Orthodontics: Braces and More

What Is Orthodontics?
Why Seek Orthodontic Care?
Who Can Benefit From Orthodontic Care?
Types of Bad Bites
Treatment: Braces and Retainers
Risks and Limitations of Orthodontic Care

What Is Orthodontics?

Orthodontics is a specialty field of dentistry that diagnoses, prevents and treats irregularities of the teeth and face. Treatment can correct an irregular or "bad" bite, also known as a malocclusion.

Orthodontic care involves the use of appliances. There are two main types. Braces are attached to the teeth. Removable appliances are put in and taken out by the patient. These devices can be used to:

• Straighten teeth
• Correct an irregular bite
• Close unsightly gaps
• Bring teeth and lips into proper alignment

They also can help with procedures in other areas of dentistry. Examples include cosmetic and implant dentistry.

In young children, orthodontic treatment also may guide proper jaw growth and permanent tooth eruption.

Bite Irregularities

Many people's teeth are irregular in some way. For example, teeth may be slightly crowded or unevenly spaced. In fact, experts say many adults have an irregular bite. Sometimes the main problem with a "bad" bite is appearance. In other cases, it can cause difficulty in chewing or talking.

You may have inherited an irregular bite, but not all bite problems are genetic. Other causes include:

• Trauma — When teeth are broken or knocked out and then replaced, they may fuse with the bone that surrounds them. This is called ankylosis or abnormal root fusion to the bone. If this happens in a growing child, the teeth will not be able to line up properly in the jaw. An irregular bite will result.
  
  
• Prolonged thumb sucking or pacifier use — These habits can cause bite problems. For example, it may cause your upper teeth to protrude (stick out) in front of your lower teeth. A tongue-thrusting habit when you swallow can cause a similar problem.
  
• Premature loss of primary (baby) teeth — If a primary (baby) tooth is lost too early, the permanent tooth loses its guide. It can drift or come into the mouth (erupt) incorrectly. In some cases, the permanent teeth may be crowded, or they may come in only partially. Sometimes the teeth next to the lost primary tooth can move or tilt into the space left by the missing tooth. This may prevent the permanent tooth from coming in.
  
  

Why Seek Orthodontic Care?

Whether to seek orthodontic care is a personal decision. Many people live with crowding, overbites or other types of bite problems and do not seek treatment. However, many people feel more comfortable and self-confident with properly aligned, attractive teeth. Orthodontic care can help improve appearance and build self-confidence. It also may help you to chew better or speak more clearly.

Orthodontic care is not just cosmetic in nature. It also can benefit long-term dental health. Straight, properly aligned teeth are easier to brush and floss. This can help reduce the risk of tooth decay. It also can help prevent gingivitis, an inflammation that damages gums. Gingivitis may lead to infection, which occurs when bacteria cluster around the area where the teeth meet the gums. Untreated gingivitis can lead to periodontitis. This type of gum disease can destroy bone that surrounds the teeth and lead to tooth loss.

People with bad bites also may chew less efficiently. Some people with a severe bite problem may even have problems getting enough nutrition. This especially may occur when the jaws are not aligned correctly. Fixing bite problems can make it easier to chew and digest foods.

When the upper and lower front teeth don't align right, people also can have speech difficulties. These can be corrected through orthodontic treatment, often combined with speech therapy.

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.

Who Can Benefit From Orthodontic Care?

The American Association of Orthodontists recommends that children have an orthodontic screening no later than age 7. By then, enough of the permanent teeth have emerged to identify potential problems.

Don't wait until all the permanent teeth erupt in the mouth. Starting orthodontic treatment early in life may have many advantages. For example, while children are still growing, expansion devices can be used to widen the palate. This can help teeth come in straighter by providing more space. It also may help to correct the way the top teeth and bottom teeth meet or come together. Such treatment should be done at an early age for best results.

Many people undergo orthodontic treatment during preteen and teenage years. At this time, most of the permanent teeth have come in and treatment can be most effective. About 3 million teenagers in the United States and Canada wear braces. Millions more would benefit from treatment.

An increasing number of adults now have orthodontic treatment as well. However, adult treatment can be more complicated. It may require more than one dental professional to fully correct a problem. For example, adult patients may be more susceptible to gum problems. They will need to take care of these problems before orthodontic treatment can begin. Sometimes they also have jaw alignment problems that require corrective surgery. One of the biggest limitations in adult treatment is that adults are no longer growing.

Types of Bad Bites

An improper bite doesn't look good. That is the usual reason that people seek treatment from an orthodontist. In addition, an improper bite causes difficulty in chewing. In people with crowded teeth, it can lead to more cavities or gum disease. Treatment of an irregular bite can improve your overall oral health and stabilize your bite.

Incorrect bites are grouped into categories. Common bite problems include:

• Crossbite — Here, the upper teeth rest significantly inside or outside the lower teeth. A crossbite often can make it difficult to bite or chew. It also may cause the jaw to shift to one side as it grows.
  
