Most of what I look for in a child’s mouth isn’t easy to spot at a glance, but some exceptions are. If you’ve noticed something about your child’s teeth and wonder whether it matters, now’s a great time to ask.
The American Association of Orthodontists recommends a first orthodontic evaluation by age 7, whether or not anything looks wrong. However, some children should come in sooner because a parent can notice something at home. Here, I’ve put together five signs that might indicate your child needs to see an orthodontist. Most warrant only a general checkup, and only a few suggest your child needs braces right away.
In this post, I’ll walk you through the five signs and how soon each one is worth a call. I’ll also cover what usually isn’t a sign, and why a child with none of these still needs that first visit at 7.
1. Front Teeth That Stick Out or a Lower Jaw That Sits Forward
These are the signs most parents notice first, because they show up in a school photo.
Upper front teeth that stick out well past the lower ones often mean the lower jaw sits behind the upper jaw. Many parents call this profile an overbite. It’s often something I monitor rather than treat right away, but if the front teeth stick out far enough, they may be more vulnerable in a fall. That’s a good reason to have them evaluated.
The opposite bite is more important to address early. When your child’s lower front teeth close in front of the upper ones, the lower jaw may be growing ahead of the upper jaw. I’d recommend having it checked early, even before age 7. Depending on the cause, I may correct it while the jaw is still growing, or monitor it closely and begin treatment when a specific trigger occurs, such as a particular tooth coming in. Either way, having an orthodontist track it from the beginning can help you stay on top of things.
2. Baby Teeth That Fall Out Too Early or Hang On Too Long
Kids lose their baby teeth on a general schedule, and most follow a familiar pattern. What I’d like to hear about is a tooth that doesn’t follow that pattern.
One example is losing a baby tooth early, especially a back baby molar lost because of a cavity. These molars hold space for the adult teeth that will come in later. When one comes out early, the teeth on either side can drift into the gap, and it can be difficult to regain that space. If this happens, let us take a look so we can plan for it.
Another example is a baby tooth that sticks around too long. Most often, you’ll see an adult tooth coming in just behind a lower front baby tooth that hasn’t fallen out yet. If you notice this, a quick call is a good idea. Sometimes the baby tooth comes out on its own, and sometimes the adult tooth needs a little help moving into place.
A baby tooth can also stick around even when no adult tooth is visible. The same tooth on the other side of the mouth may have come out long ago, while this one is still there. The adult tooth underneath may be missing or angled the wrong way. A panoramic X-ray, which shows all the teeth in one wide picture, can tell me whether the adult tooth is there and which direction it’s pointing.
3. A Jaw That Slides to One Side When Your Child Bites
Your child’s upper teeth should sit slightly outside the lower teeth when they bite down. If some of the upper back teeth sit inside the lower ones instead, this is called a crossbite. A crossbite in the back teeth often means the upper jaw is a little too narrow.
Many children naturally adapt by sliding their lower jaw to one side so their teeth fit together. You can check for this at home: ask your child to bite down slowly and watch their chin. Look for it shifting sideways just before the teeth come together. You can also see whether the gap between the two upper front teeth lines up with the gap between the lower ones. If either one doesn’t line up, it’s worth getting in touch with your child’s dentist or orthodontist.
This is one of the clearest reasons to consider early treatment. Over time, that sideways shift can cause the jaw to develop unevenly. In children, the seam down the middle of the roof of the mouth is still flexible, which allows a small appliance called an expander to widen the upper jaw over a few months. Phase 1 treatment—a short course of early treatment focused on one issue—is designed for situations like this. Once the seam fuses during the teen years, making the same correction can become more difficult.
4. Front Teeth That Don’t Meet When Your Child Bites
Ask your child to bite down gently on their back teeth and smile. The upper front teeth should overlap the lower ones slightly, covering part of them.
If there’s a gap and the front teeth don’t touch at all, that’s called an open bite. At this age, an open bite is usually linked to a habit, which is the next sign on this list. A deep bite is the opposite: the upper front teeth cover the lower ones almost completely.
