Orthodontic Treatment

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Right Time for Braces?


It is never too late to begin orthodontic treatment – but when it comes to your child’s jaw and teeth development, earlier may be better than later.

According to the American Association of Orthodontists, all children should have an initial orthodontic screening at age 7. If you suspect a growth issue including snoring, mouth breathing, grinding, a crossbite, an underbite or an overbite, please bring your child in sooner. We may not initiate treatment yet, but the initial evaluation is still important.

Things to be concerned about in growing children:

  • Underbite
  • Overbite
  • Crossbite
  • Openbite
  • Mouth breathing
  • Snoring
  • Crowding
  • “Tongue-tie”
  • Digit sucking

We understand that you and your family juggle busy schedules with afterschool activities, homework, and other obligations. We will do all we can to accommodate your schedules. We offer both braces and Invisalign for our teenage and adult patients. During your consultation appointment, we can discuss the pros and cons of both treatment options.


When a person’s teeth or jaws do not fit together properly, orthodontic treatment may be necessary to correct the problem.

If left untreated, these orthodontic problems, often referred to as malocclusions, can cause speech difficulty, premature wear of the teeth and protective enamel, and even increase the chance of injury to the teeth and jaw joints.


An underbite is characterized by an underdeveloped maxilla, causing the upper teeth to rest behind the lower front teeth. This problem is best treated as early as possible.


This malocclusion occurs when the upper teeth sit inside the lower teeth, which may cause tooth stratification and misaligned jaw growth. In order to close the mouth, patients usually move their lower jaw forward or to the side when closing. This incorrect bite results in an improper use of the lower jaws and sometimes brings about facial asymmetry.

Upper Front Teeth Protrusion

The appearance and function of your teeth are impacted by this type of bite. It is characterized by the upper teeth extending too far forward or the lower teeth not extending far enough forward.


An overbite indicates that the lower jaw is not growing properly. This can be the result of a lower lip entrapment, a digit sucking habit, a deep bite, and/or a tongue tie. When the upper front teeth extend too far forward, they are at risk of injury. If the underbite is the result of a habit we can address early, we want to intervene and get growth on the right track.


Crowding can be an early sign that there is insufficient bone growth to accommodate the eruption of the adult teeth. The best thing we can do for these growing children is expansion. Today, we can help develop more bone, alleviating the crowding and helping to avoid extractions and gum recession later in life.


Spacing is a terrific and normal finding in the primary dentition. In the adult dentition, spacing may be a sign that there is an anterior tongue placement habit. It can also be secondary to congenitally small teeth. We will look at the root cause of spacing when we determine your best treatment options.


Openbites are signs that there is not enough room for the tongue and/or that there is a tongue tie. Openbites are sometimes the first sign that there is an airway issue with a growing child. Correction of an openbite includes understanding why it happened in the first place and treating the underlying cause as a part of comprehensive treatment. If you see an openbite pattern developing, please see us for an evaluation.

Dental Midlines not Matched

Dental midlines that do not match are evident when the back bite does not fit and match appropriately. This may negatively impact jaw function and proper dental function.

We specialize in Invisalign.

We offer a wide range of treatment options utilizing clear aligners including simple cases, interdisciplinary cases and even jaw surgery cases.

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When skeletal growth is not favorable, it is important to identify and treat these problems early.

Misaligned jaws and certain issues seen in children may be early signs of airway issues, oral habits, or other skeletal and growth issues. In early treatment at our Bellevue and Seattle offices, our focus is on getting skeletal growth and development on track.

The Initial Examination

We love seeing children at any age that parents or the dentist thinks there is a problem. We prefer to see children by age seven, but we love seeing them at all ages – if nothing more than to meet them. In many instances, we will decide to monitor skeletal growth and development. If and when orthodontic treatment is warranted, we decide with the family if the child is ready and we tailor our appliance choice based on what is best for each child and family.