  
• Crowding — Permanent teeth may not have room to move into the right position:
  
  
  • If there is not enough room for the teeth
  • If the teeth are unusually large compared with the size of the dental arch
  • If the jaw is narrower than it should be
    
• Deep overbite — This occurs when the upper front teeth (incisors) overlap too far over the lower teeth. In some cases, the biting edges of the upper teeth touch the lower front gum tissue and the lower front teeth may bite into the roof of the mouth.
  
  
• Underbite — A crossbite of the front teeth is commonly referred to as an underbite if the lower teeth are ahead of the upper teeth. This may also be a sign that the jaws are not in the correct position. Sometimes surgery is needed.
  
  
• Open bite — If your upper and lower front teeth don't meet when you bite down, this is called an open bite. This may make it impossible to bite off food with the front teeth. It also can affect speech. Because the front teeth don't share equally in the biting force, the back teeth may receive too much pressure. This makes chewing less efficient. It can lead to premature wear of the back teeth.
  
  
• Spacing problems — Some people have missing teeth or unusually small teeth in a normal sized jaw. This can result in large spaces between the teeth. People who have lost one or multiple teeth may have uneven spacing because adjacent teeth may drift into the unoccupied areas. Braces can be used to shift the position of these teeth so the missing tooth or teeth can be replaced.

Treatment: Braces and Retainers

Everyone has a slightly different bite, so treatment techniques vary. Braces are the most common approach. They help to move the teeth slowly by applying precise amounts of light pressure over a long period of time.

Most orthodontic treatments occur in two phases:

• The active phase — Braces or other appliances are used to move the teeth into proper alignment and correct the bite.
• The retention phase — A retainer is used to hold the teeth in their new positions for the long term.

In addition to braces, orthodontists sometimes use special appliances (called functional appliances) to direct the growth of the jaw in young children. These appliances are rarely used in adults. That's because they are not effective after growth is complete.

Getting Braces
You can choose braces (brackets) made of metal, ceramic or plastic. However, orthodontic treatment is most often done using stainless steel brackets.

Ceramic or plastic brackets often are chosen for the sake of appearance. 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. This can increase treatment time. Your orthodontist will discuss the available options.

The cost of braces varies, but expect to pay between $2,000 and $6,000. The cost may depend on how severe the problem is. Some insurance plans may cover part of the cost. Others will not cover it at all.

Braces work by applying continuous pressure to move teeth in a specific direction. Braces are usually worn for about one to three years, depending on how severe your problem is. As treatment progresses, teeth change position. Your orthodontist will adjust the braces as needed.

A few decades ago, braces consisted of thick bands of steel wrapped around all of the teeth. These days, stronger bonding agents are available. Smaller braces can be used, and orthodontic bands rarely have to be used on front teeth.

When applying braces, the orthodontist will attach small 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 usually are made of a variety of metal alloys. They act as tracks to create the "path of movement" that guides the teeth to their correct positions.

Wires made of clear or tooth-colored materials are less visible than stainless-steel wires. However, they are more expensive and may not work as well. Tiny elastic bands called ligatures also can be used to hold the arch wires to the brackets. Patients can choose from a multitude of colors at each visit.

Expect some minor discomfort for the first few days after getting braces. Your teeth may be sore. The wires, brackets and bands also may irritate your tongue, cheeks or lips. Your doctor will give you some special soft wax to cover any sharp areas on your braces that may be irritating you. Most of the discomfort disappears within a week or two. You also may have moderate discomfort when wires are changed or adjusted. Taking ibuprofen (Motrin, Advil) or other over-the-counter painkillers can help to ease any discomfort.

Wearing a Retainer
A retainer's purpose is to maintain tooth positions after treatment is completed and braces are removed. Once your bite has been corrected, bone and gums need more time to stabilize around the teeth.

The recommended length of time for wearing a retainer varies. Most children and teenagers wear retainers until their early to mid-20s or until their wisdom teeth come in or are removed. You should strictly follow your orthodontist's advice because he or she knows your treatment best.

Risks and Limitations of Orthodontic Care

There are few risks involved in orthodontic treatment. In rare cases, certain patients may have allergic reactions to the metal or latex. People with periodontal (gum) disease have a greater risk of problems during orthodontic treatment. That's because their gums and the supporting bone may be more likely to break down. This can cause loosening and possible loss of teeth. Orthodontic treatment should not begin until all evidence of gum disease has been treated and eliminated.

It is also possible that root resorption (shortening of roots) may occur during orthodontic treatment. This is usually minor and not significant. In a few cases, however, it may be severe. This can jeopardize the life of the tooth or teeth affected.

Your orthodontist will discuss the risks of your particular treatment.

Your choices can affect whether you achieve the desired results from orthodontic treatment. Adults, in particular, may require treatment by several specialists. They may need implants, treatment of periodontal disease or even corrective jaw surgery in addition to braces.

Many times, results are limited because you don't want the full treatment. However, compromises often can be reached that improve your condition, even if not ideally. The treatment options and expected outcomes depend on the individual. Not following the doctor's instructions also can lead to less than ideal results. The orthodontist will review your options fully with you before beginning treatment.