By age 7, enough permanent teeth have come in and enough jaw growth has occurred that the dentist or orthodontist can identify current problems, anticipate future problems and alleviate parents' concerns if all seems normal. The first permanent molars and incisors have usually come in by age 7, and crossbites, crowding and developing injury-prone dental protrusions can be evaluated. Any ongoing finger sucking or other oral habits can be assessed at this time also.

Some signs or habits that may indicate the need for an early orthodontic examination are:
* early or late loss of baby teeth,
* difficulty in chewing or biting,
* mouth breathing,
* thumb sucking,
* finger sucking,
* crowding, misplaced or blocked out teeth,
* jaws that shift or make sounds,
* biting the cheek or roof of the mouth,
* teeth that meet abnormally or not at all, and
* jaws and teeth that are out of proportion to the rest of the face.

A check-up with an orthodontic specialist no later than age 7 enables the orthodontist to detect and evaluate problems (if any), advise if treatment will be necessary, and determine the best time for that patient to be treated.

For those patients who have clear indications for early orthodontic intervention, early treatment presents an opportunity to:

* guide the growth of the jaw,
* regulate the width of the upper and lower dental arches (the arch-shaped jaw bone that supports the teeth),
* guide incoming permanent teeth into desirable positions,
* lower risk of trauma (accidents) to protruded upper incisors (front teeth),
* correct harmful oral habits such as thumb- or finger-sucking,
* reduce or eliminate abnormal swallowing or speech problems,
* improve personal appearance and self-esteem,
* potentially simplify and/or shorten treatment time for later corrective orthodontics,
* reduce likelihood of impacted permanent teeth (teeth that should have come in, but have not), and
* preserve or gain space for permanent teeth that are coming in.

Pulling baby teeth may be necessary to allow severely crowded permanent teeth to come in at a normal time in a reasonably normal location. If the teeth are severely crowded, it may be clear that some unerupted permanent teeth (usually the canine teeth) will either remain impacted (teeth that should have come in, but have not), or come in to a highly undesirable position. To allow severely crowded teeth to move on their own into much more desirable positions, sequential removal of baby teeth and permanent teeth (usually first premolars) can dramatically improve a severe crowding problem. This sequential extraction of teeth, called serial extraction, is typically followed by comprehensive orthodontic treatment after tooth eruption has improved as much as it can on its own.

After all the permanent teeth have come in, the pulling of permanent teeth may be necessary to correct crowding or to make space for necessary tooth movement to correct a bite problem. Proper extraction of teeth during orthodontic treatment should leave the patient with both excellent function and a pleasing look.

Orthodontic treatment and a child's growth can complement each other. A common orthodontic problem to treat is protrusion of the upper front teeth ahead of the lower front teeth. Quite often this problem is due to the lower jaw being shorter than the upper jaw. While the upper and lower jaws are still growing, orthodontic appliances can be used to help the growth of the lower jaw catch up to the growth of the upper jaw. Abnormal swallowing may be eliminated. A severe jaw length discrepancy, which can be treated quite well in a growing child, might very well require corrective surgery if left untreated until a period of slow or no jaw growth. Children who may have problems with the width or length of their jaws should be evaluated for treatment no later than age 10 for girls and age 12 for boys. The AAO (American Association of Orthodontists) recommends that all children have an orthodontic screening no later than age 7 as growth-related problems may be identified at this time.

After braces are removed, the teeth can shift out of position if they are not stabilized. Retainers provide that stabilization. They are designed to hold teeth in their corrected, ideal positions until the bones and gums adapt to the treatment changes. Wearing retainers exactly as instructed is the best insurance that the treatment improvements last for a lifetime.