Early Braces for kids or Phase 1 Orthodontic Treatment

All you need to know for a smart choice

We know that you probably have a number of questions about your child’s orthodontic needs – everything from how to tell if your child will need braces for kids, how growth and permanent teeth will change that picture and if the jaw is growing correctly. That’s totally normal, and we want to help ease your mind about this process!

Every child’s dental and facial features are unique and evolve throughout their childhood. We keep an eye on them to determine the best time to intervene, and help you know what to look out for as things progress. Dr. Rooz, a board certified orthodontic specialist, does not believe in over treating children. We try to provide as much information as possible on our website, but for the best answers, it is always best to visit us at Porth Personalized Orthodontics.

chronological age doesn't always match dental age

Early orthodontic treatment is intervention designed for younger patients that helps guide the eruption (arrival) of adult teeth as well as skeletal development.

Contrary to popular belief, braces for kids bracesare not just for appearances or having a perfectly straight smile; they can be an important aspect of dental and overall health! When we start treatment at a younger age [6-11 years old] we are able to support healthy growth, potentially avoiding future complications and minimizing risk of trauma to the teeth and mouth.

Ideally speaking, the top and bottom teeth should line up like a zipper when they are closed together. Properly aligned teeth are easier to clean, so the risk of dental decay and gum disease is reduced. Moving teeth so that they align correctly is one of the countless benefits of early orthodontic treatment.

It is important to remember that not every child needs early orthodontic treatment, yet certain orthodontic problems are easier to fix when they are diagnosed and treated early.

Regardless of whether your child needs early orthodontic intervention, the American Association of Orthodontists encourages parents to take their child to see an orthodontist by the age of 7 for an initial examination. Because dental development is different for every child, the appropriate age to intervene will vary.

When you notice that your child has started losing their teeth, ask your dentist when a visit to the orthodontist would be appropriate. Younger children may also need orthodontic intervention if they are referred by their pediatric specialist.

Common signs that early orthodontic treatment is necessary include crowded (crooked) teeth, thumb sucking (or habits such as using a pacifier), baby teeth that are worn down, breathing issues, unusual jaw growth, crossbite, and underbite (these are further explained below).

What is Phase I of Two-Phased Orthodontics?

Children with phase I orthodontic treatment often pursue a second round of treatment. Phase I or early orthodontic treatment is a limited orthodontic treatment often in kids transitioning from baby teeth to adult teeth. The objective of this treatment is limited and the treatment takes approximately 12 months. Phase I treatment does not involve all the teeth.

Phase I of two-phase treatment is a controversial topic in the field of orthodontics. Some evidence indicates that the first phase is not always clinically indicated, since orthodontists can achieve similar results with just one round of braces further down the line. Nonetheless, there are a few issues that can warrant two rounds of braces, despite the lack of clinical efficiency in this approach; longer treatment and higher cost.

Dr. Rooz, our kid-friendly orthodontist, offers phase I treatment (early orthodontic treatment) generally for two primary reasons. (i) to correct abnormal skeletal growth and (ii) managing space for adult teeth to replace baby teeth.

Collectively, successful phase I treatment addresses structural problems that would otherwise require teeth extractions or surgery, which can become more complicated with age.

To correct orthodontic problems early on, the orthodontist can use two types of appliances; fixed or removable. These include lite version braces for kids, clear aligners for kids, expanders, habit appliances, or functional appliances.

Dr. Rooz and son

Dr. Rooz Khosravi | Orthodontist for Kids


As a father, Dr. Rooz loves working with kids and seeing them smile. He understands the influence of a healthy and beautiful smile on children, teenagers, and adults alike and he strives to provide them with the best orthodontic experience possible. Being able to laugh, speak, eat, and smile with confidence is incredibly important for one’s physical and psychological health. Dr. Rooz finds genuine joy in being able to impact others’ lives by improving their oral health for years to come.

Dr. Rooz received his orthodontic training at the University of Washington, a top 3 orthodontic program in the country. He currently is an assistant professor in the same department, where he teaches and conducts research. Dr. Rooz brings his knowledge and findings back to the clinic and directly to patients, giving them optimal treatment plans and outcomes.

Dr. Rooz has years of experience successfully treating younger patients. One of his interests is expanding clear aligner therapy in early orthodontic treatment. Pursuing its mission to provide personalized care Dr. Rooz individually customizes the treatment plan for every child. He is also a firm believer of providing only necessary orthodontic treatment to kids.

What are the indicators that your child may need orthodontic treatment?

Dental Orthodontic Problems


Crossbite in front or back teeth (upper teeth stuck behind lower teeth)


In a normal bite, the upper teeth cover the lower teeth. A crossbite occurs when the upper teeth are positioned inside of the lower teeth, sometime causing the lower jaw to shift when biting down. This can occur in the front or back teeth.

Crossbite mostly results in a shift of the lower jaw when biting down. When left untreated a crossbite can lead to irreversible problems ranging from gum and bone loss (recession), significant wear on the adult teeth, or asymmetric skeletal growth that requires surgical intervention as an adult.


Crossbite
Lite braces with Facemask (reverse head gear)

Crowding (crooked teeth)


When there isn’t enough space in the mouth for teeth to grow, it can lead to crowded, crooked teeth. Children with small jaw bone or large size teeth don’t have room for their teeth to fit and end up with a crowded bite. It’s a common problem for children with large teeth that don’t fit in their small jaws. This is what we commonly think of as crooked teeth – a very common reason people seek out braces for kids.

