Orthodontics/ Braces

1. What Is Orthodontics?
2. Why Seek Orthodontic Care?
3. Who Can Benefit?
4. Types of Bad Bites
5. Treatment: Braces and Retainers
6. Risks and Limitations

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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