The Raglan Suite

“Will my child need braces?”

19 December 2017
Categories: Children's dentistry Orthodontics
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By Specialist Orthodontist Dr. Megan Hatfield

We all watch our little ones carefully as they grow and that includes their dental development. Whether or not their child will need braces is one of the most common questions that parents put to dentists, particularly if they have worn braces themselves as a child or currently need them. However, although parents may be looking for a simple yes or no answer, it’s not always so clear-cut!

As a Specialist Orthodontist, I monitor a child’s facial and dental growth, and detect problems with bones and the position of teeth at the ideal age to treat them. In some cases, problems are best treated early when there is a mixture of baby and adult teeth which can help simplify or avoid orthodontics later on. This might include a reverse bite (lower front teeth forward of the upper ones) or teeth not coming through in the right order. In other cases, it is best to wait until most or all of the adult teeth are through (from age 10-13) to help promote a successful treatment outcome.

Early signs

Early signs that a child may need braces are:

  • Early, late, or irregular loss of baby teeth
  • Difficulty in chewing or biting
  • Crowding, misplaced, or blocked-out teeth
  • Biting the cheek or roof of the mouth
  • Teeth that meet abnormally or not at all
  • Jaws and teeth that are out of proportion to the rest of the face

A large proportion of orthodontic issues are genetic. However, some problems can develop due to the following:

  • Thumb sucking
  • Dental decay
  • Dental trauma
  • Poor nutrition
  • Childhood illness
  • Early loss of milk teeth

If a child visits the dentist regularly, they will be checked for dental development as well as dental health and advised if an orthodontic assessment is required. Usually this means a referral to a specialist orthodontist. However, if a parent has concerns, we are also happy to make appointments directly for children of age 7 or over, without a referral.

Primary reasons a child will need braces

There are three primary reasons that a child may need braces to correct the position of the teeth – dental function, dental health and aesthetic:

Dental Function

Function refers to the ability to use your mouth for eating, speaking and possibly some other activities such as playing a musical instrument or scuba diving (I once treated somebody who had to have a custom-made regulator, as he couldn’t use a standard diving mouthpiece due to the position of his teeth and jaws!).

Will my child need braces

There are a few specific instances where the position of the teeth may affect function, for example if they don’t meet (an open bite) or are unduly prominent (an increased overjet).

Dental Health

There are a number of reasons that tooth position would need braces to correct as it can affect dental health:

  • Teeth that remain buried in the gum or impacted (stuck against another tooth) might damage the teeth either side or contribute to tooth decay.A prominent bite
  • A poor bite may cause tooth wear or damage the gums
  • Prominent teeth are more liable to be damaged by trauma. Teeth that stick out are twice as likely to be damaged in childhood than those in an average position.

Crooked teeth, whilst more difficult to clean, don’t necessarily cause tooth decay or gum problems.


The majority of orthodontic treatment we do is to correct the aesthetics or appearance of the teeth.

Aesthetics has been shown in many studies to affect the quality of life of a patient, so it shouldn’t be dismissed as vanity or being any less important than dental health or function. With the rise of social media and smartphone photography, facial appearance has become, rightly or wrongly, more important to many people, especially teenagers. Thankfully wearing braces is no longer considered something to be embarrassed about. If a teenager is concerned about the appearance of braces, with the latest advancements in orthodontic technology, we can now offer less visible options.

Assessment of need

In the U.K. these factors – dental health, dental function and aesthetics – are assessed using IOTN, or ‘Index of Orthodontic Treatment Need’. Health and function are assessed by using the Dental Health Component (DHC) and is scored out of 5. Appearance is assessed using the Aesthetic Component (AC) and scored out of 10. The higher value indicates a higher need. This assessment scoring can be difficult to understand and should only be applied by a specialist orthodontist or someone who has been trained in its use.

Since 2006, the NHS has used IOTN to limit orthodontic treatment to those children with the most need – that is a DHC of 4 or 5 (or a DHC of 3 if the AC is 6 or over). If a child has been declined orthodontic treatment on the NHS, it is because the IOTN score is too low. Typically these patients will have slightly crooked or spaced teeth. Orthodontic treatment can be provided privately as long as the orthodontist feels the teeth will be improved and the patient and parents understand the possible disadvantages of treatment.

At The Raglan Suite, we want children to enjoy a happy, straight smile and are available to assess children of any age and advise of IOTN, with or without a referral from a dentist. If braces are recommended, we will also advise on the best timing of orthodontic treatment. As The Raglan Suite is an independent practice, there’s no waiting list for either the assessment or treatment. We also offer alternative treatment choices that aren’t available on the NHS, such as Invisalign® (invisible braces) or ceramic brackets, or gradually staging treatment for nervous patients.

To book an orthodontic assessment with Megan call 01423 565432 or contact us through our website.

Dr. Megan Hatfield (BChD MDentSci FDS MOrth RCS (Enghas won numerous UK awards for her orthodontic work and was voted the prestigious title of  ‘Aesthetic Dentist of the Year’ at the 2014 UK Smile Awards. She also won the category for ‘Orthodontic case – Invisalign’ in the same year.

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