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Orthodontics is a branch of dentistry specializing in the diagnosis, prevention, and treatment of jaw, face and bite irregularities (malocclusions*). Orthodontic treatment is provided by an oral health care provider known as an Orthodontist, who has typically completed two to three years of additional training beyond dental school.
Recent years have brought about many changes within the dental industry, specifically with regards to orthodontic treatment and care. Now more than ever patients are experiencing fewer incidences of cavities and missing teeth due to the heightened awareness of fluoride use and preventative dentistry. This increasing awareness on the health and look of a patient’s smile has fueled the desire for many to seek out orthodontia not only as a medical necessity, but for cosmetic reasons as well.
*Malocclusion is the technical term for teeth that don’t fit together correctly. Malocclusions not only affect the teeth, but also the appearance of the face. Most malocclusions are inherited; however some are due to acquired habits such as thumb sucking and tongue thrusting. The spacing left from an adult tooth being extracted or an early loss of a baby tooth can also contribute to a malocclusion.
A malocclusion is an incorrect relationship between the maxilla (upper arch) and the mandible (lower arch), or a general misalignment of the teeth. Malocclusions are so common that most individuals experience one, to some degree. The poor alignment of the teeth is thought to be a result of genetic factors combined with poor oral habits, or other factors in the early years.
Moderate malocclusion commonly requires treatment by an orthodontist. Orthodontists are dentists who specialize in the treatment of malocclusions and other facial irregularities.
A severe malocclusion may lead to skeletal disharmony of the lower face. In a more extreme case, the orthodontist may work in combination with a maxillofacial dentist to reconstruct the jaw. It is never too late to seek treatment for a malocclusion. Children and adults alike have completed orthodontic realignment procedures and have been delighted with the resulting even, straight smile.
Reduced risk of tooth decay – A malocclusion often causes an uneven wear pattern on the teeth. The constant wearing of the same teeth can lead to tooth erosion and decay.
Better oral hygiene – A malocclusion can be caused by overcrowding. When too many teeth are competing for too little space, it can be difficult to clean the teeth and gums effectively. It is much easier to clean straight teeth that are properly aligned.
Reduced risk of TMJ – Temporomandibular jaw syndrome (TMJ) is thought to be caused by a malocclusion. Headaches, facial pains and grinding teeth during sleep all result from the excessive pressure to the temporomandibular joint. Realigning the teeth reduces pressure, and eliminates these symptoms.
A malocclusion is usually treated with dental braces. The orthodontist takes panoramic x-rays, conducts visual examinations and bite impressions of the whole mouth before deciding on the best course of treatment. If a malocclusion is obviously caused by overcrowding, the orthodontist may decide an extraction is the only way to create enough space for the realignment. However, in the case of an underbite, crossbite or overbite, there are several different orthodontic appliances available, such as:
Fixed multibracket braces – This type of dental braces consists of brackets cemented to each tooth, and an archwire that connects each one. The orthodontist adjusts or changes the wire on a regular basis to train the teeth into proper alignment.
Removable devices – There are many non-fixed dental braces available to treat a malocclusion. Retainers, headgear and palate expanders are amongst the most common. Retainers are generally used to hold the teeth in the correct position whilst the jawbone grows properly around them.
Invisalign® – These dental aligners are removable and invisible to the naked eye. Invisalign works in much the same way as fixed dental braces, but do not impact the aesthetics of the smile. Not all patients are candidates for Invisalign®.
Orthodontics is a specialized branch of dentistry that is concerned with diagnosing, treating and preventing malocclusions (bad bites) and other irregularities in the jaw region and face. Orthodontists are specially trained to correct these problems and to restore health, functionality and a beautiful aesthetic appearance to the smile. Though orthodontics was originally aimed at treating children and teenagers, almost one third of orthodontic patients are now adults. A person of any age can be successfully treated by an orthodontist.
A malocclusion (improper bite) can affect anyone at any age, and can significantly impact the individual’s clarity of speech, chewing ability and facial symmetry. In addition, a severe malocclusion can also contribute to several serious dental and physical conditions such as digestive difficulties, TMJ, periodontal disease and severe tooth decay. It is important to seek orthodontic treatment early to avoid expensive restorative procedures in the future.
Orthodontics can treat a wide range of dental problems and in most cases, completely realign the teeth. Orthodontists may work alone, or in combination with a maxillofacial surgeon.
