What is the right age to start treatment for a Child?

I get asked this question on a daily basis. Not just for kids younger than 10 but also teens. Parents have heard different things and some end up waiting till the child is 14-16 years old, limiting my range of treatment. Before I begin, All children should receive their first orthodontic evaluation by age seven, this is a recommendation by the American Association of Orthodontist. This allows early identification of potential problems. Certain orthodontic conditions are also best treated at this age. Other conditions are treated after most of the permanent teeth erupt, generally age ten to twelve. 

Early Treatment


Some bite problems, such as cross bite, should be corrected in kids that are less than 10 years of age. Bite irregularities that gradually worsen with time can be corrected or prevented.

Adolescent Teeth

As your child grows, the need for orthodontic treatment is often obvious. Just as often, however, it is not. Even teeth that appear straight may lack proper alignment. It is advised that, as your child ages, occasional evaluations be scheduled to detect current or future vulnerabilities. When early treatment occurs, cost and time in treatment can often be minimized. You want to start the treatment for a child 6 months before they hit puberty. There are questions that an orthodontist will ask to get us in the ballpark of this timing and lead to a very efficient treatment time. 


Does Orthodontic Treatment (Braces) Cause TMJ?

TMJ problems can be a real burden for many patients, that leads to pain, limitations on eating and embarrassing jaw joint noises. I often get asked, “Can braces cause TMJ?” Although there’s no easy answer, I’ll do my best to explain.


Following a landmark lawsuit in 1987 where a Michigan patient received a legal judgment against her orthodontist for giving her “TMJ,” hundreds of studies and millions of dollars have been spent by the scientific community to find if there really is a relationship between orthodontic treatment and the health of the temporomandibular joints (TMJ). Obviously this would be an important finding for doctors and patients alike. These studies have examined the different types of bad bite as well as the various approaches to treatment to see if there are any cause and effect relationships.

Time and time again scientific studies have found that orthodontics neither causes nor cures TMJ disorders. Except for two exceptions, malocclusion in general cannot be linked to a higher prevalence of joint problems. The two exceptions are a posterior cross bite that causes the jaw to shift to one side upon closure, and an anterior open bite where all the biting force is on the back teeth only and the front teeth do not touch at all. Neither overbite, underbites, crowding, or alignment issues have been shown to cause any problems at all. As for treatment modalities, these studies have been unable to find any links between the use of headgear, extractions, rubber bands, oral surgery, or any other orthodontic treatment and TMJ problems.


There are many environmental and physiological conditions that can cause pain in the area of the TMJ that are not related to the teeth at all. Some are serious like degenerative arthritis and cancer. Others are related to functional habits (like clenching and grinding), this could be due to stress and lifestyle. While cross bites and open bites may be linked to joint problems, not all bad bites result in TMJ pain. Many orthodontic patients have “bad bites,” and yet very few report TMJ pain. On the other hand, many patients who report severe TMJ pain often have ideal bites. This simple observation supports the scientific studies that have separated the fields of TMJ and orthodontics. If all bad bites had TMJ symptoms and all great bites never had any pain, a direct relationship would be defensible. Therefore, although it is good idea to eliminate certain bite conditions such as cross bite and underbite to aid in better dental health, there is no direct correlation between TMJ and Bad Bite. 

What kind of retainer is best for you?


Every Orthodontist is different when it comes to selecting a retainer. The decision is based on their experience with a particular type of retainer and years of knowledge on success rate for each type of retainer. Although somethings for you to consider when selecting a particular type of retainer, include: How much time are you willing to devote to using and caring for your retainer? How visible do you want it to be? Do you want a removable option or something permanent? You could be using a retainer for years or indefinitely, so it is important to pick a type that works for you.

Types of Retainers

From invisible to wire, retainers come in a variety of styles. There are multiple options to suit style and appearance preferences, but retainers fall into three basic categories: permanent and two types of removable styles.

  • Permanent retainers. Permanent retainers go by several names, such as bonded wire retainers, fixed retainers or lingual retainer wire. These types of retainers are considered permanent, because while an orthodontist can remove them, patients cannot. Permanent retainers are bonded to the back of the patient’s teeth. They can be placed on the lower six front teeth and/or the upper four front teeth, depending on what is needed. This type of retainer holds the teeth firmly in place to prevent them from moving back into their previous positions.

  • Hawley retainers. Hawley retainers may be the most widely recognized type of retainer. Commonly referred to as wire retainers, this style has been around for decades and continues to be a reliable option for orthodontists. They are made from a molded acrylic arch and wire, custom-fitted to the wearer’s mouth. They work by slowly maneuvering teeth into place or holding them in place, and they can be adjusted as needed. Hawley retainers are removable.

  • Clear retainers. These types of nearly invisible retainers have become increasingly popular in recent years, as the technology has dramatically improved. They are made from clear plastic, and like Hawley retainers, they are custom-fitted for the patient’s mouth. Because they are clear, they are hard to notice without looking for them. They are not considered as durable as other types of retainers and can be removed as needed.