When Should Your Child See an Orthodontist and What Should You Ask?

Dr. Rita Taliwal, DMD, MS, demystifies the process of your child's first orthodontic consult.

By Dr. Rita Taliwal, DMD, MS October 30, 2020

Understanding the timing of orthodontic treatment and whether your child is too young to see an orthodontist is a question I get asked often. With 16 years of experience in private practice and 8 years teaching part-time at the Columbia School of Dental Medicine Orthodontic Department, I continue to learn and grow in this ever-changing environment. Needless to say, orthodontics today is a whole different ballgame than when we were kids, and I'm always happy to demystify the process for parents and their kids.

A child should have their first ortho consult at age 7, which is the age at which the first molars and some of the front teeth have usually grown in. Things to look out for when determining if it's the right time for an ortho consult include: a large overbite; an underbite; a crossbite; an open bite; mouth breathing or snoring; clenching or grinding; and unerupted permanent teeth long after a baby tooth as fallen out. These are often conditions that can only be treated while patients are young and still growing. Screening patients at an early age allows us to intercept growth and development problems that can have lifelong effects on a child's health. 

In 2020, virtual consultations via video visits have become a mainstay, as they provide patients with flexibility and convenience throughout the entire process. During the first visit, we'll discuss whether your child would benefit from Phase I treatment, as well as the various customized treatment options and the length of time for each method. If indicated, we will schedule an in-office visit for digital dental scans (patients love that we are an impression-free office!), photographs, an updated x-ray (if necessary), and a comprehensive clinical exam so that we can create a treatment plan customized to your child’s specific needs.

One out of five children will benefit from Phase I of orthodontic care, typically done between 7-9 years old, when both baby teeth and a few adult teeth are present. Phase I treatment typically lasts 9-12 months, after which a retainer is worn to maintain the corrections in the interim until the remaining permanent teeth erupt. This will usually be followed by a Phase II of treatment at a later age, usually between 10-12 years old, once all the permanent teeth have erupted to perfectly align and straighten the permanent teeth. Phase II treatment time should be significantly minimized to 12-18 months, depending on your child’s needs.

The most traditional Phase I treatment is the use of a palatal expander, which is used to widen the shape of the upper jaw to create more space for erupting teeth, as well as better tongue posture and breathing. Phase I treatment may also involve braces (we use Damon System braces), which are placed on permanent teeth and sometimes on baby teeth to help guide the eruption of permanent teeth and change the shape of growing jaws. For growing children and teenagers, Invisalign clear aligners can create similar outcomes as those of braces and functional appliances while using special features such as the mandibular advancement tool. By doing a Phase I of treatment, not only can we shorten the time needed to correct alignment at a later age, we can avoid impacted teeth, and can avoid having to extract teeth to create space for crowding. 

If your child falls into the category of the 80% where Phase I treatment is not necessary, a good orthodontist will let you know and will continue to monitor growth by visits every 6 months, to check progress with growth and development. The cost of Phase I and Phase II will vary based on your child’s specific needs. You should ask if your dental insurance may have an orthodontic benefit, and you'll be pleased to know that FSA and HSA (Health Savings Account) insurance coverage can be applied to orthodontic care. Our office will always work with you to maximize your third party contribution minimizing your out of pocket expense. 

The confidence that comes with a great smile is the best gift you can give your child, and it's a gift that can last a lifetime. At Metro Orthodontics, we take great pleasure in providing a digital, seamless, and customized experience for each individual embarking on a journey to their best smile. I invite you to visit our website,, for more information on how we can care for you.