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Braces for Children
By Matthew Freeman, DDS, MS
Board Certified Orthodontist
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You may not have considered orthodontics (orthodontia) for your child yet, and you may think that your child does not need dental braces until all of the baby teeth have fallen out.  While this may be the case, the American Association of Orthodontists recommends that children see an orthodontist by age 7.  This is because some orthodontic problems are easier corrected when the child is younger.  Waiting to get braces or starting orthodontic treatment after all permanent teeth have erupted may lead to difficulty in correcting some types of orthodontic problems. By age 7, most children will have begun growing in some permanent molars (back teeth) and incisors (front teeth) so the orthodontist can evaluate if there is an existing problem.  Read about when to get braces.

What causes crooked teeth?

Most of the time, having crooked teeth or a malocclusion (bad bite) can be traced to genetics.  This means that many orthodontic problems in children are usually inherited from their parents.  Some common orthodontic problems found in children are crooked teeth, crossbites, large overbites, deep bites, open bites, underbites, and jaw growth problems. 

Other malocclusions stem from environmental factors.  For example, harmful habits such as thumbsucking, fingersucking, or abnormal swallowing patterns may cause protruded upper teeth, narrow jaws, or a large “overbite.”  Early or late loss of baby teeth, mouth breathing, and accidents can also cause bite problems.

Where do you begin?

When you bring your child in for an initial orthodontic exam, the orthodontist will examine your child’s teeth for any crowding, bite, or jaw problems.  If your orthodontist does not detect a problem, he or she can determine a time frame for a future evaluation so that a problem does not go undetected.   If your orthodontist does detect a problem, he or she may recommend starting treatment now or waiting until the jaws are further developed or more permanent teeth have erupted to start treatment.  For every patient, there is an ideal time to start orthodontic treatment and your orthodontist will help you determine when that ideal time is.  If your orthodontist recommends starting treatment, you will be  given a  fee for the cost of braces.

Depending on your child’s orthodontic needs, the goals of treatment will vary and may include making space for the permanent teeth to erupt, straightening crooked teeth, closing spaces between the front teeth, decreasing trauma risk associated with protruded, buck teeth, guiding jaw growth, correcting harmful habits, or improving self-esteem. 

How does my child get braces?

To straighten teeth, your orthodontist may place orthodontic braces on some of the erupted permanent teeth.  In early treatment, the most common teeth that braces are put on are the first permanent molars in the back and the four incisors in the front.  This is commonly called a 2x4 and is pronounced “two by four” because of the two bands and four brackets that comprise the braces.  Sometimes additional baby or adult teeth may be included in the braces to provide additional support for tooth movement.  Limited treatment of a child still with many baby teeth remaining is often called Phase One or early orthodontic treatment.  Phase Two treatment typically occurs when all baby teeth have fallen out. 

Since many goals of Phase One early treatment include jaw modification, your orthodontist may recommend a special jaw modification appliance for your child.  Some orthodontic appliances are fixed which means that they are permanently cemented in the mouth until the orthodontist determines that it is time to have it removed.  Other orthodontic appliances are removable and so it is the patient’s responsibility to place and remove the appliance.  Below are some common orthodontic appliances used in Phase One early treatment.

Palatal Expander (Upper Jaw Expander)

A palatal expander is commonly used in young patients with a crossbite involving the back teeth and is used to widen a narrow upper jaw.  The palatal expander is a fixed appliance and is placed on the upper back teeth.  The patient or parent activates the expander by turning a screw that is connected to the expander. 


A headgear is used to improve protruded upper teeth and large overbites.  The theory behind the long-lived appliance is that the headgear holds the upper teeth and jaw while the lower jaw grows to catch up, thus improving the overbite.  The headgear is removable and is usually worn 10-14 hours a day or as prescribed by your orthodontist. This two-part appliance consists of a facebow, which connects to the upper molar teeth, and a strap that wraps around the head or neck.  In most cases, children do not have to wear it to school. 

Fixed Functional Appliance

The goal of functional appliances is to improve lower jaw growth.  There are numerous variations of this fixed appliance which usually attaches to the upper and lower molar teeth.  The theory of functional appliances is that holding the lower jaw forward will produce permanent changes in the underlying bone and soft tissues so that when the appliance is removed, the jaw will still be in a forward position. 

Removable Functional Appliance

Like the fixed version, the removable functional appliance also serves to improve lower jaw growth by posturing the lower jaw forward.  It usually consists of a combination of plastic and wires and can be removed by the patient.  Some common types include the Bionator, Frankel, and Twin Block appliances.

Alternate Approaches

In cases of severe crowding, your orthodontist may recommend a procedure called Serial Extraction.  This may be recommended when it’s determined the jaws won’t have enough space to accommodate all of the permanent teeth.  Baby teeth are extracted in a sequential pattern in order to speed up the eruption of the permanent teeth (usually the premolars) that will ultimately be extracted as well.  This allows the remaining adult teeth to erupt into the mouth without any trouble.  This is type of treatment will usually be followed by full orthodontic braces once all of the permanent teeth erupt. 

For more information about life with braces, treatment, and general braces information, please see Orthodontics FAQ.

Child Overbite and Orthodontic Problems >>

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Dr. Freeman is a Board Certified Orthodontist practicing in San Jose, California. Read more about Dr. Freeman or visit his practice online at


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