Understanding Crowding in the Early Mixed Dentition

Marlon A. Moldez
Jul 26
2 min read

Part 2: How Orthodontists Evaluate Developing Crowding

Part 1 explained why crowding develops. Part 2 describes how an orthodontist determines which factors apply to your child.

The evaluation combines the child’s history, examination, diagnostic records, and stage of development.

Medical and Dental History

The orthodontist may ask about:

The child’s and parent’s concerns
Medical conditions, medications, allergies, and previous procedures
Dental development, injuries, decay, early tooth loss, and previous treatment
Sleep quality, snoring, mouth breathing, and other breathing concerns
Dental, facial, jaw, or joint pain
Difficulty chewing or opening the mouth
Oral habits

Sleep, breathing, or pain concerns require separate assessment.

Clinical Examination

The orthodontist examines:

Facial and jaw relationships
Jaw movement
How the upper and lower teeth meet
The timing and pattern of tooth eruption
Remaining baby teeth
Space for unerupted teeth
The health of the teeth and gums
Relevant oral habits and function

When appropriate, the orthodontist may measure the teeth and dental arches and estimate the space required for permanent teeth that have not emerged. Space analysis contributes to the diagnosis but cannot predict future alignment with certainty.

Diagnostic Records

Depending on the clinical findings, diagnostic records may include photographs, digital models or scans, and X-rays.

These records can show tooth development, eruption, available space, jaw relationships, and facial growth that are not visible during the examination. X-rays are obtained only when clinically indicated.

Diagnosis and Next Steps

The orthodontist combines the findings to determine whether treatment is indicated, when it should begin, and which options are appropriate.

Some developmental or bite problems may benefit from treatment during growth. Others are better observed until more permanent teeth emerge. Early treatment does not necessarily eliminate the need for later comprehensive treatment.

The next step may be:

Periodic observation
Management of an eruption or space concern
Phase 1 treatment for a developmental or bite problem
Comprehensive treatment after more permanent teeth emerge
Referral to another health professional

If treatment is proposed, parents should receive information about the diagnosis, reasonable options, benefits, limitations, risks, costs, expected outcomes, and the consequences of delaying or declining treatment.

Key Takeaway

An orthodontic evaluation identifies the factors contributing to crowding and whether observation or treatment is appropriate.