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How and when a child is referred for orthodontic assessment. This page explains how the AAPD frames the decision. It cannot tell you whether your child needs referring — that is a clinical judgement made with records.
A referral is your dentist asking a colleague with different training to look at something. For orthodontics that usually concerns how the teeth and jaws are developing and fitting together, rather than the health of individual teeth.
The AAPD frames the responsibility clearly: dentists have the responsibility to recognise, diagnose and manage or refer abnormalities in the developing dentition, as dictated by the complexity of the problem and the individual clinician’s scope of practice. Referral is one option among several, not an escalation.
Sometimes your dentist asks another tooth expert to have a look at how your teeth are growing. It does not mean anything is wrong — it means they want the right person looking.
Two things families read into a referral that are not there. It does not mean treatment has been decided — the AAPD is explicit that treatment is beneficial for many children but may not be indicated for every patient with a developing malocclusion. And it does not mean your dentist has run out of ideas; the AAPD describes managing or referring as the same responsibility, chosen by complexity and scope of practice.
Four points, all from its guidance on the developing dentition:
The through-line is that referral is a judgement about who should look and when, not a verdict about what will happen.
Three things worth knowing.
The AAPD separates diagnosis and planning from treatment, and states plainly that treatment may not be indicated for every developing malocclusion. An assessment can conclude that nothing is needed yet.
Referrals are often made at particular stages because that is when the necessary information exists. The AAPD organises evaluation by stage for exactly this reason.
The AAPD emphasises the diagnostic summary in determining priorities and timing. A dentist who has seen your child repeatedly brings something a first appointment cannot.
Gather the information a decision needs, then decide whether to manage, refer, or continue watching.
This is a routine-checkup conversation. If you want to know whether a referral is likely, ask directly at the next visit — what are you seeing, and when would you decide? Both are reasonable questions and your dentist will have thought about them.
There is no urgent version. If you have been referred and are waiting, and something changes — pain, a tooth loosening, an injury — that is a reason to contact your dentist rather than to wait for the orthodontic appointment.
We have been referred — should we be worried? A referral means your dentist wants the right person looking, which the AAPD describes as part of the same responsibility as managing something themselves. It does not mean treatment has been decided; the AAPD states treatment may not be indicated for every developing malocclusion. Ask your dentist what specifically prompted it — that is a fair question and the answer is usually reassuring.
Not a single age, and this page will not invent one. The AAPD organises evaluation by stage and places orthodontic diagnosis and planning for crowded, Class II and Class III cases at the adolescent dentition if not instituted earlier — which explicitly allows for earlier. Your dentist decides on your child’s records.
Arrangements vary by country and by practice. Ask your dentist — and it is worth asking anyway, because the AAPD emphasises the diagnostic summary and records in determining timing, and your dentist holds those.
No. The AAPD is explicit that treatment is beneficial for many children but may not be indicated for every patient with a developing malocclusion. An assessment can conclude that watching is the right course.
There is a list on Questions to ask a dentist. Worth adding: what are the options including doing nothing, and what happens if we wait.
Waiting is a legitimate clinical position and the AAPD supports it explicitly. If you want another view you are entitled to seek one; asking your own dentist to explain their reasoning first is usually the quicker route to understanding it.
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.