Can a child get braces with baby teeth still in, and do baby teeth ever have to come out first?

Many children are evaluated with a mix of baby and permanent teeth

Many children are evaluated while they have a combination of baby and permanent teeth, the AAO says, and some may benefit from treatment during this stage, which is often called mixed dentition.

An orthodontist looks at much more than the number of baby teeth remaining: the AAO names the position of the permanent teeth, the way the upper and lower teeth fit together, jaw growth and the timing of tooth eruption as factors that can help determine when treatment should begin.

An early exam is not the start of braces

Some 7-year-olds may benefit from braces or another orthodontic appliance, the AAO says in an FAQ entry dated October 2026, but it adds that being checked at that age does not automatically mean starting treatment.

Only a few orthodontic problems will need correction at that age, according to the AAO, and not all treatment is done using braces.

The outcomes an initial consultation can lead to are listed in the practice's overview of early orthodontic treatment.

When a baby tooth is taken out on purpose

Removing a baby tooth can be part of a plan: the AAO says early treatment could consist of removing a stubborn baby tooth so the permanent tooth that follows can arrive in its proper place, and that removing baby teeth can sometimes help permanent teeth come in closer to their ideal position even without an orthodontic appliance.

The AAO's glossary also defines serial extraction: the selective or guided removal of certain baby teeth and/or permanent teeth over a period of time to create room, reduce crowding and create a better environment for the permanent teeth to erupt.

The practice's early-treatment page says removing some baby teeth may be necessary to help the permanent teeth come in better, and the AAO says the orthodontist suggests the timing to take advantage of a child's growth and development. A permanent tooth that is not coming in has its own post, why permanent teeth do not erupt.

Why a baby tooth may move during early treatment

Moving baby teeth to improve their appearance is not the purpose of early treatment, the AAO says; early treatment is done to create a healthy environment for the permanent teeth that will be coming in, and while baby teeth may be repositioned along the way, their movement is incidental.

Baby teeth still have work to do while they are in: the AAO says they hold space for the permanent teeth that succeed them and contribute to facial development and to the ability to bite, chew and speak. The reasons an early loss matters are gathered on the page about baby teeth lost early.

When a child's upper jaw is too narrow for the permanent teeth to have room to come in, the AAO says treatment could consist of a palate expander to widen the jaw; how the appliance works is described on the practice's palate expanders page.

Treatment with baby teeth in is often a first phase

Treatment done while a child has some baby teeth does not necessarily finish the job: the AAO says preventive or interceptive treatment is sometimes all a patient needs, but more often a second phase of comprehensive treatment follows once most or all of the permanent teeth are in.

Your orthodontist can explain what future treatment is anticipated, the AAO adds, and the post One Phase or Two? says the preliminary visit at Carvalho & Roth Orthodontics assesses each case and decides whether one-phase or two-phase treatment is necessary.

Each step of the consultation, from new patient forms to an initial examination with digital photos and X-rays and a piece-by-piece account of the type of treatment, its length and its cost, is laid out on the first consultation page.