Seven out of 10 children will have developed a malocclusion, or bad bite, by the time they have reached peak puberty. It is the goal of the pediatric orthodontist to intercept and rectify abnormal growth patterns of the cranio-facial structures.

Seven out of 10 children will have developed a malocclusion, or bad bite, by the time they have reached peak puberty.


Out of these malocclusions, 90 percent are tooth-related, caused by environmental issues like oral habits or medical-induced mouth breathing. The remaining 10 percent of developing pediatric malocclusions are skeletal-based, caused by hereditary and neuromuscular problems.


These conditions can affect normal jaw growth and development in the transverse, horizontal and vertical planes of cranio-facial growth. It is the goal of the pediatric orthodontist to intercept and rectify abnormal growth patterns of the cranio-facial structures.


The correction of malocclusion is an elective decision focused on esthetics and function. Both esthetics and function, without question, do affect a child's quality of life and relationships.


Recommended treatment in the U.S. and abroad are in one of three ways:




Growth modification requires early treatment to maximize the pre-pubertal growth potential of the child.

Camouflage treatment of the malocclusion resigns the correction to compensate the position of the teeth to mask the limited remaining pubertal growth position of mal-positioned jaws.

Orthognathic surgery is an option when the malocclusion is too complex to treat to acceptable standards conventionally with growth modification or camouflage treatment.

Recommended treatment strategies and protocols of malocclusions are guided by the children's dentist experience, expertise and professional training.


The dental profession promotes the need for the child to be examined, and treatment planned orthodontically no later than age 7. At that time, the parent (for the child) can discuss the advantages and disadvantages of these modes of treatment. The parent can ultimately decide what treatment approach is best for their child.


Dr. Leonard J. Carapezza is a pediatric dentist in Wayland, Mass., and an associate professor at Tufts University School of Dental Medicine where he teaches early treatment pediatric orthodontics.