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Growing Smiles
Teeth that overlap or sit out of line because there is not enough room. This page explains what crowding is and how it is assessed. It does not tell you whether your child needs treatment — the AAPD is explicit that not every developing malocclusion does.
Crowding is arch length deficiency: the teeth need more room along the arch than there is. The AAPD describes arch length deficiency as able to produce or increase the severity of malocclusions with crowding, rotations, ectopic eruption, crossbite, excessive overjet, excessive overbite and unfavourable molar relationships.
Some apparent crowding during the mixed dentition resolves as the jaws grow and remaining baby teeth are lost. Some does not. Distinguishing them is measurement over time, not appearance at a moment.
Sometimes new teeth arrive before there is quite enough room, so they look squashed or overlap. Your dentist measures how much space there is and watches how it changes as you grow.
The single most useful sentence for a worried parent, from the AAPD: treatment is beneficial for many children but may not be indicated for every patient with a developing malocclusion. Crowded-looking teeth in a nine-year-old are not automatically a treatment plan.
General, because the assessment is comparative:
That second point is worth noticing: decay between baby teeth is on the AAPD’s list of causes of space loss. Preventing crowding is one of the less obvious arguments for looking after teeth that are going to fall out anyway.
Three things worth knowing.
The AAPD states treatment is beneficial for many children but may not be indicated for every patient with a developing malocclusion. Crowding is assessed, not automatically corrected.
The AAPD sets out different evaluation emphases at each stage, and places orthodontic diagnosis and planning for crowded cases at the adolescent dentition if not started earlier.
The AAPD names decay between primary teeth and unmanaged early loss of primary molars among causes of space loss. Looking after baby teeth is part of managing space.
Measure, monitor, and decide about timing. The AAPD describes evaluation as ongoing and sets out what is emphasised at each stage.
Routine checkups are where this is handled, and continuity matters more than any single visit. If crowding is developing, your dentist will be tracking it before you ask.
Raise it sooner if a permanent tooth is clearly erupting somewhere unexpected, if a baby tooth is not coming out and the permanent one has arrived, or if your child is bothered by how their teeth look.
Will my child need braces? Not a question this page will answer, and be wary of anything that does from a photograph. The AAPD is explicit that treatment is beneficial for many children but may not be indicated for every patient with a developing malocclusion, and that timing and appropriateness are judgements made with records over time. Ask your dentist what they are seeing and when they would decide.
Often it changes as growth continues and remaining baby teeth are lost, and sometimes it does not. The AAPD assesses arch length by measurement across visits rather than by appearance at one. Raise it at a checkup.
That is a judgement your dentist makes. The AAPD describes dentists as having the responsibility to recognise, diagnose and manage or refer abnormalities in the developing dentition according to complexity and their own scope of practice. See Orthodontic referrals.
The AAPD associates long-term non-nutritive sucking with open bite and posterior crossbite specifically, and describes the relationship between habits and development as associational rather than causal. Crowding is framed separately, as arch length deficiency.
Not entirely, but the AAPD names decay between primary teeth and unmanaged early loss of primary molars among causes of space loss — both of which are influenced by care. See Brushing and Space maintainers.
A common belief and not something this page will assert. The AAPD addresses third molars separately, describing radiographic assessment in late adolescence and active surveillance in the absence of disease. Ask your dentist.
Every clinical statement on this page comes from the American Academy of Pediatric Dentistry documents below.
This website is for education only and does not replace care from your dentist, physician, or emergency services.