Orthodontics is the branch of dentistry that corrects teeth and jaws that are positioned improperly. Crooked teeth and teeth that do not fit together correctly are harder to keep clean and are at risk of being lost early due to tooth decay and periodontal disease, and cause extra stress on the chewing muscles that can lead to headaches, TMJ syndrome and neck, shoulder and back pain. Teeth that are crooked or not in the right place can also detract from one’s appearance. The benefits of orthodontic treatment include a healthier mouth, a more pleasing appearance, and teeth that are more likely to last a lifetime. Orthodontics can also be used to help with procedures in other areas of dentistry, such as cosmetic dentistry or implant dentistry, where space may need to be added or eliminated. In young children, orthodontic treatment helps to guide proper jaw growth and permanent tooth eruption.
How do I know if I am a candidate for braces or some other form of orthodontics?
Your dentist or orthodontist can determine whether you can benefit from orthodontic treatment. They base their decision on diagnostic tools that include a full medical and dental health history, a clinical exam, plaster models of your teeth, and special X-rays and photographs. If you have any of the following, you may be a candidate for orthodontic treatment:
Overbite, sometimes called “buck teeth” — where the upper front teeth lie too far forward (stick out) over the lower teeth
Underbite — a “bulldog” appearance where the lower teeth are too far forward or the upper teeth too far back
Crossbite — when the upper teeth do not slightly overlap the lower teeth when biting together normally as they should, but rather the lower teeth are overlapping the uppers
Open bite — space between the biting surfaces of the front and/or side teeth when the back teeth bite together
Misplaced midline— when the center of your upper front teeth does not line up with the center of your lower front teeth
Spacing — gaps, or spaces, between the teeth that occur naturally, or as a result of missing teeth
Crowding — when there are too many teeth for the dental ridge to accommodate
Many different types of appliances, both fixed and removable, are used to help move teeth, retrain muscles and affect the growth of the jaws. These appliances work by placing gentle pressure on the teeth and jaws. Fixed appliances include:
Braces — the most common fixed appliances, braces consist of bands, wires and/or brackets. Bands are fixed around the teeth or tooth and used as anchors for the appliance, while brackets are most often bonded to the front of the tooth. Arch wires are passed through the brackets and attached to the bands. Tightening the arch wire puts tension on the teeth, gradually moving them to their proper position. Braces are usually adjusted monthly to bring about the desired results, which may be achieved within a few months to a few years. Today’s braces are smaller, lighter and show far less metal than in the past. They come in bright colors for kids as well as clear styles preferred by many adults.
Special fixed appliances — used to control thumb sucking or tongue thrusting, these appliances are attached to the teeth by bands. Because they are very uncomfortable during meals, they should be used only as a last resort.
Fixed space maintainers — if a baby tooth is lost prematurely, a space maintainer is used to keep the space open until the permanent tooth erupts. A band is attached to the tooth next to the empty space, and a wire is extended to the tooth on the other side of the space.
Removable appliances include:
Aligners (i.e. Invisalign) — an alternative to traditional braces for adults, serial aligners are being used by an increasing number of orthodontists to move teeth in the same way that fixed appliances work, only without metal wires and brackets. Aligners are virtually invisible and are removed for eating, brushing and flossing.
Removable space maintainers — hese devices serve the same function as fixed space maintainers. They’re made with an acrylic base that fits over the jaw, and have plastic or wire branches between specific teeth to keep the space between them open.
Jaw repositioning appliances — also called splints, are devices that are worn on either on the top or lower jaw to help train the jaw to close in a more favorable position. They may be used for temporomandibular joint disorders (TMJ).
Lip and cheek bumpers — these are designed to keep the lips or cheeks away from the teeth. Lip and cheek muscles can exert pressure on the teeth, and these bumpers help relieve that pressure.
Palatal expander — a device used to widen the arch of the upper jaw. It is a plastic plate that fits over the roof of the mouth. Outward pressure applied to the plate by screws force the joints in the bones of the palate to open lengthwise, widening the palatal area.
Removable retainers — worn on the roof of the mouth, these devices prevent shifting of the teeth to their previous position. They can also be modified and used to prevent thumb sucking.
Headgear — with this device, a strap is placed around the back of the head and attached to a metal wire in front, or face bow. Headgear slows the growth of the upper jaw, and holds the back teeth where they are while the front teeth are pulled back.