The typical irregularities requiring orthodontic treatment are as follows:
Overcrowding – An overcrowded mouth means there is insufficient space within the jaw for all of the adult teeth to fit naturally. Overcrowding may lead to displaced, rotated or completely misaligned teeth.
Overbite – An overbite refers to the protrusion of the maxilla (upper jaw) relative to the mandible (lower jaw). An overbite gives the smile a “toothy” appearance and the chin looks like it has receded.
Underbite – An underbite, also known as a negative underjet, refers to the protrusion of the mandible (lower jaw) in relation to the maxilla (upper jaw). An underbite makes the chin look overly prominent. Developmental delays and genetic factors generally cause underbites and overbites.
Orthodontic dentistry offers techniques which will realign the teeth and revitalize the smile. There are several treatments the orthodontist may use, depending on the results of panoramic x-rays, study models (bite impressions) and a thorough visual examination.
Fixed dental braces can be used to expediently correct even the most severe case of misalignment. These braces consist of metal or ceramic brackets which are affixed to each tooth and an archwire which is used to gradually move the teeth through the duration of the treatment.
Removable appliances include headgear (which consists of a metal wire device attached to customized braces), retainers, Invisalign® aligners (which are almost invisible to the naked eye), palate expanders and tooth movers. Faceguards are generally used to correct developmental delays in both the upper and lower jaw, and palate expanders are used to combat overcrowding.
Whatever the dental irregularity or the age of the individual, orthodontic appliances can properly realign the teeth and create a beautiful smile.
Orthodontic treatment is highly predictable and immensely successful. Depending on the severity of the malocclusion (bad bite) or irregularity, orthodontic treatments may occur in either two or three distinct phases.
The benefits of correcting misaligned teeth are many. Straight teeth are pleasing to look at and greatly boost confidence and self esteem. More importantly, properly aligned teeth enhance the biting, chewing and speaking functions of the jaw. There are several types of irregularities, including:
Generally, orthodontic treatment takes between six and thirty months to complete. The treatment time will largely depend on the classification of the malocclusion, the type of dental devices used to correct it and the perseverance of the patient.
Here is a general overview of the three major stages of treatment:
Phase 1 – The Planning Stage
The orthodontist makes an exact diagnosis in order to realign the teeth in the most effective and expedient way. The first several visits may comprise of some of the following evaluations:
Medical and dental evaluations – Dental and physical problems tend to go hand in hand. Problems in the oral cavity can lead to (or be caused by) medical problems. The goal of this evaluation is to ensure that prior medical and dental issues are completely under control before treatment begins.
Study model (castings/bite impressions) – The patient is asked to bite down into a dental tray filled with a gel substance that hardens around the teeth. The trays are removed from the teeth and filled with plaster to create models of the patient’s teeth. Study models enable the orthodontist to scrutinize the position of each tooth, and how it relates to the other teeth.
Panoramic X-rays – X-rays are fantastic tools for viewing potential complications or pre-existing damage to the jaw joint. X-rays also allow the orthodontist to see the exact position of each tooth and its corresponding root(s).
Computer generated images – Such images allow the orthodontist to treatment plan and examine how specific treatments may affect the shape of the face and symmetry of the jaw.
Photographs – Many orthodontists like to take “before, during and after” photographs of the face and teeth to assess how treatment is progressing, and the impact the treatment is having on the patient’s face shape.
All of the above diagnostic tools will be used to diagnosis and develop a customized treatment plan for the patient. Next, the orthodontist will recommend custom orthodontic device(s) to gently move the teeth into proper alignment. This orthodontic appliance may be fixed or removable. Most commonly, traditional fixed braces are affixed, which utilizes individual dental brackets connected by an archwire. Lingual braces are also fixed, but fit on the inside (tongue side) of the teeth to make them less visible.
Removable devices are an alternative to fixed braces. Examples of removable devices include the Invisalign system, headgear and facemask. These devices are designed to be worn for a specified amount of hours each day to expedite treatment.
Whatever the orthodontic device, the orthodontist will regularly adjust it to ensure adequate and continual pressure is being applied to the teeth. It is essential to visit the orthodontist at the designated intervals and to call if part of the device breaks or becomes damaged.
