Best Age to Start

The American Association of Orthodontists recommends an orthodontic screening by age 7


Why Screen by Age 7?

  • The posterior occlusion or bite is established when the first (or 6-year) molars erupt.  At this time, the orthodontist can evaluate a child's occlusion in all planes of space as well as discover any functional shifts, or abnormal or unstable biting patterns.
  • Incisors or front teeth have begun to erupt & significant problems can be detected such as crowding, habits, deepbites, openbites and some facial asymmetries.
  • For some children, a timely screening will lead to significant treatment benefits; for most, the principal immediate benefit if the parents' peace of mind as the orthodontist confirms that they are not missing any significant "windows of opportunity" for their child.
  • The family or pediatric dentist who makes timely referrals is rightly regarded as informed, caring and concerned for the total well being of the patient. 


While the majority of children will not need Phase I or Interceptive Orthodontic Treatment, for those children who do not present clear indications, Early Treatment offers the unique opportunity to:

  • Maintain or increase space for erupting permanent teeth
  • Correct adverse oral habits such as thumb sucking
  • Improve permanent tooth eruption patterns
  • Reduce likelihood of impacted or "stuck" permanent teeth that could require surgery in the future
  • Coordinate or harmonize the width of the dental arches
  • Lower the risk of traumatic injury to protrusive upper front teeth
  • Prevent certain periodontal or gum tissue problems that can develop due to harmful bites or permanent tooth eruption into arches with severe crowding
  • Influence upper and/or lower jaw growth in a positive manner 
  • Prevent facial & jaw asymmetry by eliminating abnormal functional or biting patterns
  • Enhance facial profile by influencing jaw growth to be expressed in a favorable direction 
  • Improve speech problems
  • Improve facial & dental esthetics and patient self-esteem
  • Improve breathing patterns & mouth/tongue/lip posture to facilitate more normal facial and jaw growth pattern, close anterior openbites & reduce need for jaw surgery in the future

It is Drs. Handy & Handy's philosophy that it is NEVER too early to take a quick look, but sometime

it is TOO LATE to intercept and correct a problem.   It is this belief that underlies the doctor's commitment to providing an orthodontic examination & initial consultation FREE of CHARGE to EVERY patient who comes to our office. 



There is no area with more difference of opinion than the question of whether a patient needs early orthodontic treatment.  

Dentists & orthodontic specialists alike often hold strong and diametrically opposed views.  It is not uncommon for a family to be told that their young 8-year-old child "badly needs early orthodontic treatment" by one orthodontist and then told that early treatment is "unnecessary" by the next orthodontist seen for a 2nd opinion.  Drs. Handy & Handy believe strongly in helping patients and their families make good decisions based upon orthodontic scientific evidence from quality research rather than on unsupported opinions & personal biases.  


The gold standard in orthodontic treatment timing--the most effective & efficient time to treat--is during the adolescent growth spurt and during the late mixed or early permanent dentition.  This is due to the leeway space picked up during the exchange from the primary molars to permanent premolars & due to growth potential remaining to assist orthodontic correction.  Logical reasoning follows that the only reason to depart from this gold standard treatment time would be if   1) Earlier [=[][][=treatment would be more effective & work better, or           2) Early treatment would be more efficient & offer a better cost (time, money, energy) to benefit ratio, or  3) Both of the above. 

Who does NOT need Early Treatment?

"Everything should be made as simple as possible, but not simpler." -- Albert Einstein

Drs. Handy & Handy have helped many parents save thousands of dollars & helped their children save many months of total treatment time in braces by avoiding unnecessary & expensive early or Phase I orthodontic treatment.


Patients with Class I occlusion (good posterior bites) with crowding or spacing and protrusive teeth do NOT need early treatment.  

They may need eruption guidance or extraction of some baby teeth over time to aid eruption of permanent teeth and/or reduce risk of impaction of permanent teeth that could necessitate surgery in the future.


Patients with mild, moderate & even moderate-severe Class II malocclusion (excessive "overbites") do NOT need early orthodontic treatment.  While early treatment does lead to a reduction in overbite in 75% of cases, research has conclusively established that patients who receive early treatment do NOT finish with a better orthodontic result at the end of full treatment as compared with patients who do not receive early intervention.  The orthodontic results of the patients who receive early treatment are indistinguishable from patients who are only treated later at the normal adolescent time.  

The only difference is that the patients who receive early treatment are in braces longer & their parent's bill is higher.


Patients with severe Class III ("underbite") or severe, persistent anterior openbites do NOT** need early orthodontic treatment and may, in fact, be best advised to delay orthodontic treatment until later in adolescence.  Such cases are most often due to substantial, adverse skeletal growth patterns and may require orthodontics in combination with surgery to achieve full correction. 


** Special Note:  Some patients with an anterior openbite have airway issues as an underlying problem.  Such "mouth breathers" may benefit from our team approach to helping them achieve a normal breathing pattern and mouth/tongue/lip posture.  Openbites with airway problems are serious cases that often require orthodontics plus major jaw surgery to correct.  Early intervention & correction is NOT curative in all cases, but historical and ongoing research has shown promise in some children of facilitating a more favorable facial growth pattern, reducing or closing the openbite, improving speech, improving sleep, reducing ADHD, improving self-esteem and, in some cases, reducing or eliminating the need for later jaw surgery.


