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When should children see an Orthodontist? Dentists’ Information

All busy dentists are glad for time saving tips and clear guidance on which cases to refer in order to fulfil their responsibilities to patients who ultimately remain in their care from birth to adulthood.

A short and simple clinical examination can lead to the discovery of problems which can be addressed or corrected.

Malocclusion, like caries and periodontal disease, creeps up on its victims slowly… and we have the ethical duty to detect and inform.

Robert Kirshen

Orthodontic screening in a minute - BDJ 1998

Things dentists can check include:

1: Soft Tissue Form

Lips might not meet at rest or the patient might be unable to close their lips [incompetent]. The lips might protrude excessively as in bimaxillary proclination cases.

2: Habits

Thumb and finger sucking, nail biting and pen chewing can disrupt the occlusion.

3: Skeletal Discrepancies

Severe class II or III patterns are easy to pick up during facial examination. Moderate or mild skeletal problems require a closer look and might only become obvious through detailed measurements or radiographic examination.

Example:

Upper jaw and tooth position
Goofy appearance has resulted from upper jaw being too far forward and upper teeth pointing forward.

Lower jaw position
Lower jaw set back relative to top.

4: Ectopic, Missing Or Unerupted Teeth

With the help of an eruption calendar a tooth count can determine whether the clinical picture matches the patient’s age. Supernumerary and supplemental teeth might not be obvious clinically but a radiographic examination is recommended if these are suspected.

Example:

Supernumerary teeth.

5: The Occlusion

Teeth can be out of the intercuspal position due to crowding, spacing, cross bites, overjet or overbite problems, centerline shifts and skeletal discrepancies.

6: Premature Contacts & Displacements

These can be determined by examining the occlusion in a retruded contact position.

Eruption timetable

Upper

  1. Max. central incisors – Eruption age: 7-8 years
  2. Max. lateral incisors – Eruption age: 8-9 years
  3. Max. canines – Eruption age: 11-12 years
  4. Max. first premolars – Eruption age: 10-11 years
  5. Max second premolars – Eruption age: 10-12 years
  6. Max. first molars – Eruption age: 5-6 years
  7. Max. second molars – Eruption age: 12-13 years
  8. Max. third molars – Eruption age: 17-25 years

Lower

  1. Mand. central incisors – Eruption age: 6-7 years
  2. Mand. lateral incisors – Eruption age: 7-8 years
  3. Mand. canines – Eruption age: 9-10 years
  4. Mand. first premolars – Eruption age: 10-12 years
  5. Mand. second premolars – Eruption age: 11-12 years
  6. Mand. first molars – Eruption age: 5-6 years
  7. Mand. second molars – Eruption age: 12-13 years
  8. Mand. third molars – Eruption age: 17-25 years

Things to look for in 7 – 10 year olds

  • Moderate to severe skeletal discrepancies
  • Delayed eruption
  • Infraocclusion or submergence
  • Large overjets
  • Deep overbites
  • Centreline discrepancies
  • Crowding
  • Crossbites
  • Impacted first molars or canines
  • First molars of poor prognosis
  • Persistent habits
  • Abnormal soft tissue patterns

Things to look for in 11 – 13 year olds

  • Skeletal discrepancies
  • Marked overjets
  • Deep or reduced overbites
  • Centreline discrepancies
  • Buccal segment discrepancies
  • Crowding
  • Spacing
  • Anterior and posterior crossbites
  • Missing teeth
  • Unerupted teeth

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