What is early phase orthodontic treatment?

The practice of orthodontics can correct many dental and skeletal related problems at any age. The types of orthodontic problems can range from simple tooth alignment to severe dental and skeletal abnormalities. Recognition of the more severe related problems can often be detected at the early years of dental and facial development. Dentists are trained to recognize these potential problems and when necessary, refer these patients to an orthodontic specialist. Sometimes patients may be referred as early as seven years of age.

Early, or Phase I, orthodontic treatment refers to treatment that precedes conventional treatment protocol in which brackets and bands are placed on the erupted permanent teeth. This early treatment is initiated during the transitional dentition to intercept malocclusions (bad bite patterns) in a manner that will ultimately lead to a better, more stable result than that which would be achieved by starting treatment later.

According to a survey of orthodontists, the benefits of early phase treatment include:

  • Greater Ability to Modify Skeletal Growth
  • Improved Patient Self-Esteem and Parental Satisfaction
  • Better and More Stable Results
  • Less-Extensive Therapy Is Required Later
  • Reduced Potential Iatrogenic Tooth Damage Such As Trauma, Root Resorption and Decalcification

Is early phase orthodontic treatment absolutely necessary?

The role of the orthodontist is to evaluate all of the factors involved when creating a treatment plan, and to predict the best time to implement treatment. The reasons for correcting an orthodontic problem at an early age should be explained to the patient and the parents thoroughly.

Physiological Growth & Tooth Development at Time of Evaluation
Though there are average ages for growth and tooth eruption, each patient's case is unique. Some patient's may have lost all of their baby teeth and have all of their adult teeth by their pre-teen years while others may still have several baby teeth into their later teens. Likewise, some patients hit their growth spurts early on while others may do so later on.  These all play into the decision of whether or not early phase treatment would be beneficial for the patient.

Boys tend to get their permanent teeth later and also have a later period of significant growth than girls, allowing for a larger window of time for which interceptive orthodontics can be utilized.

Clinical Conditions
Patients requiring arch development (widening of the jaws), may require an appliance such as palatal expander. This appliance is more effective in the earlier stages of development before the skeletal sutures of the skull fuse and can no longer be manipulated. Female patients may undergo skeletal maturation much earlier than a male patient and therefore require a most assertive treatment approach.

Childhood Dental Development

The dental development of a child can vary. Certain conditions may warrant early evaluation and treatment by an orthodontist.

Goal of Early Phase Treatment

It is recommended by the American Association of Orthodontists that patients are referred to an orthodontic specialist at 7 years of age when certain problems are observed. Tooth eruption and skeletal development at this stage can be very beneficial to intercept developing dental and skeletal problems.

Generally the goal of early phase treatment is to guide or correct developing aberrant bite patterns and improve guidance of erupting permanent teeth. Conditions such as arch-length discrepancies (inadequate space for teeth to erupt) and transverse or cross bite patterns benefit from early phase treatment. Moderate to severe over bite (class II) patterns and underbite (class III) patterns are also addressed with phase I treatments.

Does your child need early treatment?

The following list from the web site of the American Association of Orthodontists can help in your decision for early orthodontic evaluations. Any single clinical condition or combination of these conditions are a good reason to schedule an orthodontic evaluation and consultation.

  • Early or Late Loss of Baby Teeth
  • Difficulty Chewing or Biting
  • Mouth Breathing
  • Finger Sucking or Other Oral Habits
  • Crowding, Misplaced or Blocked-Out Teeth
  • Jaw Shifting, Sounds, Protrusion, or Recession
  • Speech Difficulty
  • Cheek or Roof of The Mouth Biting
  • Protruding Teeth
  • Teeth That Meet In An Abnormal Way or Do Not Meet At All
  • Facial Imbalance or Asymmetry
  • Grinding or Clenching

We help to educate and explain

Phase I, or early interceptive treatment, is orthodontic treatment (i.e. expansion, active retainer or partial braces) that is done before all of the permanent teeth have erupted, and often occurs between the ages of six and ten. Not all children require phase I treatment. Your child's dentist may recommend a consultation if a developing orthodontic problem is observed.

Dr Benjamin Cassalia