Orthodontic Treatment in Children: At What Age Are Braces Fitted?

What Is Orthodontic Treatment in Children and Why Does It Matter?

Orthodontics is the branch of dentistry that studies the alignment of the teeth, the relationship between the jaws and facial development, and corrects discrepancies in these areas. When people think of orthodontic treatment in children, braces usually come to mind first; yet the field is much broader. Guiding jaw development, supporting children in giving up harmful habits, preserving the space left by prematurely lost baby teeth and preparing the ground for permanent teeth to erupt in the right position all fall within the scope of paediatric orthodontics.

The greatest advantage of childhood is that the jawbones are still developing. Orthodontic treatment applied while growth is ongoing can positively influence the course of skeletal problems such as a narrow jaw or a mismatch between the upper and lower jaws. Once growth is complete, some of the same problems can only be resolved with longer treatments — and, in advanced discrepancies, with surgical support.

In this guide you will find the ideal timing of the first orthodontic check-up, the causes of dental crowding, the warning signs families can spot at home, the benefits of early treatment, the appliance types used in children and what to pay attention to when caring for a child with braces.

When Should the First Orthodontic Check-Up Take Place?

The widely accepted recommendation in orthodontics is that the first orthodontic evaluation should take place by around the age of 7 at the latest. This age is not chosen at random: between the ages of 6 and 7, the first permanent molars and the incisors begin to erupt, and the mixed dentition period begins, in which baby teeth and permanent teeth are present in the mouth at the same time. When jaw development, the eruption path of the teeth and the bite relationship are evaluated during this period, problems that could grow larger later can be detected while they are still small.

An early check-up does not mean treatment will start immediately. In a significant proportion of the children evaluated, no intervention is needed at that moment; the dentist may simply recommend monitoring development with periodic check-ups. The aim here is not to miss the right window of time in cases that do require intervention. For children who attend regular paediatric dentistry check-ups, this evaluation is usually carried out as a natural part of the routine examination.

If your child is already past the age of seven, there is no reason to worry; there is no strict upper age limit for orthodontic treatment. However, since the advantages offered by the growth period diminish over time in skeletal problems, it is generally wiser not to postpone an evaluation if you have any doubts.

Why Do Crowded Teeth and Jaw Problems Develop in Children?

Dental crowding and bite problems do not have a single cause; hereditary and environmental factors usually play a role together. Jaw structure, tooth size and the ratio of the teeth to the jawbone are largely determined by heredity: normal-sized teeth trying to fit into a narrow jaw is one of the most common scenarios behind crowding.

A significant proportion of the environmental factors, on the other hand, are preventable. Prolonged thumb sucking and pacifier use apply constant pressure to the teeth and palate and can contribute to the narrowing of the upper jaw and the forward tilting of the front teeth. In the habit of constant mouth breathing, the tongue moves away from its natural position supporting the palate; over time this is associated with a deepening of the palate and a narrow jaw. Baby teeth lost prematurely to decay or trauma can allow neighbouring teeth to tip into the gap, narrowing the space for the permanent tooth coming from below.

The main factors associated with crowding and bite problems in children are the following:

• Heredity: A family history of narrow jaws, lack of space for the teeth or bite problems
• Thumb sucking and prolonged pacifier/bottle use: Especially if it continues beyond the age of 3
• Mouth breathing: May be linked to enlarged adenoids, tonsils or allergic congestion
• Premature loss of baby teeth: When the gap is not preserved after decay or trauma
• Swallowing and tongue habits: The tongue settling between the teeth, paving the way for an open bite
• Long-term nail biting and pencil chewing: Constant one-directional force applied to the front teeth

What Warning Signs Can Families Notice?

Some orthodontic problems can only be identified through an examination and X-rays; in many cases, however, an attentive family can pick up the first clues. If you observe one or more of the following signs in your child, it is a good idea to book an appointment for an orthodontic evaluation:

None of these signs amounts to a diagnosis on its own; the same finding can stem from different causes. A definitive evaluation is made by the dentist through a clinical examination and, if deemed necessary, a panoramic X-ray. Establishing a regular dental care routine for children at home both reduces the risk of decay and gives families the opportunity to observe their child's mouth regularly.

• Baby teeth falling out very early or noticeably late
• Visible crowding, rotation or excessive spacing of the teeth
• The upper and lower teeth not meeting properly in the bite, or the jaw shifting to one side when closing
• Front teeth protruding noticeably, or the lower teeth covering the upper teeth when the mouth is closed
• Difficulty biting or chewing, a tendency to chew on one side only
• Constantly keeping the mouth open, snoring or breathing through the mouth at night
• Thumb sucking or a pacifier habit continuing beyond the age of 4

What Does Early (Preventive) Orthodontic Treatment Achieve?

