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Fort Washington, PA
A male asked:

The aao & ada recommend 1st orthodontic evaluation age 7. why do so many gp's tell the parents, "wait, not yet." ?

8 doctor answers30 doctors weighed in
Dr. Tony Ho
Dr. Tony Hoanswered
Internal Medicine 16 years experience
Permanent teeth: Probably because they feel waiting for the permanent teeth to come out first and permanent alignment done at that point would be best? It is unclear, because you are right, the recommendations are at age 7-8.
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Dr. Levi Palmer
Dr. Levi Palmer commented
Pediatric Dentistry 19 years experience
As a pediatric dentist I only refer them to see an orthodontist when I see a problem that needs to be addressed ASAP. If you are taking your child to a pediatric dentist, he/she can tell you if it would be prudent. A lot of pediatric dentists can address these problems too. Taking kids out of school and parents missing work is a concern, so ask your dentist for an honest opinion.
Sep 22, 2014
Dr. Reed Day
Dr. Reed Dayanswered
Specializes in Oral and Maxillofacial Surgery
Understanding: Unfortunately most gp's don't adhere to ao's recommendations. So much can be done with interceptive ortho these days.
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Dr. Satish Sundar
Pediatrics 36 years experience
Between 2 and 3 , a dental eval is a good idea. The dentist can then follow up and do further referrals as needed.
Nov 27, 2014
Dr. Andrew Sonis
38 years experience
Waiting maybe OK.: The reality is that many orthodontic problems can in fact wait until the late mixed dentition. Problems that should be evaluated early include anterior and posterior crossbites, habits resulting in dentoalveolar changes, and excessive overjet where potential trauma or psychosocial concerns maybe an issue.
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Dr. Brett Noorda
Dentistry 27 years experience
It's because the DDS just DID the first Orthodontic evaluation, and determined the child is not yet in need of braces.
Apr 4, 2013
Dr. Arnold Malerman
Orthodontics 55 years experience
If the GP determines that corrective Ortho Rx will be necessary, shouldn't the Orthodontist make the decision as to when the patient would benefit most from Rx? Many patients would benefit from Interceptive Ortho Rx, and waiting may lead to a more complex solution being required.If a patient will, at some point, require cardiac bypass surgery, who should determine the best time to start treatment, the GP or the Cardiologist?
Apr 4, 2013
Dr. Michael Munn
undefined 16 years experience
Agreed. Traditionally GPs have been the gatekeepers to refer out to other dental specialists, but having an orthodontic exam does not require a referral. The recommendation for age 7 is because of the eruption of the first permanent molars which is usually the earliest you can reasonably attempt early/interceptive correction. Some discrepancies can be simple but get worse or more complex over time. I have seen many patients whose treatment could have been much simpler had I seen them at an earlier age. On the same token, use judgement when selecting an orthodontist. There are many who are driven by the market to push for treatment when it may not be necessary. If you aren't comfortable with either the GP or the orthodontist in a particular recommendation, it doesn't hurt to seek a second opinion to compare options.
Apr 5, 2013
Dr. Oresta Bilous
22 years experience
Need to educate: Perhaps the local orthodontists have not educated the dentists as to why it is important to send them in at age 7 for an evaluation.
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Dr. Arnold Malerman
Orthodontics 55 years experience
It is part of every Dental School curriculum, and the recommendation is quickly forgotten ofter graduation.
Aug 30, 2017
Dr. Stephen Carter
Orthodontics 46 years experience
Education: I don't think we as orthodontists are educating our referring dentists as to the advantages of that orthodontic evaluation at age 7. Considering that most orthodontists will not charge for that initial exam there really is no good reason not to follow the aao's recommendation.
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Dr. William Williams
Dentistry - Cosmetic 48 years experience
Most dentists know little about orthodontics and facial development. The public would be better served to have their children evaluated early in life for developing malocclusions and airway problems. We see far too many cases being ignored by parents, by physicians, and not seeing to the causative factors...airway obstruction and myofunctional imbalances. We are a small percentage of general dentists who know and understand growth and development of the child and get them into treatment early...as soon as signs are exhibited. Appliances like the OrthoTain work wonders on the primary and mixed dentition.
Aug 27, 2013
Dr. Michael Cari
Dentistry - Orthodontics 17 years experience
Development-tx needs: It is likely that the general dentist does not feel that any treatment is necessary at this time; however, the aao recommendation is really to allow an orthodontics to screen for developing problems. All children develop differently; early examination is the best way to determine if intervention is advised.
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Dr. Robert Stoner
Dentistry - orthodontics 40 years experience
Be careful of early treatment. Most of it is not supported by the scientific literature. In my practice, crossbites are addressed early. Also, if the crowding is significant and extractions will be needed later. Getting teeth out early allows the teeth that will be kept to come in straighter reducing treatment time and the burden of care for the patient and parent.
May 15, 2014
Dr. Arnold Malerman
Orthodontics 55 years experience
Training: Part of an orthodontist's specialty training is how to recognize developmental problems. Orthodontists prefer to see patients for 1st screening exam age 7...There's lots that can be done for some children to reduce or simplify tween-age corrective treatment. It's a window of opportunity scenario. Initial ortho exam often complimentary, so take advantage of it.
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Dr. Stephen Calendine
Dentistry 36 years experience
GPs Are Ortho Aware: Few 7 y.o. children need orthodontic evaluation by an orthodontist if the general dentist has had some training in orthodontics. More GPs know ortho and CF growth norms now than ever and thus orthodontists aren't really the first line of eval/treatment(in those cases).Most referrals will be severe CF cases, not a very high % of all 7 y.o.
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Dr. Arnold Malerman
Orthodontics 55 years experience
Would that this were true. "Some training" is not the same as "Specialty training." Failure to recognize and, if necessary, intervene often results in compromise. The majority of patients that will require Orthodontic Care do not need early intervention, but for those that do Age 7 is critical for 1st examination. There's usually no charge for an initial examination. Go for it.
Dec 15, 2014
Dr. Scott Berdelle
Dentistry 45 years experience
I totally agree. Interceptive orthodontics can save overall treatment time and cost and 7 yrs. old is a good time to begin seeing the patient and following the patient until orthodontics is necessary. There is a reason why orthodontists have more years of specialty training. General Dentisits can provide othodontics on selective cases when trained.
Dec 20, 2015
Dr. Arnold Malerman
Orthodontics 55 years experience
And from an ethical standpoint, if a specialist in any discipline can treat faster, better, easier, shouldn't the Generalist refer? Or is the decision being made based on the practitioner's bottom line rather than the patient's health.
Sep 1, 2017
Last updated Jan 5, 2019
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