How to Determine If Your Child Needs Orthodontics

Parents often sense that something about their child’s smile or bite seems a little off, but putting a name to that intuition can be hard. Teeth that look crowded, a jaw that clicks, or a lisp that lingers past a certain age may each point toward an orthodontic issue—or they may be normal stages of growth. At Alameda Dental in Aurora, CO, we help families sort through these questions with a straightforward evaluation, honest explanations, and a plan that makes sense for the child sitting in front of us. This article walks through what we look for, what parents can watch for at home, and how the process unfolds when a child truly needs orthodontic care.

01 / Why age seven is the right time for a first lookWhy age seven is the right time for a first look

The idea of bringing a seven-year-old to an orthodontic evaluation can surprise parents. A child at that age still has a mouthful of baby teeth, and the permanent teeth that are present may look a little chaotic. That mixture is exactly what makes the timing useful. By age seven, enough permanent teeth have usually come in—often the first molars and the central incisors—to reveal how the bite is developing. At the same time, the jaw is still growing, and growth is one of our strongest allies when we need to redirect a pattern that is heading in the wrong direction.

An evaluation at this age is not a shortcut to braces. For many children we simply take a set of records and ask the family to return for periodic observation, sometimes once a year, so we can follow jaw growth and tooth eruption. When we do recommend early treatment, it is because we can see a specific problem that will be harder—or impossible—to fix once growth slows down. Narrow upper jaws, crossbites that force the lower jaw to shift to one side, and underbites where the lower front teeth sit ahead of the uppers are examples where waiting often means trading a relatively short Phase I appliance for a much longer and more involved correction in adolescence.

02 / Signs you may notice at homeSigns you may notice at home

Orthodontic problems do not always announce themselves. A child rarely complains that their bite is off. Instead, the clues tend to show up in everyday moments—mealtime, sleep, speech, even the way a child smiles with their lips closed. None of the signs below is a diagnosis on its own, but each is worth mentioning when you call our office.

• Baby teeth that stay firmly in place long after the permanent tooth has started to peek through elsewhere, or baby teeth that fall out very early without a clear reason
• Permanent teeth that erupt far behind or in front of the baby teeth they are meant to replace, sometimes creating a doubled row
• Front teeth that do not come together when the child bites all the way down, leaving a gap even when the back teeth are touching
• Upper teeth that sit inside the lower teeth on one side, the front, or both
• A lower jaw that shifts visibly to the left or right each time the child closes their mouth
• Chewing that looks labored, or a child who consistently swallows food in larger pieces than expected for their age
• Repeated accidental biting of the inside of the cheeks, the tongue, or the roof of the mouth
• Sounds from the jaw joint—clicking, popping, or a gritty sensation—especially when they are accompanied by discomfort or limited opening
• Mouth breathing during the day and at night, snoring, or restless sleep
• A thumb or finger habit that continues past age four or five, or a tongue that pushes forward against the front teeth during speech and swallowing

These observations are worth acting on because they give us a head start. The sooner we understand what is happening, the more choices we typically have.

03 / Common malocclusions we see in childrenCommon malocclusions we see in children

When we talk about malocclusion, we mean any relationship between the upper and lower teeth and jaws that deviates from a healthy, stable bite. The patterns below are the ones we encounter most often in our Aurora office.

Crowding

Crowding happens when the jaw does not provide enough length or width to fit all the permanent teeth in a smooth arch. Teeth rotate, overlap, or get stuck in the bone entirely. Mild crowding can sometimes resolve on its own as the jaws grow, but moderate to severe crowding rarely self-corrects.

Excessive spacing

Gaps between teeth can stem from a mismatch between tooth size and jaw size, missing teeth, or a habit like tongue thrusting that pushes teeth apart over time. Spacing in the front teeth is common during the mixed-dentition stage and may close naturally, but wide or uneven gaps often need help.

Overbite (deep bite)

In a deep bite, the upper front teeth cover too much of the lower front teeth when the back teeth bite together. In severe cases, the lower teeth may contact the gum tissue behind the upper teeth, causing irritation.

Underbite

An underbite means the lower front teeth sit in front of the upper front teeth. It can be driven by the teeth alone, by the position of the jaw, or by a combination of both. When the lower jaw is contributing to the underbite, early treatment gives us the best chance to guide growth.