When the teeth have been correctly aligned, fixed braces and removable devices will be removed and discontinued. The most cumbersome part of the orthodontic treatment is now over. The orthodontist will next create a custom retainer. The goal of the retainer is to ensure that the teeth do not begin to shift back to their original positions. Retainers need to be worn for a specified amount of time per day for a specified time period. During the retention phase, the jawbone will reform around the realigned teeth to fully stabilize them in the correct alignment.
Many children are ambivalent about getting braces. On the one hand, they like the idea of perfect teeth, but on the other hand they are nervous about whether the braces will cause pain and discomfort. The good news is that the placement of orthodontic braces is not at all painful, and the end result will be a beautiful straight smile.
Although patients of any age can benefit from orthodontic braces, they tend to work much quicker on pre-teens and teenagers since they are still experiencing jaw growth. The American Association of Orthodontists (AAO) recommends that children should first see an orthodontist around the age of seven years-old. An orthodontic examination may be beneficial before age seven if facial or oral irregularities are noted.
Poorly aligned teeth often cause problems speaking, biting and chewing. Most irregularities are genetic or occur as a result of developmental issues. Conversely, some irregularities are acquired or greatly exacerbated by certain habits and behaviors such as:
The orthodontist initially conducts a visual examination of the child’s teeth. This will be accompanied by panoramic x-rays, study models (bite impressions) and computer generated images of the head and neck. These preliminary assessments are sometimes known as the “planning phase” because they aid the orthodontist in making a diagnosis and planning the most effective treatment.
In many cases, the orthodontist will recommend “fixed” orthodontic braces for a child. Fixed braces cannot be lost, forgotten or removed at will, which means that treatment is completed more quickly. Removable appliances may also be utilized, which are less intrusive, and are generally used to treat various types of defects.
Fixed braces – Braces comprised of brackets which are affixed to each individual tooth, and an archwire which connect the brackets. The brackets are usually made of metal, ceramic, or a clear synthetic material which is less noticeable to the naked eye. After braces have been applied, the child will have regular appointments to have the braces adjusted by the orthodontist. Orthodontic elastic bands are often added to the braces to aid in the movement of specific teeth.
Headgear – This type of appliance is most useful to treat developmental irregularities. A headgear is a custom-made appliance attached to wire that is worn to aid in tooth movement. A headgear is intended to be worn for 12-20 hours r each day and must be worn as recommended to achieve good results.
Retainers – Retainers are typically utilized in the third phase (retention phase). When the original malocclusion has been treated with braces, it is essential that the teeth do not regress back to the original misalignment. Wearing a retainer ensures the teeth maintain their proper alignment, and gives the jawbone around the teeth a chance to stabilize.
Orthodontic braces were historically associated with teenagers. Today, an increasing number of adults are choosing to wear braces to straighten their teeth and correct malocclusions (bad bites). In fact, it is now estimated that almost one third of all current orthodontic patients are adults.
Orthodontic braces are predictable, versatile and incredibly successful at realigning the teeth. Braces work in the same way regardless of the age of the patient, but the treatment time is greatly reduced in patients who are still experiencing jaw growth and have not been affected by gum disease. In short, an adult can experience the same beautiful end results as a teenager, but treatment often takes longer.
Absolutely! Crooked or misaligned teeth look unsightly, which in many cases leads to poor self esteem and a lack of self confidence. Aside from poor aesthetics, improperly aligned teeth can also cause difficulties biting, chewing and articulating clearly. Generally speaking, orthodontists agree that straight teeth tend to be healthier teeth.
Straight teeth offer a multitude of health and dental benefits including:
Fortunately, orthodontic braces have been adapted and modified to make them more convenient for adults. There are now a wide range of fixed and removable orthodontic devices available, depending on the precise classification of the malocclusion.
The most common types of malocclusion are underbite (lower teeth protrude further than upper teeth), overbite (upper teeth protrude further than lower teeth) and overcrowding, where there is insufficient space on the arches to accommodate the full complement of adult teeth.
Prior to recommending specific orthodontic treatment, the orthodontist will recommend treatment of any pre-existing dental conditions such as gum disease, excess plaque and tooth decay. Orthodontic braces can greatly exacerbate any or all of these conditions.
The following are some of the most popular orthodontic braces:
Traditional braces – These braces are strong and tend not to stain the teeth. They are comprised of individual brackets which are cemented to each tooth and accompanied by an archwire which constantly asserts gentle pressure on the teeth. Traditional braces are generally metal but are also available in a clear synthetic material and “tooth colored” ceramic. The ceramic brackets are generally more comfortable than the metal alternative, but can become discolored by coffee, wine, smoking and certain foods.
