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Orthodontics:
Braces and More
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
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. 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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