Crossbite

A crossbite occurs when one or more upper teeth sit inside the lower teeth. It can involve a single tooth, a segment of the arch, or an entire side. Posterior crossbites in particular deserve prompt attention because the child often compensates by shifting the jaw to one side, and that shift can become permanent as the bones grow.

Open bite

An open bite is present when the front teeth do not overlap, leaving a visible space even when the child bites on the back teeth. Finger habits, pacifier use beyond the toddler years, and a tongue-thrust swallowing pattern are common contributors.

04 / What happens at an orthodontic evaluation at Alameda DentalWhat happens at an orthodontic evaluation at Alameda Dental

We design the evaluation to be thorough but low-pressure. Children pick up on anxiety, so we move at a pace that helps them feel safe.

We start with a conversation. We ask about your child’s medical history, any medications they take, allergies, and past dental experiences that went well or poorly. We want to hear what you have noticed at home and what your child has told you—whether that is discomfort while eating, teasing at school about their teeth, or nothing at all.

Next we perform a clinical examination. We look at the face and profile, the lips at rest, and the way the jaws relate to one another. Inside the mouth we check the position of each tooth, the health of the gums, and the way the upper and lower teeth fit together when the child bites naturally. We measure overbite and overjet—how far the upper teeth extend vertically and horizontally relative to the lowers—and we feel for any instability or shifting in the jaw joints.

We typically take a panoramic X-ray and a few intraoral photographs. The panoramic image shows all the teeth, including ones that have not come in yet, as well as the jaw joints and sinuses. It helps us see missing teeth, extra teeth, root shapes, and the path developing teeth are taking through the bone. The photographs let us document the starting point and explain what we see in a way that a mirror alone cannot.

After we gather this information, we sit down together—you, your child, and our team—and walk through the findings in plain language. If everything looks on track, we say so, and we may suggest a follow-up visit in six to twelve months to monitor growth. If we see a problem that would benefit from early attention, we explain what it is, why it matters, and what the options look like. We give you time to ask questions, and we send you home with a written summary because we know it is hard to remember every detail during a single appointment.

05 / The two-phase approach: interceptive care and comprehensive treatmentThe two-phase approach: interceptive care and comprehensive treatment

Orthodontic care for children sometimes happens in two distinct stages.

Phase I (interceptive treatment)

Phase I takes place while the child still has a mix of baby and permanent teeth. Its goal is usually not to create a perfect smile—that comes later—but to fix a specific structural or functional problem that is actively interfering with healthy development. Common Phase I treatments include a palatal expander to widen a narrow upper jaw, a space maintainer to hold room for a permanent tooth after a baby tooth is lost too early, or a limited set of braces on just the front teeth to correct a damaging crossbite. Most Phase I appliances stay in place for several months to about a year.

Phase II (comprehensive treatment)

Once the permanent teeth have erupted, we evaluate whether further alignment is needed. Phase II typically involves full braces or clear aligners and addresses the position of every tooth, the final fit of the bite, and the aesthetics of the smile. For children who did not need Phase I, Phase II is their only orthodontic experience. For those who completed Phase I, Phase II tends to be shorter and less complicated because the foundation was set early.

Choosing between observation, Phase I, and waiting for a single comprehensive phase is a decision we make together based on the severity of the issue, the child’s growth stage, and their emotional readiness. There is no universal template; we let the clinical findings guide us.

06 / Treatment options we discussTreatment options we discuss

The right appliance depends on the problem, the child’s cooperation level, and family preferences.

Metal braces remain a predictable, efficient choice for a wide range of malocclusions. Brackets bonded to each tooth hold an archwire that applies steady, gentle pressure. Adjustments at regular visits move the teeth into their planned positions. Modern brackets are smaller and more comfortable than those many parents remember from their own childhoods.

Clear aligners have become an option for a growing number of younger patients who have specific alignment needs and are committed to wearing the trays as directed. Success with aligners hinges on compliance—the trays must be worn for the prescribed number of hours each day and removed only for eating and brushing. We have an honest conversation about whether your child is ready for that responsibility before we recommend this route.

Other appliances serve targeted purposes. Palatal expanders create width in the upper jaw. Space maintainers hold a gap open when a baby tooth is lost prematurely. Habit-breaking appliances help a child stop thumb sucking or tongue thrusting. Headgear, though less common today than in the past, is still used in specific situations to influence upper jaw growth.

We recommend an appliance only when we are confident it addresses a problem we have clearly identified. We do not treat for the sake of treating.

