Catching what we can fix — while we still can

Early screening is about prevention — not treatment for treatment's sake

There's a real misconception that early orthodontic screening exists to start treatment early. At Andros Orthodontics, that's backwards. Early screening exists to identify the children whose growth pattern, airway, or skeletal development would benefit from intervention while it's still possible — and to confirm the rest are developing normally and can be safely monitored until adolescence.

The honest reality of pediatric orthodontics is that most Phase I treatment is not about straightening teeth — it's about influencing how the jaws are growing relative to each other, how wide the upper palate develops, and whether airway function is healthy. These are skeletal questions, and they have a defined growth window. Once the bones fuse and the growth patterns set in late adolescence and adulthood, the same problems become surgical questions instead of orthodontic ones.

For the smaller subset of Phase I cases that does involve straightening teeth, we almost always lead with Invisalign First — Invisalign's clear-aligner system designed specifically for the mixed-dentition years. At this age, teeth move beautifully with aligners. There's also a real practical benefit: it's significantly easier for parents to help kids brush and floss without brackets and wires in the way. Hygiene matters at any age. At this age it really matters.

The growth window — in plain language

This is the clinical reason early screening matters, explained without the jargon:

When children are young, the bones of the face and jaw are connected to each other by flexible seams called sutures. During growth, those sutures are still pliable — gentle orthodontic forces applied at the right age can guide how the bones grow relative to one another. We can widen a narrow upper palate. We can encourage a recessed lower jaw to come forward. We can correct skeletal discrepancies that would be difficult or impossible to address the same way later.

As a child grows into late adolescence and adulthood, those sutures gradually close and fuse together. Once they're fused, the same skeletal problems can no longer be corrected with conventional orthodontic forces. Adults with skeletal discrepancies are typically left with two options:

1. Orthodontic camouflage — moving the teeth to compensate for the underlying skeletal problem without actually correcting it. This works for moderate discrepancies, but the underlying structure remains as it was. The aesthetic and functional results aren't always what the patient wanted, and the original problem is still there beneath the teeth.
2. Orthognathic (jaw) surgery — repositioning the jaws surgically. This is real surgery, with real recovery, real cost, and meaningful risk. For severe adult skeletal discrepancies it's sometimes the only path to a real correction.

For some categories of issue — particularly transverse (width) discrepancies of the upper jaw — MARPE can extend the orthodontic window into adulthood without surgery. But most adult skeletal cases that would have been straightforward Phase I treatments in childhood are not nearly so straightforward anymore.

This is the entire reason we screen kids early. Not because we want to start treatment early. Not because there's revenue in it. Because some interventions are only fully possible during the growth window — and we'd rather catch something at age 8 and guide it gently over nine months than have the same family come back in twenty-five years asking whether jaw surgery is the only path forward.

The 7-Up Club

We had to call it something. The American Association of Orthodontists recommends a first orthodontic screening by age 7, so we built our pediatric screening program around that recommendation and called it the 7-Up Club. (Yes, it's a play on words. The kids generally don't get the soda reference, which is fine.)

Every child who comes in for an early evaluation joins the 7-Up Club. Membership comes with:

• A pet dachshund — a stuffed wiener dog with the Andros Orthodontics logo, given to your child at their first visit. He's their new mascot.
• A dog house craft kit — a small dog house your child colors and decorates so the dachshund has somewhere to live
• The University of Michigan Pediatric Sleep Questionnaire — a validated 33-question airway screening tool (more on this below)
• A complete orthodontic evaluation with Dr. Andros — visual exam, low-dose CBCT only when indicated, full conversation with the parent
• The same case-by-case approach the rest of the practice operates by — treatment is recommended only when it's actually warranted

There's no charge for any of it. Membership is open to any child age 7 (or younger when there's a specific concern) who schedules a first orthodontic evaluation.