Most cases can be easily fixed by removing teeth before orthodontic treatment, but there are some situations that can benefit from early intervention. For example, root resorption occurs when new adult teeth intrude into the roots of other adult teeth because they do not have enough room to erupt. This can be prevented with an orthodontist’s supervision. By the age of 7, a consultation with the the orthodontist is appropriate, so you can monitor and identify whether teeth crowding is a serious problem.


Crowding
Expander Appliance

Habits (thumb sucking, mouth breathing, tongue trust)


Thumb sucking, lip sucking, mouth breathing, and chewing objects: These behaviors can create dental problems in children, such as an open bite. This means that when the mouth is closed, the child’s upper and lower teeth to not touch one another. (It often appears as the front teeth flared out forward.) The orthodontist can help eliminate these habits and correct the alignment of teeth with an orthodontic habit appliance.


Photo of fixed teeth

Flared Teeth


A possible issue that could arise from abnormal jaw growth is flared out upper teeth. This is caused by excess space between the top and bottom teeth from a smaller lower jaw. Correcting this problem is extremely important since these teeth are in high risk of trauma as they are more exposed. A fractured front tooth needs major dental repair (including a dental implant if the tooth is gone), which can be prevented by relatively quick and simple orthodontic treatment.


Proclined teeth

Skeletal Orthodontic Problems


Orthodontic problems can occur when the upper and lower jaw do not meet evenly, resulting in an imbalanced bite. This can place excessive stress on different areas of the mouth and interfere with basic functions, like eating, breathing, sleeping, and speaking.

Abnormal growth of the jaws, such as a smaller or set back lower jaw, can create a large gap between the upper and lower teeth. Alternatively, an underbite is characterized by lower teeth overlapping the upper teeth, which is often rooted in a small upper jaw.

Early orthodontic treatment can redirect the growth of teeth and prevent these scenarios from happening. Since a the upper jaw does not fully develop until adulthood, the upper palate can be gradually expanded by a special appliance. This will aid in the redirection of growth and help avoid skeletal issues in the future.


Abnormal growth in upper and lower jaws


Smaller upper or lower jaw can create a large gap between upper and lower teeth. Phase I treatment in a growing individual allows an orthodontist to redirect the growth. For example, here are two scenarios …

a) When the lower teeth bite in front of the upper teeth (called an underbite) it is most often an indicator of a smaller upper jaw in children. Underbite is rarely a consequence of large lower jaw in children, but this trend is different in teenagers.


fixed underbite

b) A smaller lower jaw in children often results in a significant gap between top and bottom teeth. This gap could be due to flared out upper teeth. Clinical examination is required to identify the origin if the problem, which is excess space between top and bottom teeth.


smaller lower jaw fixed

Sleep Disorders in Children


Sleep disorders in children is a multifactorial anomaly. Numerous issues can contribute to the development of this condition. Skeletal issues can make breathing difficult yet proper diagnosis (sleep study) by a sleep physician is required to identify the source of sleep disorder. Orthodontists and pediatric dentists generally screen for signs and symptoms associated with sleep disorder. A team of sleep physician, pediatrician, ENT specialist, and orthodontist collaborate to establish a baseline of sleep quality and proceed with interventions if required.

The role of orthodontics in the field of pediatric sleep disorders is growing. Dr. Rooz has extensive knowledge on providing orthodontic care to children with this condition, while collaborating with sleep physicians.

Treating kids with sleep disorders requires a very specific consultation that can assess the disorder thoroughly. We provide a specific consultation for kids with sleep-related issues.

What is the next step after the early treatment (phase 2 treatment)?


Children with phase I orthodontic treatment often pursue a second round of braces for two primary reasons: (i) to fine tune the bite and create an exceptional smile and (ii) unsuccessful treatment during the phase I requires second round of treatment with a different treatment plan that is tailored based on each individual’s bite. The gap between these two treatment varies between 1 and 5 years.

What to Expect at an Early Orthodontic Evaluation


Getting an early orthodontic screening is important because it can help prevent serious problems in the future, as well as circumvent the need for expensive and complicated orthodontic treatment should problems persist.

After the screening, the orthodontist will determine whether the patient needs Phase 1 treatment or not. The majority of early orthodontic screening leads to a recommendation for no treatment, and to monitor growth and development on a regular basis moving forward. Examples of issues that leads in recommendation for treatment are

  • Uneven jaw growth
  • Improper bite
  • Crowded teeth
  • Missing teeth
  • Impacted adult teeth
  • Extra tooth/teeth
  • Damaged root in developing adult teeth

Financial information (Orthodontic treatment cost)


Braces for kids cost less than comprehensive orthodontic treatment for teens or adults. We also provide significant discount for our patients who continue their care for the second round of braces or Invisalign at our clinic. Additionally. Porth works with you to maximize your insurance benefits. Dr. Rooz is an in-network provider for some plans. We also submit claims on behalf of our patients for the majority of insurance providers.

We believe that orthodontic treatment should be tailored based on the patient’s financial needs. Porth offers numerous payment plans in order to eliminate any potential hardship with financial aspects of orthodontic care.

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