Braces for Kids: When Is the Right Time to Start?

Many parents ask about braces for kids and wonder if they should act early or wait. The short answer is that your child should see an orthodontist by about age 7, but most children start treatment much later, around 12 or 13. This guide explains why, what the research says about early treatment, and what Nigerian studies tell us about how many children need braces.

A first check-up by age 7

The American Association of Orthodontists (AAO) recommends that children complete their first check-up with an orthodontist by age 7. At that age children have a mix of baby and permanent teeth, which lets an orthodontist spot problems early [1]. The aim of that early look is to spot problems while the jaws are still growing.

When do most children start braces for kids?

The British Orthodontic Society (BOS) says: “Most children begin treatment around the age of 12 or 13, once all their permanent teeth have erupted. In a few instances treatment is better started early” [2]. The NHS says braces “are often recommended for children and teenagers after all their adult teeth have come through” [3].

Does early treatment give better results?

For one common problem, prominent upper front teeth, we have strong evidence. A Cochrane review looked at 27 randomised trials with 1,251 children and adolescents under 16 [4][5].

• Early treatment with functional appliances reduced the chance of injury to the front teeth compared with starting later (odds ratio 0.56). New injuries occurred in about 19% of the early group against 30% of the late group [5][6].
• The final result, however, was no different. There was no difference between the groups in final overjet (the gap between the upper and lower front teeth) once both had finished treatment, although the Cochrane authors rate that evidence as low quality [4].

So early treatment for prominent upper teeth does not give a better end result. Its main benefit is a lower chance of knocking those teeth. The Cochrane authors note that prominent upper front teeth “are more likely to be injured and their appearance can cause significant distress” [5].

There are limits. The risk-of-bias assessment rated 15 of the 27 studies as high risk [6]. We also did not gather evidence on early treatment of crossbites or underbites, so an orthodontist should advise on those.

Which braces for kids work best?

The early treatment in those trials used functional appliances and headgear, not clear aligners [5]. For teenagers with significant problems, fixed braces are the usual choice. The BOS says aligners are “ideally suited to adult patients” and “not well suited to correcting problems like prominent upper incisor teeth” [2][7]. If you want to compare the two, read braces vs aligners.

How many Nigerian children need braces?

Nigerian studies give a wide range, because they use different measures and age groups.

• Rural and urban Nigerian children, 703 students aged 12 to 18: 77.4% needed no treatment, 13% needed elective treatment and 9.2% had severe or handicapping malocclusion [8].
• Benin City, 441 children aged 11 to 18: 21.5% had a definite need, but only 3.9% of children felt they needed treatment themselves [9].
• Lagos, ages 12 to 16: treatment was “mandatory” in 24.3% [10].
• Rivers State: 38.1% had a need for treatment on the ICON index [11].

So estimates run from roughly 9% to 38%. Present them as a range, not a single number.

Children often notice before parents do. In a study of 242 Nigerian schoolchildren aged 11 to 14, 27% of the children thought they needed treatment, and almost twice as many children as parents thought so. An orthodontist judged 38% to have a moderate to definite need [12]. If your child says they are unhappy with their teeth, take it seriously.

Risks to know about for children

• Injury to prominent front teeth: this is the main reason early treatment is sometimes advised [4].
• White spots and decay with poor cleaning: these are a known risk with fixed braces [13].
• Poor wear of removable appliances: in a survey of aligner patients, 53.7% reported wearing their trays 20 to 22 hours a day, and the paper notes that self-reported wear tends to be overestimated [14]. That survey was self-reported. It is a reminder that children need support if a removable appliance is used.

What parents can do with braces for kids

• Food: keep to the NHS advice of no hard, crunchy or sticky foods and no chewing gum [3].
• Cleaning: braces carry a higher risk of white spots, which are early decay, than aligners [13]. Supervise brushing.
• Warning signs: call the clinic if a brace breaks, or if pain or red gums last more than a few days [3]. Read more in Is Braces Painful?.

