Dr. Catherine Foote has recently noticed a common misconception: that parents need a dentist’s referral to see an orthodontist. They don’t. And waiting for that referral can sometimes mean missing the ideal window for treatment.

“This is not medicine; you don’t need a referral to see a specialist,” Dr. Foote emphasizes. “For 50 years the American Association of Orthodontists has recommended an orthodontic evaluation by age seven.”

How Orthodontists Partner With Your Dentist

With 25 years of orthodontic experience, Dr. Foote has watched the specialty evolve, especially in how it supports healthy breathing, airway growth, and sleep. Dentists and pediatric dentists provide excellent ongoing dental care, treating cavities and oral health.  Orthodontists partner with them by focusing on how the teeth, jaws, and airway develop over time. Orthodontists evaluate facial growth, jaw development, airway function, and how teeth will fit as a child grows. These are fundamentally different assessments.

“Orthodontists bring another layer of expertise,” Dr. Foote says. “We look at the big picture of how a child is growing so we can guide healthy development early.”

Warning Signs Parents Should Watch For

Dr. Foote urges parents to watch for specific signs that indicate their child needs an orthodontic evaluation.

Key signs include:

• Mouth breathing during the day or night
• Snoring or fitful sleep
• Dark circles under the eyes (sometimes called “allergic shiners”)
• Enlarged adenoids or tonsils
• Chronic ear infections or ear tubes
• Thumb, finger, or pacifier habits
• Grinding or clenching teeth
• Speech issues or tongue tie
• Open mouth posture (can’t close their mouth comfortably)
• Bed wetting
• ADHD-like behaviors that may actually be sleep-related breathing disorders

“These are all red flags that indicate the need for some type of intervention,” Dr. Foote says. Parents need to understand there’s a huge benefit to early palatal expansion, which can be as early as ages  three, four, five, six. This has to do with oral and facial development as well as sleep, breathing and airway.

Dr. Foote’s message to Main Line parents: trust your instincts. If something seems off with your child’s breathing, sleep, speech, facial development, or teeth, schedule a consultation.

The Airway Connection

About 15 years ago, Dr. Foote noticed the shifting focus in orthodontics toward airway-focused treatment. Practitioners realized that when they expanded the upper jaw (maxilla), they weren’t just making room for teeth—they were opening the nasal passage and sinuses, creating space for the tongue and helping patients to become better breathers and sleepers.

The maxilla is a large bone that takes up the entire center of the face. When it’s too narrow, it creates a cascade of problems. The tongue helps to develop the palate from birth, so tongue tie evaluations are also part of an assessment. If the upper jaw isn’t developed to the proper width, the tongue doesn’t have enough space, forcing the mouth open to breathe. Nasal passages become pinched. Sleep suffers. Children wake up tired and unfocused.

Parents often don’t realize these issues connect to orthodontic problems. For example, a child struggling with ADHD behaviors might actually have sleep-related breathing disorders caused by a narrow palate. “There’s a disconnect between pediatricians, pediatric dentists, general dentists, ENTs, and orthodontists,” Dr. Foote observes. “These specialties overlap and there is a need to understand that we are all tied together.”

The Tongue Tie Factor

Tongue ties affect far more than breastfeeding. If a baby’s tongue can’t reach the roof of the mouth, that muscle isn’t pushing against the palatal bone to widen it and develop it properly.

Children with tongue ties often substitute thumb, finger, or pacifier for that stimulation. Some struggle with speech and need therapy. Others become picky eaters because they can’t move food around their mouths effectively.

Most critically, a tongue-tied child cannot be a nose breather. “In order to be a nose breather, your tongue has to rest center high, lips closed, and breathe through your nose,” Dr. Foote explains. When children fall into deep sleep, the tongue muscle relaxes back to wherever the frenum restricts it. They then have to open their mouths to breathe.

Dr. Foote discovered all three of her own children were tongue-tied, despite having nursed successfully. She had their tongue ties released after having expanded them starting at ages three, five, and six. “The tongue tie release is a quick and easy procedure,” she says. “Now they’re all nose breathers. They have beautifully straight teeth and the need for, and the duration, of full braces at this point is very minimal.”

What Happens at a First Orthodontic Consultation

Parents intimidated by orthodontic consultations should know they’re comprehensive, educational appointments. At Foote Orthodontics, first consultations are complimentary and require no referral.

“We take photos and X-rays, and then the patient and parents sit down and review them with our treatment coordinator, Jan, who will explain to both parent and child what their treatment entails and why. It is important to us that the child understands their treatment plan and is part of the process. I then will come in and go over the X-rays and answer any additional questions,” Dr. Foote explains.

The appointment lasts about an hour.

Early Intervention Doesn’t Mean Early Braces

Parents often worry that “early intervention” means years of braces starting in kindergarten. That’s not what early treatment involves. Early, or interceptive, orthodontic treatment is bone focused and orthopaedic in that we are creating the ideal bony foundation for the teeth to erupt into.

Young children typically receive expanders—devices that gradually widen the upper jaw. The process is slow and gentle. For young children, parents turn a small screw every third day. Older children turn it every other day.

“We’re developing the palate and helping to direct facial growth in a positive direction as they’re growing.” Dr. Foote explains. 

Children might need multiple expanders over several years, each creating space for different teeth as they come in. The expanders guide proper oral and facial development 

The Social and Emotional Advantage

Telling a teenager they need an expander triggers emotional resistance. “Socially and emotionally, it’s not as easily accepted, even though they understand the need for it. They don’t want to be the odd man out,” Dr. Foote says.

Young children adapt easily without self-consciousness and are often very excited to start treatment. Young patients who start treatment at earlier ages progress smoothly through expansion and often need minimal braces treatment later.

It’s Never Too Late

Parents who worry they’ve waited too long should know that expansion works at any age. “You can expand a three-year-old, a five-year-old, a 50-year-old,” Dr. Foote says. “They’re just different types of expanders.”

For teenagers and adults, treatment becomes more involved but remains effective. Dr. Foote herself had an expander last spring. Adult patients report additional benefits. Most adults are seeking not only cosmetic results but to function better. Expanding the maxilla not only corrects the width deficiency to accommodate the teeth, but aids in better sleep and breathing, and provides structural support for the midface. Additionally, an ideal maxillary width provides the best aesthetic support for the face as we age.

Trust Your Instincts

Dr. Foote’s core message to Main Line parents: trust your instincts. If something seems off with your child’s breathing, sleep, speech, facial development, or teeth, schedule a consultation.

“You don’t need a referral from your dentist,” she reiterates. “For the last 50 years the American Association of Orthodontics has recommended that children be seen for an orthodontic evaluation by age seven.”

First consultations are complimentary. Parents and child are educated about development, whether treatment is needed now, or if monitoring makes sense.

“If you go to an orthodontist who says, ‘You can wait,’ and you have concerns about the issues on the warning sign list, perhaps you should get a second opinion.,” Dr. Foote advises. “If you see any of these things in your child, please come for a complimentary consultation. It is free and you do not need a referral.”

Foote Orthodontics combines early intervention philosophy with advanced technology, including custom 3D-printed ceramic braces or aligners, and remote monitoring through a mobile app that reduces office visits.

“Kids should be coming for an orthodontic evaluation by age seven,” Dr. Foote concludes. “If you’re concerned about any of the warning signs, remember you don’t need a referral and it’s never too early or too late to intervene.”

Foote Orthodontics supports the Main Line Parent Community’s Health and Wellness Guide. Collaborate with us!