Early-stage approaches, known as preventive and interceptive orthodontics, aim to make positive use of the growth process rather than waiting for the problem to grow. In a narrow upper jaw, for example, palatal expansion appliances applied during the growth period can take advantage of bone development; the same problem is far more difficult to address in adulthood. For this reason, treatment in some children is planned in two phases: a short first phase targeting skeletal problems during the mixed dentition period, and a second phase completing the alignment of the teeth once all permanent teeth have erupted.

One of the best-known preventive measures of the early period is the space maintainer. If a baby tooth is lost to decay or trauma years before the permanent tooth beneath it is due to erupt, the neighbouring teeth drift into the gap and the space for the permanent tooth narrows. A simple fixed or removable space maintainer preserves this gap and can prevent — or reduce the scope of — a more extensive orthodontic treatment that might otherwise be needed later.

That said, early intervention is not necessary for every child; in some cases the best decision is to monitor development and leave treatment until all the permanent teeth have erupted. Which approach is appropriate is determined by the dentist according to the type and severity of the problem and the child's stage of development. It is worth remembering that starting early is not a value in itself — correct timing is what matters.

Which Orthodontic Appliances Are Used in Children?

The tools used in paediatric orthodontics are not limited to classic braces. Different appliances may be preferred depending on the type of problem and the child's age:

In adolescents, clear aligners may also be considered as an alternative to brackets in suitable cases. Which option is more appropriate depends on the complexity of the problem, the child's cooperation and the dentist's evaluation. We examined the strengths and weaknesses of the two methods in detail in our article comparing braces and clear aligners.

• Removable appliances: Plates that can be taken in and out, used for simple tooth movements and breaking habits
• Palatal expansion appliances: Fixed or removable devices that widen a narrow upper jaw by making use of the mid-palatal suture
• Space maintainers: Simple appliances that preserve the gap left by a prematurely lost baby tooth until the permanent tooth erupts
• Fixed braces (brackets): The classic method that fine-tunes tooth alignment and the bite once nearly all permanent teeth have erupted
• Clear aligners: Removable transparent trays that can be an alternative to brackets in suitable adolescent cases

How Should a Child with Braces Be Cared For?

Because brackets and wires increase the surfaces where food debris can cling, oral hygiene matters more than ever during the braces period. When brushing is neglected, white spot lesions, early decay and gum inflammation can develop around the brackets. Brushing after every main meal should be the goal, with special attention to the areas under the brackets and around the wire; for the correct technique, you can consult our guide on how to brush your teeth properly. Interdental brushes and, if needed, a water flosser make it easier to clean the areas under the wire.

A few simple rules also apply to eating. Biting into hard foods (whole apples, carrots, nuts) and sticky sweets can cause brackets to come off or wires to bend; cutting hard fruits and vegetables into small pieces reduces this risk. Limiting acidic and sugary drinks also lowers the risk of enamel damage around the brackets.

In the first days after the braces are fitted and after adjustment appointments, it is normal to feel a sensitivity in the teeth that may last a few days; this usually subsides on its own. Orthodontic wax can provide relief when the wires irritate the inside of the cheeks and lips. In the event of a broken bracket, a poking wire or pain that does not subside, informing the clinic without waiting for the next appointment helps the treatment proceed as planned.

Frequently Asked Questions About Orthodontic Treatment in Children

At what age are braces fitted in children? Fixed braces usually come into consideration between the ages of 10 and 13, when nearly all the permanent teeth have erupted. In problems involving jaw development, however, intervention with appliances may be needed at much earlier ages; the right timing is determined through a dental examination based on the child's dental development.

When should the first orthodontic check-up take place? The common recommendation is that the first evaluation should be carried out by around the age of 7 at the latest. In most children this check-up results not in treatment but in a decision to monitor development; the aim is not to miss the right window of time in cases that require intervention.

Does having braces fitted hurt? No pain is expected while the braces are being fitted; the procedure involves no needles or incisions. In the few days following the fitting and the adjustment appointments, a feeling of pressure and sensitivity in the teeth may occur; this usually eases on its own within a short time, and children generally adapt to braces faster than adults.

How long does orthodontic treatment take in children? The duration varies according to the type and severity of the problem and the child's cooperation. Simple appliances can be completed within a matter of months, while fixed braces treatments usually take 1 to 2 years. A definite duration can only be estimated after an examination and treatment planning.

Can orthodontic treatment start before all the baby teeth have fallen out? Yes; in situations such as a narrow jaw, a crossbite or harmful habits, waiting for all the baby teeth to fall out can mean missing the right moment. Guiding treatments carried out during the mixed dentition period can prepare the ground for the permanent teeth to erupt under more favourable conditions.

Can clear aligners be used in children? In suitable adolescent cases, clear aligners can be an alternative to brackets; wearing the aligners for enough hours each day is decisive for the success of the treatment. The decision is made by the dentist after evaluating the child's age, the complexity of the problem and the child's discipline in wearing them.

Do the teeth move back after treatment ends? Teeth can show a tendency to drift back towards their old positions after treatment; this is why a retention period follows the treatment. Wearing the fixed or removable retainer for the period recommended by the dentist plays an important role in preserving the result achieved.