07 / Why alignment matters beyond appearanceWhy alignment matters beyond appearance

It is easy to focus on the cosmetic benefit of orthodontics, and that benefit is real—a smile a child feels good about can change how they carry themselves. But the functional consequences of malocclusion reach further.

Teeth that are crowded or overlapping are harder to brush and floss thoroughly. Plaque accumulates in the tight spaces, and over time that raises the risk of cavities and gum inflammation. A bite that does not distribute chewing forces evenly puts extra load on certain teeth, which leads to accelerated wear, chipping, and sometimes fracture. Jaw muscles and joints can become sore when a child chews in a strained position day after day to compensate for a bite that does not fit well. Speech sounds that depend on tongue-to-tooth contact—like “s” and “th”—can be affected when the front teeth are not in the right relationship. Airway and sleep quality are also connected to jaw structure; a narrow upper jaw can contribute to a narrow nasal floor, which may make nasal breathing harder. Addressing these issues during childhood, when the structures are still developing, often yields benefits that last a lifetime.

01 / Practical scenarios: when to move forward with an evaluationPractical scenarios: when to move forward with an evaluation

The retained baby tooth that refuses to budge

Your eight-year-old still has a lower front baby tooth that is not loose, while the permanent tooth has already erupted behind it. This pattern—sometimes called “shark teeth”—is common. Often the baby tooth just needs a little help coming out. Once it is gone, the tongue and lip often guide the permanent tooth into a better position on its own. We assess the space and may place a simple appliance if the permanent tooth needs more room.

The thumb sucker at age six

A child who is still sucking a thumb or finger past the toddler years can push the upper front teeth forward and the lower front teeth back, creating an open bite and a narrow upper arch. If the habit stops early enough, some spontaneous improvement is possible. When the habit is persistent, a habit-breaking appliance worn for several months can remove the reward of sucking and let the bite recover. Addressing this early often prevents the need for more extensive tooth movement later.

A crossbite that shifts the jaw

A single upper tooth that sits inside the lower teeth can cause the entire jaw to shift to one side every time the child bites down. Over months and years, that functional shift can become a structural asymmetry of the jaw itself. A short course of expansion—sometimes just a few months—can eliminate the crossbite and allow the jaw to grow symmetrically.

Lower front teeth arriving behind baby teeth

Permanent lower incisors that come in behind retained baby teeth create the appearance of a second row. Removing the baby teeth is often the first step. If the arch is large enough, the permanent teeth may drift forward into the correct position. If crowding is severe, we may recommend a brief Phase I with a few brackets on the front teeth to create order and prevent adjacent teeth from getting blocked out.

02 / Common questions families askCommon questions families ask

Will an expander affect my child’s speech?

A palatal expander takes up some tongue space, so a mild lisp is normal during the first few days to a week. Reading aloud at home helps the tongue adapt faster.

Can my child play a musical instrument with braces?

Yes, though brass and woodwind players may need a short period of adjustment to find a comfortable embouchure. A thin layer of orthodontic wax over the brackets can reduce lip irritation during long rehearsals.

What happens if a baby tooth falls out while braces are on?

We remove the bracket or band from that tooth and keep the wire engaged elsewhere while we wait for the permanent tooth to come in. It is a common and straightforward adjustment.

Is early treatment covered by dental insurance?

Many plans that include orthodontic benefits cover a portion of interceptive care, but benefits vary widely. We verify coverage before treatment begins and provide a clear breakdown of what your plan will pay and what will be the family’s responsibility.

What about emergencies outside office hours?

True emergencies—trauma to the face or teeth, or severe pain that cannot be managed with over-the-counter relief—are rare during orthodontic care. We provide an after-hours contact number for those situations. For loose brackets or poking wires, orthodontic wax and a phone call during the next business day usually handle things.

03 / Mistakes families sometimes makeMistakes families sometimes make

Waiting for the general dentist to sound the alarm. Your child’s dentist is an important partner, but orthodontic assessment is a specialty evaluation. Parents can request a consultation directly once a child is seven, even if the dentist has not mentioned a concern.

Assuming crowded baby teeth are fine because “they’ll fall out anyway.” Baby teeth are smaller than the permanent teeth that replace them. Crowding in the primary dentition often signals even worse crowding in the permanent dentition. Noticing it early gives us options.

