When Should a Child See an Orthodontist? A Specialist’s Guide for Irish Parents

By Dr. Susan O’Connell, BA, B.Dent.Sc TCD (Hons), MFDS RCSEd, MSc U.Birm (Research), M.Orth RCSEng — Specialist Orthodontist | Last reviewed: October 2026

Parents usually ask this question for one of two reasons: a dentist has mentioned crowding or a bite problem, or a classmate has just appeared with a brace. The short answer is that a first orthodontic check belongs much earlier than most families expect, and that for most children it ends with reassurance and a plan to wait. At the Institute of Specialist and Cosmetic Dentistry (ISCD) in Dublin’s IFSC, our specialist orthodontists see children, teenagers and adults. This guide sets out when to have a child assessed, what we look for, which problems the evidence says are worth treating early, and when a general dentist should refer.

When should a child first see an orthodontist in Ireland?

The Orthodontic Society of Ireland recommends that every child has an orthodontic assessment around age seven, or earlier if there has been a dental or orthodontic problem such as the early loss of baby teeth.

That guidance, published in the Society’s patient information, matches the position of the American Association of Orthodontists, which advises a first check-up with an orthodontist by age seven. The age is not arbitrary. At around seven a child has a mix of baby teeth and permanent teeth: the first adult molars and the front incisors are arriving, which is the first point at which the way the upper and lower teeth meet, front to back and side to side, can be read reliably.

Seven is a guide, not a deadline. A child of nine or ten who has never been assessed should simply be seen now, and an older child or teenager can be assessed at any stage.

Does an early orthodontic assessment mean early braces?

No. An early assessment is a check, not a commitment: the Orthodontic Society of Ireland describes ten to twelve as usually a good age to start braces, with some simple treatments from about eight.

This is the point parents most often misunderstand, and it is worth being plain about. An early assessment and early treatment are different things. For most children seen at seven or eight, the right advice is to do nothing yet and to look again as more adult teeth come through. A smaller group has a problem that is simpler to deal with while the child is still growing. The purpose of the first visit is to tell the two groups apart.

We would add one thing from our own practice. Advising a family to wait is a clinical decision in its own right, and it should come with a reason and a date for review, not a vague suggestion to come back at some point.

What does an orthodontist look for at age seven or eight?

At a first assessment the orthodontist checks how the jaws and the newly erupted adult teeth meet, whether there is room for the teeth still to come, and whether any tooth is developing off course.

In practice that means looking for a short list of findings:

• Crossbites — upper teeth biting inside the lower teeth, at the back or the front, sometimes with the lower jaw shifting to one side on closing.
• Markedly prominent upper front teeth, which are more exposed to injury in falls and sport.
• Crowding or early loss of baby teeth, which can leave too little space for the adult teeth behind them.
• Teeth that are missing, extra or late, and adult canines that do not appear to be travelling along their expected path.
• Habits such as thumb or finger sucking that are beginning to shape the bite.

Most of this is visible on examination. An X-ray may be taken where there is a specific question to answer.

Which problems are worth treating early?

The best evidence for early (interceptive) orthodontic treatment covers two situations: a posterior crossbite, and markedly prominent upper front teeth at risk of injury. Outside those, waiting usually gives the same result.

Posterior crossbite. A Cochrane review by Ugolini and colleagues (2021) pooled 31 randomised studies with approximately 1,410 participants and put the prevalence of posterior crossbite at around 4% of children and adolescents in Europe. For children in the early mixed dentition, aged seven to eleven, it found that both a fixed expander (the quad-helix) and removable expansion plates were more beneficial than no treatment for correcting the crossbite, and it graded that evidence high certainty. The authors were equally clear about the limits: beyond those comparisons, the evidence was insufficient to draw robust conclusions.

Prominent upper front teeth. A second Cochrane review, by Batista and colleagues (2018), analysed 27 randomised trials involving 1,251 participants. In the three trials comparing early treatment with a functional appliance, started at around seven to eleven, against a single course of treatment in adolescence, 19% of children treated early (31 of 161) reported new injury to the front teeth, compared with 30% (51 of 171) of those treated later. That evidence was graded moderate quality. Once both groups had finished treatment, there was no difference between them in how far the front teeth protruded. The review’s conclusion is the one we give parents: early treatment reduces the risk of injury to prominent front teeth, and there appear to be no other advantages over treating once in adolescence.

A third situation is an adult canine that is not erupting on course, where timing matters for different reasons; our article on impacted canines covers it, including the cases that involve our colleagues in oral surgery. For everything else — and that is most children — treatment is normally planned for the early teens, as described in our guide to braces for teenagers.

