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When you think of orthodontics, what typically comes to mind is generations of brace-wearing teenagers, right? You might even flashback to your own adolescence. But did you know that sometimes orthodontics for kids should happen earlier? It’s safe to say that if your kid is showing signs of needing orthodontic care in their elementary school years, early orthodontic treatment can help prevent or minimize alignment and bite issues later on. 

So how do you know your child should see an orthodontist? One easy indicator is your child’s age. The American Association of Orthodontists says that 7 years old is a great time for a first orthodontic visit. By age 7, your child most likely has their adult back molars in and some of their baby teeth have been replaced by adult ones. The shape of their jaw is also pretty much set by this age. At this transitional time, an orthodontist can spot any potential orthodontic issues. 

Of course, it’s not just age that signals an early trip to the orthodontist. Here, we’ll talk about 7 other important signs that your child should see an orthodontist.

Infant Habits That Just Won’t Quit

As parents, we pay close attention to our children’s milestones and we expect some of their babyhood habits to fade away as they grow. (Let’s admit, though, some of those baby habits are super cute and we’re a bit sad when our kids outgrow them.) But when some of these habits continue into early elementary school, they could be harmful to your child’s oral development in the long run.

Thumb sucking

It goes without saying that thumb sucking is a natural part of a baby’s self-soothing reflex and it usually begins to lessen between ages 2-4. If your child is sucking their thumb into elementary school, this could be a sign to see an orthodontist like Dr. VanderWall who has expertise in early orthodontics. You see, prolonged thumb sucking can cause constant pressure on your child’s upper front teeth and upper jaw, moving their teeth outward.

Tongue thrust

When your baby pushes at a spoon of pureed kale with their tongue, it’s a good thing — they know how to prevent choking! And let’s be honest, what baby actually likes kale?! But if your child forms a habit of pushing their tongue out into early childhood, this can cause oral issues just like thumb sucking can. So what does tongue thrusting in childhood look like?

  • the tip of your child’s tongue sticks out between their teeth when they’re resting, sleeping or swallowing.
  • they mouth breathe, even when they aren’t congested
  • they can’t completely close their lips
  • slow, fast or messy eating
  • they lisp their “s” and “z” sounds

Losing Baby Teeth Early

Typically, kids start losing their baby teeth around 5-6 years old but sometimes kids lose a tooth earlier because of an injury or tooth decay. When this happens, the corresponding adult tooth might not be ready to fill the gap, and the teeth around tend to shift and fill the empty space. By the time the adult tooth is ready to erupt, it could be impacted, meaning it can’t move into position because its path is blocked.

Difficulties With Eating and Chewing

Do you notice your child avoiding certain foods that need a bit more effort to eat? Food that’s crunchy — like raw carrots, or food that you have to tear off — like pizza. The beginnings of an overbite, underbite in kids, or a crossbite could discourage kids from eating certain foods. We all know it can be hard enough to get kids eating healthy and eating a range of foods, so if they’re having trouble chewing, this could affect their overall nutrition.

Concerned About The Way Their Smile Looks

As much as we want our kids to love themselves for who they are and not how they look, sometimes unhappiness about their smile is worth a follow up. Kids with crooked teeth, crowding or spacing might benefit from a diagnostic visit with Dr. VanderWall at our Raleigh, Cary or Durham office. 

Adult Teeth That Don’t Erupt in the Right Order 

The order in which children get their adult teeth is different from child to child. But, generally, the first molars come in, then the front middle teeth, the ones on either side of those, premolars, then second molars. Last to appear are the wisdom teeth, though not everyone gets them. If you notice that your child’s adult teeth are erupting in a vastly different order, it might be that their teeth are having some issues coming in. At VanderWall Orthodontics, we use cutting-edge technology like the iTero digital scanner and digital x-rays to see exactly what’s going on with your child’s teeth, beyond the naked eye.

