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When should my child start braces? And do they need them at all?

Not every child needs braces, and some problems are easier to treat while your child is still growing, so an early orthodontic assessment, an examination focused on the bite and the growing jaw, tells you whether anything needs monitoring, treatment now, or can wait. The time for it is when the adult teeth start coming through, or sooner if you notice something; Dr. Adnan's training brings two fields together, paediatric dentistry and orthodontics.

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A thin terracotta line drawing on handmade paper: a row of small baby teeth, and beneath them bigger adult teeth waiting their turn, with olive sprigs around.

What you might notice in your son or daughter

These are things you might spot while you brush their teeth or when they laugh. None of them means braces for certain, but each one deserves a look:

Their teeth overlap. The new front teeth are coming in tilted, or one behind another, because there is not enough room. A little crowding at the front when the adult teeth first arrive sometimes improves on its own as the rest come through, but clear crowding deserves a look.
There are large gaps between their teeth. A gap between the upper front teeth while the adult teeth are coming through is often a normal stage, and it gets smaller by itself as the teeth beside them arrive. But a large gap, many gaps, or a tooth that has not come through where it should, deserves an examination.
Their front teeth stick out. The upper teeth sit forward, and the lips do not close comfortably. The cause can be the teeth themselves or the jaw, and the examination tells the two apart.
Their lower jaw sits forward. The lower front teeth close in front of the upper ones, or the chin looks prominent from the side. Sometimes the cause is an upper jaw that is small rather than a lower jaw that is large, or the child slides the jaw forward because a tooth gets in the way as they close. In a child, the timing of treatment matters particularly here.
They bite off to one side. On one side the lower teeth close outside the upper ones instead of inside, or a single upper front tooth is caught behind the lower teeth, and sometimes you notice them sliding the jaw sideways as they close. That is a crossbite, and left alone it can cause uneven wear on the teeth over time; the examination decides whether it needs treating now.
They still suck a thumb or a dummy, though they have outgrown it. Sucking that carries on can affect the front teeth and the width of the upper jaw. The detail is in the question “Does thumb-sucking damage the teeth?” below.
They breathe through the mouth, or snore. They sleep with the mouth open, snore, or keep the mouth open for much of the day. The cause is often in the nose or the tonsils, not in the teeth, and that is for your child's doctor or an ear, nose and throat doctor to look at. But it can go together with a narrow upper jaw, so mention it at the examination.
A baby tooth lost very early, or one that has not come out. A baby tooth lost early to decay or a knock, and the teeth beside it have started leaning into the gap. Or the opposite: an adult tooth has come through behind a baby tooth that is still in place, or one side has lost its baby teeth and the other has not.

Whichever of these you have noticed, the examination tells you what it means for your child. The same problems, in children and in adults, are explained on Braces. And to put what you have noticed in order before the appointment, try Is your child ready for braces?: a few one-tap questions, with the result straight away.

Stages of treatment by age

Age gives a rough idea, but the real measure is how far the teeth have come and how the jaw is growing, so two children of the same age can be at two different stages. Here are the stages, simply put, and not every child goes through all of them:

Monitoring. At every check-up, the doctor follows how the jaws are growing, how the teeth are coming through and how they meet. Most children need nothing at this stage except watching, and we will tell you so plainly.
Sometimes, early treatment. Not full braces; a small step at the right time for a problem in the jaw or a habit, which may lighten the work later. Such as widening a narrow upper jaw, holding the space of a baby tooth lost early, correcting a crossbite (a bite reversed on one side), or a simple appliance that breaks a thumb-sucking habit. If the plan includes a removable appliance, your child puts it in and takes it out, so it only works as much as it is worn, and the doctor will tell you whether it is done here or whether he refers you. And while the jaw is still growing, some treatment can make use of that growth; how much it helps varies from child to child, and the examination tells you whether it suits yours.
Fixed or clear braces, once the adult teeth are through. If crowding, protrusion or a bite that does not meet properly remains once most of the adult teeth have come through, it is time for full braces. Fixed braces, small brackets and a wire, are often easier for a teenager, because they do not depend on remembering to wear anything. Clear aligners, trays that come out, suit the teenager who keeps them in for most of the hours of the day, and only for cases they suit: Clear aligners. One jaw or both is decided at the examination: Braces on one jaw only?
The retainer afterwards, and it is not optional. Teeth keep wanting to drift back after any braces, and the retainer is what holds the result, which is why it is part of the plan from day one, not an add-on at the end. And even after early treatment, sometimes an appliance holds what was done until the next stage.

