Earlier isn’t always better.

My wife texted me a photo of her friend’s six-year-old daughter’s smile last weekend. The text read: “Will she need to do interceptive orthodontics?”

Short answer: it’s too early to tell — her permanent teeth haven’t come in yet. Slightly longer answer: come see me, I’ll know more once the permanent teeth start showing.

The American Association of Orthodontists recommends a first orthodontic check around age seven. That’s the headline most parents have heard. What they sometimes miss is the verb: check, not treat. By seven, most permanent molars are in and the dental arches are showing their cards. We can see the architecture early. That doesn’t mean we have to start swinging hammers.

There are cases where intercepting early genuinely changes the trajectory. Crossbites — where upper teeth bite inside lower teeth on one or both sides — start to drag the lower jaw off-centre if left long enough. Severe crowding with permanent canines on a collision course can be eased with strategic baby-tooth extractions. Thumb habits driving an anterior open bite respond well to a small appliance and a parent willing to be the reminder. Jaw asymmetries quietly establishing themselves between ages eight and ten are easier to course-correct while the growth plates are still cooperating.

One of these cases came through my chair via my wife, too. A friend of hers brought in her son — around nine, still well inside the window where early intervention works — with a crossbite that needed real attention. Left alone, it would have pulled his lower jaw further off-centre with every passing year. Caught when we caught it, and with a kid compliant enough to wear his appliance properly, we corrected it in two months.

That’s the part of early intervention parents don’t always hear about: when the timing is right, the window doesn’t have to be long. Two months at nine can save a kid from needing jaw surgery at seventeen. It also doesn’t promise he’ll skip braces later — most kids in this category still need a second phase as the permanent teeth come in. What early treatment buys is jaw development going in the right direction, which is the expensive thing to fix once growth is done. Teeth can be moved at any age. Jaws are a different conversation.

But for most kids? The seven-year-old with mildly crooked front teeth and good bite alignment is fine. Their teeth at eleven won’t be the same teeth I’m looking at today. Some of what worries parents at seven solves itself.

The most common worry I hear is about the big gaps between baby teeth — but those gaps are usually a good sign. Permanent teeth are bigger than the baby teeth they replace, and they need that extra space to come in straight. Most of the time, those gaps close on their own as the adult teeth arrive. A gappy six-year-old smile is often the early architecture of a well-aligned eleven-year-old one.

This is the answer parents are most often relieved to hear. They’ve taken the afternoon off, sat in the chair half-expecting a treatment plan, and what they get is: she’s fine, see you next year. The visible exhale is one of my favourite parts of the job.

The honest version of orthodontics for kids is: come in by seven, let me look, and we’ll decide together. The right answer is sometimes now, sometimes next year, sometimes we’ll watch this, and occasionally we don’t actually need to do anything.

The point of the seven-year visit isn’t to start treatment. It’s to start watching. Children’s faces and bites change in narrow windows — the upper jaw responds to expansion best between roughly seven and ten, growth modulation works best while there’s still growth to modulate, and certain bite issues become dramatically harder to correct after puberty. Monitoring catches those windows before they close. It’s also the cheapest part of orthodontics: usually nothing more than a yearly check until something either resolves itself or becomes worth addressing.

So if you’re a parent reading this: yes, come in by seven. No, you’re probably not behind. The window for good orthodontic timing is wider than the internet suggests — and the right intervention is sometimes patience, paired with paying attention.