A common misunderstanding is that orthodontic treatment can only commence when all adult teeth have erupted. Early treatment is sometimes required before this, and is aimed at treating functional issues with developing bites and occasionally for psycho-social reasons (e.g. teasing at school due to the appearance of the child’s teeth). Your dentist is usually the first person to detect such problems and may recommend an early referral to an orthodontist for your child to undergo an assessment. Usually early treatment occurs any time after eruption of the front adult teeth and first adult molars (from age 6 onward) up until eruption of the adult teeth (approximately age 12). It is uncommon for treatment to be required earlier than this. Some problems that are best treated early to avoid significant dental issues in the future are listed below: Protrusive upper front teeth: If the upper teeth stick out over the lower teeth to a significant degree, they are more susceptible to trauma. This is particularly so if a patient cannot close their lips over their front teeth or for children engaging in contact sports. Deep bite: Upper teeth cover the lower teeth more than they should, which can cause increased wear to the enamel of the front teeth and sometimes damage to upper gum tissue. Under bite: Lower teeth are forward of the upper teeth. This may be the result of a jaw growth discrepancy and/or tooth problem. Open bite: Upper and lower front teeth do not come together. This is often the result of a finger/thumb sucking habit. Crowding: Jaws are too narrow or teeth are too large causing crowded or misaligned teeth. Spacing: Teeth are too small or jaws are too large causing space between the teeth. Sometimes teeth also fail to develop which can lead to increased spacing of the teeth. Space maintenance: If a baby molar tooth is lost early (e.g. due to decay), it is often necessary to hold the space with a space maintainer for the developing adult tooth to erupt into the arch. Crossbite: Upper teeth are inside the lower teeth, causing wear to the teeth and possible asymmetrical growth of the lower jaw. Malpositioned teeth: Teeth erupting into the wrong position can sometimes cause damage to adjacent teeth as they erupt. It is important to detect this problem early to facilitate treatment to allow for normal dental development. Impacted teeth/delayed eruption: If teeth have not erupted at the usual age or there is a significant delay between corresponding teeth erupting on different sides of the mouth, investigation is required. Teeth can sometimes become ‘stuck’, which is often the result of an extra tooth growing, previous trauma to the baby teeth affecting root development, or incorrect position. If you have concerns that your child may have any of the above issues, it is recommended to speak with your dentist or arrange for a consultation with your local orthodontist. They can then determine if early treatment is required or whether treatment can wait until the child is in the adult dentition. Written by Yvette Ding.