At what age should children see an orthodontist?

I am concerned about the way my child's teeth are coming through but they still have some baby teeth. Is it too early to see an orthodontist?

Many people have the opinion that it is not worth visiting an orthodontist before all the baby teeth have fallen out. This is because, the traditional fixed (train-track type) braces can only be used for adult teeth. 

However, there are situations where it is better to see an orthodontist earlier. 

The adult teeth start coming through from around 6 years old and if there are any concerns an orthodontic assessment can be done between the age of 7-9 years.

For some orthodontic problems treatment can be started before all the adult teeth have come through.

Which orthodontic problems may be suitable for early diagnosis and treatment?

• Baby teeth removed early - other teeth may tilt into or take up the vacant space, causing the permanent teeth to come through crooked. Using a space maintainer can prevent more complicated and costly treatment later on.

• Protruding front teeth - which can be prone to accidental injury.

• Open bites - teeth not meeting when biting together.

Upper incisor tooth in "cross-bite" behind lower incisor

• Cross bites - upper teeth coming through behind the lower teeth.

• Difficulty in biting or chewing.

• Growth discrepancies of the jaws and/or teeth out of proportion.

• Some cases of crowding - not enough space for all the adult teeth.

• Missing teeth - sometimes teeth are absent from birth (they just do not grow). An x-ray would be needed to confirm the tooth or teeth are missing. A decision can be made to either close the space or maintain the space for dental implants later.

• Adult teeth under the gum that do not come through within the normal age range - the cause can be investigated and treated. 

• Large gap between the upper front teeth (diastema) - investigation and treatment is often more successful if done earlier.

• Asymmetrical smile

• Persistent thumb or finger-sucking habits - see previous blog for more information. 

What are the goals of early orthodontic intervention?

• Make room for permanent teeth to come through and guide them into the correct position.
• In the case of jaws which are out of proportion, functional appliances can guide the growth of the jaws and correct certain bite problems.
• For simpler problems, later orthodontic treatment may be avoided.
• Potentially simplify and shorten later comprehensive orthodontic treatment  for more complex cases.
• Improve personal appearance and self esteem.

If you are unsure, it is best to see your dentist for a check-up first - they will be able to advise you whether your child would benefit from an early assessment with an orthodontist.

How can I stop my child sucking their thumb?

Is thumb sucking normal?                                                                                                                                             

At what age does it become a problem if my child has not stopped the habit?                                                                                                                                                       I'm concerned that thumb sucking is affecting my child's teeth - what can be done?                                                                                                                                                                                                                                                                                                                                   

       

Why do children suck their thumbs?                          

Thumb or finger sucking is perfectly normal for babies. In fact, some babies even start in the womb! The sucking reflex is necessary for feeding but babies also have a natural instinct to suck when they are not feeding as a way of self-soothing.

Babies and small children may suck their thumb or fingers or a pacifier when they are anxious, unwell, bored or as a way to get to sleep. Many children give up the habit on their own between 2 and 4 years old.

When does thumb-sucking become a problem?

If a child sucks their thumb, finger or pacifier intensely and regularly or for long periods of time it can affect their front teeth, causing them to be pushed forwards and creating a gap between the upper and lower front teeth. This can sometimes cause speech problems. In young children, unless there is some other factor causing the teeth to be crooked, the teeth will usually move back to their normal position spontaneously once the habit is stopped

If a child continues the habit after 4 or 5 years old then it may start to affect the position and appearance of their adult teeth as they come through. The longer the habit continues after 6 years old, the more likely that orthodontic treatment (braces) will be required to correct position of the adult teeth. 

What can I do to help my child stop?

• Don't nag or punish your child for sucking their thumb. Many children suck their thumbs when they are stressed or anxious, so this will only make the problem worse.
• Talk calmly with your child to try to find out why they suck their thumb. 
• Explain that the habit can cause teeth to become crooked. Ask if they would like help to stop.
• Reassure your child that as they are maturing and growing up they will be able to stop - discuss some things they used to do as a baby which they no longer do now.
• If there are particular situations that trigger the habit try to offer distractions or something to keep their hands busy.
• If your child is sucking their thumb when anxious or stressed discuss the issues and try to find other solutions for reassurance or comfort.
• Use positive reinforcement. You could make a chart where you can give a star for each day your child goes without sucking their thumb. You could agree on a reward or treat after a number of days or weeks.
• For some children, it is a subconscious habit and just reminding them (without nagging!) when they are doing it can help them stop.
• For others, putting something on the thumb, such as a small bandage, can act as a reminder. 
• If you find your child is using thumb-sucking as a way of getting attention you may be better to start ignoring it instead.