Neither one is an emergency at age 7. In most cases, I’ll note it in your child’s chart so we have a starting point to compare against. When I see your child at their next recheck—a short follow-up visit—I can tell whether growth is improving the bite or making it worse. That comparison helps us decide whether treatment is needed, so it’s helpful to get an early look. If your child is in this watch-and-wait stage, you may also find it useful to read about what growth monitoring means when we don’t start treatment yet.
5. Thumb Sucking or Mouth Breathing Past Age 5 or 6
Thumb and finger sucking is a normal part of toddlerhood. However, if it continues beyond age 5 or 6, the ongoing pressure can push the upper front teeth forward and hold the lower teeth back. It may also narrow the upper jaw. Breathing through the mouth most of the time or pressing the tongue against the front teeth can have a similar, quieter effect.
If the habit continues past that age, it may be helpful to schedule a visit. There’s no need for a lecture—we can simply talk with your child and, if needed, consider a simple appliance to make the habit less satisfying. Once the habit stops, the changes stop getting worse. That’s why I focus on addressing the habit before the teeth.
Signs Your Child Should See an Orthodontist at a Glance
“Call now” means you don’t need to wait for a routine visit or your child’s next recheck.
| What you notice | What it can mean | When to call |
|---|---|---|
| Upper front teeth that stick out, or lower front teeth that close in front of the upper | The lower jaw is sitting behind the upper jaw, or growing ahead of it | Book an evaluation. Call now if the lower teeth close in front, even before 7. |
| A baby tooth lost early, or one that hangs on too long | Lost space for the adult teeth, or an adult tooth that needs help coming in | Book an evaluation. Call now if an adult tooth is coming in behind a baby tooth. |
| A jaw that slides to one side when biting | A crossbite from a narrow upper jaw | Call now. |
| Front teeth that don’t meet, or overlap almost completely | An open bite or a deep bite | Mention it at the first visit. |
| Thumb sucking or mouth breathing past 5 or 6 | Teeth pushed forward and a narrower upper jaw | Book an evaluation. |
What Usually Isn’t a Sign: Crooked Baby Teeth and Early Crowding
Some things can look worrying, but often they’re nothing to be concerned about.
Crooked baby teeth don’t tell me much about how the adult teeth coming in behind them will look. Many crooked baby teeth are followed by well-aligned adult teeth, while straight baby teeth can still sit on a jaw that may run out of room.
A little crowding as the adult front teeth come in is normal, too. These teeth are bigger than the baby teeth they replace, so they can look crowded at first and often settle as the jaw grows. Gaps between the front teeth are usually nothing to worry about at this stage, either. I keep an eye on these, but they’re rarely a reason to start treatment early.
If you’re unsure whether something you’ve noticed is a sign of a concern, a quick check can help put your mind at ease. And you don’t need a referral from your dentist to book a visit.
Why a Child With No Signs Still Needs a Visit at 7
Everything on this list is something you can see, but many of the concerns I find at age 7 aren’t visible at home. A back-tooth crossbite or an adult tooth with no clear path to come in can look completely normal. These issues can show up on an X-ray or 3D scan long before they’re visible in the mirror.
That’s why I recommend having every child checked around age 7, even if you haven’t noticed any of these signs. Most 7-year-olds I see don’t need treatment. They simply need an orthodontist to take a look and let you know when—or whether—anything needs to be done. In my separate post about what I look for at age 7, I walk through that first visit in more detail.
If you’ve noticed one of these signs and your child is younger than 7, you’re welcome to come in sooner. An early look doesn’t mean you’re committing to treatment. If the answer is “not yet,” you’ll still leave with a plan. And if you’re wondering whether your child is too young for braces, I cover that question in a separate post.
Getting Started
Whether you’ve spotted one of these signs or your child is 7 and you haven’t noticed anything yet, the next step is our free VO Smile Assessment. It’s a first consultation where we take an X-ray and a 3D scan, then review both with you. You’ll leave with a clear sense of whether it’s best to start now or wait—and, if we wait, what I’ll be watching for.
We welcome families at our Creve Coeur and St. Peters offices, so you can choose whichever is closer to home. We look forward to meeting you.
