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“We should’ve been here sooner” Is a phrase that I am much too familiar with. Most recently I heard it from a Mom with a look of resolution on her face after she understands that her daughter, in addition to braces, will now need to visit an oral surgeon to gain access to two teeth that are years late in erupting and will never come in on their own. It’s very obvious even to someone who is looking at a panoramic X-Ray for the first time.

I go through “doctor moments” like these with families on a weekly, sometimes daily basis, and the parents reach these conclusions on their own. I don’t place any blame because I don’t know what the monitoring plan was for a Patient I’ve never seen before. It may be a lack of x-rays taken because insurance only pays for one a year. (or 3 or 5 years!) It may be lack of regular visits to the family dentist.

Assuming this was a case of the former, regular orthodontic checkups are critical. I’m a fan of the Doctor being the one to decide what diagnostics should be done and when, not the insurance company. The way around that in our office is simply not charging for x-rays, records, or consultations. Not only does it mean less time our staff uses filing insurance claims, but I think there’s a “positive vibe” when the Patient is in an observation mode to stop in for a quick check and not have to worry about what the charges may be. Essentially, there’s no way I can properly monitor a developing smile without x-rays so I’m not going to wait until insurance will cover them.

There’s a big misconception about orthodontic checkups. Don’t get me wrong, some dentists do a great job monitoring and referring before there is a problem. The American Association of Orthodontists has recommended that kids be seen “by age seven” for decades, so this is nothing new. Years ago I started the webpage to work on awareness for the need for early orthodontic checkups. Here are a few facts about this concept:

  1. After the 6-year molars erupt, an orthodontist can give a reasonable opinion on whether treatment will be needed and when.
  2. Even if the teeth look great clinically, there could be something much more concerning on the x-ray (like in the Patient I discussed in the beginning).
  3. A small percentage of Patients benefit from treatment in two stages, one while there are still baby teeth and one once all the permanent teeth have come in.
  4. Only severe problems are treated in two steps, or “Phases”. The reason for the early phase or “Phase I” could be significant jaw growth issues, severe crowding where jaw expansion is needed, psychological concerns with significantly crooked teeth and correcting other growth related concerns, just to name a few.
  5. We always carefully explain the criteria for Phase I treatment and point out the findings and recommendations, including delaying treatment. Once they see the concerns and understand everything, the parent always makes the final call. In orthodontics you don’t have to be an orthodontist to make a decision to treat or not, you just need to be one to get the job done right.

The vast majority of my Patients need treatment in only one Phase and if they follow the retention protocols, likely won’t ever need treatment again. To treat or not to treat early comes down to this: if I can “look forward” to age 13 and feel as though I would wish I’d recommended treatment earlier to make the current situation better, then I recommend treatment.

On a personal note, I treated my oldest daughter with Phase I treatment and she’s now in Phase II. My second daughter looks as though she’ll need Phase I as well in addition to having a tooth that has an eruption angle that I’m concerned about. My core philosophies are to recommend for your child as if they were my own and doing the right thing sometimes takes a bit more work but in the end it’s always worth it.


Dr. John