Early signs of orthodontic problems in children

The aim of orthodontic treatment is not only to straighten the teeth, but also to ensure proper bone development and a healthy, functional bite. For this reason, early detection of crooked teeth in children is important, as it allows for the early identification of any orthodontic or developmental issues.  

To ensure healthy development of the smile, the American Academy of Paediatric Dentistry (AAPD) recommends that the first orthodontic check-up should take place around the age of 7. At this age, the orthodontist can assess the structure of the jaws and the alignment of the teeth at an early stage, so as to intervene quickly if necessary.

Interceptive orthodontics, or the early detection of orthodontic problems, aims to prevent future complications, such as difficulties with chewing, speech or aesthetic issues. Early monitoring also helps ensure the healthy development of the bite and facial harmony. 

The recommendation to visit an orthodontist around the age of 7 is based on the fact that, in most children, this is when the central incisors and first permanent molars appear. This stage allows the orthodontist to detect the first abnormalities in the growth and development of the facial bones and dental system, such as crooked teeth, dental crowding, jaw compression or malocclusion (incorrect bite).

Children may have crooked teeth or other orthodontic problems for a number of reasons, the most common being:

• Genetic factors: Genetic predisposition can influence the shape, size and alignment of the teeth and jaws.
• Abnormal jaw development: Insufficient or excessive growth of the jaws can lead to misaligned teeth.
• Thumb sucking: Bad habits, such as prolonged thumb sucking or the use of a dummy, can affect the position of the teeth in the jaw.
• Early or delayed teething: Problems during tooth eruption can lead to misalignment.
• Trauma or injury: Blows to the mouth can alter the natural position of the teeth.
• Breathing problems or nasal congestion: These can influence the position of the head and jaws, contributing to crooked teeth in children. 

Parents should be aware that, alongside the paediatrician, ENT specialist and paediatric dentist, the specialists in Orthodontics and Dentofacial Orthopaedics at the DENT ESTET 4 KIDS and DENT ESTET 4 TEENS clinics monitor vital functions such as breathing, speech, chewing and swallowing. During the clinical examination, orthodontists assess whether these functions are operating normally, without any disruptive factors that could affect the child’s harmonious development.

“Children with misaligned teeth may experience problems with chewing and speech, which affects their diet and communication. Furthermore, dental malocclusions and crooked or crowded teeth facilitate the build-up of bacterial plaque, which can lead to tooth decay and gingivitis. Furthermore, incorrect tooth alignment in children can lead to uneven tooth wear and long-term jaw posture problems,” explains Dr. Kimia Azar, Specialist in Orthodontics and Dentofacial Orthopaedics at DENT ESTET 4 KIDS clinics.

Crooked teeth in children – the impact on self-confidence

To support healthy physical and emotional development, it is important to monitor and intervene early in children with crooked teeth or dental malocclusions.

Unattractive teeth can cause children to become reluctant to smile, speak in public or socialise. Over time, they may develop low self-esteem, exacerbated by comments or teasing from peers, which can significantly affect their social and emotional development. 

It is important to note that a specialist in Orthodontics and Dentofacial Orthopaedics is a dentist who can identify the early signs of problems requiring treatment with braces. That is why a visit to the orthodontist from the age of 7 is extremely important. However, there are situations where the early signs of orthodontic problems in children can be spotted even by parents, before a visit to the dentist or orthodontist.  

Among the most common signs are:

• Incorrect bite: the upper teeth do not overlap the lower teeth normally (reverse bite, open bite, deep bite);
• Crowded teeth: permanent teeth erupt crookedly or do not have enough space;
• Large gaps between teeth: these may indicate missing teeth or disproportionate jaw development;
• Delayed or premature tooth eruption: loss of milk teeth too early or too late;
• Persistent oral habits: thumb sucking, prolonged use of a dummy, mouth breathing;
• Difficulty chewing or biting food;
• Teeth that rub abnormally or show visible wear;
• Midline deviation: the upper and lower teeth do not align in the middle;
• Asymmetrical facial appearance or a jaw that is too prominent or receding;
• Slurred speech (in some cases, orthodontic problems affect pronunciation).

Early signs of orthodontic problems in children are not limited to the teeth, but also extend to craniofacial development. Facial asymmetries, obvious discrepancies between the size of the maxilla and the mandible, or an abnormal convex or concave facial profile may indicate the presence of skeletal malocclusions.  

“Identifying these at an early age by an orthodontist is essential, as interceptive treatment can guide the harmonious development of the jawbones, with immediate implications for the child’s general health. Ignoring orthodontic problems in children or adolescents can, over time, lead to both aesthetic and functional complications,” explains Dr. Kimia Azar.

The most significant risks are:

Dental and oral health problems

• Tooth decay and periodontal disease – crowded teeth are harder to clean properly, increasing the risk of bacterial plaque, tartar and gum inflammation.
• Abnormal tooth wear – an incorrect bite causes teeth to wear down unevenly or even crack.
• Premature tooth loss – due to inappropriate pressure on the roots and gums.

Chewing and digestion problems

Crooked teeth and misaligned jaws can make it difficult to chew food properly. Over time, poor chewing can affect the digestive process and, consequently, the way the body absorbs the nutrients needed for healthy development.

Aesthetic and speech problems

• An unattractive smile or misaligned jaw can affect a child’s self-esteem and confidence.
• Pronunciation defects (e.g. lisping) caused by incorrect positioning of the teeth or tongue.

