Early orthodontic evaluations

Why orthodontists recommend a check by age 7

The American Association of Orthodontists (AAO) recommends that every child have a first orthodontic check-up no later than age 7. That doesn't mean your child will need braces at 7. It means this is a smart age to take a closer look.

Around this age, children have a mix of baby teeth and new adult teeth. The first permanent molars usually arrive around age 6 and set up how the back teeth bite together, and the front adult teeth are starting to come in. The jaws are still growing, too. That combination lets a dentist see where the bite is heading and spot problems while there's still time to guide growth instead of correcting it later.

Many children need nothing more than routine monitoring at their regular checkups. For others, finding a problem early may make later treatment simpler, or shorter.

We start paying attention to bite development long before age 7. From the earliest visits in our infant and toddler dentistry program, we keep an eye on sucking habits, spacing, and how the jaws are lining up.

What we look for

An early evaluation looks at much more than whether teeth are straight. We check for:

• Crossbite. Upper teeth that bite inside the lower teeth, on one side or in front. Sometimes the jaw shifts sideways to make the teeth fit together.
• Crowding or extra space. Teeth without enough room, or gaps larger than expected for your child's age.
• Overbite. Upper front teeth that overlap the lower teeth too much or stick out. Teeth that stick out are also more likely to be injured, which our dental emergencies page covers.
• Underbite. Lower front teeth that sit in front of the upper teeth.
• Open bite. Front teeth that don't touch when your child bites down, sometimes linked to thumb or pacifier habits.
• Jaw growth. Whether the upper and lower jaws are growing in balance, and whether the jaw shifts or looks off-center.
• Early or late tooth loss. Baby teeth lost early to cavities or injury, or baby teeth that hang on long after the adult tooth should have arrived.
• Habits. Thumb or finger sucking, pacifier use, or pushing the tongue forward when swallowing.
• Mouth breathing. Breathing through the mouth most of the time, or snoring, can be linked to how the face and jaws grow. It may also be a reason to talk with your pediatrician, who can check the nose, tonsils, and adenoids.

Signs you might notice at home

You don't have to wait for a birthday to ask about your child's bite. Mention it at the next visit, or book an earlier look, if you notice:

• Baby teeth falling out much earlier or later than other kids the same age
• Trouble biting or chewing, or frequently biting the cheek
• Teeth that look crowded, out of place, or blocked from coming in
• Front teeth that don't meet, or upper teeth that sit behind the lower ones
• A jaw that shifts to one side, pops, or clicks
• Mouth breathing, snoring, or lips that usually rest apart
• Thumb or pacifier sucking that continues as the adult front teeth come in

Plenty of quirks are normal. Gaps between baby teeth, for example, are a good sign, because adult teeth are bigger and need the room. We'll tell you what's typical for your child's age and what's worth watching.

What happens at the evaluation

There's nothing uncomfortable about it. Most of the visit is talking and looking, and you're welcome to sit right alongside your child the whole time.

1. Talk

   We ask about your child's health, habits like thumb sucking, how they breathe and sleep, and anything you've noticed or wondered about.

2. Look

   We examine the teeth, gums, and bite, watch how the jaw opens and closes, and note how the lips and tongue rest.

3. X-rays, if needed

   Sometimes low-dose digital X-rays help us see the adult teeth still under the gums, including whether any are missing, extra, or heading in the wrong direction.

4. Explain

   We walk you through what we see in plain language. You'll leave knowing whether things look on track, what we'll keep an eye on, or what we suggest next.

This check can often happen during a regular visit. If there's a lot to talk through, we're happy to set aside more time.

Possible next steps

Every child grows differently, so the plan depends on what we find.

Watching and waiting

If things look on track, or a concern is mild, we keep monitoring at your child's regular checkups. Some issues settle on their own as more adult teeth arrive.

Holding space for adult teeth

When a baby back tooth is lost early to a cavity or injury, nearby teeth can drift into the gap and block the adult tooth. A space maintainer, a small custom appliance, can hold that space open until the adult tooth is ready. Keeping baby teeth healthy in the first place helps avoid this, which is why we repair decayed baby teeth with fillings or crowns for baby teeth when needed.

Help with habits

If thumb sucking or pacifier use is starting to affect the bite, we'll talk with you and your child about gentle ways to stop. Our parent guide on thumb sucking, pacifiers, and your child's bite shares strategies you can try at home.

Referral to an orthodontist

Some problems, such as certain crossbites, an underbite, or severe crowding, may benefit from early treatment while the jaws are still growing. Orthodontists call this interceptive treatment. We don't provide braces or other orthodontic treatment ourselves. When early treatment might help, we'll refer you to an orthodontist, and with your permission we can share our findings and X-rays. The orthodontist will make the final recommendation about whether and when to treat.

Coverage for evaluations and orthodontic care varies widely between plans. We'll verify your benefits before any treatment in our office, and our insurance page explains how billing works.

How your child's bite develops, age by age

Use this as a rough guide. The range of normal is wide, and your child's timing may differ.

For more on when baby teeth arrive, see our baby teething timeline. And because healthy baby teeth help guide adult teeth into place, our guide on why baby teeth matter is worth a read too.