Why we screen kids for airway concerns

One of the biggest reasons to evaluate children early is the connection between jaw development and airway function. A child whose upper palate is developing narrow, who breathes through the mouth chronically, or who shows signs of sleep-disordered breathing has a structural picture that often gets worse — not better — without intervention. Dr. Andros has spent eight consecutive years (2018-2026) in continuing education focused specifically on the airway-orthodontics connection, training under faculty including Dr. Rebecca Bockow, Dr. Audrey Yoon, Dr. Soroush Zaghi, and other leaders in pediatric airway care.

The University of Michigan Pediatric Sleep Questionnaire

Every child seen at Andros Orthodontics fills out the University of Michigan Pediatric Sleep Questionnaire (PSQ) — a 33-question screening tool developed and validated by Dr. Ronald Chervin and colleagues at U Michigan to identify children at risk for sleep-disordered breathing. Children scoring above the elevated-risk threshold are referred to a pediatric sleep specialist for formal evaluation. The questionnaire is included in the complimentary first visit. Read the original validation study →

Why we use a validated tool rather than just asking parents: many of the orthodontic concerns we see in kids — narrow palate, mouth breathing, certain bite patterns — are downstream effects of underlying airway issues that aren't obvious without a structured screen. The PSQ catches what informal questions miss.

Signs of pediatric airway issues — the ones parents often miss

The clearest sign is usually obvious: chronic mouth breathing or snoring. But several of the most important warning signs are easier to overlook because they don't look like a breathing problem:

• Hyperactivity and ADHD-like behavior. A child whose sleep is being disrupted by their airway every night doesn't show up tired the next day — they show up wired. The brain's response to non-restorative sleep in children is frequently behavioral. The takeaway: for some kids, ADHD-like behavior is actually an untreated sleep-breathing problem in disguise. A 2007 study (Huang, Guilleminault, et al.) followed children diagnosed with ADHD whose airways were also treated — by tonsil and adenoid removal, or by palatal expansion. Many of them saw their ADHD symptoms improve or resolve. If your child carries an ADHD diagnosis and also shows airway signs, an airway evaluation is worth doing. Read the study →
• Restless sleep, thrashing, unusual sleeping positions, sweating during sleep
• Bedwetting past the typical age
• Dark circles under the eyes ("allergic shiners")
• Frequent congestion, sinus infections, or ear infections
• Daytime fatigue, attention difficulties at school, or behavioral changes that don't have an obvious explanation
• A long, narrow face — a developmental pattern often associated with chronic mouth breathing
• A narrow palate, crowded teeth, or a high-arched palate visible from inside the mouth

None of these is diagnostic on its own. Together, several of them often point to an underlying airway issue worth investigating — which is exactly what the Pediatric Sleep Questionnaire screens for. Read more about airway-focused orthodontics →

Phase I treatment — what it usually involves

Phase I happens during the mixed-dentition years — when a child has a combination of baby teeth and permanent teeth, and the jaws are still actively growing. The treatments are designed to influence growth and structure during the window where that's still possible:

• Palatal expanders — to widen a narrow upper jaw before the bones fully fuse. Done at this age, expansion is straightforward and uses gentle forces. The same condition in an adult often requires MARPE or jaw surgery.
• Functional appliances — to influence how the jaws grow relative to each other in cases where an upper or lower jaw is meaningfully behind or ahead of where it should be. This category is the heart of Phase I — most early-treatment cases are about growth, not teeth.
• Habit appliances — to help interrupt thumb-sucking, tongue thrusting, or other habits that are actively shaping the developing bite
• Invisalign First — when Phase I does require tooth alignment, clear aligners designed for mixed dentition. Easier to keep teeth clean than braces at this age.
• Coordinated airway care — referral to ENT, sleep medicine, or myofunctional therapy as appropriate

Phase I treatments typically run 9-12 months. After Phase I, most children enter a "rest period" with periodic check-ins until the permanent teeth have come in and Phase II is ready to begin.

