Growth and Development (Will my Child Need Braces?)

The pediatric dentist is uniquely trained to recognize and treat early problems, and to evaluate the development and growth of children into adulthood.  Parents want to know what is going on in their child's appearance and to learn about future issues.  The teeth, facial bone structure, heredity, disease and the patient's habits all play a role in facial appearance.The second most common question, after cavities, parents ask is, "Will my child need braces?"  With this question parents commonly  ask, "When should we start braces?"

To understand the development of teeth in children we must always keep in mind that there is a lot of variability from child to child.  The age date given for eruption and growth is only an average estimate and can be as much as a year off, and is different from patient to patient.  I have seen patients that did not get their first tooth till 15 months, yet had perfect teeth into adulthood.

The primary (baby-milk) teeth normally start to erupt at around 6 months.  Usually the lower front teeth come in first followed by the upper front teeth.  There are normally 20 primary teeth that erupt, 10 upper and 10 lower teeth.  By age 3, for the average child,  all the primary teeth have should have erupted.

Also around the child's 3rd birthday some patterns may be apparent. such as crowding, over-bite, cross- bite, under bite, missing teeth or extra teeth.  Spacing between teeth is important at this age, called normal developmental spacing, as spacing in the baby teeth allows room for the permanent teeth to grow in. It is important to repair decay in the primary to prevent space loss.  Teeth lost prematurely may need space maintenance to prevent teeth from shifting. Parents should discuss these growth issues with the pediatric dentist.  Some habits at this early age are not treatable because of the child's age.  Most habits self correct themselves as the child grows.

By age six the front teeth start to fall out and the permanent teeth begin to grow in.  Also the "6" year molars begin to erupt behind the primary molars.  The back primary molars stay in till around 12. They guide the "6" year molars into position.  I have found that the age range for the front teeth growing in, starts at around four and a half years to ten.  This is quite a variation but is normal.  During this transitional period the child's growth pattern begins to become established enough so that in most cases a pediatric dentist can reasonably evaluate the future patterns.

A good age to evaluate the average child for orthodontic issues is  between 6 and 8 years of age. This is the age when parents first see the permanent teeth erupting and want to see what their child needs.

Many minor rotations and tilting may correct themselves as part of normal development.  Sometimes minor orthodontic appliances may be used to correct problems and allow growth to take its course.   Early appliance therapy may be recommended when there are esthetic issues that are readily apparent. Functional problems that cause the jaws to bite improperly such as cross-bites may also require early treatment.  In a large number of children it may be better to have more permanent teeth to erupt to  allow for proper esthetic facial development.  Parents should discuss their child's dental, facial and esthetic development with the pediatric dentist.