Problems with maxillofacial development and structure

• Imbalances between the upper and lower jaws, which can become more difficult to correct in adulthood.
• In some cases, pain in the jaw, the temporomandibular joint (TMJ) or even headaches may occur.

More complex and costly treatment in the future

If problems are not detected early, correction may require longer treatments, more complicated braces or even surgery in adulthood.

According to the recommendations of the American Association of Orthodontists and European specialist societies, the first orthodontic assessment should take place around the age of 7, when most children have a mix of milk teeth and permanent teeth, and the dentist can assess both dental alignment and skeletal development.

Recognising and monitoring early signs of orthodontic problems in children allows for the initiation of interceptive treatments or even simple growth guidance measures, which play a vital role in preventing the development of complex malocclusions and ensuring the harmonious development of the dento-maxillary system.

“At the DENT ESTET 4 KIDS and DENT ESTET 4 TEENS clinics, interceptive orthodontic treatment is personalised, which means that the therapeutic measures and methods differ from one patient to another, depending on the child’s individual characteristics and stage of development,” says Dr. Kimia Azar, Specialist in Orthodontics and Dentofacial Orthopaedics. 

Nowadays, paediatric orthodontics has come a long way and offers solutions that are more effective, more aesthetically pleasing and more comfortable than in the past. Whereas parents used to think almost exclusively of traditional metal braces, today there are modern options that address both medical needs and concerns regarding appearance and comfort.

Fixed, removable and clear aligners are the most commonly used solutions for correcting crooked teeth in children or other orthodontic problems. The correction of crooked teeth is carried out in a personalised manner, taking into account the child’s age, the type of malocclusion and the family’s preferences, so that the treatment is not only effective but also easier for children to accept.

Fixed braces vs. removable braces

Fixed braces are the traditional, yet modernised, form of orthodontic treatment, making them the right choice for a wide range of orthodontic problems in children and teenagers alike.  

Generally, a child can begin orthodontic treatment with fixed braces around the age of 12, when, in theory, the process of permanent tooth development has been completed. However, there are situations where starting orthodontic treatment at a younger age (interceptive orthodontics – phase I) can help reduce the duration of subsequent orthodontic treatment (phase II), as issues are addressed and treated at an early stage.  

Whether we are talking about braces with metal, ceramic or self-ligating brackets, they ensure precise and constant movement of the teeth, leading to stable, long-term results.

Removable braces are generally used for younger children, around the age of 6–10, during the period when milk teeth are being replaced by permanent teeth. Its main role is to guide tooth eruption and prevent more serious problems, whilst fixed braces become the standard solution once the permanent teeth have erupted and are the most effective for the complete and comprehensive correction of crooked teeth and bite issues.

Also included in the category of interceptive orthodontic treatments is the dental disulator. This serves to widen the upper jaw when it is narrow, to create space for the permanent teeth. The use of a disulator can even correct breathing, in cases where the child breathes predominantly through the mouth.

Treatment of maxillary compression

Currently, cases of maxillary compression detected at a young age are becoming increasingly common. Maxillary compression is a dento-maxillary anomaly characterised by the transverse narrowing of the upper jaw, which leads to an imbalance between the two dental arches.

It most commonly manifests as a posterior crossbite (the upper teeth bite ‘inside’ the lower teeth).

Maxillary compression has numerous causes:

• Hereditary factors – genetic predisposition to a narrow jaw.
• Functional factors – chronic mouth breathing, adenoid hypertrophy, bad habits (thumb sucking, tongue thrusting).
• Growth imbalances – insufficient development of the upper jaw compared to the lower jaw.
• Local factors – early loss of milk teeth, abnormal tooth eruption.

Maxillary compression has sufficiently obvious clinical manifestations, so parents may notice some of these signs:

• Unilateral or bilateral crossbite
• Crowding (teeth do not have enough space)
• Mouth breathing and sleep disorders (in severe cases)
• Aesthetic: high-arched palate
• Possible speech disorders

The role of technology in paediatric orthodontics

Today, with the help of modern technology, a visit to the dentist is transformed into a much more child-friendly experience. Instead of traditional methods, which are often uncomfortable or difficult to accept, at DENT ESTET 4 KIDS and DENT ESTET 4 TEENS clinics we use digital solutions and appliances perfectly tailored to children’s needs.

The benefits of technology in identifying early signs of orthodontic problems:

• Rapid and accurate diagnosis – 3D scans and digital X-rays provide clear images with minimal exposure, avoiding the discomfort of traditional impressions.
• Personalised treatment – removable appliances or aligners for children are made using innovative technologies, ensuring a perfect fit and making them easy to wear.
• Comfort and aesthetics – modern solutions are more discreet, more comfortable and better tolerated by young patients.
• Remote monitoring – digital apps and sensors help parents and doctors track the effectiveness of treatment without frequent visits to the clinic.
• Education and motivation – digital simulations show children what their smile will look like at the end, which motivates them to cooperate.

“Early identification and treatment of orthodontic problems in children are essential steps in ensuring harmonious dental development and preventing long-term complications. Early intervention not only corrects tooth alignment but also contributes to the child’s general health, comfort and self-confidence. Investing in oral health from an early age plants the seeds for a beautiful smile and a life full of confidence and happiness,” explains Dr. Kimia Azar, Specialist in Orthodontics and Dentofacial Orthopaedics.