we still need to see our family dentist during orthodontic treatment?

Patients with braces and other orthodontic appliances require more effort to keep their teeth and gums clean. Because we want to insure the highest level of dental health, we recommend you see your family dentist for regular check-ups and cleanings at least every 6 months during treatment.