Orthodontic Information

Orthodontic Problems to Look for in Children

If you have concerns about the alignment of your child’s teeth, we welcome the opportunity to discuss these with you. Whilst the majority of orthodontic treatment is usually undertaken in the teenage years (after the primary teeth have been lost and the permanent teeth have erupted into the mouth), there are some orthodontic issues which can benefit from early treatment (Phase I or Interceptive treatment). The benefits and risks of early treatment are carefully weighed before we decide the best time to begin treatment. The position of the Australian Society of Orthodontists and the American Association of Orthodontists is that children should be screened at age 7 – please don’t worry if they are already older. It can be as simple as a quick look when you bring your child in for their regular check-ups.

Please note that all information is of a general nature and does not constitute any form of advice.  

Below are some examples of some orthodontic problems which may benefit from early treatment.  


Misalignment of the front teeth may be a concern for you or your child and can impact their well-being mentally and socially. Early treatment can neaten the appearance of your child’s smile while your child is transitioning to their adult teeth. In some cases, careful management of the transition between the primary and permanent teeth can reduce the need for aggressive orthodontic treatment, including later extractions.

Early/delayed loss or eruption of teeth

In some individuals, it is normal for dental age not to correlate with chronological age. In a small number of cases, teeth may not be lost or erupt due more concerning issues. It may be the teeth are missing or there is something impeding normal tooth loss or eruption. Please contact us if you notice anything unusual so we can follow-up with appropriate investigations if they are required.

Posterior crossbite

This is often a problem that is picked up by the dentist or orthodontist. In a normal bite, the upper back teeth positioned just outside of the lower back teeth. In posterior crossbite cases, the upper back teeth may be positioned inside the lower teeth on one or both sides. Sometimes this is caused by a sucking habit (digit or dummy). Often the child has to move the jaw over to an unnatural position in order to fit the teeth together when biting. This can lead to permanent asymmetry of the jaws as growth adapts to this unnatural bite (you may notice your child’s chin is deviated to the left or right as they bring their teeth to bite together). Early treatment may be indicated to prevent abnormal jaw growth. Posterior crossbite may be difficult to correct by the mid- to late teens without surgical intervention, due to fusion of jaw bones as a result of normal growth and development.

Excessive overjet (or 'overbite')

Risk of traumatic injury to the front teeth is increased and commonly seen in children with excessive overjet. This may lead to chipping, fracture, nerve damage necessitating root canal treatment or knocking the teeth out of the socket altogether. In some cases, this is caused by a thumb or fingersucking habit.

Anterior crossbite (or 'underbite')

Upper front teeth bite in front of the lower front teeth in anterior crossbite. It may affect single or multiple teeth. The lower front teeth may cause wear and chipping of the upper front teeth if not treated in a timely manner. In some instances, the jaws may need to bite in an unnatural position to close fully. This can result in abnormal and/or asymmetric jaw growth which may be difficult to correct later without surgery.

Increased overbite or deep bite

Excessive vertical overlap of the front teeth can result in excessive wear of the back surfaces of the upper front teeth. In severe cases, the gum may be permanently stripped away from the back surfaces of the upper front teeth exposing the roots.  In extreme cases, the lower front teeth can chisel into the back surface the upper front teeth and root surfaces, leaving permanent gouges.  

Anterior open bite

‘Anterior open bite’ refers to the upper and lower not meeting when they back teeth are biting together. In anterior open bite patients, the tongue is often positioned between the upper and lower front teeth which worsens the dental problem. Eating may be difficult and you may notice your child bring food to the side of the mouth to bite.  Speech problems, such as lisping, will often manifest (try saying ‘sixty-six’ with your front teeth apart!).  Sometimes anterior open bites are caused by a digit or dummy habit.  Orthodontic correction, sometimes with the aid of a habit-breaker, may be required.

Case Example

It is possible that your child may have more than one orthodontic issue.  Phase I, or ‘interceptive treatment’ is exactly what the name implies – we endeavour to ‘intercept’ some orthodontic problems so natural growth and development can be used to our advantage, and to ‘intercept’ before permanent damage is done.  
The following is a person who would have benefitted from Phase I or interceptive orthodontic treatment.  Some of the orthodontic problems here are crowding, excessive overjet and deep bite.  Excessive overjet substantially increases the risk of traumatic tooth damage.   Chipping of the incisors can be seen in these photos.  This damage is permanent.  
It is not uncommon to see these teeth requiring root canal therapy (nerve treatment) or if they are knocked out of the mouth altogether.  
The deep bite (excessive vertical overlap) of the front teeth have resulted in the gums being stripped away from the inner surface upper central incisors.  This will worsen the longer it is left untreated, including gouging of the root surfaces of the upper incisors.  
If you have any concerns at all about your child’s teeth, please do not hesitate to contact us on (02) 9746 6749, or your normal dental professional for advice.  Early, timely assessment can prevent later problems.  Not all orthodontic problems require early treatment, and we will accordingly advise you if treatment can and should be delayed.