Orthodontics & Braces

Orthodontics & Braces

The reasons for getting orthodontic treatment and braces can vary from one patient to another. In the United States alone, approximately 3 million people wear braces, with adults starting orthodontic treatment steadily rising.

What is an orthodontic treatment?

What is an orthodontic treatment?

In essence, an orthodontic treatment is a way of moving or straightening teeth to improve their appearance and function. Orthodontic treatment can also help improve the long-term health of the teeth, jaw joints, and gums by spreading the biting pressure over all the patient’s teeth.

Why is orthodontic treatment important?

Why is orthodontic treatment important?

Many people have crooked or crowded teeth and orthodontic treatment is needed to straighten or move the teeth in a better position. Aside from enhancing the teeth’s appearance, orthodontic treatment can also make teeth cleaning easier and improve the teeth’s bite.

For individuals with a misaligned bite (an overbite or underbite) or crooked teeth, there are several treatment options that can help straighten the teeth like retainers and braces.

General dentists perform basic alignment and orthodontics. However, orthodontists specialise in the correction of teeth irregularities.

Typically, questions about the health will be asked, a clinical exam will be conducted, and impressions of the teeth are taken before an appropriate treatment plan is made. In addition, photos of the teeth and face as well as X-rays of the head and mouth may also be requested.

In certain cases, a removable retainer is all that is needed to correct the condition. In cases that involve extreme underbites or overbites, surgery might be recommended. In most cases however, braces will be necessary.

Who are Candidates for Braces?

Who are Candidates for Braces?

As per the recommendation of the American Association of Orthodontists (AAO), children should have their first orthodontic consultation not later than 7 years of age.

While 7 years old might seem too early to consider braces, prompt pre-screening can help ensure preventative measures can be administered when needed to avoid braces in the future.

Adults who think they might be candidates for orthodontic treatment should consult with their dentists right away so appropriate options are explored.

Typically, initial consultation with a dentist or orthodontist will involve visual evaluation of both the facial structure and teeth of the patient. If more in-depth information is needed or if treatment needs to start, diagnostic records will be requested.

The diagnostic tools can include models of the patient’s teeth, X-rays, and photographs of the patient’s teeth and face. The diagnostic records will be used to create a custom  treatment plan for the patient.

When are braces necessary?

When are braces necessary?

To align how they bite together (occlusion) and move teeth into their ideal position, braces are used. The misalignment of teeth between the lower and upper dental arches (with the first molars as a reference point) is called malocclusion.

According to the Angles Classification Method, there are three different misalignment types. Developed by Dr. Edward Angle, whom many referred to as the founding father of orthodontics, the Angles Classification Method is used widely by dentists the world over.

According to the Angles Classification Method, the three types of misalignment are:

  • Class I – This is considered the ideal relationship between the lower and the upper teeth. With Class I bite, spacing or crowding may be present.
  • Class II – This type is more commonly known as “overbite.” The lower first molar of the patient is posterior positioned or is more towards the mouth’s back. The maxilla or the upper jaw appears to protrude forward. This type has two subclasses that describes the upper front teeth’s position. However, in both cases, the molar relationship is just the same.
  • Class III – The lower first molar of the patient is closer to the front of the mouth or is positioned anterior. The mandible or the lower jaw protrudes forward. This type is often referred to as “underbite.”

Even if a patient has the ideal bite, it is possible that they can have varying degrees of spacing or crowding, yet another factor that’s associated with a misaligned bite.

Crowding causes teeth to rotate, overlap, and in some cases, become positioned incorrectly in the mouth. In extreme cases, crowding can cause the tooth to be trapped in the bone.

Crowding can occur when the adult teeth is larger than normal or the dental arch is way too small for the adult teeth. Losing the baby or primary teeth early or retaining them longer than usual in the mouth can also result to crowding.

Aforementioned factors can inhibit the adult teeth and force it to grow or erupt into an incorrect position. Crowding can make flossing and brushing the teeth correctly difficult and may result to gingivitis or tooth decay.

Alternatively, there are also varying degrees of spacing which can occur due to jaw size or smaller teeth. The most prevalent example of spacing is between the centrals or the upper two front teeth. This is called diastema.

How do braces work?

How do braces work?

In essence, braces work by continuously applying pressure on the teeth over a period of time. This is done to slowly move the teeth in the desired direction. As the teeth moves, the bone also changes shape.

