When Should Children and Teens Get Braces: Cases for Early Treatment, Phase 1 and Phase 2, and How to Decide

When should a child start orthodontic treatment?

There is no single rule; it is decided case by case based on the type of malocclusion and the growth stage [1]. Early treatment during growth is considered for problems involving jaw growth, while problems mainly about tooth alignment can sometimes wait until the permanent teeth have come in [1]. During growth, an orthodontic checkup can assess jaw development and tooth eruption to decide when to intervene even before a problem becomes visible, so a first orthodontic checkup around the early elementary school years is sometimes recommended [2].

When DentStat analyzed 1,200 patient comments about timing for children and teens, most were questions asked by parents on their child’s behalf, centered on “when to start” and “being confused because each clinic gives a different diagnosis” [3].

How do cases that need treatment now differ from cases that can wait?

The first dividing line is whether the problem involves jaw growth [1].

Category	Examples	Reasoning
Early treatment considered	Underbite (tendency toward a protruding lower jaw), uneven growth of upper and lower jaws, severe lack of space [1]	The window for using jaw growth during treatment is limited [2]
Waiting may be considered	Problems mainly about tooth position, such as simple crowding or uneven alignment [1]	Cases where treating after all permanent teeth are in makes little difference to the result [2]

Even when symptoms look the same, timing differs depending on whether the cause is skeletal or dental, so the distinction is confirmed with diagnostic records such as X-rays [1].

If my child has Phase 1 treatment, is Phase 2 unnecessary?

That is not guaranteed. Phase 1 treatment during growth (the mixed dentition period, when baby and permanent teeth coexist) mainly aims to guide jaw growth and manage space for the permanent teeth, and Phase 2 treatment to finish alignment and bite after all permanent teeth are in may follow [2]. In some cases Phase 1 makes later treatment simpler, but plans can also change as growth progresses, so finishing Phase 1 does not necessarily mean treatment is over [2]. In the comment analysis, reactions from parents who only learned later that Phase 2 would also be needed after Phase 1 came up repeatedly [3].

Can a palatal expander help avoid extractions?

That cannot be guaranteed. Palatal expansion is one way to create space by widening the dental arch, and its use is considered under the skeletal conditions of the growth period [2]. However, when the lack of space is large or there is a big mismatch between tooth size and jaw size, some cases still need extractions later even after expansion [2]. An explanation that a particular appliance guarantees avoiding extraction leaves out how much depends on the case, so checking the basis for using it (space analysis, skeletal examination) helps with the decision [1].

How can parents decide when clinics give different diagnoses?

Given that dentists can differ in how they predict growth and judge when to intervene, a realistic approach is to compare the reasoning behind each diagnosis [2]. In the comment analysis, many parents reported receiving different advice for the same child, such as waiting for growth, using an expander, or early appliance treatment, and some parents raised concerns that the need for early treatment was being exaggerated [3]. Many parents ask for an explanation, with examination records, of which problem needs treatment, why now (or later), and what is expected if it is not treated, and then compare several clinics [3]. Overall oral care for children is also covered in the pediatric dentistry guide.

Common myths and facts

• Myth: “The earlier you start orthodontics, the better, no matter what” → Fact: Only some problems benefit from early treatment, and some cases can be treated after all permanent teeth are in [1].
• Myth: “One round of Phase 1 treatment is all you need” → Fact: Phase 1 is largely about growth and space management, so Phase 2 may be needed once the permanent teeth are in [2].
• Myth: “Pulling baby teeth early helps alignment” → Fact: Baby teeth hold space for the permanent teeth, so whether to extract them is a case-by-case diagnostic decision [1].

You can also refer to a column by a board-certified orthodontist on what changes in a child lead parents to consider an orthodontic consultation [4].

You can learn about pain, extractions, retainers, and cost breakdown in orthodontics overall in the orthodontics guide, and check clinics with pediatric dentistry or orthodontics by area in Find a dentist.