The bottom line

For braces for kids, book a first orthodontic check-up for your child around age 7. Expect most treatment to start at 12 or 13, unless the orthodontist has a reason to begin sooner. If your child has prominent upper front teeth that are at risk of injury, ask whether early treatment makes sense. Learn more about how braces work in our guide to braces on teeth, or book a consultation at Ask The Dentist in Ibadan.

Frequently asked questions

At what age should a child see an orthodontist? The AAO recommends a first check-up by age 7 [1].

What age do most children get braces? Most start around 12 or 13, once all their permanent teeth have come through [2].

Does early treatment give a better final result? For prominent upper front teeth, no. It reduces injury risk but the final result is the same [4][5].

Can my child have aligners instead of braces? For teenagers with significant problems, fixed braces are usually used. A dentist or orthodontist should decide [2][7].

References

1. American Association of Orthodontists. “Child Orthodontics: Pediatric Braces & Early Treatment.” https://aaoinfo.org/child-orthodontics/
2. British Orthodontic Society. “FAQs.” https://bos.org.uk/patients/treatments/faqs/
3. NHS. “Braces.” https://www.nhs.uk/tests-and-treatments/braces/
4. Batista KBSL, Thiruvenkatachari B, Harrison JE, O’Brien KD. “Orthodontic treatment for prominent upper front teeth (Class II malocclusion) in children and adolescents.” Cochrane Database Syst Rev 2018, Issue 3, CD003452.pub4. https://research.manchester.ac.uk/en/publications/orthodontic-treatment-for-prominent-upper-front-teeth-class-ii-ma-2/
5. Same review, full text. https://pmc.ncbi.nlm.nih.gov/articles/PMC6494411/
6. National Elf Service summary. “Orthodontic treatment for class II division I malocclusion.” https://www.nationalelfservice.net/dentistry/orthodontics/orthodontic-treatment-class-ii-division-i-malocclusion/
7. British Orthodontic Society. “Clear aligners.” https://bos.org.uk/clear-aligners/
8. Otuyemi OD, Ogunyinka A, Dosumu O, Cons NC, Jenny J. “Malocclusion and orthodontic treatment need of secondary school students in Nigeria according to the dental aesthetic index (DAI).” Int Dent J 1999;49(4):203-210. https://pubmed.ncbi.nlm.nih.gov/10858755/
9. Ajayi EO. “Normative and self-perceived orthodontic treatment need in Nigerian school children.” Acta Odontol Scand 2015;73(5). https://www.tandfonline.com/doi/abs/10.3109/00016357.2014.967721
10. “Malocclusion and its Impact on Quality of Life of School Children in Nigeria.” West Afr J Med 2010;29(6). https://www.ajol.info/index.php/wajm/article/view/68298
11. Aikins EA, et al. “Orthodontic Treatment Need and Complexity among Nigerian Adolescents in Rivers State, Nigeria.” Int J Dent 2011, 813525. https://pmc.ncbi.nlm.nih.gov/articles/PMC3222895/
12. Kolawole KA, Otuyemi OD, Jeboda SO, Umweni AA. “Awareness of malocclusion and desire for orthodontic treatment in 11 to 14 year-old Nigerian schoolchildren and their parents.” Eur J Orthod 2008. https://pubmed.ncbi.nlm.nih.gov/18649560/
13. Raghavan S, Abu Alhaija ES, Duggal MS, Narasimhan S, Al-Maweri SA. “White spot lesions, plaque accumulation and salivary caries-associated bacteria in clear aligners compared to fixed orthodontic treatment.” BMC Oral Health 2023;23:599. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10463770/
14. Ghoneim SH, Afif KS. The effect of personality traits on patient compliance with clear aligners. Cureus. 2024. https://www.cureus.com/articles/308414-the-effect-of-personality-traits-on-patient-compliance-with-clear-aligners.pdf