GUEST DENTIST FEATURE · CHILDREN'S TEETH AND JAW DEVELOPMENT

Crowded teeth, an underbite or mouth breathing? 7 signs your child may need an early orthodontic assessment

An early assessment does not automatically mean braces. Learn the signs involving tooth alignment, bite, breathing and oral habits that may be worth discussing with a dentist.

Dr Tay Ying Xi DDS (UKM) Principal Dentist · Klinik Pergigian Great Smile Dental

HiParents Guest Contributor

From HiParents: Some bite and tooth-alignment concerns show signs before all the permanent teeth have appeared. HiParents invited Dr Tay Ying Xi, Principal Dentist at Great Smile Dental, to explain seven signs parents can look for and when an early orthodontic assessment may be helpful.

Seven signs that may warrant an early orthodontic assessment

A single sign does not mean that a child definitely needs orthodontic treatment. However, when a concern persists, becomes more obvious or affects chewing, breathing or daily life, it is worth arranging a professional assessment.

Crowded baby teeth or no spaces between them

Obvious crowding or a complete lack of spacing in the baby teeth may mean there will be less room when larger permanent teeth erupt. The dentist will also consider arch size, permanent-tooth development and the child's individual growth pattern.

Early loss of baby teeth

Baby teeth lost early because of decay, infection or trauma may affect the space needed for the permanent teeth. A dentist can advise whether simple monitoring or space management should be considered.

Underbite or crossbite

When the lower front teeth sit in front of the upper front teeth, or some upper teeth bite inside the lower teeth, the child may have an underbite or crossbite. An assessment helps determine whether the concern involves tooth position, jaw relationship or both.

Excessive overjet or protruding front teeth

Upper front teeth that project noticeably forward may make lip closure more difficult and can be more vulnerable to injury. The dentist may assess the child's bite and jaw-development pattern.

Open bite

If the upper and lower front teeth do not meet when the child bites together, there may be an open bite. This can be associated with tooth position, jaw development or persistent oral habits, and may sometimes affect biting or speech.

Persistent mouth breathing, loud snoring or teeth grinding

Regular mouth breathing, loud snoring or night-time teeth grinding can be easy to overlook. These signs are not always caused by a dental problem, but a dentist can consider them as part of the overall assessment and recommend further medical evaluation when appropriate.

Thumb sucking or prolonged pacifier and bottle use

Oral habits that continue for a long time may be associated with changes in tooth position and bite. The aim is not to blame the child, but to understand the frequency and reason for the habit before helping the child make an age-appropriate change.

Key point for parents: These are signs that may justify an assessment, not a checklist for self-diagnosis. A dentist must consider the child's mouth, tooth-eruption stage and individual growth before determining whether there is a bite or jaw-development concern.

Which changes are commonly missed at home?

Dr Tay highlights mouth breathing, loud snoring, persistent thumb sucking, prolonged pacifier or bottle use, and certain eating or sleep-related behaviours as signs parents may overlook in daily life.

Breathing and sleep

Regular mouth breathing during the day or while asleep
Loud snoring
Still appearing tired in the morning
Dark circles around the eyes or reduced alertness
Night-time teeth grinding or persistent bed-wetting

Eating and oral habits

Picky eating or reluctance to chew certain foods
Persistent thumb sucking
Frequent pacifier or bottle use beyond the expected stage
Lips that often remain apart at rest

Do not assess these signs from a dental perspective alone

Snoring, mouth breathing, tiredness, dark eye circles, picky eating and bed-wetting can have many different causes. These observations cannot by themselves confirm an orthodontic problem. Persistent breathing or sleep concerns should be discussed with a dentist or an appropriate healthcare professional.

When should parents consider an early assessment?

Dr Tay explains that an assessment may be useful once all the baby teeth have erupted, or during the mixed-dentition stage when baby and permanent teeth are present together. A child may be assessed sooner when there is an obvious bite, eruption, breathing or oral-habit concern.

2 Useful stages to observe dental development

After the baby teeth have erupted and during mixed dentition

Children grow at different rates, so timing should not be based on age alone. The dentist will consider tooth eruption, bite, jaw development and actual symptoms before recommending monitoring, habit changes or further investigation.

Consider asking sooner when there is: an obvious underbite or crossbite, protruding front teeth, early loss of a baby tooth, an unusual eruption pattern, persistent mouth breathing, or a concern affecting eating or sleep.

What happens during an early orthodontic assessment?

An early assessment looks at more than whether the teeth are straight. Based on Dr Tay's input, the dentist may consider the following areas when reviewing the child's current oral health and development.

Oral hygiene and tooth eruption

The dentist may review the teeth and gums, decay risk, the sequence of baby-tooth loss and permanent-tooth eruption, and whether there is limited space or an unusual eruption position.

Occlusion or bite

The relationship between the upper and lower teeth may be assessed from front to back, side to side and vertically, including crowding, underbite, crossbite, open bite and excessive overjet.

Jaw and facial development

The dentist may observe the growth relationship between the upper and lower jaws, facial symmetry and lip closure to determine whether development should be monitored over time.

Breathing and oral habits

Parents may be asked about mouth breathing, snoring, thumb sucking and pacifier or bottle use, and whether these signs appear alongside changes in tooth position or bite.

An assessment does not always mean immediate braces

Dr Tay emphasises that the main purpose of an early assessment is to identify a possible problem sooner. It does not mean every child needs immediate orthodontic treatment or braces.

Monitoring development

Some concerns are best recorded and monitored as the teeth erupt, the bite develops and the jaws grow. The next step can then be based on changes seen at review visits.

Changing an oral habit early

When thumb sucking, prolonged pacifier use or another habit may be affecting development, an age-appropriate change may help support healthier oral and dental development.

The message is not “the earlier the braces, the better”: The aim is to recognise a concern at an appropriate growth stage and avoid missing the right time for monitoring, referral or timely intervention. Recommendations should always be based on the child's individual assessment.

About our guest dentist

Dr Tay Ying Xi

DDS (UKM)
Principal Dentist
Klinik Pergigian Great Smile Dental

Professional insights for this article were provided by Dr Tay Ying Xi, Principal Dentist at Great Smile Dental. Her contribution helps parents understand observable signs involving tooth alignment, bite, breathing and oral habits, as well as the purpose and timing of an early assessment.

HiParents Expert Medical Insights

HiParents invites dentists and child-development professionals with relevant expertise and practical experience to explain health topics that matter to parents in a clear, trustworthy and accessible way. Our content supports parent education while recognising the importance of professional judgement and individual assessment.

Malaysian professional references

Medical information disclaimer: Professional content for this article was provided by Dr Tay Ying Xi and edited by HiParents with supporting Malaysian professional references. It is intended for general parent education only and does not constitute a diagnosis, orthodontic treatment recommendation or doctor-patient relationship. Every child's teeth, bite, breathing and growth are different; if you have concerns, seek an individual assessment from a qualified dentist or an appropriate healthcare professional.