Early Orthodontic Treatment
If someone has suggested that your child may need early orthodontic treatment — and you're not quite sure what to think — you're asking exactly the right questions. Early treatment, sometimes called Phase I treatment, is one of the most discussed and most misunderstood topics in orthodontics today. Our approach is straightforward: we recommend it selectively, conservatively, and only when the evidence clearly supports it.
When Early Treatment Makes Sense
Early orthodontic treatment focuses on guiding jaw growth and bite development in younger children — typically those who still have a mix of baby and permanent teeth. It is not about straightening teeth early. It is about addressing specific structural concerns at a moment when growth can be used to meaningful advantage.
The conditions that most reliably benefit from early intervention include significant jaw discrepancies, posterior crossbites affecting jaw development, and bite relationships that, left unaddressed, would become considerably more difficult to correct later. In these situations, early treatment can simplify or reduce the scope of future care — and sometimes make treatment possible that might otherwise require surgery.
For the majority of children, however, the most appropriate course is careful monitoring and well-timed intervention closer to adolescence. Watching and waiting is not doing nothing. It is making sure that when treatment begins, the timing is right and the outcome is as efficient and effective as possible.
A Measured Perspective
There is a great deal of enthusiasm in orthodontics right now around early expansion, airway treatment, myofunctional therapy, and frenectomies. Some of it is well-founded. Much of it, in our view, is not.
Palatal expansion can be genuinely beneficial — there is reasonable evidence supporting its role in correcting posterior skeletal crossbites, and in specific cases it may support nasal airway function. But expansion prescribed broadly, without a clear structural indication, is not supported by the evidence and adds unnecessary treatment, cost, and burden for children and families.
Airway concerns are worth taking seriously. Enlarged tonsils or adenoids can affect both breathing and bite development, and when a crossbite is present alongside these concerns, treatment may well be indicated. But orthodontic expansion is not a treatment for airway obstruction in the absence of a genuine bite problem. If your child has significant airway or breathing concerns, the right first conversation is with your pediatrician or an Ear, Nose and Throat Specialist, not an orthodontist. When medical or functional concerns extend beyond the scope of orthodontics, we are glad to help connect families with the right specialists, including ENTs, speech therapists, and oral surgeons. Getting the right provider involved at the right time is always in the patient's best interest.
Myofunctional therapy covers a wide range of interventions, most of which have limited clinical evidence behind them. There are specific situations — tongue thrust contributing to an anterior open bite, for example — where targeted therapy may be appropriate. But broadly prescribed myofunctional programs are something we approach with considerable skepticism.
On frenectomies, we defer to our colleagues in speech therapy at Connecticut Children's Medical Center, whose experience with pediatric patients is extensive. Their clinical view, which we share, is that the majority of frenectomies currently being recommended are unnecessary. Genuine tongue tie with clear functional consequences is a real condition that warrants treatment. Frenectomy as a routine intervention for a wide range of concerns is not well supported.
We raise these topics not to dismiss the concerns that bring families in, but because we believe you deserve a measured, honest perspective — one that isn't shaped by what generates the most treatment. If you've been told your child needs any of these interventions and you'd like a second opinion, we welcome that conversation.
What to Expect
Your child's first visit is complimentary and comes with no obligation. If early treatment is genuinely indicated, we will explain clearly what it involves, what it is intended to accomplish, and what comes after. If it isn't indicated, we will tell you that too — along with what we'll be monitoring and when we'd expect to revisit the question.
Our goal is for every family to leave with a clear, honest picture of where things stand. Not a treatment plan designed to start as soon as possible, but a thoughtful roadmap that puts your child's long-term wellbeing first.