By Mark H. Kaley, DDS, Kaley Orthodontics

When I talk to parents both in and out of our office, three topics come up over and over again: thumb sucking, tooth spacing, and orthodontic timing. If you are like most, there was no need to consider such things until that first glimmer of white pops through your baby’s gums. If you are like me, these questions then become some of the many parenting thoughts that keep you up at night.

Below are some tips regarding these hot topics, plus things to consider when selecting an orthodontist.

It can be a little scary to see a thumb sucking habit hang on longer in your child than some of their friends, but don’t get worried quite yet. In most cases, the little one will self-wean as they get closer to school age. One good sign that it is on the way out is when they start using it only at night or when they are tired. While I will fully admit to cringing when I saw my three-year-old sucking her thumb like it was her job, it soon became the surest sign that she was ready for a nap. Most problems created by thumb or pacifier habits can be easily correct with treatment later. However, if you are concerned, talk to your orthodontist or dentist. There are some aids that can help start the process of breaking the habit.

Many parents notice the gaps between their toddler’s shiny new teeth and see a need to start an orthodontic fund. Don’t panic! Even spaces between those baby whites is just what we want. When a child’s permanent teeth start coming in around six or seven, those spaces provide valuable real estate for the larger adult teeth. In fact, a “perfect” gapless grin in a toddler can mean crowding later. My three-year-old’s thumb sucking isn’t an issue, but her tight teeth let me know she’ll grace one of my treatment chairs one day!

If you find yourself at your child’s dentist wondering why she just told your first grader, “It’s about time to meet the orthodontist,” you are not alone. Most parents are rightfully confused, since their child still has mostly baby teeth and hardly fits the image of the “braced” teen.

It is true that full braces are used most effectively and efficiently during the peak growth years – girls usually starting around 11, boys around 12 or 13. By this time the baby teeth are gone, the permanent teeth have come in; and the body’s natural growth spurt is, orthodontically speaking, on your side. So, why would a seven-year-old need to see an orthodontist?

There are many reasons. They could have a crossbite (where some of the upper teeth are behind the lower teeth), severe crowding, early loss of some baby teeth, or an esthetic problem that is bothering them, like protrusive upper front teeth. While not necessarily common, these problems can often be corrected in a shorter time (usually less than 12 months) and with fewer appliances at a younger age. In most cases, being referred to an orthodontist simply means your child will be checked every 6-12 months until they are ready for treatment. It is better to get an opinion early rather than miss the best opportunity to treat your child, especially if your dentist suggested it.

Once you’re ready to make an appointment how do you pick the right doctor? If your dentist was the first to bring it up, he or she may have a list of orthodontists that they have worked with and trust. It also helps to talk with friends who have had or currently have braces who will give you an “in the trenches” perspective. Opinions from local message boards and blogs offer additional valuable thoughts on practitioners around the area.

Most importantly, visit several orthodontists before making a decision. Does the doctor use the techniques best for your child? Do they have the training and affiliations you are comfortable with? Does the practice feel organized and caring? Does the doctor listen to you? Orthodontic treatment can be a lot of fun, but it is also a commitment of both time and money. You want to make sure that the “fit” is right for you and your child. Every orthodontist has a different personality – find the one that works best for you.

Don’t feel weird about early visits to the orthodontist! You can come away with a clear plan if there is anything to address, or a reprieve if not. Talk to your dentist and don’t be afraid to ask questions. Orthodontics is a very interactive process, and the best results are the ones we achieve together!

Dr. Mark Kaley and his father, Dr. James D. Kaley, are the doctors behind the family-friendly practice of Greensboro-based Kaley Orthodontics. Its combined team experience exceeds 200 years. As with the doctors, their Certified Dental Assistants make continuing education a priority; this includes yearly CPR training for our entire team. Kaley Orthodontics serves patients throughout the Greater Triad area.

You can find Kaley Orthodontics at 2510 Oakcrest Avenue in Greensboro. Its office hours are Monday-Thursday, 8am-5pm. It is closed for lunch from 1-2pm. On Fridays, Dr. James Kaley teaches at UNC Chapel Hill in the Orthodontic Department; therefore, its office is open from 8am-12:00 noon on Fridays to handle emergencies. Phone: 336.282.2150. Fax: 336.282.2125.