Does it matter whether a child sees a specialist orthodontist?

Orthodontics is one of only two dental specialties recognised by the Dental Council of Ireland, the other being oral surgery, and the Council’s specialist register is public and can be checked by anyone.

A specialist orthodontist is a dentist who has completed a further three years of full-time university training in orthodontics and is entered on that register. Braces and aligners are also provided in general dental practices, and the title on the door does not always make the distinction clear. With a growing child the judgement that matters most is often whether to treat at all, and when, which is what specialist training is designed to develop. Both of our orthodontists, Dr Susan O’Connell and Dr Erfan Salloum, are on the specialist register. Our guide on how to check an orthodontist’s specialist registration explains how to look anyone up.

Will my child qualify for HSE orthodontic treatment?

The HSE provides free orthodontic treatment only for children with the most severe problems, under nationally agreed eligibility guidelines based on an international grading system, the Index of Orthodontic Treatment Need (IOTN).

According to the Orthodontic Society of Ireland, the problems that qualify include front teeth that are buried and fail to erupt, multiple missing teeth, very prominent front teeth, and severe problems with the bite or jaw development. The public service is reached through the dental screening appointments held in primary schools, or by contacting the local HSE dental clinic, and waiting times vary from region to region. Eligibility is decided by the HSE, not by a private practice, so we can describe a child’s bite but cannot tell you whether the HSE will accept them.

What happens at a child’s first orthodontic assessment at ISCD?

A specialist orthodontic assessment at ISCD is €150. It is a detailed examination with the records and measurements needed, followed by a written report setting out the proposed plan.

The appointment starts with what the parent and child have noticed and what the family dentist has said. After the examination we explain what we have found in plain terms, and the written report sets out the proposed plan, the alternatives and the cost of any treatment before anything is agreed. Where the advice is to wait, we say so, and explain what we are waiting for. Where early treatment is recommended, its fee is given in that written plan. We do not discount orthodontic treatment and we do not offer free consultations.

Dr O’Connell has a particular interest in early intervention in children, which means avoiding complex treatment later where that is possible, not starting sooner than is needed; you can read more in her specialist profile. Families can book directly or be referred by their dentist. When treatment does go ahead, at whatever age, the result has to be held afterwards, which we explain in our guide to retainers after braces.

When should a general dentist refer a child for an orthodontic opinion?

For referring dentists, the findings worth sending early are a crossbite with a mandibular shift, a markedly increased overjet, and a permanent canine not palpable in the buccal sulcus by age ten to eleven.

Refer at the point of suspicion rather than the point of certainty. A short letter with the chief concern, any habit history and a recent panoramic radiograph, where one has already been taken, lets us stage the first visit efficiently. Children remain with their own dentist for routine care throughout. Our referral process for Dublin dentists sets out what to send, and we are glad to discuss a case by phone first.

Arranging an assessment

If your child is around seven and has never had an orthodontic check, if your dentist has mentioned the bite, or if you are a dentist with a young patient you would like a second opinion on, a specialist assessment is the place to start. You can read more about orthodontic care for children, teenagers and adults at ISCD.

Institute of Specialist and Cosmetic Dentistry (ISCD)
4 NCI, Lower Mayor Street, IFSC, Dublin, D01 R7W7
Telephone: +353 1 504 2065
Email: info@iscd.ie

Written by Dr. Susan O’Connell, BA, B.Dent.Sc TCD (Hons), MFDS RCSEd, MSc U.Birm (Research), M.Orth RCSEng — Specialist Orthodontist at the Institute of Specialist and Cosmetic Dentistry, Dublin.

References

1. Orthodontic Society of Ireland. Patient information: questions and answers. orthodontist.ie (accessed October 2026).
2. Orthodontic Society of Ireland. HSE braces: does my child qualify for HSE braces? orthodontist.ie (accessed October 2026).
3. American Association of Orthodontists. Child orthodontics: the importance of early check-ups. aaoinfo.org (accessed October 2026).
4. Ugolini A, Agostino P, Silvestrini-Biavati A, Harrison JE, Batista KB. Orthodontic treatment for posterior crossbites. Cochrane Database of Systematic Reviews. 2021;12(12):CD000979. doi:10.1002/14651858.CD000979.pub3
5. Batista KB, Thiruvenkatachari B, Harrison JE, O’Brien KD. Orthodontic treatment for prominent upper front teeth (Class II malocclusion) in children and adolescents. Cochrane Database of Systematic Reviews. 2018;3(3):CD003452. doi:10.1002/14651858.CD003452.pub4