Mom’s Guide to Visiting the Orthodontist

By Anjum Choudhry Nayyar

When your child’s teeth are out of line do  you panic and start looking for which side of the family to blame? Some of the most common problems in kids’ teeth can be overcrowding, over or underbites  and spacing. But deciding when to make that visit to the orthodontist and what to look for in one, is key. We spoke to Orthodontist, Jason Tam about orthodontics and kids.


When is the right time to visit an orthodontist? Does everyone need to have their child see one or is it optional?

The best time for the first visit to an orthodontist is usually when the first permanent molars and upper front teeth have come in.  Orthodontic associations recommend that all children see an orthodontist by the age of 7, but this will vary,
depending on the development of your child.  Most of the time, orthodontic treatment is not necessary, but in 10-15% of patients, early interceptive treatment is required and can help avoid costly and uncomfortable problems later on.  Some of these problems include underdeveloped upper jaws, ectopically erupting permanent teeth, and bites that cause the jaw to shift to one side.

Many parents ask me if orthodontic treatment is needed for their child.  I always answer this question with “it depends”.  If you want your child to have a nice smile, with healthy teeth that bite and function properly, then almost everyone can
benefit from orthodontic treatment.  For better or for worse, our society places a high emphasis on our smiles, and this can have an impact on social as well as professional opportunities.  A great smile is a gift that can last a lifetime.


What are the most common concerns at the first visit? What reasons are most kids  are given a referral?

Some of the most common concerns include severe spacing or crowding, and a big “overbite” (when the top teeth stick out from the bottom, the technical word is  overjet, where as overbite refers to how much the top teeth overlap the bottom ones).  Our most common concern is that our patients want “straight teeth”. Many of our patients are referred for a general orthodontic evaluation when the dentist feels it is appropriate for the child to have orthodontic treatment.
However, not all dentists will look actively for orthodontic issues and many parents tell us that they requested a referral.  It is important to note that, unlike in the medical profession, most orthodontic specialists do not require a referral from your family dentist.  Increasingly, our patients are finding us online and through existing patients.

How do you determine which orthodontist to book with? what things should moms look for? what questions should they ask?

In Canada, you want to find a doctor who has completed 2-3 years of specialized training after dental school to be come an orthodontist.  Currently, every new orthodontic specialist must complete a rigorous exam by the Royal College of Dentists of Canada to become a fellow or FRCD(C).

It is important to be aware that general dentists can also provide orthodontic services.  The public is usually unaware that their treatment is not being done by a specialist.  This would be like asking your family doctor to perform heart surgery. While they are licensed and able to do it, few, if any would ever choose their GP over a cardiac surgeon.

When looking for an orthodontic office, the number one thing is to consider the skill and experience of the orthodontist to direct your treatment.  Do you feel comfortable with their plan and is there evidence of excellent work?  Keep in mind
that you may not agree with the orthodontist’s plan, even though it is the best treatment for you or your child.

Here are some other factors to consider:

Cost- Most parents are most concerned about this aspect, but when it comes to healthcare, cost should not be the number one priority.  Some orthodontic fees will include everything other than general dental services while others will
add on the cost of broken appliances/braces, extra visits, retainers, mouthguards, etc.

Technology-  The field of orthodontics changes rapidly from year to year. Modern braces, Invisalign, digital x-rays, computer animations, and email/text message appointment reminders should all be common-place in today’s orthodontic practices.

Level of comfort– Apart from making teeth straight, orthodontic offices can also be a nice place to visit.  Think about how you feel about the staff, the doctor, and about the physical facility of the office.

Location-  Although it is nice to have an orthodontist close by, most orthodontic visits are generally every 6-10 weeks.  It is more important to find an orthodontic office you are comfortable with than to begin treatment with one simply because it is close by.

Convenience and time-  Determine if the office hours will work with your schedule.  Does the office see you on time for each visit or are you left waiting long past your scheduled appointment time?

 Treatment results and experience-  Check to see if your doctor has before and afters of their own patients for you to see, online reviews, and testimonial letters.  Speak to current patients in the office to see how happy they are with
their progress.  Above all, we are looking for amazing orthodontic results!

What are the biggest misconceptions around braces?

A few of the biggest misconceptions are that all baby teeth should be out before seeing an orthodontist, that one can be too old for treatment, and that one should never have teeth extracted for orthodontics.

As described earlier, orthodontic treatment can often be simplified if issues are identified early enough.  With proper monitoring or early treatment, we can usually avoid more costly or uncomfortable situations down the road.  In some situations, it is ok to see the orthodontist when all the permanent teeth are in, but in others, it would be helpful to begin treatment earlier.  This is why it is important to get an assessment early.

-Age is not the critical factor in determining whether you can have orthodontic
treatment.  Rather, it is the stability of the gums and bone supporting the teeth
that is important.  With the increasingly aesthetic options for orthodontics, more
and more adults are seeking treatment.  In our own practice, about 35% of our
patients are adults.

-There are orthodontic companies and orthodontists scaring the public about
extractions.  We avoid extractions whenever possible, but sometimes it is healthier
for the gums and bone to remove teeth, rather than cause periodontal (gum and bone)
issues.  Also, there are times when the teeth may be straight, but make the mouth
protrude.  In these instances, the facial profile would benefit from extractions to
retract front teeth and lips so that they do not stick out so much.

What are the consequences of your child not having orthodontic treatment?

From the standpoint of needing treatment, there are few people who need orthodontic treatment to survive.  There are many with crooked teeth and bad bites who live many years without knowing they have an issue. I always tell parents  hat if they have the opportunity to do so, orthodontic treatment is one of the best things they can do to help their children in the long term.  It means healthy, straight teeth that are easier to clean, places the teeth in positions of minimal trauma, and allows them to function properly for a lifetime. There are also the benefits of improved aesthetics and a beautiful smile, resulting in improved confidence and self-esteem.

For whom is something like Invisalign an option?

Invisalign is an excellent option for those who would like to enjoy the benefits of straight teeth and a healthy smile, without having to wear braces.  Just like with braces that are on the teeth all the time, Invisalign should be worn virtually all the time, 22 hours per day, in order to work properly.  Without this commitment to wearing the aligners, treatment will not progress properly. Invisalign can been used to correct a number of different malocclusions, including severe crowding, spacing, crossbites, large overbites, and even in conjunction with jaw surgery.  It is important to look at Invisalign as a technique, rather than a product, as Invisalign’s marketing suggests.  Whether you are an Invisalign candidate will depend on the skill and experience of your doctor to use Invisalign in your particular situation.


More about Dr Jason K Tam

MCO Orthodontics- Markham and Stouffville

Dr. Jason K. Tam was born and raised in Toronto and is a current Markham resident.  He is a Greater Toronto Invisalign Elite Preferred Provider, recognizing the top 1% of Invisalign practitioners in North America based upon experience.  As of November 2010, he is one of only 3 orthodontists in the Greater Toronto Area with the Invisalign Teen Provider designation, teaches Invisalign nationally to dentists and orthodontists, and lectures to the dental hygiene students and hygienists at George Brown College.
For more information visit:

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