Drag and see: baby teeth, and the adult teeth beneath

An illustration. Age gives an idea; the exam shows where your child's teeth have really reached.

Why the two fields together make a difference

Dr. Adnan's training brings two fields together, paediatric dentistry and orthodontics. So when your child comes in for a check-up or a filling, we are also looking at how the jaw is growing and how the teeth are coming through. And if the time for braces comes, it carries on in the same place, with the same file.

And the cost? It is discussed after the examination, and what decides it is explained on What decides the cost of your treatment.

How it happens, step by step

Braces for a child are not one appointment; they are a course of visits. Here are the steps as they are, with no number of months, because the figure for your child comes after the examination as an expectation, not here as a promise.

1
The examination, and an x-ray if it is neededThe doctor looks at your child's teeth and bite from the front and from both sides, which adult teeth have come through and which are still to come, and how the jaw is growing. An x-ray if it is needed, not as routine: it shows the teeth still under the gum and where they are heading. Nothing is fitted at this visit.
2
A plan explained to you and to your childYou hear what we saw: monitoring only, treatment now, or waiting until more teeth come through, and why. Your child hears it too, in words for their age, because they are the one who will wear the appliance and keep it clean. Sometimes the plan is explained at a second visit, once the x-rays have been studied. And you go home and think it over before you decide.
3
The appliance or the bracesIf the plan includes a removable appliance: your child collects it and learns to put it in, take it out and clean it, and for the first days it feels tight and strange in the mouth until they get used to it. With fixed braces: the small brackets are bonded to the teeth and the wire is threaded through, usually in one visit, with no needle and no anaesthetic because nothing is drilled. With clear aligners: collecting the first trays and learning to put them in and take them out.
4
Regular visitsAt each visit the appliance or the wire is checked and adjusted, and the cleaning and the gums are checked. The visits run regularly through the whole course, and every delayed visit adds time. If something breaks between visits, you call; you do not wait for the appointment.
5
The retainerWhen the teeth have reached their place, the retainer comes in to hold the result, and you both hear how to wear it, for how long, and when to come back for it to be checked.

The downsides and the commitment, before the advantages

Braces for a child are half at the clinic and half at home. So here is the hard part first:

The commitment is your child's, and yours. Appointments on time, the appliance or the trays worn as asked, and the retainer afterwards. If the plan includes a removable appliance, it is usually worn most of the time, and comes out for brushing, sport and swimming, unless the doctor says otherwise. Whenever it is out of the mouth, it goes in its case, so it does not get lost or broken. An appliance that stays in its case does not work.
Cleaning is harder, and neglect shows on the tooth. Plaque collects around the brackets and under the wires more than usual. If it is not cleaned properly every day, white marks appear on the tooth where the bracket was once the braces come off, along with decay and gum inflammation. With a child, brushing needs your eyes on it, not just a reminder. And if there is a removable appliance, it is cleaned every day too, with a soft brush.
Pressure in the first days. Pressure and tenderness on the teeth in the first days after fitting and after each adjustment, and it usually eases on its own within days. The detail is under “Does it hurt?” below.
Hard and sticky food. With fixed braces: hard and sticky food breaks the brackets, so apples and carrots are cut up, chewing gum and caramel are out, and so is biting nails or a pen. That is the hardest part for a child at school and with friends, so talk it through with them from the start.
Sometimes teeth need to come out, not always. When the crowding is heavy or the teeth stick out a long way, they need room to line up, and room is made by gentle widening in a child, by light filing between the teeth, or by an extraction. That is decided with the plan after the examination and the x-ray, not before, and you hear why before you decide. The detail is under “Do I need teeth taken out for braces?” on Braces.
And not every problem is solved early. Early treatment eases some problems, but it does not always replace full braces once the adult teeth are through. And some larger jaw problems cannot be fully corrected while the child is still growing, and the full decision on them sometimes waits until growth has finished; the options for adults are explained on Braces. You hear that plainly from the start, not later.

And the advantages

Sometimes growth helps. In a child whose jaw is still growing, some things are easier to treat while they are young, such as a narrow upper jaw.
Straight teeth are easier to clean. No hidden corners where tartar collects, so the gums and the teeth are easier to look after in the long run.
A bite that meets properly. It spreads the load across all the teeth instead of a few, which lowers the chance of wear in one spot.
And the look of their smile. Which matters to a lot of children, and it is a fair reason. It comes last here because health comes before looks.