When Earlier Treatment Is Better

All adult teeth erupt into the mouth usually between the ages of 10-13 – with a great deal of individual variation. By this age, much of skeletal growth is complete. We can successfully move teeth at this age, but we sometimes loose the opportunity to influence and change skeletal growth patterns.

Crossbite. Crossbite is a condition where the upper teeth close inside the lower teeth. To treat this problem, a device called a palatal expander can be used, which gradually and painlessly widens the upper jaw; it is especially effective when the jaw itself hasn’t fully developed. If we wait too long, a more involved treatment might be required to correct the problem.

Crowding. Another condition that may benefit from early orthodontic intervention is severe crowding. This can be a sign that the jaws are too small to accommodate all of the permanent teeth. Often, simple intervention such as upper and lower jaw expansion can grow the bone to make room for the erupting teeth. This can potentially help reduce the need to take out teeth later, improve airway and sleep, and can help prevent recession. It can also make the second phase of orthodontic treatment more efficient and predictable.

Protruding teeth. Early intervention may also be helpful in resolving several other problems. Protruding teeth, especially in front, can be prone to chipping and fractures; they may also lead to problems with a child’s self-image. A severe underbite, caused by the lower jaw growing much larger than the upper jaw, can result in serious bite problems. Orthodontic appliances can be successfully used to correct these problems at this stage, when the child’s skeletal development is in full swing, thereby increasing the chances that surgery can be avoided.

Correcting Bad Habits. At one time or another, anyone may pick up a bad habit. But there are some situations where a child’s parafunctional (detrimental to health) habits can actually influence the development and function of his or her teeth, jaws and mouth. Some examples of these are persistent thumb or pacifier sucking, tongue thrusting and mouth breathing.

Mouth breathing. An abnormal breathing pattern in which the mouth remains open, passing air directly to the lungs, is related to alterations in the muscular function of the tongue and face. It may cause the upper and lower jaw to grow abnormally, which can lead to serious orthodontic and skeletal growth and development problems. Although mouth breathing may start from a physical difficulty, it can become a habitual action that is hard to break. Mouth breathing can also indicate underdeveloped nasal passages, large adenoids and tonsils, or a tongue tie. Further evaluation is often indicated when treating mouth breathing.

Learn About the Pediatric Expander

Learn More about Early Treatment

Various orthodontic treatments are available at our orthodontic offices in Seattle and Bellevue to help correct these parafunctional habits — and the sooner they are taken care of, the less damage they may cause. But these potential problems are not always easy to recognize. This is one more reason to bring your child in for an early orthodontic screening.

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Adolescence is the optimal time for comprehensive orthodontic treatment at our Bellevue or Seattle offices, though occasionally even earlier intervention is called for. Generally, by the age of 10-13 the permanent teeth have all come in. Once all adult teeth are present, we can start aligning the teeth and perfecting the bite.

Orthodontic problems do not improve over time — as we age, crowding gets worse, we can start to see gum recession and other complications, and issues that were once minor become more complex. It is easier to treat many orthodontic problems during adolescence because the body is still growing. When we combine orthodontics and appliances like palatal expanders, we create dental and skeletal stability and an aesthetic result. If we wait until patients are older, the bones of the face and jaw are more fully developed, and many conditions become more difficult (and costly) to treat.

Orthodontic Appliances

Metal braces. Metal braces today are lighter and smaller than ever. For elastic ties, we offer every color and combination you can imagine.

Clear or tooth colored braces. Clear or tooth colored braces are made of a ceramic material so they blend in with the color of your teeth. Ceramic braces work and function the same as metal braces, but they can be more aesthetic.

Clear aligners. Clear aligners, including Invisalign, are becoming a popular treatment option for our adolescent and adult patients.

