| What Is Orthodontics?
Orthodontics is the diagnosis, prevention and treatment of dental and facial
irregularities. This specialty field of dentistry offers correction for people
with an irregular or "bad" bite, also known as a malocclusion.
Orthodontic care involves the use of corrective appliances, usually
braces. These corrective appliances can be used to:
- Straighten teeth
- Correct bite irregularities
- Close unsightly gaps
- Bring teeth and lips into proper alignment
They can also be used to help with procedures in other areas of dentistry,
such as cosmetic dentistry or implant dentistry.
In young children, orthodontic treatment also may guide proper jaw growth
and permanent
tooth eruption.
Bite Irregularities
Many people's teeth have some irregularity, from slight crowding to uneven
spacing. In fact, experts say many adults have a bite irregularity. Certain
irregularities can cause cosmetic concerns, as well as functional problems,
such as difficulty chewing or talking.
You may have inherited a bite irregularity, but not all bite problems
are genetic. Other causes include:
- Trauma — When teeth are fractured 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, causing
an irregular bite.
- Prolonged thumb sucking or pacifier use — These habits can
cause a bite irregularity, such as a pronounced protrusion (extension)
of your upper teeth over 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 and 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 primary tooth that was lost too early
can move or tilt into the space left by the missing tooth and prevent
the permanent tooth from coming in.
Why Seek Orthodontic Care?
Whether to seek orthodontic care 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, and orthodontic care can help improve appearance
and build self-confidence.
Unlike strictly cosmetic procedures, orthodontic care also can benefit
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 tooth
decay as
well as gingivitis,
an infection that damages gums, and occurs when bacteria cluster around
the area where the teeth meet the gums.
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.
Who Can Benefit From Orthodontic Care?
The American Association of Orthodontists recommends children have an
orthodontic screening no later than age 7. By then, enough of the permanent
teeth have emerged to identify potential problems. However, you shouldn't
wait until all the permanent teeth erupt in the mouth. Starting orthodontic
treatment early in life offers many advantages. For example, while children
are still growing, expansion devices can be used to modify the width
of the palate, which can help teeth come in straighter. Such treatment
is best done at an early age to maximize a patient's orthodontic potential.
Many people undergo orthodontic treatment during adolescent and teen-age
years, when most of the permanent teeth have come in and treatment can
be most effective. About 3 million teen-agers in the United States and
Canada wear braces, and millions more would benefit from treatment.
An increasing number of adults now undergo orthodontic treatment, due
to heightened dental awareness and the fact that more patients have all
or most of their teeth. However, adult
treatment can be more complicated and may require more than one dental
professional to fully correct a problem. For example, adult patients
may be more susceptible to gum problems and will need to address these,
or they may have skeletal (jaw alignment) problems that require corrective
jaw 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, and that is usually the reason that
most people seek an orthodontist for treatment. In addition, an improper
bite causes difficulty chewing and can lead to more cavities (in people
with crowded teeth). Treatment of these bite irregularities can improve
your overall oral health and stabilize your bite.
Incorrect bites are grouped into categories. Common bite irregularities
include:
- Crossbite — Here, the upper teeth seat significantly
inside or outside the lower teeth. A crossbite often requires orthodontic
treatment because this problem can make it difficult to bite or chew.
- Crowding — If there is not enough room for
the teeth, if the teeth are unusually large compared to the size of
the dental arch or if the jaw is narrower than it should be, permanent
teeth may not have enough space to move into the right position.
- Deep overbite — This occurs when the upper
front teeth (incisors) overlap excessively over the lower teeth. In
some cases, the biting edges of the upper teeth touch the lower front
gum tissue.
- Underbite — A crossbites of the anterior
front teeth is commonly referred to as an underbite where the lower
teeth are ahead of the upper teeth.
- Open bite — If your upper and lower front
teeth don't meet when you bite down, this is referred to as an open
bite. Because the front teeth don't share equally in the biting force,
the back teeth may be subjected to too much pressure. This makes chewing
less efficient and can lead to premature wear of the back teeth.
- Spacing problems — Some people have missing
teeth or unusually small teeth compared to the size of their dental
arch. If the size of the jaw is normal, 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.
Treatment: Braces and Retainers
Everyone has a slightly different bite, so treatment techniques vary.
Braces, the most common approach, 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 — This involves the use
of braces or other appliances to move the teeth into proper alignment
and correct the bite.
- The retention phase — This involves the use
of a retainer to hold the teeth in their new position for the long
term.
In addition to braces, orthodontists use special appliances to direct
the growth of the jaw in young children. These appliances are rarely
used in adults.
Getting Braces
ou 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. Your orthodontist will discuss
the available options.
The cost of braces varies, but expect to pay between $1,800 and $5,500.
Some insurance companies may cover part of the cost of orthodontic treatment,
whereas others will not cover it at all.
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. A
few decades ago, braces consisted of thick bands of steel wrapped around
all of the teeth. With the advent of new, stronger bonding agents, smaller
braces can be used, and orthodontic bands rarely have to be used on front
teeth.
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 called ligatures also can be used to 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.
Wearing a Retainer
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.
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 problems, such as people with type 1 diabetes, are more
likely to have complications during orthodontic treatment because they
may be predisposed toward the breakdown of gum and supporting tissue.
In such people, there is an increased risk that orthodontic treatment
may jeopardize the long-term integrity of affected teeth. Your orthodontist
will discuss the risks of your particular treatment.
Achieving the desired results from orthodontic treatment often depends
on the patient's choices. Particularly with adults, an ideal treatment
plan may require a multidisciplinary approach with periodontic and prosthodontic
work or even corrective jaw surgeries. Many times, results are limited
because the patient is not willing to undergo comprehensive treatment.
However, acceptable treatment compromises often can be reached that improve
a patient's condition, even if not ideally. The treatment options and
expected outcomes depend on the individual, and the orthodontist will
review them fully with you before beginning treatment.
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