Is Phase I and Phase II Orthodontic Treatment Necessary for Everyone?

You have likely seen your children’s friends with braces and wondered, does my child need treatment too? While many children can benefit from an early phase of orthodontics, many more would be best served by waiting for further dental development before starting braces or clear aligners. However, that does not mean you should put off a consultation with an orthodontist until your child is a teenager.

In this article, you’ll learn:

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When should children have an orthodontic evaluation?


The American Association of Orthodontists (AAO) recommends an initial orthodontic screening at the age of 7 years. While this may seem early to start bringing your child to the orthodontist, changes in the developing teeth and jaws should have regular monitoring. Most orthodontists are happy to provide an evaluation if you or your child’s dentist has concerns before age 7. Dental cleanings and check-ups are important, but they are not substitutes for an orthodontic evaluation. To learn more about what age to start braces, read our post: How Old Do You Need to Be to Start Braces?


What are the indications for Phase I Treatment?


1) Unbalanced upper and lower jaw growth
When the jaws are not in balance, an excessive “overbite” or “underbite” can result. Addressing jaw imbalance during a period of growth can result in improved outcomes while simplifying future treatment needs.

2) Crossbites
A crossbite is when an upper tooth sits inside or behind a lower tooth. Crossbites may cause the jaw to shift, which can cause asymmetric jaw growth and irreversible wear on permanent teeth. Treatment of a crossbite works best when children are in a growing phase because the sutures of the palate have not yet fused, allowing for the expansion of the palate.

3) Deepbites & openbites
A deepbite is when the front teeth overlap too much, which can cause pain and periodontal (gum tissue) issues. An openbite is when the teeth do not overlap enough, often caused by finger sucking or tongue thrusting. Openbites sometimes cause difficulty with speech or eating.

4) Severe crowding
Crowding or overlapping teeth can impact the ability of the permanent teeth to erupt correctly. If left untreated, crowded teeth may need an extraction or surgical exposure. Mild crowding is generally not a concern as long as permanent teeth have space to erupt and are not negatively impacting other teeth.

5) Teeth developing out of position as seen on an x-ray
Annual x-rays are typical in orthodontics to evaluate the position of teeth that have not yet erupted. Many orthodontists offer digital x-rays, so there is less exposure to radiation than older machines. Not addressing teeth erupting in the wrong direction can cause damage to neighboring teeth and result in impacted teeth, both of which could lead to more costly and invasive treatment options. It is sometimes possible to redirect an erupting permanent tooth by having a baby tooth removed or orthodontically making space.

6) Psychosocial concerns or difficulty eating/cleaning teeth
These concerns would come from you or your child, not your orthodontist. If your child is concerned about how his teeth look, or he does not like to smile, it may be time to consult with an orthodontist.

7) Airway
The size and position of the jaw bones can directly impact the flow of oxygen through the nose and mouth. Addressing the airway during a growth period can affect the airway and the child’s quality of life. Management of airway concerns often involves your child’s pediatrician, speech therapist, ENT, and other specialists. If you have concerns about your child’s airway, consult your pediatrician.

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What are the indications for Phase II Treatment?


Because the goals of Phase I treatment are usually specific and limited, Phase II treatment is often recommended for the final correction of the bite (how the teeth fit together when you bite down) and tooth position for optimal function, esthetics, and health.


What are the benefits & potential drawbacks of Two-Phase Treatment?


Benefits:
  • Phase I treatment can often provide a superior result compared to waiting until all the permanent teeth erupt
  • Younger patients are often better cooperators with treatment than they would be as pre-teens/teenagers
  • Phase I treatment is usually pretty quick, taking only about 12 months
  • Phase II treatment is often shorter in duration and less complex than a comprehensive phase of treatment
Potential drawbacks of Phase I treatment:
  • Going through orthodontics two separate times means more time and money invested in the process and potential burnout for the patient.

Do all children need Phase I and Phase II Treatment?


Just like medical doctors have varying opinions, so do orthodontists. Some orthodontists prefer that all their young patients receive two phases of treatment, while others prefer that all permanent teeth are in before starting treatment. And others, like Dr. Garfinkle, only recommend Phase I treatment because it could result in a superior clinical outcome or eliminate more costly problems in the future.


The Takeaway


At Garfinkle Orthodontics, our goal is to optimize the treatment outcome and experience for each patient while minimizing the burdens of treatment (cost, length of treatment, and discomfort). On average, Dr. Garfinkle recommends Phase I treatment for 1 in 10 children in our practice. Otherwise, we see young children annually to monitor jaw growth and tooth eruption. If you are unsure about the treatment recommendation for your child, seek a second opinion to learn more about your options.

Erin Fortman is a long-time employee of Garfinkle Orthodontics, working as our Marketing and Treatment Coordinator. She is a mother of two young children and a former patient of Dr. Garfinkle, which provides her with a unique and in-depth understanding of the orthodontic process as it relates to the concerns of our patients and their parents.