Topic Overview

Many treatment options are available for malocclusion ("poor bite"), and expert opinions differ about timing. Your dentist or orthodontist may give you a choice between early or later treatment or may prefer one particular approach.

Consider these points:

• An underdeveloped lower jaw (mandible) is best treated as soon as a child is old enough to cooperate with treatment (age 5 or older).
• The amount of space for teeth does not increase with time. In fact, it gradually shortens throughout adulthood, because the teeth naturally drift toward the front.
  • In cases of severe crowding of baby (primary) teeth, the need for future orthodontic treatment is clear. Some practitioners choose early treatment using growth modification. Others use serial extraction or wait to use extraction and a single stage of orthodontic treatment.
  • In mild cases of crowding (when some permanent teeth have already come in, or erupted), malocclusion may improve because of your child's jaw growth through the teen years. You may avoid orthodontic treatment altogether by waiting until more permanent teeth have come in.
• Ideal timing of two-stage treatment can vary depending on the what the condition is, when the adult teeth come in, and how much growth is needed to correct the malocclusion. Many children who begin treatment by the second or third grade are finished with orthodontic treatment before they begin high school.
• Two-stage treatment often costs more than one-stage treatment.
• Children tend to be more cooperative than teenagers when it comes to wearing their appliances for a certain number of hours a day. Children typically allow closer parental supervision than teens do. Completing two-stage treatment before the teen years may be easier.
• Two-stage treatment spans a longer period of time, with a break between the first and second stages. Parents and the dental professional must make treatment as easy as possible for the child to avoid "burnout" before the child has completed treatment.

If you have any doubts about whether a particular dental professional's approach is right for you, seek a second opinion from another dentist or orthodontist.