By Dr. Kelly Giannetti, DMD, MPH, MS · Diplomate, American Board of Orthodontics · Early Intervention · Parent Guide
Phase 1 Orthodontic Treatment: When Your Child May Need Early Intervention
A clear guide to Phase 1 (early) orthodontic treatment for children ages 6-10. When it's needed, what it includes, and how to know if your child should be evaluated.
The Short Answer
- Phase 1 orthodontic treatment is early intervention for children typically between ages 6 and 10. It addresses jaw growth, palate development, and bite issues during a developmental window when the body responds best. Phase 1 should be considered as interceptive — it's targeted treatment for specific problems, often using a palate expander, partial braces, or a habit appliance rather than full braces, and has a very specific goal.
- The American Association of Orthodontists recommends a first orthodontic evaluation by age 7, but it is never too early to have your child evaluated. The goal of that first visit is to establish a baseline and identify the small percentage of children who benefit from acting during this growth window. For everyone else, we monitor through our Growth Guidance Program at no charge until comprehensive treatment is appropriate, usually around age 12.
Why age 7
By the time a child is 7, the first permanent molars and incisors have usually erupted. We can see how the upper and lower jaws are growing in relation to each other, whether the palate is developing wide enough for the adult teeth, and whether early habits like thumb-sucking or mouth breathing are affecting bite shape.
Some of these patterns are easier to address while the jaw is still actively growing — and can be much more difficult to correct after growth slows in the early teens. It's not about starting braces early. It's about catching a small set of problems at the only point when the body's own growth still does most of the work.
The soft-spot window
How are we able to modify the growth and shape of the upper jaw in our younger patients? The upper jaw — the maxilla — has soft spots when a child is young, much like the soft spots on a baby's skull. These soft spots are otherwise known as the intermaxillary sutures. Those soft spots eventually harden and interlock with the rest of the jaw. While the upper jaw is still soft, it's more malleable, and it's far easier to mold and guide its growth. Once a patient is an adult and those soft spots have hardened into bone, treatment can still be done — but the amount of change we can achieve without surgery decreases, and the result may not be as stable. Orthodontists are specialists in facial growth, and we prescribe treatment according to what can be accomplished at each stage of development. That's why being seen at an early age matters: growth can still be redirected.
When Phase 1 may be appropriate — and when it can wait
When we examine a younger child, there are four things we screen for: crowding, crossbite or narrow arches, a class-three growth pattern, and oral habits.
- Crowding — when there isn't enough room for an adult tooth to come in, so it can become impacted or erupt far out of alignment. Caught early, we can create the space a tooth needs to come in naturally where it belongs — preventing the need for an extraction, or defects in the soft tissue and bone.
- Narrow Upper Jaw — when the upper jaw is too narrow, it leads to compensations within the upper jaw such as narrowing and difficulty breathing. When one or more upper teeth bite inside the lower teeth, this is considered a crossbite. With a back-tooth crossbite, a child sometimes has to shift the jaw to one side just to chew, which we call a functional shift. Left uncorrected through the growth years, that shift can lead the jaw to grow asymmetrically into adulthood. Corrected early — usually with a palate expander — it resolves before it shapes the face.
- Class three — when the lower jaw grows more than the upper, sometimes producing an underbite or a front-tooth crossbite. Treating it while the upper jaw is still soft can, in some cases, prevent the need for jaw surgery in adulthood.
- Oral habits — thumb or finger sucking, and dysfunctional muscle patterns like tongue thrust and mouth breathing. Any of these can put enough force on a growing mouth to alter how the jaws develop.
Most children we see at age 7 do not need Phase 1. The evaluation tells us which group your child is in.
Signs that may indicate Phase 1
- A crossbite — upper and lower teeth do not meet correctly side-to-side or front-to-back
- Severe crowding with no room for adult teeth coming in
- A narrow upper jaw or palate
- An underbite, where the lower jaw extends past the upper
- An asymmetric jaw — one side growing differently from the other
- A severe overjet — front teeth far ahead of the lower, increasing risk of trauma during sports
- Prolonged thumb-sucking or tongue-thrust habits that are shaping the bite
- Mouth breathing, snoring, or sleep-disordered breathing signs
- Speech development noticeably affected by tooth or jaw position
Signs we typically monitor instead
- Mild crowding without bite issues
- Cosmetic concerns alone, with normal jaw growth
- Front teeth slightly rotated or spaced — common at this age
- Baby teeth that haven't fallen out on a textbook schedule
Children in the "monitor" group are enrolled in our complimentary Growth Guidance Program — a free service we offer our patients and our referring dentists. Beginning at age 7, we see these children about every six months to monitor jaw growth and tooth eruption, so small problems don't have a chance to turn into bigger ones. We take photos at every appointment, examine the mouth, and take X-rays only when they're needed. We never tell a parent of a seven-year-old to "just come back when she's twelve." And we don't bill your insurance for it. We do it because it's the right thing to do — no ethical orthodontist wants to see a patient get more treatment than they need.