Orthodontic treatment in young children is known as interceptive orthodontics, in which intervention begins before the child starts first grade. At this age, tooth development and jaw growth have not been completed, so certain conditions, like crowding, are easier to address. Before permanent teeth have come in, it may be possible to help teeth to erupt (emerge through the gums) into the proper positions. It’s common, for example, for the dental arch to be too small to accommodate all of the teeth. A few decades ago, the solution for crowding was to extract some of the adult teeth and use fixed braces to position the teeth properly. Early intervention takes advantage of the fact that a child’s jaw is still growing. For example, a device called a palatal expander may be used to expand the child’s upper arch. Once the arch is the proper size, there’s a better chance that the adult teeth will emerge naturally where they should. If all teeth have erupted and there is still a great deal of crowding, some permanent teeth may have to be extracted to align the teeth properly. Children who receive interceptive orthodontics may still need braces or other orthodontic appliances later. However, this early treatment may shorten and simplify future treatment and may eliminate the need for more drastic measures such as the need to extract permanent teeth in the future.
Braces today tend to be less uncomfortable and less visible than they used to be, but they still take some getting used to. Food can get caught in the wires, flossing and brushing can take more time, and after the monthly adjustments sometimes the teeth are a little sore. Tooth discomfort can be controlled by taking an analgesic, such as ibuprofen (Advil, Motrin and others) or aspirin if necessary. The use of lighter and more flexible wires has greatly lessened the amount of soreness or discomfort during treatment. Because treatment has become more socially acceptable, social embarrassment may be less of a concern
Whether or not one should seek orthodontic care at an older age is an individual decision. Many people live with crowding, overbites or other types of alignment problems without the motivation to seek orthodontic treatment. However, many people feel more comfortable and self-confident with properly aligned, attractive teeth. Unlike strictly cosmetic procedures, orthodontic care can also benefit your long-term dental health. Straight, properly aligned teeth are easier to maintain with proper oral hygiene, such as flossing and brushing. This can help reduce the risk of cavities as well as gum disease, which occurs more readily as it becomes increasingly more difficult to clean around crowded and rotated teeth. In addition, people with bad bites may chew less efficiently. In severe cases (particularly when the jaws are not aligned correctly), this can result in nutritional deficiencies. Correcting bite irregularities can make it easier to chew and digest foods. Improperly coordinated upper and lower front teeth also can create speech difficulties, which can be corrected through orthodontic treatment. Finally, orthodontic treatment can help to prevent premature wear of back tooth surfaces. As you bite down, your teeth withstand a tremendous amount of force. If your front teeth don’t meet properly, it can cause your back teeth to wear more.
Braces work by applying continuous pressure to move teeth in a specific direction. Braces are worn for an average of one to three years. As treatment progresses, teeth change position, and the braces must be adjusted. When applying braces, the orthodontist will attach tiny brackets to your teeth with special dental bonding agents. He or she will then place wires called arch wires through the brackets. The arch wires, which usually are made of a variety of alloys, act as tracks to create the “path of movement” that guides the teeth. Wires made of clear or tooth-colored materials are less visible than stainless steel wires but are more expensive. Tiny elastic bands hold the arch wires to the brackets, and patients can choose from a multitude of colors at each visit. Expect to be uncomfortable for the first few days after getting braces. Your teeth may be sore, and the wires, brackets and bands may irritate your tongue, cheeks or lips. Most of the discomfort disappears within a week or two, although you may experience moderate pain when wires are changed or adjusted. Taking ibuprofen (Motrin, Advil) or other over-the-counter painkillers can help to ease any discomfort.
You can choose between braces made of metal, ceramic or plastic. However, orthodontic treatment usually is done using stainless steel brackets. Ceramic or plastic brackets often are chosen for cosmetic reasons, but plastic brackets may stain and discolor by the end of treatment. Bands made of plastic or ceramic also have more friction between the wire and brackets, which can increase treatment time. Other options for adults include a series of clear aligners designed to move teeth into proper alignment, but may have certain limitations when it comes to more advanced tooth movements.
A retainer’s purpose is to maintain tooth positions after corrective orthodontic treatment. Once your bite has been corrected, bone and gums need additional time to stabilize around the teeth. The recommended length of time for wearing a retainer varies from orthodontist to orthodontist. Most children and teenagers wear retainers until their early to mid-20s, but your orthodontist’s recommendation should be followed strictly because he or she knows your treatment best. You can choose from a removable retainer or a fixed wire retainer that gets bonded to the inside surface of your teeth to prevent relapse and movement.