Jaw Pain

Is your child complaining of constant jaw pain? Misaligned teeth or jaws can cause stress on the joints, nerves and facial muscles. Every time your kid eats, speaks, or even opens and closes their mouth, the connective tissue that connects their jaws can get stressed and cause pain.

Early Orthodontic Treatment Pros and Cons

Rest assured, an early visit to an orthodontist doesn’t automatically mean your child will need orthodontic treatment right away. In fact, most orthodontists — including Dr. VanderWall — agree with the American Association of Orthodontists about delaying comprehensive treatment if issues are mild. An initial visit is a great signpost, though. Even if your orthodontist determines that early treatment isn’t needed, you’ll at least have peace of mind. You’ll find out if your child’s jaw and teeth are on track, if and when they’ll need treatment later on and what that might be. On the other hand, if your orthodontist does suggest early orthodontic treatment, here are some early orthodontic treatment pros and cons to think about:


  • Improves your child’s chewing, speaking or breathing
  • Makes room for emerging adult teeth
  • Preserves space for teeth that haven’t erupted yet
  • Lowers the risk of damage to protruding teeth
  • Creates facial symmetry
  • Improves self esteem and confidence
  • Reduces the need for tooth removal
  • Lessens or avoids future orthodontic correction or surgery


  • Kids (and parents) will have more appointments if two-phase treatment is necessary
  • Kids aren’t always keen on the in-depth oral care that might be needed
  • Some orthodontic treatments — like braces, orthodontic expanders or the Herbst orthodontic appliance — cause mild tenderness, though this will go away quickly as soon as kids get used to their appliance

Early Orthodontic Treatment Happens in Two Phases

So your orthodontist has found that your child can benefit from early orthodontic treatment. What happens next? Early orthodontic treatment is all about preventing more severe problems later on. It’s also meant to go hand-in-hand with your child’s oral development so early treatment happens in two phases:

Phase 1:

Phase 1 orthodontics does a lot of the heavy lifting when it comes to early orthodontic treatment. Depending on your child’s orthodontic issues, phase 1 orthodontics might involve functional appliances for aligning the jaws, braces for kids, specialized retainers, orthodontic expanders or space maintainers. Phase 1 braces typically include only select teeth. Dr. VanderWall and our team understand it can all feel overwhelming for kids. We totally get it! That’s why we make early orthodontic treatment as efficient, comfortable and fun as possible. And it’s surprisingly short: phase 1 orthodontic treatment typically lasts only 9-12 months.

Phase 2:

Simply put, phase 2 continues your child’s progress when they’re a bit older — in the early teen or teen years when all their adult teeth have erupted. In phase 2, we want to make sure every tooth has a spot, and we can even replace missing teeth if that’s the case. This phase is all about making sure your child’s teeth are straight, function efficiently and remain stable, setting them up for a healthy, beautiful smile for the rest of their life. You’ll find that full upper and lower braces or Invisalign Teen are common in phase 2, and sometimes retainers or expanders are also used.

Dr. Clay VanderWall is your orthodontist in Raleigh, NC and we offer the highest quality orthodontic care to families in a warm and welcoming environment. With early orthodontic treatment, our goal is to provide careful intervention that can prevent bigger problems down the road… in the most enjoyable, fun way possible!

If you notice signs that your child should see an orthodontist, we’d love to help. Contact our Raleigh, Cary or Durham office today for a free initial consultation.

Dr. Clay VanderWall

Author Dr. Clay VanderWall

Dr. VanderWall attended Kalamazoo College, graduating with a Bachelor of Arts in Health Sciences. He spent a semester doing research at the Dental Research Center of the University of North Carolina-Chapel Hill where he wrote his Senior Individualized Project (SIP). He furthered his studies at the University of Detroit-Mercy School of Dentistry, receiving his Doctor of Dental Surgery in 1999. He graduated with honors and was inducted into the national dental honor society, Omicron Kappa Upsilon (OKU). He also received the Pierre Fauchard Academy Student Award and was a recipient of the Health Professions Scholarship from the United States Navy.

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