When should my child get braces?

Teen with braces

A common question I get asked is “When should my child get braces?” 

The answer is an ambiguous “it depends” and then I open up some key factors to consider:

First of all, braces are for kids who already take good care of their teeth.  “Do you question your kid’s oral hygiene?  Do you constantly have to bug them to brush and floss?”  If the answer is yes, it’s not the right time to get braces. 

They need to mature and to show you they are ready.  Braces are a privilege that must be earned.  Otherwise the gums will get puffy and bleed and cavities can occur.  Another likely outcome is having white spots that halo around the bracket where bacterial plaque stayed too long.  This takes out the minerals on the tooth surface leaving behind a chalky-white unsightly appearance on the front teeth.  Not what anyone wants.

Second question is, “does your child want braces?”  Sometimes it’s mom or dad who is driving the decision to get braces.  But does your child want them?  If not, that’s okay and as we all know kids change a lot.  Sometimes they need to understand why braces are a good thing.  Maybe they need to be a little older.  Convincing most boys about age 12 takes some doing.  Pushing them is a big mistake.

So what are some reasons to consider?  There is the obvious case when a child has a skeletal problem with a severe over or under-bite.  Usually this requires tooth extractions and maybe even oral surgery like I had as a kid.  This is the category I fell into and it was easy to convince me by age 14.

Less obvious are cases where your child is starting to wear off certain key teeth and chipping front teeth.  This can be a sign of a bite that is off and destructive to the teeth.  This is the case where braces can prevent a life time of avoidable dentistry.

Crowding can be a hygiene problem.  Kids might not be proud of their teeth and decide that they aren’t worth the trouble if they don’t like themselves.  Showing them that there are ways to straighten the teeth and make them easier to clean might motivate some children.

Prevention of jaw pain.  Having an ideal bite lessens the wear and tear on the jaw joints, muscles and nerves.  If you suffer from this, it might be worth checking out to see where your child is with their bite.  Once jaw pain starts there is already some amount of damage taking place.  Best time to act is early.

Timing.  They say timing is everything, this is true with braces.  Two approaches are common.  first is an early, usually two-stage approach and the other is a single stage approach.

Assuming that your child has good oral hygiene and that they want braces, the next step is to see an orthodontist for a consultation.  Age seven or eight is the best time.  This is because much can be done to influence the growth of your child to correct problems at that age.  If untreated, surgery and tooth removal becomes more likely.  Early intervention usually requires a second stage after all permanent teeth are erupted, about age 12 or so.

If all permanent teeth are able erupt and there is no need to create extra room, a single stage approach might be sufficient beginning when your child has all permanent teeth.

Having a good long-term relationship with your dentist will lead to better information for yourself and your child.  They will be better able to catch the early intervention cases and will be able to follow your child’s growth and development.  That means better TIMING for braces.  It also means prescribing necessary treatment without over-treatment.

I hope this discussion helps, please let me know if you have any questions.  Thank you!

Dr. Philip Estes