You can also find Kaley Orthodontics online at (their web site has great patient tips and suggested web sites for kids), on Facebook, and on Twitter at @DoctorKaley.

Questions & Answers with Dr. Mark Kaley:

Anonymous asked…
My daughter lost her two front bottom baby teeth in an accident when she was one, and the other baby teeth are starting to fill in the gap. She is now 3 1/2. Will I need to think about an orthodontist for her before her permanent teeth come in because of the lack of space, or will the spacing work itself out as the permanent teeth push in?

Mark said…

Good question and thanks for asking! It would not be a bad idea to at least have an orthodontist or pediatric dentist look at your daughter’s teeth to check. While they may not do anything now, it’s better to have her followed periodically and plan for any future treatment. It’s always easier to maintain space than it is to create it later, so getting her checked early never hurts. Good luck!

Anonymous asked…
I went to Dr. Kaley as a kid and absolutely loved the experience. The staff was always so nice and friendly. When my child has old enough to see an orthodontist I had no question of where I was taking her. We live less than 5 min from an orthodntist, but I choose to drive 35 to take her to Dr. Kaley’s.

Mark said…
Thank you for the kind words! We are very lucky to have terrific patients and we love seeing multiple generations come through our office. I’m glad your experience was such a positive one!!

Debbie asked…
I didn’t have to wear braces as a child but my husband did. What are the chances that our son, who is 5, won’t have to wear them? Should we wait until our pediatric suggest us going to an Orthodontic Practice or should we start yearly consults with one just to make sure if he needs them, he gets them as soon as possible?

Mark said…
You are what we call an “orthodontic emergency,” since you didn’t need braces.
Just kidding! There are a few things that do tend to run in families. For example, larger lower jaws or congenitally missing teeth are proven hereditary traits. However, I frequently see patients with a tremendous amount of crowding where neither parent needed any braces. So it can be very hard to tell whether your son will need treatment in the future from a genetics perspective.
Unless something is bothering him (which, at age five, I would be very surprised if something was), I would wait until his pediatric dentist mentions orthodontics. Pediatric dentists are very good at intercepting problems and knowing when to send kids to an orthodontist. They tend to be very proactive and get patients into an ortho office with plenty of time to address any sort of problem. That having been said, however, if something is bothering you or him, discuss your concerns with your pediatric dentist. They may refer you to an orthodontist or at least keep a watchful eye on your concern as your son grows.
In the meantime, you can keep your fingers crossed that he takes after you dentally more than your husband! Good luck!

Amy asked…
Is it unusual that my seven year old has only lost two teeth? She lost her first two only one month ago, and does not seem to have any others that are loose. She was the only child her in class last year who had not lost a tooth and it really seemed to bother her. Is this normal? Thank you for all the tips today!

Mark said…
While it can be frustrating, it is not unusual for your daughter to be a little later than her peers in losing baby teeth and gaining permanent ones. There is a wide range of “normal” when it comes to dental development. Usually, kiddos start losing their first teeth (typically the lower front teeth) around six to seven, and most of the baby teeth are gone by twelve or thirteen. However, some teeth take their sweet time.

I will fully admit to looking furiously through my pediatric dentistry textbook when my oldest daughter didn’t get her first teeth at the “normal” time, but every mouth has its own clock and she eventually got her full set. If you are worried, your dentist can take an x-ray to make sure that everything is on track and that she is not missing permanent teeth (not uncommon, but not an everyday occurrence). In any case, it’s good that you are aware and following her progress.
Tell her to hang in there – the Tooth Fairy will not pass her by!
Thanks for the question and good luck!

Anonymous asked…
I checked out your website but was unsure of whether or not you treat adults as well?

Mark said…
Yes, we do treat adults. As a matter of fact, adults are the largest growing population of orthodontic patients – percentage-wise – in the country! With more adult-friendly options like clear brackets and clear aligners, folks are able to straighten their teeth without the concern of being an adult “brace face”.

