dental instruments and oral health

What Is Early Orthodontic Treatment (Phase I)?

Most patients begin orthodontic treatment around age 14. This is because all of the permanent teeth have fully erupted and the jaw structure will not change drastically. In some cases, younger patients start orthodontic treatment around age 7. Although, not all young children benefit from early orthodontic treatment since irregular teeth positioning is common in those who still have primary teeth.

“Early” orthodontic treatment is also called “interceptive” treatment. It is completed when some baby teeth and some permanent teeth are present in the mouth (mixed dentition phase). The purpose of interceptive treatment is to prevent future orthodontic issues, not cure the current problems. This is because the teeth and jaw are still developing between ages 7 and 14.

To determine if early treatment is right for your child, the American Association of Orthodontists (AAO) recommends scheduling his or her first check-up no later than age 7. The earlier any discrepancies are caught, the better their dental health will be in the long run.

Determining Candidacy for Treatment

Your child may be a candidate for early orthodontic treatment if they have:

  • Crowded Teeth — some young children develop severe dental crowding because their jaws are too small. As a result, some or all of the teeth may overlap.
  • Gapped Teeth — gaps can form between any two teeth in the mouth, with the most common being the two upper front teeth (midline diastema). If your child has excessively spaced teeth, they may be a candidate for early orthodontic treatment.  
  • An Underbite — when the lower jaw is pushed too far forward, the lower front teeth overlap the upper front teeth.
  • Jaw Irregularities —children who have abnormal jaw sizes or narrow dental arches may need treatment. This typically involves palatal expansion, which widens the jaw and allows for more effective orthodontic treatment later in life, such as braces.
  • Other Discrepancies — children who have extra teeth, missing teeth, or abnormally aligned teeth may be candidates for treatment. In addition, jaws and teeth affected by thumb-sucking or long-term pacifier use may also benefit from early treatment. 

Non-Candidacy for Treatment

Children are most likely not candidates for early orthodontic treatment if they have:

  • Overbites (Buck Teeth) — when the upper jaw is pushed too far forward, the upper front teeth overlap the lower front teeth. Starting orthodontic treatment for this condition during the mixed dentition phase does not have as many benefits. This is because another phase of treatment is still necessary, around age 14. Although, When patients undergo phase treatment, it typically shortens the actual time spent in braces. It also usually breaks up the cost, making it more affordable.
  • Open Bites — this is the rarest form of malocclusion. It occurs when the teeth in the upper and lower jaw slant outwards and do not touch, even when biting down. Similar to overbites, early orthodontic treatment can be effective for this type of malocclusion. By intercepting open bites early, you can prevent the need for jaw surgery later on.
  • Other Discrepancies — if your child has slightly misaligned teeth during the mixed dentition phase, treatment is not always beneficial. As children grow, so does their jaw and dental arch, which means natural changes may occur over time. It is important to talk with your child’s orthodontist to determine the best treatment route. 

Pros and Cons of Interceptive Treatment

While early treatment can help prevent future orthodontic issues and improve your child’s smile, it is not always necessary. For example, one study found that 75 percent of patients treated early with headgear or braces showed improvement. During the second phase of treatment, though, the previously treated patients saw little difference in teeth alignment and skeletal changes. In addition, the length of treatment did not decrease significantly. 

Below outlines the pros and cons of early treatment:

Pros of early orthodontic treatment:

  • It can help prevent current bite and skeletal problems from progressing. 
  • It improves your child’s smile. 
  • Depending on your child’s situation, it can make phase II treatment shorter in the future (not guaranteed).

Cons of early orthodontic treatment:

  • There is no way to guarantee against phase II treatment during the teenage years.
  • It may not save time or money.

Common Types of Early Orthodontic Treatment

Four common types of early orthodontic treatment include, but are not limited to:

Palate Expanders

The most common reason children receive orthodontic treatment during the mixed dentition phase is due to abnormal jaw formation. For example, if your child’s jaw is not wide enough for permanent teeth to grow in, they may need a palate (palatal) expander. In short, expanders create more space in the mouth by widening the upper jaw over time. When a child’s palate is extremely narrow, expansion also correctly aligns the upper teeth and jaw. A wider jaw also allows for more effective and quicker orthodontic treatment, such as aligners or braces

Impacted teeth, crossbites, dental crowding, and breathing problems are common indicators for palatal expansion. However, expanders are only beneficial for younger children because their jaws are still developing. Teens and adults, on the other hand, already have fully developed jaws that cannot be expanded without surgery. 

Traditional Braces

Traditional braces are the most popular orthodontic treatment that correct misaligned teeth, crooked teeth, and other bite problems. The most common age group to get braces are children and teens between 10 and 14 years of age. Children younger than 10, though, might need braces if they have severely crowded teeth, an underbite, gapped teeth, missing teeth, or other discrepancies

Headgear

Additionally, headgear may be necessary if your child’s jaw and teeth are severely misaligned. The appliance is usually attached to a patient’s head or face with a neck strap and is used in combination with braces. This is because braces only fix teeth positioning. Headgear actually influences proper jaw growth. Common types of appliances include: 

  • Cervical Pull Headgear — treats overbites and underbites. 
  • Reverse-Pull Headgear — treats underbites and crossbites. 
  • High Pull Headgear — treats open bites.

 

Invisalign (Clear Aligners)

Clear aligners, also called invisible braces, have grown in popularity since the 90s. In particular, adults prefer clear aligners over braces because they are removable, virtually invisible, and comfortable. However, some younger children are also candidates for invisible braces. For example, Invisalign—which is the most well-known clear aligner brand—has aligners for those who still have baby teeth.

 

According to the Invisalign website, phase I treatment for children in the mixed dentition phase has many benefits. They include:

  • Fixing current teeth misalignment issues.
  • Preventing current bite problems from progressing.
  • Improving your child’s smile and overall appearance.
  • Shortening and simplifying future treatment (phase II).
  • Reducing the negative effects caused by thumb-sucking or tongue thrusting.