Are Braces Medically Necessary?


Are Braces Medically Necessary?

Some people choose orthodontic care purely for cosmetic reasons, but for many children and adults, braces are medically necessary.

Whether you are wondering if you or your child need braces, or if perhaps you’re uncertain about what your insurance will cover, it’s important to know when and why orthodontic treatment is medically beneficial.

What Are Some Medical Reasons For Braces?

Your regular dentist is a great place to start. He or she can tell you if you or your child, regardless of age, could benefit from an orthodontic visit.

The American Association of Orthodontists recommends that all children should have a visit with an orthodontist no later than age seven to proactively identify any medical issues that could benefit from orthodontic treatment. 

Braces may be a medical necessity if any of the following are present in your child:

  • Early, late, or irregular loss of baby teeth
  • Difficulty chewing or biting
  • Breathing through the mouth
  • Thumb or finger sucking
  • Crowding, misplaced, or blocked-out teeth
  • Jaws that shift or make sounds
  • Biting the cheek or roof of the mouth
  • Teeth that meet abnormally or not at all
  • Jaws and teeth that are out of proportion to the rest of the face

Here is some additional information about medically necessary orthodontic situations that children and adults may experience:

How do braces affect your speech? What's an impacted tooth? How braces can help your child breathe better Bite matters
Do Braces Affect Your Speech? Orthodontics and Impacted Teeth How Braces Help Your Child Breathe Better Your Bite Matters: How Braces Help

Medical Necessity and Insurance

When it comes to orthodontic coverage, there’s no one size fits all answer. While some dental insurance plans may cover orthodontic care for children or adults, it usually is not covered purely for cosmetic reasons.

Most health plans don’t pay for orthodontic treatment for people over 18 years old, but some do partially cover children under age 18. Some plans may cover orthodontic care if it’s necessary to help you or your child chew better (or for similar medical reasons).

Fortunately, if you are enrolled in a Flexible Spending Plan, the plan does cover orthodontic care. 

We recommend that you check with your personal dental coverage to see if medically necessary orthodontic care is covered. Then, schedule a free consultation here in Brookings to receive expert diagnosis from our board-certified orthodontist, Dr. Meyer.

Braces are an important investment, no matter what your reasons are for choosing orthodontic care. We want to make sure that you receive the treatment you need.