When Should My Child See an Orthodontist for the First Time?

By the team at Borello Orthodontics, serving families in Lake Saint Louis, Kirkwood, and the greater St. Louis area

Most parents wait too long. If you're picturing a nervous tween with a full mouth of permanent teeth sitting in the orthodontist's chair for the first time, you're picturing a kid who's probably already missed the easiest window for treatment. The right answer for a first orthodontic visit is almost always earlier than families expect, and there's a very good reason for that.

Let's walk through when your child should actually see an orthodontist, what warning signs to watch for at home, what Phase 1 treatment is (and isn't), and what happens at that first complimentary visit. By the end, you'll know exactly what to do.

when should my child see an orthodontist

when should my child see an orthodontist?The Short Answer: Age 7

The American Association of Orthodontists recommends that every child have their first orthodontic evaluation by age 7. Not when they get all their permanent teeth. Not when a dentist says something looks off. By age 7.

We get the surprised-parent reaction on this one constantly. "She still has half her baby teeth. Why on earth would she see an orthodontist?" Great question, and the answer matters:

At age 7, your child usually has a mix of baby teeth and their first permanent molars and front teeth. This gives an orthodontist enough to work with to spot developing problems while there's still time to guide growth rather than correct it after the fact. Their jaw is still growing, their palate is still malleable, and any skeletal issues (like a narrow upper jaw, a crossbite, or an underbite) are far easier to address before puberty than after.

The other thing to understand: an age-7 visit rarely means treatment. For most kids, the first visit is a quick exam followed by "everything looks great, see you in a year or two." We call this an observation visit, and it's arguably the most valuable thing you can do for your child's orthodontic future. It establishes a baseline, flags any small issues before they become big ones, and lets us catch the rare situation where early intervention will genuinely save time, money, and complexity down the road.

At Borello Orthodontics, every first visit is complimentary, whether your child ends up needing treatment or not. There's truly no downside to coming in.

Signs to Watch for at Home

You don't need to wait for the age-7 mark if you're already seeing something that concerns you. And you shouldn't wait past age 7 just because your child seems "fine" on the surface. Some orthodontic issues hide in plain sight.

Here are the signs that warrant an orthodontic evaluation, regardless of your child's age:

• Crowded or crooked permanent teeth. If adult teeth are coming in overlapping, twisted, or at odd angles, the jaw may not have enough room for them. Early evaluation can help guide growth to make space.

• Gaps that don't match the rest of the family. Some spacing is normal and genetic. Unusually wide gaps, or gaps that appear suddenly, can signal missing teeth or jaw development issues.

• Baby teeth that fall out too early or too late. Baby teeth are placeholders for adult teeth. Early loss (from injury or decay) can cause neighboring teeth to shift into the empty space, blocking the permanent tooth. Delayed loss (past age 12 or so for most kids) can mean the permanent tooth is stuck or missing underneath.

  
  

• Difficulty chewing or biting. If your child chews only on one side, avoids certain foods, or frequently bites their cheek, lip, or tongue, the bite may be misaligned.

  
  

• Mouth breathing, snoring, or chronic congestion. Children who breathe primarily through their mouths, snore regularly, or can't comfortably close their lips may have underlying airway or jaw development issues that deserve attention. This is often more of an ENT or pediatrician conversation first, but orthodontics can sometimes play a supporting role.

  
  

• Thumb sucking or pacifier use past age 4 or 5. Thumb sucking is completely normal in babies and toddlers. When it continues past about age 4, the steady pressure can push upper front teeth forward, narrow the upper jaw, or create an open bite. If you're struggling to break the habit, we can help.

  
  

• Speech issues beyond the typical age range. Trouble with sounds like "s," "sh," "th," or "t" past the age when those sounds normally develop can sometimes be related to tooth or jaw positioning.

  
  

• Jaws that shift, pop, or click. If your child's jaw visibly moves to one side when they bite down, or makes noise when opening and closing, the bite may not be aligned properly.

  
  

• Protruding front teeth. Upper front teeth that stick out noticeably ("buck teeth," or what we call an overjet) can be a cosmetic concern, but more importantly, they're at higher risk of being chipped or knocked out during sports or falls. Early evaluation can lead to simple protective steps.

  
  

• Teeth grinding. Some grinding is normal in kids, but persistent grinding or clenching can indicate a bite issue.

  
  

If you're reading this list and checking off two or three of these, don't panic. Many of these are completely normal phases of development. Our job is to look at the whole picture and tell you whether anything needs attention now, later, or at all.

What Is Phase 1 (Early) Treatment?

This is where a lot of parents get confused, so let's clear it up.

Phase 1 treatment (sometimes called early orthodontic treatment or interceptive treatment) refers to orthodontic care that happens before all the permanent teeth have come in, typically between ages 7 and 10. It's used to address specific skeletal or developmental issues that are easier to correct while your child is still growing.

