What is the best age to begin orthodontics?

The answer to this question depends upon the problem, and it also depends a great deal upon the treatment philosophy of the orthodontist.  There are some situations that all orthodontists believe are very important to begin early (before age 9).  These may involve orthopedic changes, like widening of the palate.  Another example involves arch bars across the palate or in front of the tongue.  These appliances help make more room as the primary molars fall out and the bicuspids are growing in.  It is always important to correct crossbites.  Other situations are more controversial.

When someone has early treatment, we call this Phase I.  In almost all circumstances, a Phase I treatment necessitates a Phase II treatment, which means full braces when all of the permanent teeth have grown in.  This means more expense and a lot more visits.  To justify this, there has to be a real good reason to do a Phase I.   After many years of doing a lot of two-phase treatments, I decided that many of these cases were not significantly better off than if they had just waited and did treatment in one phase when they were older.  Today, for many situations,  research is validating what I have discovered on my own.  The following is the conclusion from a prospective, randomized clinical trial out of Breat Britain, doi:10.1016/j.ajodo.2007.10.042

[Functional Appliance] treatment when a child is 8 to 9 years old has no advantages over treatment started at an average age of 12.4 years. However, the cost of early treatment to the patient in terms of attendances and length of appliance wear is increased.—Supported by the Medical Research Council (G9410454).

A functional appliance is any appliance which pushes the lower jaw forward to treat overbites.  (These include MARA’s, Twin Blocks, Bionators, Jasper Jumper’s, Forsus Springs, etc. )  There have been several other well done long term studies which draw similar conclusions. 

In summary, I am much less likely to recommend a two-phase treatment than many of my competitors.  Only for very specific situations have I found Phase I treatment to be clearly beneficial.  Please call for an appointment and find out if I think your child would benefit from two-phase treatment. 

When the patient is ready for full braces is when all of the permanent teeth have erupted.  This includes the twelve year molars!  Dr. Nisson almost always feels it is important to wait until these teeth have grown in before placing braces.  He can do a better job getting the bite right.  Getting the bite right is the key to helping the teeth to stay straight and it is the key to long-term health of the jaw joint and of the teeth!

–Dr. Nisson   October, 2017