Patients with Class III malocclusions ("underbites") DO often need early orthodontic treatment.  Orthodontic treatment for and "underbite" is more effective at a younger age (between 7-10 years old most commonly) & can help protect a patient's teeth from wear and fracture, protect their gum tissue from recession and reduce the risk of needing orthognathic surgery to correct their bite later. 


Patients with a posterior crossbite (narrow palate) and an associated shift or deflection of the lower jaw when biting down DO need early orthodontic treatment as correction of the crossbite & reduction or elimination of the mandibular shift has been shown to reduce the risk of asymmetrical lower jaw growth.  Research as yet is not definitive regarding whether early expansion of the palate if critical in cases without an associated shift of the mandible though experienced orthodontists have long observed bite opening.


Patients with significant social concerns due to their bite or the alignment of their teeth MAY often times benefit from early orthodontic treatment.  Kids can be tough on each other (and on themselves) and addressing smile esthetics through early treatment can benefit some patients with regard to their self-image & interactions with peers.  In such cases, it is important that the orthodontist confirm that permanent tooth root development is sufficient & proximity of tooth roots to be moved relative to unerupted teeth is acceptable to allow safe orthodontic tooth movement. 



Drs. Handy & Handy are highly trained in all forms of early or Phase I orthodontic treatment.   In fact, early treatment through growth modification was a strong focus & passion of Dr. Gordon's during his orthodontic residency and remains an area of diligent study for him to this day.  But in the end, evidence trumps opinion.  It Is Dr. Thom's & Dr. Gordon's commitment to recommend early orthodontic treatment when it would help achieve a better ultimate result for your child in the end but to recommend against early treatment when all it would do is keep your child in braces unnecessarily long & cause your bill to for treatment to be unnecessarily high.

One Important Note:  If your child is having social concerns and/or getting teased at school because of his or her teeth, please share this with Dr. Handy.  We love kids & we don't like to see them bullied or made fun of.   Early treatment may be the most loving thing we can do for your child in this situation.  

Drs. Handy & Handy hope this review of scientific research regarding early orthodontic treatment will help you & your family distinguish between opinion or concerns regarding early treatment, please do not hesitate to ask Dr. Thom or Dr. Gordon.  They will be happy to talk with you & always recommend for your child only the treatment they would pursue for their own children and grandchildren. 

Scientific Study Abstract

Below is the abstract of an excellent UNC Department of Orthodontics scientific study documenting that 2-phase orthodontic treatment (early or Phase I followed by later comprehensive or Phase II treatment) of children with severe "overbites" was no more effective than 1-phase treatment (only comprehensive or full treatment) starting during adolescence in the early permanent dentition.

Outcomes in a 2-phase randomized clinical trial of early Class II treatment

J.F. Camilla Tulloch, BDS, FDS, DOrth,  William R. Proffitt, DDS, PhD,  and Celb Phillips, PhD, MPH

Chapel Hill, NC

In a 2-phased, parallel, randomized trial of early (preadolescent) versus later (adolescent) treatment for children with severe (>7mm overjet) Class II malocclusions who initially were developmentally at least a year before their peak pubertal growth, favorable growth changes were observed in about 75% of those receiving early treatment with either a headgear or a functional appliance.  After a second phase of fixed appliance treatment for both the previously treated children & the untreated controls, however, early treatment had little effect on the subsequent treatment outcomes measured as skeletal change, alignment, and occlusion of the teeth, or length and complexity of treatment.  The differences created between the treated children & untreated control group by phase I treatment during adolescence.  This suggests that 2-phase treatment started before adolescence in the mixed dentition might be no more clinically effective than 1-phase treatment started during adolescence in the early permanent dentition.  Early treatment also appears to be less efficient, in that it produced no reduction in the average time a child is in fixed appliances during a second stage of treatment & it did not decrease the proportion of complex treatments involving extractions or orthognathic surgery.  (AM J Orthod Dentofacial Orthop 2004;  125: 657-67)

If you are interested in more detail, we will be happy to provide our patients or their parents with a copy of this journal article in its entirety.


H2O Canine Kids Club is a special club just for our younger patients who are not yet ready to be in full braces.  Most patients are seen for brief recall evaluations approximately every 9 months at this stage.  

Drs. Handy & Handy like to begin to monitor children at about 7-8 years of age.  Kids at this age can begin to get comfortable in an orthodontic setting, make friends with the H2O team & learn that there is no reason for any fear nor anxiety in our fun office!  


As the permanent 1st molars & permanent incisors are also erupting at this age, this is a great time to evaluate some baseline tooth and bite characteristics so that Dr. Handy can carefully monitor & anticipate developing orthodontic problems and be certain not to miss any important windows of opportunity for correction.

There is no fee for these early evaluations.  The benefit is great peace of mind from knowing that Dr. Handy is overseeing emerging orthodontic issues at this important developmental stage in your child's life.  

Kids Love Being Part of H2O Canine Kids Club!



At their 1st visit to our office, they receive a bag of fun prizes & a cool T-shirt 


Kids & their parents become eligible for office drawings for all BIG PRIZES and special H2O Canine Kids Club only drawings throughout the year


Get free "H2O to Go" seasonal products


Most importantly, send a photo of you & your dog (or other pet) for us to post in the Canine Kids Club Section of our website, and on Facebook, Instagram & Twitter