Timing it Right

THE QUESTION
When is THE best time to begin orthodontic treatment? This question is often
asked of me by parents, especially as they see other young children (ages 7-9)
in orthodontic appliances.

MY ANSWER
Based upon my own clinical experience and reviewing available orthodontic
literature, I can only conclude that for the vast majority of young patients are
best treated with one comprehensive phase of orthodontic therapy beginning
around age 11-13. Treatment times at this age are generally about 2 years but
can range from 1-3 years depending upon the complexity of the problem.

Before
After

THE REASONS
Four major advantages and benefits of one phase treatment are:
1. Decreased time in braces resulting in
• Less chance of enamel decalcification and root shortening
• Less time absent from school or work
• Less opportunity for broken braces
2. Fewer overall appointments
3. Growth modification during the pubertal growth spurt can accomplish greater
and more stable skeletal/dental changes relative to less active periods of
growth
4. Completing treatment in one phase is a little less costly than a two-phase
approach

EXCEPTIONS
The American Association of Orthodontists (AAO) recommends that children
receive their first orthodontic evaluation at age 7. This age was selected by the
AAO because it is during this time that primary incisors (front teeth) are
exfoliating and larger, permanent ones are taking their place exposing problems
that were not as easily seen prior to the changeover. These orthodontic
conditions include:
• Cross bites (such as those causing the lower jaw to shift)
• Severe jaw imbalances (such as an upper jaw that is too in or
underdeveloped)
• Protruding upper incisors increasing their risk to trauma
• Space maintenance for early loss of primary (baby) teeth.





• Psychological or social/self-esteem issues resulting from crooked front
teeth
• Excessive dental crowding causing damage to teeth and/or gums.
• Harmful habits (such as thumb sucking and tongue thrusting while
swallowing)
• Airway problems.

The above conditions warrant a brief period (generally 12 months or less) of
Phase I orthodontic therapy. After appliance removal, patients who have
received Phase I therapy are seen generally every six months to check
retainer(s) and monitor tooth eruption until a decision regarding Phase II
therapy can be made. Recent studies state that about 90% of the patients who
receive Phase I therapy will need Phase II to finalize dental alignment and the
bite.

PARTING WORDS
The timing of orthodontic treatment is an important issue that can make
orthodontics either a rewarding and enjoyable experience or one that is
prolonged and tedious.
I hope this information has given you both a better understanding of our
practice philosophy and a positive introduction to orthodontics. Additionally, I
hope you can see that waiting is many times the “best treatment”.

Please feel free to contact our office if we can assist you with any questions or
visit our website at www.TringasOrthodontics.com. You may also wish to visit
the American Association of Orthodontists (AAO) website at www.braces.org.

written by Dr. Andrew Tringas
Windermere Orthodontist