Evaluation for Children
Orthodontic evaluation during childhood is performed when the upper and lower incisors are erupting and the jaws are developing.
Orthodontic organizations, including the American Association of Orthodontists (AAO) and the Canadian Association of Orthodontists (CAO), recommend that children have an orthodontic evaluation by age 7.
The goal is to identify conditions early and determine whether monitoring or early treatment is appropriate.
Treatment Pathways
There are two possible pathways based on clinical findings.
Phase 1 orthodontic treatment when a defined condition is present.
Observation when development is within acceptable limits.
Phase 1 Orthodontic Treatment
Phase 1 orthodontic treatment is limited intervention during mixed dentition when a defined condition is present and is best managed prior to or during peak facial growth or before eruption of the permanent canines and premolars.
Phase 1 does not eliminate the need for future treatment. A reassessment is required once the permanent dentition has erupted.
When Phase 1 Treatment May Be Recommended
Maxillary transverse deficiency. The upper arch is narrow relative to the lower arch.
Sagittal discrepancy. The upper and lower jaw relationship may present as increased overjet or an underbite.
Vertical discrepancy. The relationship between the upper and lower teeth may present as deep bite or open bite.
Arch space deficiency. Available space is insufficient to accommodate the dentition within the existing arch form.
Loss of arch space following exfoliation of the primary second molars. Increased risk of lower incisor crowding.
Screening Findings
Tongue thrust swallow may be present in association with developing malocclusion and may warrant myofunctional assessment.
Clenching or grinding may be present and may be associated with dental wear or muscle tenderness and may warrant habit awareness and modification.
Mouth breathing or snoring may be present and may warrant airway screening and medical referral.
Considerations
Upper arch width is addressed with maxillary expansion when transverse deficiency is present.
Lower arch space may be preserved with a lingual holding arch when indicated.
Maxillary expansion becomes less responsive with increasing midpalatal suture maturation.
After peak facial growth, the ability to guide jaw development decreases and treatment relies more on dental compensation.
Follow-up and Monitoring
When treatment is not indicated, follow-up visits are used to monitor growth, tooth eruption, and changes in bite relationships. Reassessment timing is based on developmental milestones and clinical findings.
Explore Related Orthodontic Information
Additional information about orthodontic care at different stages of development is available below.