Allysone McGreal still wonders whether her son Spencer really needed braces. “His jaw was a little asymmetrical — and it still is,” says the Toronto-based communication specialist, who paid $6,000 for braces when her son was 12. “We were erring on the side of caution.”

Like many parents, McGreal also wishes she had sought a second opinion, though she was happy with the orthodontist recommended by her dentist. “We met with her and loved her. But it was very expensive.”

Because of the cost and the lengthy time commitment, knowing if and when braces are needed should take careful investigation. Research is vital, says Dr. Virginia Luks, a Toronto-based orthodontist, as the surge in orthodontists in major centres has led to different treatment philosophies.

Some practitioners begin treating children as young as seven, says Luks. She frowns upon the practice. “I find it discouraging to see patients who have been told they need braces, when more often than not I would postpone beginning anything until the permanent teeth have all completed their eruption,” says Luks. General dentists are also offering orthodontic services without actually holding degrees in orthodontics, and their levels of expertise vary wildly. Luks warns parents to be wary.

Get a second opinion

The best way to determine whether your child needs braces is to have more than one consultation with an accredited orthodontist. They will be able to diagnose the signs of a dental issue, such as:

  • An overbite (upper teeth cover lower teeth)
  • Overcrowding of teeth (teeth may overlap)
  • A top or bottom jaw that’s too small, too narrow or underdeveloped
  • Teeth that come in at odd angles and displace other teeth
  • An overjet (bunny or buck teeth)

Signs of an orthodontic issue can show up once adult teeth start coming in, which is why a visit to an orthodontist is a good idea at about age eight, says Luks. “In some cases, kids may benefit from an early phase of orthodontic treatment. But parents need to keep in mind that starting early means a second phase of treatment will be necessary, since all issues cannot be addressed until permanent teeth are erupted.” At the very least, a plan of action can be mapped out for later years — usually ages 12 to 13.

How to proceed with orthodontia

Choosing an orthodontist requires investigating credentials, reputation, referrals and policies. Find out:

  1. Is he or she a trained orthodontist, or a general dentist who has taken courses but does not have a degree in orthodontics? Have there been complaints? Find out from the college of orthodontists or dental surgeons in your province.
  2. Have you heard positive comments from parents whose kids have had work done?
  3. Will the orthodontist be applying and maintaining your child’s braces, or will assistants be doing that work?
  4. What is the orthodontist’s rationale for treatment? Can this dental issue get better by itself with time, or will it get worse? At what age will your child be treated?

Of course, cost also comes into play as braces can cost approximately $5,000 and up. “If you don't have insurance and are worried about the cost, most orthodontists will be willing to work with you,” says Sandra Hanna, CEO and owner of the Smart Cookies money management website, “A payment plan can help give you some options, but you'll normally get a discount between 5% to 15% if you pay in full.”

If your child needs braces, just remember, though the price is high, the payoff for your child can be improved long-term dental function and higher self-esteem. “Kids who didn’t smile before can’t smile enough,” says Luks.

If you decide to get braces for your child:

  • Enquire about discounts for appointments at certain times of the day.
  • Find out whether and for how much braces are covered by your workplace health benefits, and whether you have to get pre-authorization from your insurer.
  • Claim the amount you spend on braces that's not covered by insurance as a tax credit.
  • Look into discounted orthodontic programs at local universities.