Two-Phase Orthodontic Treatment

In general, the first phase of treatment is designed to lessen the severity and complexity of the eventual second phase of treatment.

Phase-One Treatment

Some parts of orthodontic treatment are best started before all of the permanent teeth have come in. This is generally between the ages of 7 and 10 years old. Most of these treatments are directed at underlying jaw development problems, tooth eruption disturbances, and correcting habits (such as thumb sucking) that, left untreated, allow orthodontic problems to worsen while the child grows


Types of jaw problems include:

  • Underbites
  • Large overbites (buck teeth)
  • Narrow upper jaws
  • Combination of the above

It is essential to identify and correct many jaw issues at an early age, while the jawbones and joints are still flexible and more easily guided into proper relationships with the opposing jaw. There are many jaw growth problems that, if not treated at a young age, can only be treated with more invasive procedures later, including jaw surgery.

Tooth Eruption Disturbances

  • Teeth growing in the wrong direction in the jawbone
  • Front teeth wildly twisted or flared out
  • Early loss of baby teeth, causing permanent teeth to collapse into their spaces
  • Impacted permanent teeth
  • Permanent or baby teeth fused to the bone
  • Genetically missing teeth
  • Two teeth developing in the same space

Habit Correction

Thumb sucking, chewing on clothing, tongue thrusting and unusual swallowing patters, as well as lip biting or cheek biting behaviors can cause teeth to be pushed into more crooked positions. Some of these habits go undetected by parents while others (such as thumb sucking) can cause parents and children much anguish as they attempt to deal with them on their own.

Correcting these problems requires a combination of compassion, an understanding of the underlying causes, a plan based on positive reinforcement, and most importantly, an understanding and agreement by the child that it’s time to stop the damaging habit. Without buy-in from the child, it is almost impossible to eliminate habits such as these.

(Note: Dr. John’s underlying philosophy regarding habits is that we never use sharp or uncomfortable devices to try and dissuade the child from thumb-sucking or finger-sucking. Our greatest success comes from empowering children to make choices and set goals, then setting up positive reinforcement so that the parents can help the children reach their goals. It’s a team effort, and one that has been successful for the last 20 years in our practice.)

A final word on phase-one treatment. Sometimes (but not often), a successful phase-one treatment eliminates or makes optional the need for a second phase of treatment. This is a rare, but happy occurrence for all involved.

Phase-Two Treatment

The second phase of treatment is focused on the final positioning and alignment of the teeth. Because many of the underlying jaw development and tooth eruption problems were addressed during phase one, the second phase of treatment is almost always much easier than it would have been had phase one not been completed.

Two-phase treatment almost always provides a better overall result in terms of facial balance, smile esthetics, and long-term stability of the teeth.