When it is not right for now, or should wait

In these cases the answer is usually not “no”. It is “not yet”, and you hear what has to happen first:

Decay or gum inflammation. Decay and gum inflammation carry on around the brackets, under the wires and under the appliance if they are not treated beforehand. So the fillings and the cleaning first, and braces go onto a healthy mouth. That is done in the same place: Children's dentistry.
Problems that wait for more growth. For some problems, the right time is once more adult teeth are through, or once the jaw reaches a certain stage of growth, and starting before then only makes treatment longer. Here we will say “not yet, but we keep watching”, and that is not a refusal; it is timing.
Your child is not ready to commit. A removable appliance and clear aligners only work if they are worn. If your child is not ready yet, you hear plainly what the options are, or whether it makes more sense to wait a little.
And if the growing years have passed? That does not mean it is too late. Teeth move at any age, as long as the bone and gum around them are healthy, and the difference is in the plan: Braces as an adult: age is not the barrier.

In all of these, the decision comes from the examination and the x-ray, not from age alone.

What to do from here, and when to call

1
Book an assessment, not a decisionIf you have noticed any of the signs above, or your child's adult teeth have started coming through, book an assessment. An assessment is not a commitment to treatment.
2
Tell your child in a couple of calm words“The dentist is going to count your teeth and see how they are coming in.” Don't say “don't be scared” and don't mention needles, because a child hears the word, not the “not”.
3
Tell us what you have noticedThumb or dummy sucking, snoring, a tooth lost early or one that has not come out, an earlier knock to a tooth. And bring any old dental x-rays you have. If your child started treatment or was being monitored in another country, bring whatever records you have: notes, x-rays, the type of appliance. All of it helps at the examination.
4
Health before hardwareBrushing twice a day with a fluoride toothpaste, and regular check-ups. If there is decay or gum inflammation, it is treated first.
5
Plan the visits from nowBraces are a course of regular visits, not one session. If exams or a busy school term are coming up, say so beforehand, because that goes into the plan.
6
If you are in Amman for a whileBraces need regular visits in one place, on one plan, and neither a removable appliance nor fixed braces is meant to go long stretches without a check. So if your family is in Amman for a posting, a contract or a school year, or you travel often over the holidays, say so at the first visit, before anything is fitted. How to arrange it is discussed at the examination: it goes into the timing, the choice of type and the shape of the plan, and sometimes into the advice to wait and start where you will be living. It is fairer to hear that before you begin than midway through.

When to call

Most of what happens with braces can be sorted out at the next visit. But some things do not wait for the appointment:

A bracket that has come off the tooth, a wire that has snapped, or a removable appliance that has broken or no longer fits.
A wire sticking out and cutting their cheek or tongue that you could not cover with wax.
Pain that gets worse after a few days instead of easing, or pain in one particular tooth.
An appliance, a tray or a retainer lost or broken, because without it the teeth can start drifting back quickly.
A knock to the mouth, or a tooth broken, moved out of place or knocked out completely: call right away. What to do in the first hour: Children's dentistry. If the head was hit too, and there is dizziness, vomiting or any loss of consciousness, even for a moment: go straight to the nearest hospital emergency department, before the teeth.

Call and we will find you the earliest slot, and tell you what to do until you arrive. Before any painkiller for your child, ask the doctor first, so it suits their age and case.

This does not wait

These signs do not usually come from braces, but they do not wait for an orthodontic appointment.

Go to the nearest hospital emergency department now, not an appointment:

Difficulty breathing or swallowing.
Swelling that has reached the eye or the neck.

And let us know afterwards.

Call now:

Swelling under the jaw.
Fever with the pain.
Difficulty opening your mouth.

Call the clinic now⁦+962 7 8887 9175⁩

If the clinic is closed or you can't reach us: go to the nearest hospital emergency department. Don't wait. The details: Dental emergencies and abscesses.

If you are not in Jordan, go to the nearest emergency service where you are.

And who treats you?

The clinic has a team of dentists, Dr. Adnan Alakhras among them. He holds a clinical master's degree in paediatric dentistry and a Professional Diploma in Fixed Orthodontics. Read about the doctor and the clinic.

Questions people ask

Does it hurt?