How aligners work. We take a digital scan of your mouth, and use special software to plan all of the tooth movement down to the 0.1mm. The software allows us to 3D print a series of aligners. We give you all of the aligners and you switch them out on your own. We will see you at regular intervals to check progress, monitor the gums and teeth, and monitor the bite. What this means for you:

  • No food restrictions like we have with a cemented appliance like braces
  • Less frequent visits because we do not have to tighten the appliances
  • No “emergency” visits due to broken brackets or poking wires
  • Sometimes more efficient treatment due to less appliance breakage
  • Easier to clean teeth

What is a typical treatment duration?

Some treatment plans can be as short as 5 months, and others are longer than 2 years. If you have specific time constraints as you enter treatment, please share this with us at your initial consultation.

Your comprehensive care includes your first set of upper and lower retainers. These will be worn full time at first, then you will switch to nighttime wear. These retainers protect your teeth and help prevent relapse.

What to expect the day braces are put on:


We see many adult orthodontic patients in our practice.

Our orthodontists' training and expertise give them the tools to treat adults with predictability and efficiency. They all understand the nuances of moving teeth while protecting the gums, bones, and joints. Our orthodontists in Seattle and Bellevue have extensive training in treating simple and complex cases with both braces and clear aligners.

Healthy teeth can be moved at any age

There is no such thing as being too old for braces. However, orthodontic treatment for adults is different than for children. Adult jaws are no longer growing, so the orthodontic treatment plans are different. Additionally, the bones, gums, and TMJs respond differently to treatment.

Surgical cases and airway treatment. We have a greater understanding of sleep apnea and airway today. Many sleep and airway-related issues stem from underlying discrepancies in the jaws. If we can get the jaws in the right place, we can open up the airway – helping patients breathe better, sleep better, and experience a greater quality of life.

Non-surgical alternatives. Have you been told that you need jaw surgery but you do not want to pursue it? Our practice offers multiple newer and innovative ways to align the teeth and sometimes bone in a stable and predictable way while avoiding jaw surgery.

Non – Surgical Skeletal Expansion with TAD-Borne Expanders

Today, we can offer non-surgical and minimally invasive surgical options to widen upper jaws. This is an incredible option to improve airway and make room for the tongue, to open nasal cavity spaces, to correct crossbites, and to possibly avoid taking out teeth in very crowded situations.

Non Surgical MSE Device

The Maxillary Skeletal Expander is placed using only local anesthetic and can provide changes in as soon as two weeks.

Case Example: Adult Female

See the stunning results for our patient in the before and after photos below:

Non-surgical MSE

3D X-Rays

We incorporate low radiation 3D X-Rays in our practice when indicated. Our 3D radiographs allow us to visualize the following:

  • Airway dimensions and possible blockage including tonsils and adenoids
  • Impacted teeth
  • TMJs
  • Skeletal relationships
  • The position of the teeth within the bone

Before & After Adult Expansion

As viewed with our 3D XRay technology:

3D X-Ray Expansion

Adenoids (outlined in pink) in a snoring child

The x-ray illustrates that the adenoids are blocking the airway:

3D X-Ray Expansion

Orthodontic Treatment

Sometimes jaw issues that can’t be resolved by orthodontic treatment alone may require jaw surgery. Jaw surgery may also be needed as a means to open the airway for patients with moderate to severe sleep apnea. Jaw surgery is a procedure that corrects the irregularities of the jawbones, realigning the jaws, teeth, and soft tissue to harmonize their function.

Issues that may require jaw surgery include problems with swallowing or speech, difficulty chewing, incorrect mouth closure or facial asymmetry, pain due to an improper bite, or obstructive sleep apnea relief. Jaw surgery is considered an option once the growing period has ended, typically around 14-16 years for females and 17-21 years for males.

Braces or aligners are often worn before the procedure and during the recovery period after jaw surgery. Dr. Bockow and Dr. Truong of Inspired Orthodontics will work with you to determine the optimum treatment plan for your particular needs. If you have been considering jaw surgery to improve the quality of your life, give Inspired Orthodontics a call at (206) 623-2192.

Learn More About Jaw Surgery

Our goal is a beautiful smile at two locations
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