Services · Growth & space
Growth, space & early orthodontic screening
A first orthodontic look at about seven. Most of the time the honest answer is that nothing needs doing yet — and we would rather say that than sell you something.
AgesFrom about age 7
Appointment30 minutes
IncludesBite and jaw growth check · Space maintainers · Habit help (thumb, dummy, tongue) · Referral to an orthodontist when it is time
Why we look at about age seven
An orthodontic evaluation at around seven is the standard recommendation, and the reason is arithmetic rather than fashion. By seven the first permanent molars have arrived at the back of the mouth and the permanent incisors are coming through at the front. That is the first moment there is enough in place to see how the bite is actually meeting.
Look earlier and we would be guessing from baby teeth. Wait much later and a handful of the simplest, shortest interventions — the ones that take a few months and use the child’s own growth to do the work — have quietly stopped being options.
For most seven-year-olds the result of this appointment is: nothing yet, see you in a year. That is a real result, and it is the one we hope for.
Six things that become visible at seven
None of these are visible in a mouth full of baby teeth. All of them are easier to deal with the earlier somebody writes them down.
Crossbites
A back tooth or a front tooth biting inside its opposite number instead of outside it. Once the first permanent molars are in, we can see whether it is one tooth or the whole side.
Crowding
Whether the permanent incisors are arriving with room to spare, just enough, or visibly nowhere to go. The lower front teeth tell us this first.
Open bites
A gap between the front teeth when the back teeth are together, often held open by a thumb, a dummy or a tongue habit.
Ectopic eruption
A permanent tooth heading in the wrong direction — most often an upper first molar wedged under the baby tooth in front of it, or a canine drifting off course.
Missing or extra teeth
A permanent tooth that never formed, or an extra one blocking the way. Both are far easier to plan around at seven than at thirteen.
Jaw growth
Whether the upper and lower jaws are growing in proportion to each other, and whether the lower jaw is being pushed off line to bite comfortably.
The minority
When early treatment is genuinely worth it
Interceptive treatment means doing something small now to avoid something larger later. It is right for a minority of children and oversold to a great many more. These are the four situations where we would actually raise it, and if your child is not in one of them we will tell you so.
A posterior crossbite with a functional shift
The upper arch is narrow, so the child slides their lower jaw sideways to get the teeth to meet. Widening the upper arch while the palatal suture is still open removes the shift, and it is much simpler at eight than at fourteen.
A severe anterior crossbite
An upper front tooth trapped behind a lower one. Left alone it wears the teeth and can push the lower jaw forward. This is often a short, simple piece of treatment with a clear finish line.
A habit-related open bite
Where thumb, dummy or tongue posture is actively holding the bite open. The habit has to go first; occasionally a reminder appliance helps, but only once the child is genuinely on board.
Space loss after an early extraction
A baby molar lost years before its time, with the teeth either side already tipping into the gap. Holding that space is cheap. Reopening it later is not.
Space maintainers
When a baby molar comes out years before it was due — knocked out, extracted because of decay, or lost to an abscess — the teeth on either side start tipping and drifting into the gap within months. The permanent tooth waiting underneath then arrives to find its parking space taken.
A space maintainer is a small fixed appliance cemented to the tooth beside the gap, with a wire loop or a band that physically holds the space open. It does not move anything. It just refuses to let anything else move.
Why a baby tooth sometimes has to come out- When it goes in
- Usually within a few weeks of the tooth being lost, before the neighbours have started to tip.
- How long it stays
- Until the permanent tooth underneath is ready to come through, which we watch for at each recall.
- Looking after it
- Brush around it carefully, and skip toffee and chewing gum, which pull bands loose faster than anything else.
- If it comes loose
- Ring us the same week. A loose maintainer is not holding the space, and a few weeks of drifting matters.
Thumb, dummy and tongue
Habits, without shaming a child
Thumb sucking, dummy use and tongue posture can all hold a bite open, and all three get handled badly more often than not. Sucking is a self-soothing habit. Children already know that adults disapprove of it, which makes them defensive, secretive and less likely to stop rather than more.
So we talk to the child, directly, about what their own teeth are doing — most seven-year-olds are genuinely interested — and then about when the sucking actually happens. Tired. Bored. Worried. Watching television. That is the useful conversation, because those are the moments a plan can work on.
Most children stop between four and six with no help at all. If it is still going at seven and it is visibly moving teeth, we make a plan together with your child. Never a plan announced at them, and never bitter varnish sprung on them as a surprise.
When we refer, and why we say so plainly
We are paediatric dentists. We screen, we maintain space, we help with habits and we do the occasional straightforward interceptive appliance. Comprehensive orthodontics — full fixed braces, aligners, surgical cases, anything with a long plan attached — belongs with an orthodontist, and we will say so rather than treating outside our lane and hoping it works out.
When we refer, you get the reason in writing, our records and images sent over, and the names of more than one practice. We are not sending you anywhere we have an arrangement with, because we do not have one.
Questions about growth and early screening
Why age seven exactly?
Because that is when there is enough in the mouth to see. By around seven the first permanent molars have come through at the back and the permanent incisors are arriving at the front, so we can finally see how the bite is meeting, whether the incisors have room, and whether the jaws are growing in proportion. Before that we would be guessing. Much after that, some of the simplest interventions have stopped being available.
Does a screening at seven mean braces at seven?
Usually not. For most children the honest result of a screening at seven is "nothing needs doing yet, see you in a year" — and we will say that plainly rather than inventing a reason to start something. Only a minority need anything done early, and the point of looking at seven is to find that minority, not to recruit everybody else.
What is a space maintainer and will my child notice it?
It is a small fixed appliance cemented to a tooth beside a gap, with a wire or loop that stops the neighbouring teeth drifting into it. Most children forget it is there within a week. It comes out when the permanent tooth underneath is ready to arrive. It needs brushing round carefully and checking at every recall, and it does occasionally come loose — if it does, ring us, because a loose one does not hold the space.
My child still sucks their thumb. How do you handle it?
Without shaming them, which rules out most of what gets suggested on the internet. Thumb sucking is a self-soothing habit and children are usually well aware that adults disapprove of it, which makes them defensive rather than motivated. We talk to the child directly about what their teeth are doing, we look at when the sucking actually happens — tired, bored, anxious — and we work on those moments. Most children stop between four and six on their own. If it is still going at seven and it is visibly moving teeth, we make a plan together with the child, not about them.
Book a screening
A growth and bite check takes about half an hour and slots alongside a routine check-up. If nothing needs doing, we will tell you that and book you back in a year.