Braces are made up of the following components:

  • Brackets. The small squares bonded directly to the front of each tooth is called brackets. Brackets are either attached to orthodontic bands or bonded using a special dental bonding agent. Brackets work like handles and will hold the arch wires that will move the teeth. There are different types of brackets including tooth-coloured plastic or ceramic and stainless steel. The former is preferred by many however since it’s less obvious. In some instances, in order to hide them from view, brackets are cemented to the back of the teeth.
  • Orthodontic bands. These materials are cemented to the teeth using dental bonding agents. Orthodontic bands can be clear, stainless steel, or tooth-coloured. They are wrapped around each tooth and will serve as an anchor for the brackets. The tooth-coloured or the clear bands are considered by many as more cosmetically appealing. Some people however will have no bands, only brackets.
  • Spacers. The spacers that fit between the teeth in order to place a small space before orthodontic bands are placed are called spacers.
  • Arch wires. These are attached to the brackets and will act as tracks that will guide the teeth’s movement. Arch wires can be tooth-coloured, clear, or made of metal.
  • Ties. These are fine wires or rubber rings that are used to fasten the arch wire to the brackets. Just like arch wires, ties can be metal, coloured, or clear.
  • Buccal tube. A buccal tube placed on the band of the last tooth will hold the arch wire’s end in place securely.
  • Ligatures. These are tiny and elastic rubber bands that hold the arch wires to the brackets. Springs may also be placed on the arch wires between brackets to open, pull, close, or push spaces between the teeth.
  • Headgear tubes. Headgear tubes may be placed on the two bands on the upper teeth to ensure the facebow of the headgear is kept in place.
  • Rubber bands or elastics. These are attached to the hooks on the brackets and are worn in various ways between the upper and lower teeth.
  • Facebow headgear. The wire gadget that is used in moving the upper molars back in the mouth is called facebow headgear. The wire gadget is used to create room for crowded teeth and correct bite discrepancies.

For some, “mini-braces” (which are smaller than traditional braces) may be the ideal option. When teeth crowding is not too severe, removable plastic retainers may be used. Various types of braces will be discussed with the patient so the best option is chosen.

Frequently Asked Questions

Frequently Asked Questions

How long do I need to wear braces?

Time required for braces will vary from one person to another and will depend on several key factors. Some of the factors that are taken into consideration include severity of the problem, distance the teeth needs to travel, and the health of the gums, teeth, and supporting bone, among many others.

On average, once the braces are on, they typically remain for one to three years. After the braces are removed, most patients are required to wear a retainer for the first 6 months and wear it only during sleep for a few years.

How often do I need to see an orthodontist during treatment?

You will need to see your orthodontist every month or so to ensure the braces are exerting consistent pressure on the teeth. To create more pressure and tension on the teeth, the orthodontist will make adjustments in the springs, rubber bands or wires of the braces.

In some instances, braces alone won’t be enough to shift the jaw or straighten the teeth. In similar cases, an external appliance like a headgear may be worn at home through the night.

Is wearing braces painful?

Some adjustments to the braces may cause you to feel uncomfortable or sore. When needed, over-the-counter pain relievers might be prescribed. If pain is always experienced every time an adjustment to the braces is made, consider it best to talk to your orthodontist about it so it can be addressed accordingly.

Will age affect the success of braces?

The mechanical process that is used to move teeth with braces is the same regardless of age. That means the benefits orthodontic treatments provide are available to both children and adult.

Primarily, the difference between treatments in children and adults is that some corrections in adults might require more than just braces. In addition, treatments may take longer in adults since the bones are no longer growing.

What happens after my braces are removed?

After your braces are taken off, your teeth will be cleaned thoroughly. Another set of bite impressions and X-rays might be taken to assess how well the teeth are straightened and to check if there are any developing wisdom teeth.

If wisdom teeth comes in after the removal of the braces, your orthodontist or dentist might recommend extraction of the wisdom teeth to prevent the newly straightened teeth from shifting.

Your orthodontist or dentist may also have you wear a retainer. A retainer is a removable or fixed appliance that is custom-made and designed to help maintain the teeth’s new position after the removal of the braces.

Retainers are also sometimes used to treat minor orthodontic issues. Using retainers is a key component of post-braces care. Retainers are typically made of clear plastic, rubber, or metal wires.

After the braces have been removed, you will be required to wear retainers all the time, at least for the first 6 months. After 6 months, you can wear the retainers only during sleep.

Time frame for wearing retainers can vary from one person to another. Even after the teeth has been successfully straightened, it is possible that they have not completely settled in their position yet. Retainers are there to help ensure the teeth stays straight until the gums, bones, and muscles are able to adapt to the change

What other conditions can be corrected by orthodontics?

An incorrect bite and misaligned teeth can affect more than just the smile and appearance. The following conditions can be corrected through orthodontics:

  • TMJ or jaw pain
  • Sleep apnea secondary to snoring and mouth breathing
  • Chewing and eating difficulties
  • Speech impediments
  • Clenching or grinding of the teeth
  • Tooth decay and gum disease

Patients who experience any of the symptoms above should immediately get in touch with their dentist so the cause of the condition can be determined.

For many however, aesthetics can be a factor when deciding if braces is right for them. Correcting any concerns they may have with their teeth or facial shape might help enhance their self-confidence.

If braces is the recommended solution, an appliance that’s specific to the needs of the patient will be prescribed by the dentist or orthodontist. Braces can consist of wires, bands, and other removable or fixed corrective appliances. When it comes to braces however, no one method will work for everyone.