Braces for children, and the honest answer on when to start

Seven is when to look. It is usually not when to treat.

Orthodontists recommend a first check at about age seven, because that is when adult and baby teeth are both in the mouth and a problem can be spotted early.^[1] What that check usually produces is a note to review in a year. Most children seen at seven need monitoring, not brackets.^[1]

You will hear treatment called “Phase 1” and “Phase 2”. In plain words there is an early round, roughly seven to eleven, and a main round, roughly eleven to fourteen, once most adult teeth are through. The whole argument in children’s orthodontics is about which problems genuinely need the early round.

Six things that bring parents in

1. 1

   Front teeth stick out

   The one reason where starting early has proven benefit.

2. 2

   Crowding

   Teeth overlapping because there is not enough room.

3. 3

   Gaps

   Often normal at six or seven. Worth a look, rarely worth treating yet.

4. 4

   The bite does not meet

   Upper and lower teeth not lining up when the mouth closes.

5. 5

   Thumb sucking past six

   The habit matters more than the teeth it moves.

6. 6

   A baby tooth that will not go

   Or an adult tooth that has not arrived.

Any of these is worth looking at. Only one has strong evidence for treating early, and it is the first. See all treatments at Tooth Tales.

When we would start early, and when we would wait

This is the part of children’s orthodontics most worth being sceptical about, so here is the evidence rather than an opinion. A Cochrane review pooled 27 trials and 1,251 children, comparing treatment started at seven to eleven against a single round in the teens.^[2]

Cochrane review, 27 trials, 1,251 children. Moderate-quality evidence for functional appliances.^[2]

That difference is real, and it is the reason early treatment exists. But the same review is just as clear about everything else: “There appear to be no other advantages of providing early treatment when compared to late treatment.”^[2] Final tooth position and jaw relationship came out the same either way.

Are braces necessary, or is this about looks?

Sometimes it is genuinely about appearance, and that is a legitimate reason a family may choose treatment. It is not a reason to be told the treatment is medically required when it is not. We will tell you which one you are looking at.

Necessary covers teeth at real risk of being knocked, a bite wearing teeth down or causing pain, a jaw that has to shift sideways to close, and teeth so crowded they cannot be cleaned. Optional covers most of the rest, and optional is an honest word rather than a dismissive one.

Prominent upper front teeth are common. They affect roughly a quarter of twelve-year-olds.^[2] Common does not mean every one of them needs treating at nine.

Do braces hurt? Fitting them does not.

Putting braces on involves no injection and no drilling. What your child feels is an ache for two or three days after each adjustment, strongest on the first night and easing steadily. Soft food and ordinary pain relief cover it.

The other thing is rubbing. A bracket can catch the inside of a cheek for the first week or two until the mouth toughens up, and wax over the bracket handles it. Tell us about a sore spot rather than putting up with it, because adjusting one bracket takes minutes.

What happens, from the first check to the retainer

1. 1

   A first check, usually at seven

   Not to start treatment. To see whether anything needs watching.

2. 2

   Photographs and a scan

   Records, so growth can be compared later rather than guessed at.

3. 3

   We tell you if the answer is wait

   Most seven-year-olds need monitoring, not brackets.

4. 4

   If we act early, we say why

   One clear reason, one clear goal, and when it ends.

5. 5

   The main round, usually 11 to 14

   When most of the adult teeth are through and growth is on our side.

6. 6

   Retainers, and this part is not optional

   Teeth move back. Retainers are how the result is kept.

The options, described honestly

Every option below moves teeth. They differ in how predictably, how visibly, and how much they depend on a child actually cooperating.

Clear aligner treatment for children and teens is covered on the Invisalign page. If mouth breathing is part of the picture, read airway and mouth breathing first, because the airway is dealt with before the teeth are guided.

One option we are cautious about. Pre-orthodontic trainers such as Myobrace are marketed hard to parents of young children. A systematic review screened 355 publications and found only four that qualified, all at high risk of bias, and a conventional twin-block appliance outperformed it on skeletal change.^[3] That is not a reason it can never be used. It is a reason not to build a treatment plan on it.

Questions parents ask us about braces for children

These are the questions parents ask us most, in the words they ask them.

Medically reviewed

Dr. Sanchit Paul

MDS Pediatric Dentistry

Fifteen years treating children only. Associate Professor of pediatric dentistry at ITS Dental College. Reviewed this page for accuracy on children’s growth and development.^[4]