Dual Arch Orthopedics: Phase I Treatment in the Early Mixed Dentition

The debate over early orthodontics and or orthopedic arch development in the growing child has long been controversial. There are numerous articles in the literature in favor of early treatment strategies beginning in the mixed dentition (1-15). It makes sense to correct problems early rather than let them linger and even worsen over time. I can think of no other area in medicine that allows problems to deteriorate over time without intervention. In order to provide treatment early, however, it is necessary to identify developing problems early, or at least to anticipate these problems before they occur so that corrections can be made in a timely and efficient manner. The American Association of Orthodontists (AAO) recommends children get an orthodontic screening by age 7. The timing of this recommendation, by no accident, coincides with exchange of the front teeth (early mixed dentition). Many an experienced clinician has heard the all too familiar question from a concerned parent whose child is at this stage, ‘will my child need braces?’ In the interest of doing what is best for our patients, we should as dentists, be able to respond correctly, and provide the necessary treatment guidance at this stage, or be able to refer the child to someone who can treat appropriately. Watchful waiting does the child no good and may even cause more harm in the long run. The window of opportunity demands diligence on the part of the treating dentist, as many patients will not achieve proper facial balance, esthetics, or optimal health without early intervention.