What if I have tried these ideas and it has not worked?

Firstly, visit you dentist. They can assess your child's teeth and give advice.

For those children who have real difficulty giving up the habit, a habit breaker appliance can be used. This would involve first making a mould of the teeth, so that the appliance can be made in a dental laboratory.

Habit-breaker Appliance

A habit breaker appliance is fixed to the back teeth and has a blunt wire which sits behind the upper front teeth. This does not cause any pain but it makes trying to the suck the thumb uncomfortable and therefore takes away the pleasure of the habit. Even if your child still puts their thumb or finger in their mouth they will not be able to create  the suction force which causes pressure on the teeth.

The same day a habit breaking appliance is fitted, a child may experience initial discomfort around the back teeth. Speaking and eating but be a bit more difficult for the first few days but should soon return to normal. Advice is given on care and cleaning of the appliance.

The appliance is usually worn for 6-12 months, with regular checks at the dentist. It has found to be very successful in breaking the habit and allowing the teeth to return to their normal position.

If you have any other questions, please make a comment below or visit your dentist.

How to help a child who is anxious about the dentist - Part 2

In the first part of this blog we discussed finding a child-friendly dentist and how to help your child before an appointment.

Maybe you have a dental appointment approaching. How can both you and your dentist make things easier for your child during their visit?

How can the dentist help my child?

Treatment room at Small Bites

• Taking things one step at a time will help to build up confidence. It is usually best to start with a check-up and simple cleaning before moving onto other treatment.  
• Young children are not able to sit still or concentrate for long periods of time, so visits are best kept shorter or have breaks when needed.
• The dentist may introduce a "stop signal," like raising a hand, that can be used so that your child can let the dentist know if they are not comfortable or need a break.
• Distraction can be used to give your child something else to think about other than the dental treatment. For example, music, cartoons on a TV screen or simply chatting about something else.
• A good dentist will explain things in a way that your child can understand as they go along. Long explanations and words may be confusing for your child. It is best to have a separate chat with parents while the child plays it the waiting room if required.
• The dentist can first explain, and then demonstrate any tools or materials before using them. For example, an instrument can be used on the back of the hand or finger nail before it is used in the mouth so your child knows what it feels like. 
• Although the dentist should be friendly with your child they may need to use a sterner tone of voice if a child is not listening and following instructions much the same as a schoolteacher would.

Certificate of Bravery

• Positive Reinforcement - when a child behaves and cooperates well they should be rewarded with praise, stickers, a small gift or "bravery" certificate.

Should parents stay in the room for dental treatment?

This depends on your child's age and behaviour. Young children (below 4 years) tend to experience separation anxiety and therefore it is usually advised that parents stay in the room. 

Some children "play up" to their parents and behave better when they are not in the room. One solution for this is to allow the parent or carer to stay in the treatment room whilst the child behaves well, but ask them to go to the waiting room if the child is not listening and following instructions.  

How can I help my child during a dental visit?

• In the previous post we discussed the importance of staying positive and encouraging your child. 
• For young children, you may need to help support your child on your lap while that dentist checks their teeth as shown in the picture.

• If your child makes a fuss try to remain calm. Dentists who treat children regularly will have seen their share of tantrums and be prepared for this. Allow the dentist to guide you on how to best support you child.  
• Some children will "act up" at the dentist to try to avoid treatment. If they are immediately taken out of the treatment room they are more likely to do the same thing the next time. Instead it should be explained to the child what needs to be accomplished in that visit. If cooperation is difficult it is better to achieve a lesser goal than planned, for example, placing a temporary filling, than abandon treatment altogether.

It is better to use rewards after the treatment is over than to promise bribes before hand. 

Show your child how proud you are of them for each new achievement.

Finally - Prevention is better than cure

Although, with some help, the majority of children can learn to cope with (or maybe even enjoy!) visiting the dentist the goal should be to prevent the need for dental treatment as far as possible.

It's a great feeling to take your child for a check up and be told that there are no cavities!