Common examples of Phase 1 treatment include:

• A palate expander to widen a narrow upper jaw or correct a crossbite

• A partial set of braces on just the front teeth to correct severe protrusion

• Appliances to stop thumb sucking or tongue thrust habits

• Space maintainers to hold space for permanent teeth when a baby tooth is lost too early

Phase 2 treatment is what most people think of as "braces" or "Invisalign." It typically happens in the early teen years (ages 11 to 14) when all or most permanent teeth are in, and it focuses on aligning teeth and finalizing the bite.

Here's the critical point: most kids don't need Phase 1 treatment. The majority of children who come in for an age-7 exam go into observation mode and start comprehensive treatment later, in one phase, as teenagers. Phase 1 is reserved for specific situations where waiting would make the problem harder to fix, or would require more invasive steps (like surgery or extractions) down the road.

Borello Orthodontics is a conservative practice, and we don't believe in overtreatment. If your child doesn't need Phase 1 treatment, we'll tell you that clearly. We'd rather put your child on an observation schedule and see them once a year than start treatment that isn't necessary. When Phase 1 is the right call, we'll explain exactly why and walk you through what it involves.

What to Expect at Your Child's First Visit

We know first visits can feel intimidating for kids (and parents). Here's exactly what happens at your complimentary consultation at either of our St. Louis offices:

• A warm welcome. We introduce ourselves, give your child a quick tour, and answer any questions. Our team spends a lot of time making sure kids feel comfortable. Nothing scary happens at a first visit, and we'll explain every step to your child as we go.

• A full exam. Dr. Borello or Dr. Little will examine your child's teeth, jaw, and bite. We look at how the teeth are coming in, how the upper and lower jaws relate to each other, and whether anything is developing in an unexpected way.

  
  

• X-rays if needed. Depending on what we see, we may take a panoramic X-ray or other imaging. This lets us see adult teeth that haven't erupted yet and check for anything hidden.

  
  

• Photos. We usually take a set of intraoral and facial photos so we have a visual record to compare against future visits.

  
  

• A straightforward conversation. After the exam, we'll sit down with you and your child and tell you exactly what we see. One of three things will be true:

  • Everything looks great. No treatment needed now. We'll put your child on a monitoring schedule and see them every 6 to 12 months until the right time for treatment (if ever).

  • There's something we want to watch. We see something that may need treatment later, but not now. We'll explain what it is and what we're monitoring.

  • Treatment is recommended now. This is the least common outcome for a first visit. If it applies, we'll walk you through the full treatment plan, timeline, and cost, and you can decide whether to move forward.

    
    

No pressure, no surprises. If treatment is recommended, we'll give you a written plan and pricing so you can think it over. We never push families into same-day decisions, and we're always happy to answer questions after you've had time to consider.

Total time for a first visit: usually about 45 to 60 minutes.

Why the Age-7 Visit Matters Even If Nothing Is Wrong

If you take one thing away from this article, let it be this: the age-7 visit is valuable even when treatment isn't needed. Here's why.

It establishes a baseline. We get to know your child's mouth and growth pattern. At future visits, we can compare and catch subtle changes that might otherwise go unnoticed.

It catches the small percentage of cases where timing really matters. For most kids, orthodontic timing is flexible. For a small subset, there's a real window (ages 7 to 10) when specific problems are much easier to fix. Missing that window doesn't mean the problem can't be corrected later, but it often means more complex, longer, or more expensive treatment when it is.

It builds comfort with orthodontic visits. Kids who've visited the orthodontist before braces day are significantly less anxious when treatment eventually starts.

It gives you, the parent, peace of mind. You stop wondering whether something is wrong. You have a professional in your corner monitoring your child's development, and you know who to call when questions come up.

Your Next Step: A Complimentary Consultation

If your child is around age 7 (or older and hasn't been seen yet), now is the right time to schedule a first visit. If you're noticing any of the warning signs above, don't wait.

At Borello Orthodontics, your child's first visit is always free and includes a full exam with Dr. Borello or Dr. Little, any needed X-rays, and a straightforward conversation about whether anything needs attention. Most kids walk out on an observation schedule with no treatment needed. A few find out that a small amount of early intervention will save a lot of effort later. Either way, you'll leave with clarity and a plan.

We have two convenient locations to serve St. Louis families:

Lake Saint Louis, 701 Robert Raymond Drive, Lake Saint Louis, MO 63367

Kirkwood, Woodbine Center, 439 S Kirkwood Road, Suite 205, Kirkwood, MO 63122

Schedule your complimentary consultation online or give us a call.

We'd love to meet your family.

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Borello Orthodontics has been creating confident smiles in the St. Louis area for over 15 years. Drs. Blake Borello and Taylor Little provide personalized orthodontic care for children, teens, and adults in Lake Saint Louis and Kirkwood.