Most retainers are removable, meaning that you take them out when eating, brushing and flossing. For this reason, they are easy to misplace. Many people wrap their retainers in a napkin when eating, then forget about them afterwards and have to spend hundreds of dollars on a new retainer. A good solution is to always carry your retainer case with you and to use it whenever you’re not wearing your retainer. For added protection, never leave the case on a table or a bench — always put it immediately in your backpack, purse or pocket. Your dentist can give you information on how to clean and care for your specific type of retainer. Regardless of the type, you need to make sure you don’t sit on, step on or otherwise damage this delicate and expensive piece of equipment.
What should I do to fix my braces if a bracket or band comes lose or a wire breaks or sticks out?
Braces, bands or the wires that are affixed to each tooth occasionally will break or fall off completely, but usually what happens is that one of the parts will loosen, which may cause minor discomfort. Here are a few problems that can occur:
Loose bracket — Brackets are the metal or ceramic pieces that are bonded (glued) to the teeth. If the bond weakens or breaks, which can happen after you chew something hard or sticky, the bracket can dislodge and may poke at the gum tissue or other soft tissues in the mouth, such as your tongue or cheek. You can temporarily reattach loose brackets with a small piece of orthodontic wax, or place wax over the bracket to provide a cushion so it doesn’t poke you. This should provide some comfort until you can see your orthodontist
Loose band — Orthodontic bands are the metal rings cemented with dental bonding agents or cement around back teeth. If an orthodontic band becomes loose, call for an appointment to have it re-cemented or replaced. If the band comes off the tooth or the wire completely, do not replace it yourself. Save the band and call to schedule an appointment for repair.
Protruding or broken wire — This is a common problem. If a wire sticks out of the bracket or band or breaks, it may poke or damage your cheek, tongue or gum. The easiest solution is to use the eraser end of a pencil to push the wire into a less bothersome position. If you can’t bend it out of the way, put a small piece of orthodontic wax over the end that is sticking out. You should not cut the orthodontic wire. A cut wire can be accidentally swallowed or inhaled into your lungs. If the damaged wire has caused a painful sore, rinse your mouth with warm salt water or an antiseptic rinse. This will keep the area clean and help reduce the discomfort. You can also apply an over-the-counter dental anesthetic (pain reliever), which will temporarily numb the area. If the pain doesn’t get better or the sore seems to be getting worse, call your orthodontist
Loose spacer — Spacers or separators are rubber circular pieces that are put between your teeth. They are left in place for a brief period of time, usually for several days. They open a small space between your teeth so that the orthodontic band will slip into place easily. Sometimes, they can slip out of position or fall out entirely. If this happens you should make an appointment with your orthodontist to have them replaced.
Do I need to spend more time caring for my teeth when wearing braces?
Yes, a lot of extra care is needed during orthodontics. The brackets and wires have many nooks and crannies that can trap food and plaque. This means your risk of tooth decay and gum problems may be higher while you are wearing braces. You need to pay special attention to cleaning your teeth everyday and to your diet (try to avoid acidic foods and beverages like soda). Permanent damage to tooth enamel can occur if the teeth and brackets are not kept clean, such as unsightly white spots due to the enamel becoming demineralized. Most of us are well aware that sugary foods and drinks can lead to tooth decay, but starchy foods, such as potato chips, and foods like nuts and raisins can also stick to teeth for long periods of time and cause tooth decay. Avoid hard foods such as nuts and hard cookies. There are foods that can loosen, break or bend wires and bands when you are wearing braces. Foods such as apples and carrots should be chopped into small pieces before eating to reduce the stress on your braces. Avoid sticky foods such as caramels, toffees, or fruit bars. No chewing gum! No chewing ice! Drink plenty of water, and use fluoride tooth pastes and rinses as recommended by your orthodontist. Additionally, try to avoid giving in to bad habits such as nail biting, unnatural tongue thrusting, pencil chewing and picking at your wires, which can also break your braces. Consider using special electric brush tips or orthodontic brushes, along with a water pik and floss threaders to clean more efficiently. While you are having orthodontic treatment, you need to continue to have regular check-ups with your dental professional to ensure little problems don’t become big ones.
A series of clear, virtually invisible custom-molded aligners that are made from impressions taken by your dentist or orthodontist. Unlike braces, aligners have no metal bands or wires to irritate your mouth. Since It is removable, you can take the clear aligner out for meals, brushing and special events, although you will need to wear your trays for at least 21 hour a day for it to be effective. It also allows you to view your own virtual treatment plan before you start so you can see how straight your teeth will look once your treatment is complete.