Early orthodontic treatment (also called interceptive treatment or phase one treatment) is a limited, targeted treatment carried out during the mixed dentition stage, when baby teeth and permanent teeth are in the mouth together, roughly between ages 7 and 11. Its aim is to use jaw growth to correct certain problems early or to keep them from becoming more complex later on. The key point is this: an early checkup and early treatment are not the same thing. Orthodontic associations recommend a first orthodontic checkup at around age 7 so that problems are spotted in time; for a large share of the children examined, regular monitoring is all that is needed. We explained why the first checkup is recommended at this age in our article on the age-7 checkup; this page focuses on when treatment is started and when it is better to wait.
Which problems are addressed early?
Early treatment makes sense for problems that can influence the direction of growth or that may cause harm if left untreated. The main situations are:
- Posterior crossbite and jaw shift: If the lower jaw slides to one side when closing because the upper jaw is narrow, correction during the growth period is recommended. At this age the midpalatal suture is still flexible, so expansion is more predictable. For details, see our jaw expansion treatment page.
- Anterior crossbite: One or more upper front teeth biting behind the lower teeth can lead to tooth wear and gum problems.
- Tendency toward a forward lower jaw: If the problem stems from an underdeveloped upper jaw, appliances such as a face mask can be more effective during growth. We covered this topic on our underbite (forward lower jaw) treatment page.
- Markedly protruding upper front teeth: Protruding teeth that the lips cannot cover are more prone to breaking in falls and knocks; they can also affect a child's social life.
- Habit-related open bite: If thumb sucking, pacifier use or tongue thrusting continues, a gap may form between the front teeth that does not close. It is difficult for this gap to close permanently unless the habit is stopped.
- Severe crowding and teeth erupting in the wrong direction: A permanent tooth erupting in the wrong place can affect the root of a neighboring tooth. In some children whose upper canines are at risk of becoming impacted, timely extraction of the baby canine can improve the eruption path of the permanent tooth.
- Early loss of a baby tooth: A space maintainer may be needed to keep the space from closing.
When is it better to wait?
Early treatment does not have to be applied to every problem. In some cases, starting early may make no difference other than the child wearing an appliance for longer:
- Mild crowding: Mild crowding of the front teeth is common in the mixed dentition stage and may partly change with growth. Monitoring is usually enough.
- Gaps between the upper front teeth: After the permanent front teeth come in, gaps between them and a fan-shaped appearance are considered normal at this stage; they usually decrease as the canines erupt.
- Mild to moderate Class II without trauma risk: Research has shown that for protruding teeth caused by a retruded lower jaw, two-phase treatment does not significantly change the outcome for most children compared with single-phase treatment started in adolescence. However, if the teeth are highly exposed to trauma or the child is socially affected by the condition, early intervention may be considered.
This distinction is what families most want to understand. Whenever early treatment is recommended at a checkup, what waiting would change should also be discussed openly.
What methods are used in early orthodontic treatment?
Phase one treatment is usually a short, limited plan aimed at a single problem. The methods used vary with the problem:
- Expansion appliances: Used for a narrow upper jaw and posterior crossbite.
- Face mask: Worn at night and at home, often together with an expansion appliance, to support forward growth of an underdeveloped upper jaw.
- Functional appliances: Appliances that position the lower jaw forward in some children with a retruded lower jaw. We covered this topic on our retruded lower jaw treatment page.
- Habit-breaking appliances: Help the child stop thumb sucking and tongue thrusting.
- Partial fixed braces: Limited brackets placed only on the front teeth and the first permanent molars can correct an anterior crossbite or rotated teeth.
- Clear aligners: Invisalign First, designed for the mixed dentition stage, can be used in suitable cases for mild expansion and alignment of the front teeth. The child needs to wear the aligners 20–22 hours a day, so assessing compliance is important.
- Space maintainers and guided extractions: Used to prevent loss of space or to guide the eruption path of teeth.
How does the early treatment process work?
- First checkup: The eruption pattern of the teeth, the relationship between the jaws, habits and breathing pattern are assessed.
- Records: If needed, an intraoral scan or impressions, photos and X-rays are taken.
- Decision: There are three possibilities: regular monitoring, phase one treatment, or postponing treatment until the permanent teeth have come in. The reasons are shared with the family.
- Phase one: If planned, it usually lasts 6–18 months and ends once a specific goal is reached.
- Monitoring period: The eruption of the permanent teeth is followed with checkups every few months. A retention appliance may be used during this period to maintain the result achieved.
- Phase two: After most of the permanent teeth have come in, usually in adolescence, a second phase with braces or clear aligners may be needed for the final alignment of the teeth. Phase one does not always eliminate phase two, but it can often make it simpler.
Why do the child's cooperation and the family's role matter?
One of the factors that determines the outcome of early treatment is the child's cooperation. Removable appliances and face masks do not have the expected effect if they are not worn for the recommended time. With fixed appliances, it is important to avoid sticky and hard foods, to help with brushing as a parent, and not to miss checkups. Explaining to the child, in age-appropriate language, why the appliance is being worn makes cooperation considerably easier. There may be a slight change in speech during the first days and a short adjustment period when eating; for most children this passes quickly. You can find the general advantages of braces for children in our article on orthodontics for children.
What are the limits of early treatment?
Although early treatment offers an opportunity to guide growth, it does not fully control growth. A child's genetic growth pattern continues to express itself throughout adolescence; especially in children with a tendency toward a forward lower jaw, the problem can become noticeable again with the growth spurt, even after a successful phase one. With some skeletal discrepancies, the option of jaw surgery may need to be discussed once growth is complete. In addition, starting treatment early can lengthen the total time an appliance is worn, which should be weighed in terms of the child's motivation and oral hygiene. Sharing these limits openly with the family before treatment helps keep expectations realistic.
Questions families can ask at the checkup
- What changes if my child's problem is not treated now, and what is the cost of waiting?
- Does this treatment guide growth, or does it only move the teeth?
- How long will phase one take, and what goal will have been reached at the end?
- How likely is it that a phase two will be needed later?
- How many hours a day should my child wear the appliance, and how is it managed at school?
- How often will checkups take place?
For a general overview of which treatment options may come up depending on your child's age, you can also take a look at our at what age can you get clear aligners page.
How is a child's checkup planned at our clinic?
At Funda Sarıkaya Oral and Dental Health Polyclinic, children's orthodontic assessments are carried out by Funda Pekyılmaz Sarıkaya, specialist orthodontist (Uzm. Dt.). At the checkup, whether treatment is needed, and if so why it is being recommended now and what the possible consequences of waiting are, are discussed together with the family. If treatment is planned, the duration, checkup schedule and fee are shared in writing. Because the clinic is open Monday–Saturday from 09:00–20:00, checkups can be scheduled outside school hours and on the same day as siblings' appointments.