The usual feeling with braces is pressure and tenderness, not the throbbing toothache that wakes you at night. In the first days after fitting and after each adjustment there is pressure and tenderness on the teeth, and it usually eases on its own within days. If the plan includes a removable appliance, it feels tight and strange in the mouth when your child first wears it, and they get used to it. The brackets can rub the cheek at first, and wax covers them. The examination itself involves no needle and no drilling. Pain that gets worse instead of easing, or in one particular tooth, is a reason to call. Before any painkiller for your child, ask the doctor first, so it suits their age and case.

How long does it take?

No number fits every child, and any number you have heard belongs to a child who is not yours. It depends on the problem itself, on the stage your child is at (a mix of baby and adult teeth, or the adult teeth already through), and on how well they keep to the appliance and the appointments. In children, treatment sometimes comes in two phases: an early phase for a specific problem, then a period of monitoring with nothing in the mouth, and then full braces if they are needed once the adult teeth are through. And sometimes nothing more than monitoring is needed. What keeps it short: appointments on time, an appliance worn as asked, and clean teeth. What stretches it: a bracket that breaks, or a visit that slips. The expectation for your child comes with the plan after the examination, as an expectation, not a promise. And after that comes the retainer, which has its own time.

Are there payment plans?

Not at the moment. The doctor is looking into it, and wants a trustworthy partner before he commits to anything; the details are under Payment and insurance on What decides the cost of your treatment. What you can do now: book the assessment, and the decision after it is yours. You will find out whether your child needs anything at all, and what has to happen first (decay, gums). The cost itself is discussed after the examination, not over the phone.

When should I first bring my child in?

When the adult teeth start coming through, or sooner if you notice any of the signs above. There is no single age that fits every child, because each child's teeth come in on their own timetable, and two children of the same age can be at two different stages. An assessment at that point does not mean braces: most children need nothing but monitoring. If your child already comes to us for regular check-ups, the growth of the jaw and the teeth coming through are looked at every time, so you do not need to book anything separate; if something needs a closer look, you will hear whether it is done at the same visit or at an appointment of its own. If your child does not come for regular check-ups, or you notice something before the next one, book an assessment. The first visit to a dentist in general comes much earlier, from the first tooth: Children's dentistry.

Does thumb-sucking damage the teeth?

In a young child, sucking a thumb or a dummy is normal, and it soothes them. The problem is when it carries on after they have outgrown it, especially once the adult teeth start coming through: it can push the upper front teeth forward, leave a gap between the upper and lower front teeth when they bite, and narrow the upper jaw. Not every child who sucks a thumb ends up with this, and the examination shows whether anything has happened. Many children stop on their own, or with encouragement and calm talk, not punishment. And if the habit carries on and starts to affect the teeth, a simple appliance can help them break it. If it is needed, the doctor will tell you why, and whether it is done here or whether he refers you.

Do braces at a young age shorten treatment later?

Sometimes, not always. Some problems are easier to treat while the jaw is still growing, such as a narrow upper jaw, a crossbite, a baby tooth lost early whose space needs holding, or a habit such as thumb-sucking. There, early treatment can lighten the work later. Other problems gain nothing from early treatment, and their right time is once the adult teeth are through. And early treatment does not always replace full braces later either. The examination tells you which of these applies to your child, and you hear why.

My child is scared. How do you handle that?

That is normal, and it is exactly what we have a way of handling. A scared child gets more time and a different approach here, not the same visit done faster. We don't force it, and we go at their pace: we tell them what we are going to do in words for their age, we show them before we do it, and then we do exactly what we said. If they feel anything, they raise a hand and we stop. That is an agreement we make with them before we start. The detail is in The child who is scared or won't cooperate on Children's dentistry. And if the fear is yours rather than your child's, there is a page written for you: When the visit is hard.

We suggest only the treatment your child needs, we tell you why, and we protect their tooth before we think about extraction.

Your next step

An assessment, and an x-ray if it is needed. You hear whether your child needs only monitoring, treatment now, or should wait, and why. Then you decide at ease, whether you live around the corner or are only in Amman for a while.

Book the assessment Call

Pages that go with this one

Written by: RyanMedical review: Dr. Adnan Alakhras · pending approvalSources: The clinic's services as published: early orthodontic assessment for children · fixed braces · clear aligners · retainers after treatment · monitoring jaw growth, tooth eruption and the developing bite · Dr. Adnan Alakhras's articles on how children's teeth and bite develop, removable appliances and habit breakers, and jaw problems in the growing child

This page explains braces for children and teenagers in general; it is not a diagnosis of your child's case. The decision is made at the examination, and the cost is discussed after the examination.