What Phase 1 actually looks like
Phase 1 is not full braces. The appliances we use depend on what we're trying to correct:
- Palate expander — A device fitted to the upper teeth that gently widens the upper jaw over a few months. Used when the palate is too narrow for the adult teeth or contributing to a crossbite or restricted airway.
- Partial braces — Brackets placed on select teeth, on either the upper/lower arch or both, used to correct severe rotation, an underbite, or a severe overjet that needs early correction.
- Habit appliance — A small fixed device that helps a child stop a thumb-sucking or tongue-thrust habit that is shaping the bite.
- Space maintainer — Holds space for an adult tooth when a baby tooth was lost early.
- Functional appliance — Used selectively to guide jaw growth when one jaw is meaningfully ahead of or behind the other.
Active Phase 1 treatment usually lasts 6 to 12 months. After that, the child wears a retainer and enters a resting period of 1 to 3 years while the remaining adult teeth come in.
The diagnostic step that decides everything
The recommendation to treat or to wait depends on what we can see — and what we cannot see with a clinical exam alone. At the first Phase 1 evaluation we capture:
- A 3D digital intraoral scan of the teeth. Goopy impressions are a thing of the past!
- A 3D CBCT scan — a highly detailed 3D view of the teeth, jawbone, and facial structures. This is the difference-maker for a Phase 1 evaluation: it allows us to evaluate impacted teeth, root position, the temporomandibular joint, and the airway. A flat 2D X-ray cannot show any of this.
- A clinical exam by one of our doctors, both of whom are Diplomates of the American Board of Orthodontics
- A written treatment plan that lays out the recommendation, the timing, and the cost in itemized form
After Phase 1: what happens next
It helps to think of Phase 1 like the first step in building a house: creating a solid foundation, including normal muscle function. Phase 2 — done around age 12, once most of the adult teeth are in — is where we align the teeth on top of that foundation. If we've built a good foundation, a well-developed jaw with enough room for the teeth, then even if the teeth aren't yet in good alignment, we're in good shape.
Phase 1 corrects the specific underlying problem. It does not mean a child will never need that second comprehensive phase. Some children come out of Phase 1 with a foundation good enough that no further treatment is needed. Others need Phase 2 once all the permanent teeth are in — and when they do, it's usually shorter and simpler than treatment would have been without the Phase 1 foundation. We discuss the likelihood of Phase 2 with each family at the original consult so there are no surprises.
Many parents are rightly cautious about Phase 1 — there's a perception that it's a way to get younger children into more treatment than they need. That's not how we practice. We recommend Phase 1 only when we're confident it will make Phase 2 shorter or more predictable, or the final result better.
If you're ever unsure why early treatment is being recommended — by us or any orthodontist — ask the direct question: "What will the implications be down the road if we don't do Phase 1?" A good orthodontist will give you specifics. Most children don't need Phase 1. For the few who do, it matters that you understand exactly how and why.
What Phase 1 costs in Davis and Sacramento
Phase 1 orthodontic treatment in the Sacramento region typically costs around $4,000, meaningfully less than the $6,000–$8,000 typical range for comprehensive (Phase 2) treatment. The exact fee depends on which appliance is used and the length of active treatment.
Most dental insurance plans with orthodontic benefits treat Phase 1 and Phase 2 as separate treatments under the same lifetime maximum. We call your insurance provider before your consultation to confirm your specific benefit.
HSA and FSA accounts can be applied to the out-of-pocket cost. We offer in-house interest-free monthly payment plans through the active treatment period.
For a complete cost breakdown across all orthodontic treatment types, read our honest 2026 breakdown of braces and orthodontic costs in Sacramento.
The local context — Davis, Sacramento, and surrounding Yolo County
Phase 1 evaluations are one of the most common reasons families across Davis, Sacramento, Woodland, Dixon, and Winters bring their children to us. Each year, families in the Davis Joint Unified School District and Woodland Joint Unified School District schedule first orthodontic evaluations as their kids hit second and third grade. The complimentary nature of that first visit — and the no-charge Growth Guidance Program for kids who don't need treatment yet — means there's no clinical or financial reason to wait past age 7.
What to expect from your child's first visit
- Front-desk intake — brief medical and dental history, no paperwork mountain
- 3D intraoral scan + 3D CBCT scan (5 minutes total)
- Clinical exam by one of our doctors
- Honest conversation about whether action is warranted now, later, or not at all
- Written treatment plan if treatment is recommended — including timeline and itemized cost
- Enrollment in the complimentary Growth Guidance Program if your child is in the watch-and-monitor group
The visit takes about 45 minutes. There is no records fee, no evaluation fee, and no pressure to schedule treatment that day.
Frequently Asked Questions
Your child's first visit is complimentary.
By age 7, the first evaluation should happen
3D intraoral scan, 3D CBCT scan, exam by one of our doctors, and a written treatment plan — at our Sacramento or Davis office. No referral needed. No obligation.