A Guide for Parents

A timeline of physiological (normal) changes to expect in your child’s teeth

Physiological Changes of Primary (Baby) Dentition

By age 2.5 years, all the baby teeth should have erupted. It is very common to see spacing present between the baby teeth. As the child gets older, the spacing may begin to appear or increase in the front teeth as a result of growth. Occlusal wear of the teeth may become evident. Sometimes, the front teeth can reach an edge to edge bite as a result of growth of the lower jaw. 

Physiological Changes of Mixed Dentition

The child enters into the mixed dentition when the first permanent (adult) molars erupts into the mouth at around the age of 6 years old.

As the upper permanent incisors erupt into the mouth, spacing may be present between these front teeth. This spacing is termed “ugly duckling stage” or physiological spacing. It is a normal stage of development and usually closes spontaneously with eruption of the permanent canines. Consult an orthodontist for a full evaluation if the spacing persists.

Do not be overly alarmed if your child does not exhibit the changes described above as not all the classically de-scribed age changes may take place in every child. If in doubt, always seek advice from your orthodontist.

When should the first visit to the orthodontist be scheduled?

Most children begin comprehensive orthodontic treatment around the age of 12-13 years when most of their permanent teeth have erupted. In a few instances, treatment may be required earlier and this type of treatment is called Interceptive orthodontics. 

We encourage children to be screened by an orthodontist at the age of 7-8 years old as this allows problems to be picked up early, if any. There are a few types of dental problems that should be corrected earlier to preserve dental health. Subtle problems with jaw growth and erupting permanent teeth may also be picked up early and some problems may be better treated early. (see tab on early orthodontic treatment) 

What should you look out for as a parent?

Apart from ensuring that your child sees his/her dentists regularly, we encourage parents to look out for a few common problems that are best treated earlier on. If your child presents with any of the malocclusions shown below, early treatment with an Orthodontist may be beneficial.

What to expect from your first orthodontic appointment?

During the first visit a comprehensive examination, an interview will be carried out to find out what your concerns are regarding your child’s face and teeth. Questions pertaining to previous dental trauma or related oral habits i.e. thumb-sucking may be asked.

Your child will also need to be cooperative and allow an examination of the oral cavity. More detailed records may often be required. These typically include x-rays, photographs and study models of the teeth. X-rays show the orthodontist where teeth (both baby and adult teeth) are positioned and whether there are unerupted, buried or extra teeth present. Study models allow the orthodontist to examine discrepancies in the bite. To make these models, the orthodontist can either make impressions of the upper and lower teeth or do a digital scan of the teeth with an intra-oral scanner. 

If your child needs treatment, your orthodontist will explain the type of treatment required, duration and costs. You do not need to make a decision immediately and can ask for time to think about your options at home.

If your child does not need treatment at the moment, the orthodontist will advise on when your next follow-up appointment will be. Even if you are unsure whether your child needs braces treatment, it is better to seek an opinion rather than waiting until it is too late! 

When will my child require early treatment (before all permanent teeth are out)?

Early orthodontic treatment may be necessary in some cases, with the aim of treating developing problems early that complex treatment may be avoided in future. This may be necessary relating to delayed eruption of permanent teeth, bite problems and problems with jaw growth.

Early treatment may give your orthodontist the chance to:

Correct harmful oral habits (i.e. thumbsucking) 

Lower risk of trauma to protruded front teeth



Redirect impacted (stuck) teeth


Guide favourable growth of jaws


Correct minor anomalies in tooth position causing shift of the jaws 


During early orthodontic treatment, various appliances may be used. These include plates, functional appliances, headgear, expansion springs, face masks and even partial braces. Your orthodontist will be able to advise on the best type of appliance needed for your child.