I am frequently asked whether a gap in a child’s front teeth means that braces are always needed. My answer is, “Not necessarily.”

Two years ago, a mother brought a 7-year-old girl into my office for an exam.  The mother’s concern was that the child had a gap between her new permanent upper central incisors. Baby teeth and permanent teeth were growing in normally. Everything else looked normal. I told the mother that a gap between front teeth is normal at this age. I scheduled a free recall or “wait and see” appointment for 6 months later.

When I next saw the patient, 6 months later, the upper central incisors had erupted further. The gap was the same as before. But I noticed two bumps on the roof of the girl’s mouth. These bumps were the new upper lateral incisors, the teeth on either side of the two teeth in the center. They were beginning to grow in. To help those new lateral incisors erupt forward into their proper positions, I recommended that the family dentist remove the upper cuspid baby teeth: the pointed teeth just to either side of the upper lateral incisors. I scheduled another free recall or “wait and see” appointment in 6 months.

When I next saw the patient, at age 8 1/2, the new lateral central incisors had grown in, moving forward. However, I noticed that they could not move all the way forward to the correct position because the opposing lower baby teeth, the cuspids, were interfering with them.  Again, I sent the patient back to her family dentist.  I recommended removal of the lower baby teeth cuspids.

At the next recall appointment, when the patient was 9 years old, all four permanent upper incisors, central and lateral, were in their correct positions. The gap is now nearly closed. We are now waiting for other teeth to continue growing in.

Some orthodontists would have recommended a Phase I treatment for this patient. I prefer to avoid Phase I treatments if possible, because of the added cost and time the patient has to spend in treatment. In the case of this patient, removal of baby teeth that would fall out anyway allowed the permanent teeth to move into their proper positions without any further intervention.

I will continue to schedule free “wait and see” appointments for this patient. It is quite possible that no orthodontic treatment will be necessary. If treatment does become necessary, it  can be done when she is older and growth is more complete.

If you are concerned about a gap or other issue in your young child’s teeth, call our office to schedule a free exam! We are always glad to see patients for second or third opinions. Exams are always free, and recall or “wait and see” appointments are also free.