Early orthodontic treatment continues to be a hotly debated topic among orthodontists, with discussions often becoming polarized. Some practitioners hold deeply entrenched, almost dogmatic views on the subject, which can prevent open, evidence-based conversations. Unfortunately, this rigid stance can lead to confusion among parents who are unsure if early intervention is genuinely necessary for their child.
Early orthodontic treatment, often referred to as Phase 1 treatment, involves orthodontic interventions before all permanent teeth have erupted, typically between the ages of 6 and 10. The idea is to address certain dental or skeletal issues early on to potentially prevent more severe problems later. Common goals include expanding the upper jaw, correcting crossbites, attempting to guide jaw growth, improving breathing in children with airway issues, and preventing future dental extractions. However, these last two indications warrant a closer look.
Despite the promises of early treatment, numerous studies show that its benefits are limited, and often temporary—especially when started too early. Research has demonstrated that any early improvements tend to diminish over time. By adolescence, much of the initial progress is often lost, requiring a second phase of treatment to readdress the same issues. In reality, early treatment often serves only to prolong the overall duration of orthodontic care rather than prevent the need for later treatment.
One critical factor that often gets overlooked is that jaw size and shape are primarily determined by genetics. There is no robust evidence suggesting that early orthodontic interventions or exercises can significantly alter this genetic blueprint. While some practitioners claim that early interventions can “guide” jaw growth, the scientific support for these claims is weak.
The same applies to early expansion treatments. When expansion is performed too early, much of its effect diminishes over time, often requiring re-treatment during the second phase. Additionally, studies have consistently shown that expansion does not reliably improve breathing long-term.
One common justification for early treatment is to expand the upper jaw to improve breathing in young children or to reduce the need for future dental extractions. However, the evidence supporting these approaches remains mixed and inconclusive. Studies on whether expansion can alleviate breathing difficulties, such as mouth breathing or sleep apnea, show varied results. Notably, more effective solutions for airway issues are often non-orthodontic, such as removing adenoids or tonsils.
Additionally, the studies that report improved breathing after expansion often have small sample sizes and lack control groups. Some controlled studies have even shown that breathing issues can resolve on their own without any orthodontic intervention, while others suggest that expansion might not make a difference—or could even worsen the problem in some cases.
As for preventing extractions, the claim that early treatment can avoid future dental extractions is largely a myth that has been debunked by research. Even in cases of severe crowding or bite issues, early treatment does not eliminate the need for extractions if they are warranted.
It’s important to acknowledge that early orthodontic treatment often involves a two-phase approach—first with early intervention, followed by braces during adolescence. While this approach is sometimes recommended, it may not always be the most cost-effective way to achieve long-term results. Treating children in two separate phases can extend the duration and complexity of treatment, often increasing the overall cost for families.
For many cases, addressing orthodontic issues in a single, comprehensive phase after the permanent teeth have erupted can be a more efficient and cost-effective strategy, providing equally good, if not better, outcomes. The decision to pursue early treatment should always be based on the specific needs of the patient, not on a generalized approach.
The more experience I gain and the deeper I dive into the scientific literature, the less inclined I am to recommend early orthodontic treatment. While there are certainly specific cases where early intervention can be beneficial—such as preventing severe crossbites or addressing functional issues—the evidence overwhelmingly suggests that, for most children, waiting until the majority of permanent teeth have erupted is a more effective and efficient approach.
In the end, orthodontic treatment should be guided by solid evidence when available and not dogma or other incentives.
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I recommend and prescribe orthodontic treatments to my patients as if they were my own family and I value meaningful relationships based on communication, confidence and trust.
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