Early Orthodontic Treatment:

What is it?

Around 1990, the American Association Of Orthodontists began to recognize that some children would benefit from early treatment and should be seen before adolescence, before all the adult teeth erupt. The association recommends children be seen by age 7. This coincides with the eruption of the adult anterior teeth. Seeing a child at this time can allow the orthodontist to intervene and prevent an orthodontic problem from getting worse and subsequently more difficult to correct at a later date. Sometimes, there is a very apparent problem, and it could wait to be treated during adolescence, but there is a psychological reason to treat “early.” A child may be getting teased because of the appearance of his or her teeth. Another reason is to reduce the chance of trauma resulting from severe overbite, also known as overjet, or buckteeth. You can view some common problems here, where early intervention is beneficial.

Three of the most common problems that are easier to treat early are posterior crossbites, underbites, and ectopic eruption complications (when a tooth doesn’t follow its normal path).

Many children undergo “Phase I” or interceptive treatment, other terms for “early,” with a palatal expander. In this case, a posterior crossbite may or may not be present, and expansion can widen the upper jaw and give the front teeth room to erupt and be aligned. This is easier to correct—while the child patient is still growing—before the palatal suture starts to fuse or becomes fused during adolescence. Once the suture fuses, it could involve surgery to correct—this in not preferable.

Underbites are a challenge to correct, and they tend to get even more difficult the older the patient gets. Again, sutures, growth, and the forward growth of the lower jaw around 11 to 12 years of age make treatment more difficult in adolescence. However, overbites are generally easier to treat during adolescence because of the forward growth of the jaw at that time.

Many patients have complications with the eruption of the teeth. Treatment of ectopically or mal-positioned teeth, if detected early, can prevent a future impaction (when a tooth is erupting at the wrong angle and pushing against another tooth). Impacted teeth are stuck in within the jawbone (upper canines are most common, but here is an X-ray of an impacted premolar). Treatment of an impacted tooth involves a surgical procedure in which a chain is attached under the gum tissue to the tooth and the tooth is slowly “force erupted” over a long period of time. This involves many visits. Diagnosis of ectopically positioned teeth with X-rays can allow guidance of eruption treatment, which involves removal of baby teeth in a timely fashion.

About 15–20% of patients who are 7–10 years old receive interceptive treatment. Some early treatment is elective and not mandatory. If you have questions about this, we would gladly answer them — just call for a complimentary consultation.


What is the purpose of braces?

Braces help to correct anterior crossbites, underbites, overbites (buckteeth), crooked teeth, and spacing.

What do braces do?

Braces ensure correct tooth movement. Children with baby teeth who get braces usually get braces on the first permanent molars in the back and the four front teeth (incisors), resulting in two bands and four brackets. To give more control for tooth movement, sometimes baby teeth will be bonded or bracketed with braces.

Palatal Expander

What is the purpose of palatal expanders?

When the upper jaw is narrow relative to the lower jaw, expanders can correct a posterior crossbite and make room for anterior teeth to erupt.

What do expanders do?

Expanders widen the upper jawbone so that upper posterior teeth line up better with lower posterior teeth. Expanders are either permanently fixed in the mouth for 6 or more months, or are removable like a retainer. In the center of the expander, a key is used to slowly turn a screw that puts pressure on the upper jaw’s left and right halves, which are separated by a suture, pushing them outward and causing new bone to develop in the suture space. Here are our instructions for an expander (link).


What is the purpose of extractions?

Guidance of eruption involves extraction of baby teeth to encourage ectopically positioned teeth within the jawbone (not visible except on an X-ray) to change direction and, hopefully, not become impacted. Serial extraction involves pulling baby teeth to help the eruption of permanent teeth, usually the first premolars, which may ultimately be pulled. In most situations, braces will be eventually required. A space maintainer may be necessary in the interim to hold extraction spaces open till the adult teeth erupt.

Protraction Face Mask

What is the purpose of a protraction face mask?

The face mask is for treating a severe anterior crossbite, or underbite with the lower jaw growing ahead of the upper jaw.

What does a face mask do?

Also called “reverse pull headgear,” the mask pulls the upper jaw and teeth forward to encourage growth of the upper jaw.

Did You know

To become an orthodontist takes a minimum of 10 years. There is undergrad (BS in Chemistry for Dr. Wirant, 4 years), dental school (4 years), and then an orthodontic residency program (now 3 or 4 years).

After that, an orthodontist can become board certified by passing a written exam and presenting cases the orthodontist has completed to the American Board of Orthodontics. This is just one more credential that lets you know how seriously Dr. Wirant takes his profession.

Dr. Wirant is also a member of the American Dental Association and the American Association of Orthodontists. You can click on the Logos below for more information.

ABO logo
AAO logo