Believing that orthodontics must wait until all the permanent teeth are in. For some problems, waiting means missing the window when growth can do some of the work for us. A narrow jaw expanded at age eight may need no further skeletal treatment, while the same jaw at age fifteen may require surgery.

Picking an appliance based on appearance alone. Clear aligners are popular, and for good reason, but they are not the ideal solution for every bite problem or every personality. A child who will not keep track of removable trays is better served by fixed braces that do not depend on cooperation for every hour of wear.

04 / Children with special circumstancesChildren with special circumstances

Anxiety or sensory sensitivity

We shape the visit around what the child can handle. We use tell-show-do, where we demonstrate each step on a model or a gloved finger before doing anything in the mouth. We keep parents nearby and move at a pace that respects the child’s comfort. We schedule these visits when we have the time to go slowly.

Asthma, allergies, or medical conditions

Let us know about inhalers, epinephrine auto-injectors, or any other emergency medication your child carries. We make sure those items stay within reach during appointments. We select materials with attention to sensitivities, including latex-free options.

Premature loss of primary molars

A baby molar lost long before the permanent successor is ready can set off a chain reaction: neighboring teeth tip into the gap, the space closes, and the permanent tooth gets trapped. A space maintainer is a small device that holds the gap open and often saves years of complicated treatment down the road.

05 / What parents can do between visitsWhat parents can do between visits

Keep an eye on oral habits. Thumb sucking, prolonged pacifier use, nail biting, and tongue thrusting all apply forces that can shape the developing bite. Catching these habits early and mentioning them to us gives us a chance to intervene before the bite changes.

Offer a diet that encourages chewing. Crunchy vegetables, fibrous fruits, and foods that require real jaw work stimulate the bone and muscles that support proper dental arch development. A diet dominated by ultrasoft processed foods does not provide the same stimulus.

Make six-month dental checkups a priority. Your child’s general dentist sees their mouth more often than we do during the pre-orthodontic years. Those regular visits often spot eruption problems, retained baby teeth, or early signs of decay that could complicate orthodontic planning.

Trust what you see. You know your child’s face, smile, and habits better than anyone. If something looks asymmetric about the jaw, if you hear clicking when they chew, or if their teeth seem to be shifting in a direction that worries you, bring it up. Your observations are a critical piece of the diagnostic puzzle.

06 / How we make treatment decisionsHow we make treatment decisions

When our team evaluates a child, we weigh three factors before recommending any treatment:

1. 1.The nature and severity of the problem. A skeletal issue, such as a narrow upper jaw or a true underbite, almost always warrants interceptive care because growth is the key to correction. Mild dental crowding in a child with ample jaw size may be something we simply watch.
2. 2.The child’s developmental stage and growth potential. The younger the child, the more growth remains. We assess height trends, the eruption stage of the teeth, and sometimes X-rays of the hand and wrist to estimate how much growth is left.
3. 3.Readiness for the responsibility of treatment. A child who is cooperative during exams, can follow oral hygiene instructions with some parental help, and understands why they are wearing an appliance is far more likely to have a smooth experience. We do not push a child into treatment before they are ready, because the emotional toll of a bad experience can color their relationship with dental care for years.

We document these factors in a plain-language summary and review it together. There is no obligation at the end of an evaluation—just information you can take home and think about.

07 / Retention: keeping the result stableRetention: keeping the result stable

Orthodontic treatment does not end the day appliances come off. Teeth have elastic memory, and the surrounding bone and gum tissue need time to reorganize around the new positions. We prescribe retainers—either removable trays or a thin wire bonded behind the front teeth—and a specific wear schedule. We also continue to monitor the bite through the remaining growth years, because a late growth spurt can shift teeth even after a seemingly stable result.

08 / Scheduling a visit at Alameda DentalScheduling a visit at Alameda Dental

If your child is around age seven—or older and has not yet had an orthodontic screening—we welcome you to schedule an evaluation. There is no downside to gathering information. If we find nothing that needs attention, you walk away with peace of mind and a baseline record of your child’s development. If we do identify an issue, you have the advantage of time on your side.

We see families from Aurora, CO and the surrounding communities at our office at 14591 E Alameda Ave. We know that school schedules and workdays are tight, so we work to find appointment times that fit your family’s rhythm. To start the conversation, call us at (303) 343-7072. We look forward to meeting you and your child, listening to your questions, and helping you map out the path that makes the most sense.