Phase II — comprehensive treatment (typical ages 11-13+)

Phase II is what most people picture when they hear "kid orthodontics" — straightening the permanent teeth into their final positions. By Phase II, all the permanent teeth are usually in, the jaws have stabilized, and the work is primarily tooth movement.

At Andros Orthodontics, Phase II uses the same fully digital workflow we use for every patient — CBCT-based virtual case planning, 3D-printed indirect bonding, and Damon Ultima self-ligating brackets. For appropriate cases, Invisalign clear aligners are also an option. Read more about our digital workflow →

Phase II runs 18-24 months for most cases, depending on complexity. Children who completed Phase I often have shorter, simpler Phase II treatment than they would have had if no early treatment had been done — and in some cases, Phase I prevents the need for extractions or jaw surgery that would otherwise have been required.

What the first visit is actually like

Kids who come in for a first orthodontic evaluation are sometimes anxious. We work to make the visit as low-pressure as possible.

• A friendly tour of the office and a visit with our team
• A visual clinical exam — Dr. Andros (or a member of the clinical team) examines the teeth, takes a quick set of intraoral photos, and identifies any visible concerns. Most kids don't need any imaging at all at the first visit.
• The Pediatric Sleep Questionnaire — completed by the parent during the visit
• CBCT imaging only when indicated. We do not do panoramic X-rays or periapical X-rays as part of routine pediatric evaluation. When imaging is required, we use a low-dose, limited-field CBCT machine specifically to minimize radiation exposure — and it provides three-dimensional information (including airway volume) that 2D X-rays simply can't. Imaging is never done prophylactically; if the visual exam shows no concerns, we don't take radiographs.
• A conversation with the parent — what we saw, what we'd recommend, what we'd watch for, and what the next visit looks like
• Joining the 7-Up Club — your child leaves with their dachshund and a dog house craft kit to take home

There's no pressure to commit to treatment at the consultation. Parents leave with a written treatment plan summary and time to think about it. Most parents take a few days to a few weeks to decide. Many kids don't need any treatment yet and come back for a re-evaluation in a year.

Why we built the 7-Up Club

Most parents don't know what to look for. Even when something feels off — your kid is hyperactive and you don't know why; your kid is a chronic mouth breather but you've been told it's just allergies; your kid snores and you assume kids snore — there's no real way to know whether what you're seeing is a developmental concern with a window to address it, or just a phase.

We built the 7-Up Club so parents have somewhere to bring that question. The screening is complimentary, the screening tools are validated, and Dr. Andros personally reviews every case. If we see nothing concerning, you leave knowing your child's development is on track. If we see something worth watching, you'll know what it is and what to do next. If we identify something with a real growth window — a developing airway issue, a narrowing palate, a jaw growth discrepancy that's still influenceable — we tell you clearly and lay out the options.

Dr. Andros grew up in Richland. His five siblings all came back to raise families in the Tri-Cities too. The kids who come through Andros Orthodontics are the kids of his neighbors, classmates, and longtime friends. Building a free screening program for them was an easy decision. Catching a developing problem at age 7, when it can still be guided, rather than at age 27 when it can only be managed — that's the difference between something that can be fixed and something a family has to live with. That's why the screening is free, and why even when treatment is warranted, we work hard to keep the costs as accessible as we can for the families who need them.

A note on insurance and financing for pediatric cases

The first evaluation — the full 7-Up Club visit — is complimentary regardless of insurance. There's no charge to be seen.

For children who do go on to treatment, most dental insurance plans with orthodontic benefits cover children. Andros Orthodontics works with most major insurance plans and accepts Washington Apple Health (Medicaid) for qualifying pediatric cases. Before your visit, our patient platform OrthoFi handles the insurance verification, so the financial conversation at your consultation is specific to your child's actual coverage rather than a generic estimate.

For families without insurance — or whose plan doesn't cover orthodontics — we offer in-house monthly payment plans. We'll cover the financial details at your consultation along with the treatment plan, so you can make an informed decision.