Early orthodontic intervention, known as interceptive orthodontics, has recently sparked considerable controversy. With a continuously rising number of referrals for younger children, clinicians must often compare timely treatment with the potential jeopardies of unnecessary and premature treatment. Precise diagnosis and informed planning are essential in avoiding overtreatment, enhancing clinical outcomes, reducing patient burden, and minimising the risk of complications. Furthermore, the correct use of diagnostic imaging ensures the lowest necessary radiation exposure.
In a recent international study, 88% of dentists reported referring children aged 8-12 years old for orthodontic referral. Despite the proactivity in their efforts, researchers noted that not all patients met the referral guidelines and so may not have been ready for treatment.[i] Premature recommendations and treatment can be avoided by ensuring the patients’ growth patterns and skeletal development have first reached an appropriate stage.[ii]
Weighing the benefits of interceptive orthodontics
Interceptive orthodontics encompasses the diagnosis and treatment of malocclusion at an early stage in a child’s life. This is often prior to the eruption of all permanent teeth. The intention behind such early treatment is to influence facial growth, prevent future misalignment, and to simplify or expedite future treatment.
It is tenable to state that early intervention proposes many benefits. Primarily, it can prevent the escalation of complex cases, particularly in Class II or III malocclusions, crossbites, or airway problems, and significantly reduce the requirement of more invasive procedures in adolescence.[iii] In certain scenarios this approach could eliminate the need for further treatment completely further down the line.
Despite these successes, concerns around potential overtreatment are growing. Oftentimes, dental problems have the ability to self-correct without any procedures. Beginning orthodontic treatment can cause unnecessary inflictions for both the patient and their families. These include avoidable expenses, emotional toil, physical pain, and wasted time. In a study conducted surrounding inappropriate patient referrals, it was noted that up to 45% of new orthodontic referrals may be unsuitable, often due to factors such as referrals made too early.[iv]
Could the patient wait a few more years?
The British Orthodontic Society (BOS) suggests that although early intervention can be advantageous, it must be reserved for very certain circumstances with an appropriate clinical requirement to do so.[v]
To reduce inappropriate referrals and gain greater determination on patient requirements, precise clinical diagnostic methods are indispensable. These are particularly essential in young, growing patients as their skeletal growth is continuing. Identifying the root cause of malocclusion in growing patients requires advanced technology, particularly cephalometric imaging – a vitality in paediatric orthodontic diagnosis.
Minimising radiation exposure in young patients
Children are particularly vulnerable to the negative effects of ionising radiation, which increases concern surrounding their dental care. Modern practice for all age groups is guided by the ALARA (As Low As Reasonably Achievable) and ALADA (As Low As Diagnostically Acceptable) principles. Although dental imaging usually involves low doses, multiple peer-reviewed studies suggest that even at minimal levels, repeated exposure can have negative biological effects, including DNA alterations over time and oxidative stress.[vi][vii] Due to this, the use of radiographs must be justified, attaining integrity with each use, particularly on young patients.
Where imaging is essential, multiple precautionary measures can be installed to improve safety. Radiation exposure can be minimised by narrowing the field of view to a precise area of interest, selecting high-resolution sensors that can operate well at lower radiation dose settings. Scan frequency should be minimal with each patient, typically for solely baseline assessments and targeted follow-up appointments. Focused cephalometric imaging has reduced radiation exposure by up to 50% compared to standard panoramic methods, while simultaneously providing clinicians precise data and diagnostically reliable results required to make informed decisions.[viii]
Technology that supports clinical judgment
When clinical evaluation requires advanced imaging, a system that balances image quality with paediatric safety is essential. The CS 8200 3D Access from Carestream Dental with the Cephalometric Imaging module fulfils all requirements by providing children-specific settings with pulsed low-dose modes. Collimating the image field to the area of interest, the exposure area is limited for better patient protection. Its efficient workflow integrates seamlessly into every practice and offers hybrid 2D and 3D imaging capabilities in a compact design. The accumulation of each revolutionary element gives practices a technological edge now, and in coming years.
Early orthodontic intervention can offer patients the expedited potential of perfecting their smile. Clinicians must differentiate patient cases that would benefit from interceptive treatment from those with potential to self-rectify. Cephalometric imaging provides vital diagnostic clarity, with lose- dose technology protecting young patients from the risks of radiation exposure.
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Nimisha is the Trade Marketing Manager at Carestream Dental covering the UK, Middle East, Nordics, South Africa, Russia and CIS regions. She has worked at Carestream Dental for the past 7 years, where she has developed her marketing skills and industry knowledge to bring the core values and philosophy of the company to the market.
[i] Reddy, S., Derringer, K. & Rennie, L. Orthodontic referrals: why do GDPs get it wrong?. Br Dent J 221, 583–587 (2016). https://doi.org/10.1038/sj.bdj.2016.826
[ii] Proffit, W. R., Fields, H. W., Larson, B. E., & Sarver, D. M. (2019). Contemporary Orthodontics (6th ed.). Elsevier.
[iii] Zhou, X., Chen, S., Zhou, C. et al. Expert consensus on early orthodontic treatment of class III malocclusion. Int J Oral Sci 17, 20 (2025). https://doi.org/10.1038/s41368-025-00357-9
[iv] Turbill¹, Elizabeth A., et al. “An Audit to Address the Problem of Inappropriate New Patient Referrals For Orthodontic treatment in the Northern Isles of Scotland.”
[v] British Orthodontic Society, 2019. Orthodontic Referral Guidelines. [online] Available at: https://www.bos.org.uk/Portals/0/Public/docs/Referral%20Guidelines.pdf [Accessed 11 June 2025].
[vi] Mendonça, Rafael Pereira de, et al. “Principles of Radiological Protection and Application of ALARA, ALADA, and ALADAIP: A Critical Review.” Brazilian Oral Research, vol. 39, 2025.
[vii] De Grauwe, A., Ayaz, I., Shujaat, S., Dimitrov, S., Gbadegbegnon, L., Vande Vannet, B., & Jacobs, R. (2019). CBCT in orthodontics: a systematic review on justification of CBCT in a paediatric population prior to orthodontic treatment. European journal of orthodontics, 41(4), 381–389. https://doi.org/10.1093/ejo/cjy066
[viii]Visser, H., Rödig, T., & Hermann, K. (2001). Dose Reduction by Direct-Digital Cephalometric Radiography. The Angle Orthodontist, 71(3), 159-163. https://www.doi.org/10.1043/0003-3219(2001)071<0159:DRBDDC>2.0.CO;2