Jill asked…
My 5-year-old will need an appliance to correct her cross-bite due to sucking her fingers, but we are waiting until after her 6-year molars come in because she is so averse to even a cleaning (they have to wipe her teeth with gauze because she won’t let them use the water sprayer!). Making the appliance mold would be awful for her. The dentist assures me that other than having to look at her wacky teeth a couple more years, we are not “losing any time” by waiting. Is that accurate? Would it take less time to correct if we put the appliance in now? (Nevermind that we will have some sleepless nights as she learns to fall asleep without sucking her fingers..)

Mark said…
My daughter has refused a cleaning and fluoride because she likes her teeth “just the way they are!” so I totally sympathize with you. It is easier to correct a crossbite earlier rather than later, but “earlier” has a wide range.

In our office, we prefer to wait at least until the six-year-molars are in. You can effectively and efficiently correct a crossbite of the back teeth up though age 10 and, to a lesser degree, even beyond. The older you get, the more tooth movement you get and less of the true skeletal correction that you want. But, since your daughter is five, you’ve got quite a bit of time before you’re running into that problem. So, your dentist is right – you can let your daughter get more used to the dental chair before correcting the crossbite. Good luck with future cleanings!

Jayna P. asked…
My son is 7 and lost 8 teeth in a matter of months over a year ago. All the other teeth have grown in except the two on each side of his front teeth. He currently has a gap between his front teeth and our dentist referred us to see an ortho to discuss if he needs to have the skin between his front teeth clipped in order for them to push together and make room for those 2 teeth. Do you see this type of thing with kids and think it is something we need to look into?

Mark said…
It’s not uncommon to see that flap of skin dip down in between the front teeth and keep the gap wide open. It’s called a frenum and it attaches the upper lip to the maxilla, or upper jaw. It can certainly exacerbate the gap and make it more difficult for the teeth to naturally close on their own as more permanent teeth erupt. The corrective procedure is called a frenectomy, where they move this tissue up out of the way of the crowns of the teeth. It is typically performed by a periodontist and usually has a pretty easy and brief recovery period.
While the majority of frenectomies are performed after the space has been closed following ortho treatment, in a few occasions you want to do a preemptive strike to make it easier for the adjacent teeth to erupt. It is certainly worth a visit to an orthodontist to see how severe it is and how it would be best managed. I know I can sound like a broken record about getting to an orthodontist to check, but while the procedure is typically done later in the teenage years, it may benefit your son’s situation to have it addressed early. They may decide to do something now, in which case he would get it behind him and not have to worry about it in the future. Or, they may decide to wait, and you have the piece of mind that you’ve checked into it and are being proactive. In either case, you know he’s has some watching over him. Good luck!

Debbie asked…
Thanks for your responses. Lots of great information in it. The Pediatric dentist has mentioned that his teeth look crowded,so should we still wait until the dentist says go? I just want to make sure we get the teeth corrected (if needed) as early as possible. Since I never needed braces (you know an “orthodontic emergency” – LOL), I am not sure on whether the earlier the treatment you get if it will cut down on the length of the treatment? Sorry for the additional question, I’m a little OCD. Thanks

Mark said…
Very good question on the benefits of early treatment. Chapel Hill did a study a number of years ago about this very topic and found that, in most cases, early treatment does not necessarily make future treatment any shorter – it just fixes a problem that may be present and more efficiently corrected at an early stage. Also, for full treatment (upper and lower braces as opposed to limited treatment on a few select teeth in a younger patient) you usually want to wait until the permanent teeth are all in or are almost all in to make the treatment time as short as possible.

Having said that, if your dentist has mentioned the crowding and you have some concerns, ask them for a referral. Most likely, the orthodontist will watch your son for the next few years to time it so that you start braces as soon as he is ready. If there is severe crowding, certain interceptive treatments could set him up for an easier time in the future, when full braces are indicated. Again, piece of mind is worth some time in an initial ortho exam.

Don’t worry about being “a little OCD.” You’re talking to a guy who has been trained in this, but still checks his textbooks 15 times when his own children don’t hit their dental patterns in the EXACT order, so I know where you’re coming from. Ask your pediatric office who they would recommend and have them check. It’s always best to be proactive.

I hope this helps. Please don’t hesitate to ask if you have any more questions. I love to talk, so I don’t mind a bit!