What Can Orthodontics Actually Change While Kids Are Growing?
Dr. Sheila here! If you’ve read some of my other articles, you’ve probably noticed that I talk a lot about waiting.
I won’t expand a jaw just because teeth are crowded, and I won’t put braces on a 7-year-old just because their front teeth aren’t straight. Just because we can treat something doesn’t mean we should.
So you might reasonably be wondering: What do I actually want to change while a child is growing?
Quite a few things, actually. Growth gives orthodontists some opportunities we simply don’t have in the same way later — the trick is knowing which problems are worth using that window for, and which ones are fine left alone.
We can change the width of the upper jaw
This is probably my favorite example because the change is truly skeletal.
In a growing child with a narrow upper jaw, a palatal expander can open the growth suture running down the middle of the upper jaw. New bone forms in that space, leaving us with a wider bony foundation.
That can correct crossbites and mismatches between the upper and lower jaws, create high-quality space for developing teeth, and sometimes help correct a functional shift where a child moves their lower jaw to one side to make their teeth fit together.
Because the roof of the mouth is also the floor of the nose, expansion also increases the dimensions of the nasal airway. That may make nasal breathing easier for some children who actually need expansion.
But crowding or mouth breathing alone doesn’t automatically mean a child needs an expander.
We can help an underbite while the face is growing
In children with a developing underbite, the upper jaw isn’t growing forward enough relative to the lower jaw. When we identify the right child at the right age, we can use orthodontic treatment to encourage the upper jaw forward while the face is still growing.
This is one of those situations where timing can really matter. A significant skeletal underbite after growth is complete is a very different problem and may ultimately require jaw surgery to fully correct.
That doesn’t mean every 5-year-old with an underbite needs treatment immediately. Some early underbites improve as the bite develops. Family growth patterns, jaw relationships, the adult teeth, and the individual child all matter. I’m less interested in treating early than in finding the right window for this particular kid.
We can help adult teeth find a better path
Some of my favorite early orthodontic “treatments” barely look like orthodontics.
Adult teeth develop underneath the gums for years before you see them. Sometimes an X-ray shows me that a tooth isn’t heading where I want it to go.
Upper canine teeth are a classic example. When a developing canine is drifting toward a path where it may eventually become impacted, creating the right space — or sometimes simply removing a particular baby tooth at the right time — can give it an opportunity to change direction.
That’s a pretty good trade: a relatively small intervention now may help us avoid a much more complicated problem involving orthodontics and oral surgery later.
We can also preserve space when baby teeth are lost and manage severe crowding when it’s genuinely interfering with the eruption of adult teeth.
What about those really crowded bottom teeth?
This is where things get interesting.
Parents will sometimes look at four giant adult lower incisors trying to fit into a very small-looking space and understandably think, Surely we’re going to fix that.
Sometimes we do. Often, I wait.
The lower jaw doesn’t have the same type of growth suture that lets us widen the upper jaw skeletally. A “lower expander” primarily changes the position of the teeth and supporting tissues rather than widening the lower jaw bone the way a palatal expander widens the upper jaw.
That can absolutely be useful in the right situation. I’m just selective about when I think it’s useful. Often my goal in the lower jaw is preserving the valuable space a child already has. A lower lingual holding arch can help me do that as baby teeth are lost. I can also make small adjustments to gently upright or advance the back teeth when that’s useful.
Meanwhile, those crowded little lower incisors may improve quite a bit as the mouth develops.
Could I put braces on them and make them straighter sooner? Sure. But what job am I asking those braces to do — and does that job need to be done now? If I have a good answer, I’ll treat them. If I don’t, I’m comfortable waiting.
We can address habits and function
Sometimes the problem isn’t just where the teeth started — it’s what has been happening to them over and over.
Long-standing thumb- or finger-sucking and certain tongue or lip habits can influence how teeth erupt and how the bite develops. Depending on the child, treatment might mean coaching, an orthodontic appliance, or working with another professional such as a speech-language pathologist.
When we remove the thing that’s pushing the bite in the wrong direction, a growing child sometimes does an impressive amount of the correction for us.
And what about breathing?
Airway matters, but this is an area where I think it’s particularly important to be clear about what orthodontics can and can’t do.
If a child routinely mouth-breathes, snores, struggles to breathe through their nose, or isn’t sleeping well, I want to know about it.
Jaw structure can be one part of that picture. For example, appropriately widening a truly narrow upper jaw increases the dimensions of the nasal airway and may make nasal breathing easier. Creating more room in the mouth may also be helpful for tongue posture and function in the right child.
But orthodontics can’t remove enlarged tonsils or adenoids, treat allergies, or fix every nasal obstruction — and an expander isn’t a cure for every child who snores. Sometimes my role is orthodontic treatment. Other times it’s recognizing that something doesn’t have an orthodontic solution and bringing the right person onto the team.
Growth gives us opportunities — not superpowers
This may be the most important part.
Orthodontists can do some pretty remarkable things while kids are growing. We change the width of the upper jaw, influence a developing underbite, guide teeth away from impaction, preserve space, correct functional shifts, and help remove habits that are changing the bite.
What we can’t do is control a child’s genetic growth pattern, promise that every small lower jaw can simply be “grown forward,” or guarantee that early treatment eliminates the need for braces later. Changing the jaws doesn’t automatically solve every breathing or sleep problem either.
Growing kids give us a window we won’t have forever. What happens inside that window still depends on how the child grows, not just on what we do.
That’s why early orthodontics isn’t about making everything perfect as early as possible. Some kids need intervention now. Some need space preserved and time. Some need another specialist brought in. And plenty of crooked little smiles just need to be left alone.
Have questions about your own child’s growth or bite? Inner-Smiles offers complimentary, no-pressure consultations in Colorado Springs and Woodland Park, and second opinions are always welcome.