Here are some tips for preventing dental decay and gum disease:

• Thorough tooth brushing twice a day, morning and night. For more brushing tips see this post (click for link).
• Rinsing out the mouth with water after eating.
• Eating a healthy diet and making snacks and drinks, between meals, sugar free as far as possible. 
• Dental sealants are a coating placed on the biting surface of the back molar teeth by a dentist. They protect the narrow pits and grooves of the tooth which can be prone to decay. See this post for more information (click for link).
• Regular check-ups not only get your child used to visiting the dentist but enable any early signs of dental disease to be spotted and prevented from progressing into a bigger problem.

How to help a child who is anxious about the dentist - Part 1

Do you dread taking your child to the dentist? 

Are you worried about how your child will behave? 

Do you put off visiting the dentist until your child has toothache?

Maybe you are anxious yourself and don't know how to help you child overcome their fears?

In this two part blog we will look at ways in which you can make visiting the dentist less stressful, and maybe even enjoyable for you and your child.

Children are not born with a fear of going to the dentist. A small child visiting the dentist for the first time will not know what to expect, apart from what they have picked up from their parents and others around them. Therefore, it is important to try to give your child a positive view of dental health. Depending on your child's age, you can discuss or show them the importance of teeth and looking after them in an appropriate way. They can be encouraged to view the dentist as someone who helps them look after their teeth.

If you are anxious yourself, or have had a bad experience in that past, try not to talk about this in front of your child and advise other family members and friends to do the same. 


A recent study showed that parents' attitudes towards dentistry are often passed on to their children. Children are often listening in on our conversations with others, even while we think they are playing or doing something else. They even pick up on anxieties that we do not speak about by our expressions. If you have fear of the dentist you may find this 4 part blog (click for link) helpful for advice on overcoming your own anxiety.

Finding a child friendly dentist

Of course, it is important to find a dentist who is good with children. Not all dentists are good at, or enjoy, working with children. Find a practice where the dentist and their support staff relate well to your child and work to gain their trust so that your child can feel comfortable with them. The environment is also important in putting your child at ease and the decor should be fun. The waiting area should have toys, books or some form of entertainment to make waiting easier. 

Ask around for recommendations from friends and family or look at reviews from other parents. You can ask dental practices about their experience and expertise in treating children. Pediatric Dentists (or Pedodontists) are specialists in children's dentistry and usually have 3 years further training in Pediatric Dentistry after dental school. If you are in Bangalore, Small Bites in Indiranagar provides exclusive dental care for children. Here, we believe that every child deserves a good start in life with the best preventive dental care.

How can I help my child at home before a visit?

• Try to schedule the appointment at the best time for your child. Small children especially do not do so well if they are tired and hungry. 
• If you or your child are anxious, try to choose a time when the dentist is less busy to minimise waiting and so that there will be more time to discuss any issues and concerns. Even if this means that you have to take time off work it may be worth it for a first visit.
• Be positive. If your child is anxious, listen and show them you understand their concerns but express confidence that they will be okay. 
• Do not use words or scare stories that may upset your child. Even if you say "it's not going to hurt" the main word that your child will hear is "hurt", even though this may not have been in their mind before. 
  
• For young children, you could "play dentist" at home. You and your child can take it in turns to "be the dentist" and check each others teeth. Also try using your child's favourite soft toy or a puppet and "check their teeth." You can buy small plastic mouth mirrors for this, or just use your toothbrush. 
• If your child has a sibling, cousin or friend who is good with the dentist it may be helpful to visit the dentist with them first.
• There are many good children's books and videos available which can help children to understand about going to the dentist.
• If your child has had a difficult time at the dentist in the past, ask them about their concerns. Discuss these with your dentist to find ways to help your child before the next appointment.
• If one parent is particularly anxious, it may be better for the other parent, or another close relative, to bring the child for their appointments.

Ideally, a child's first experience at the dentist should not be for treatment. If at all possible, try to take your child just to see the dental practice and meet the dentist, or at most have a quick check-up, before they have any problems. This will help them to feel comfortable with the environment. 

At Small Bites we also have children's activities (advertised on our Facebook page - click for link) held in the clinic. This is a chance for children to get used to the environment and have fun on a separate day from any appointments. 

If your child, already has pain or problems before they have visited the dentist, don't worry. A good dentist will aim to alleviate the pain at a first visit but do further treatment as your child increases in confidence and cooperation.

Regular visits for check-ups will help your child. It is much better if they do not need treatment every time they have an appointment.

In the second part we will discuss ways that you and your dentist can help your child during their visit and some tips for preventing dental problems.