What Is Two-Phase Orthodontic Treatment?

Parents are often surprised to discover that the American Association of Orthodontists recommends that all children visit an orthodontist by the age of 7. While orthodontic treatment used to begin in the teenage years, it is becoming increasingly common for younger children.

When you see a small child wearing braces or dental appliances, she likely has a two-phase orthodontic treatment plan. This is a special treatment option that is usually available only to children in cases where early orthodontic intervention will reduce the amount of work needed during treatment in adolescence.

As the name suggests, two-phase orthodontic treatment involves two rounds of treatment with orthodontics. The initial phase helps guide the growth of the jaw and teeth while the child still has primary teeth. An observation phase follows where the orthodontist monitors the child’s dental development for approximately one to three years while waiting for all the primary teeth to fall out. The second phase of treatment with braces takes place after the child’s permanent teeth have grown in.

Children between the ages of about 6 and 9 with abnormal jaw development can be good candidates for two-phase treatment. This may be due to early or late loss of primary teeth, crowded or misplaced teeth, underbites, overbites, crossbites, and oversized or undersized jaws. Your orthodontist is most likely to recommend two-phase treatment when one or more of these conditions is severe.

Only a consultation with an orthodontist can determine whether your child is a candidate for two-phase treatment. Your orthodontist is likely to recommend this approach if she believes it can prevent a problem from occurring, intercept a problem that is already developing, or guide the development and positioning of the jawbones.

Signs Your Child Might Need Early Orthodontic Treatment

There are several indicators that your child might benefit from two-phase orthodontic treatment.

One sign is the early loss of primary teeth. Typically your child will start losing teeth at about age 6. If your child begins losing teeth before age 5 or significantly out of order (for example, losing molars first), you should schedule an appointment with an orthodontist.

Thumb, finger, or pacifier sucking is normal for infants and very young children. However, if your child is still engaging in this behavior at age 5 despite your efforts to break the habit, you should schedule an appointment with an orthodontist. Persistent thumb sucking can cause an overbite and malformation of the roof of the mouth.

Difficulty biting or chewing may also signal the need for early treatment. Your child could be experiencing pain from tooth decay or a tooth infection. These problems also could indicate a misaligned bite or a temporomandibular joint (TMJ) disorder.

An orthodontist also can address early signs of a crossbite, which occurs when the top teeth and bottom teeth do not come together correctly. You will notice a crossbite if your child’s top teeth fit inside the bottom teeth or if the top back teeth bite inside the bottom back teeth.

Prematurely crowded adult teeth may also indicate a need for orthodontic correction. If your young child’s adult teeth are coming in overlapping, rotated, or too high, early treatment can help make room for them. This may involve expanding the jaw while the bones are still developing.

If your child’s upper or lower teeth are protruding, early correction may also be beneficial. Protruding teeth can cause difficulty biting, chewing, and can impact speech development.

How Two-Phase Treatment Works

The primary goal of the first phase of treatment is to allow for normal development of the permanent teeth. This usually stems from issues involving jaw growth in children who are at significant risk for needing jaw surgery later in life. This early phase occurs when the jawbones are highly malleable. Once the bones firm up, reshaping becomes far more difficult and may require surgery.

Common methods of treatment in phase one include:

• Traditional braces (usually on select teeth)

• Specialized retainers

• Headgear

• Space maintainers

• Functional appliances

• Expansion appliances

Phase one treatment prepares your child for a better outcome and smoother treatment path in phase two. In most cases, this early intervention does not eliminate the need for braces in adolescence.

Between phases one and two, orthodontists use X-rays and exams to monitor jaw development and the eruption of permanent teeth. While this period usually does not require appliances, your child may be asked to wear a retainer to maintain progress. Regular appointments and following instructions can significantly improve phase two outcomes.

Phase two treatment is the braces phase most people recognize. Braces are applied to the top and bottom teeth to position all permanent teeth correctly and create a healthy, functional bite. Specialized retainers or expansion appliances may also be used. Missing teeth may be replaced, and impacted teeth may be guided into place. For most children, phase two begins around ages 11–12 and lasts one to two years.

How Does Two-Phase Treatment Benefit My Child?

If your child is a candidate for two-phase treatment, he may be experiencing symptoms such as jaw or facial pain, difficulty biting or chewing, or trouble producing certain speech sounds.

Phase one treatment can ease these symptoms, reduce the risk of broken or cracked teeth, and improve your child’s confidence—especially when speech or eating is affected.

If you think your child may benefit from two-phase orthodontic treatment, schedule a complimentary consult with one of our board-certified orthodontists today.