Invisalign® – Invisalign aligners are favored by many adults because they are both removable and invisible to onlookers. Invisalign® aligners are clear trays, and should be worn for the recommended amount of time each day for the quickest results. Invisalign® aligners are more comfortable and less obtrusive than traditional braces, but also tend to be more costly. Not all patients are candidates for Invisalign®.
Lingual braces – These appliances are usually metal and fixed on the tongue side of the teeth, therefore not seen when a patient smiles. Lingual braces tend to be moderately expensive and in some cases, can interfere with normal speech.
One of the most commonly asked questions about dental braces is whether placing them causes any pain or discomfort. The honest answer is that braces do not hurt at all when they are applied to the teeth, so there is no reason to be anxious. In most cases, there may be mild soreness or discomfort after the orthodontic wire is engaged into the brackets, which may last for a few days.
There are two common types of fixed dental braces used to realign the teeth: Ceramic fixed braces and metal fixed braces. Both types of fixed appliances include brackets which are affixed to each individual tooth, and an archwire the orthodontist fits into the bracket slot to gently move the teeth into proper alignment. Elastic or wire ties will be applied to hold the wire in place. Some orthodontists may use self-ligating brackets which do not require a rubber or wire tie to secure the wire.
Fixed dental braces are used to treat a wide variety of malocclusions, including overbite, underbite, crossbite and overcrowding. If the orthodontist has determined that the malocclusion has been caused by overcrowding, it is possible that teeth may need to be extracted to increase the amount of available space to properly align the teeth.
Here is an overview of what you can expect when getting braces:
Placement day – The placement of braces will not be painful in the slightest. It may take longer to eat meals, but this is largely because it takes some time to adjust to wearing the braces. In some cases, the teeth may feel more sensitive than usual. Hard, difficult to chew foods should be avoided in favor of a softer, more liquid-based diet for the first few days after placement of braces.
Two days after placement – The first several days after placement of braces can be slightly uncomfortable. This is because the teeth are beginning the realignment process and are not used to the pressure of the archwire and orthodontic elastic bands. The orthodontist will provide relief wax to apply over the braces as necessary. Wax helps provide a smooth surface and alleviates irritation on the inner cheeks and lips. Additionally, over-the-counter pain medication (e.g., Motrin® and Advil®) may be taken as directed to relieve mild soreness.
Five days after placement – After five days, any initial discomfort associated with the braces should be completely gone. The teeth will have gradually acclimated to the braces, and eating should be much easier. Certain hard foods may still pose a challenge to the wearer, but normal eating may be resumed at this point.
Orthodontic appointments – Regular orthodontic appointments are necessary to allow the orthodontist to change the archwire, change the rubber or metal ties, and make adjustments to the braces. Fixed braces work by gradually moving the teeth into a new and proper alignment, so gentle pressure needs to be applied constantly. The first several days after an orthodontic adjustment may be slightly uncomfortable, but remember that this discomfort will quickly fade.
Dealing with discomfort – Over-the-counter pain medication and orthodontic relief wax will help alleviate any mild soreness and discomfort following placement o braces and orthodontic adjustments. Another effective remedy is to chew sugar-free gum, as this increases blood flow which helps reduces discomfort and can also encourage the teeth to align quicker.
When braces are finally removed, the “retention” phase begins for most individuals. The objective of this phase is to ensure the teeth do not regress back to their previous position. A retainer will be used to maintain the improved position of the teeth. A retainer is a fixed or removable dental appliance which has been custom-made by the orthodontist to fit the teeth. Retainers are generally made from transparent plastic and thin wires to optimize the comfort of the patient.
Retainers are worn for varying amounts of time, depending on the type of orthodontic treatment and the age of the patient. Perseverance and commitment are required to make this final stage of treatment successful. If the retainer is not worn as directed by the orthodontist, treatment can fail or take much longer than anticipated.
There are a variety of retainers available; each one geared towards treating a different kind of dental problem. The orthodontist will make a retainer recommendation depending on the nature of the original diagnosis and the orthodontic treatment plan.
Don’t lose the appliance – Removable retainers are very easy to lose. It is advisable to place your retainer in the case it came in while eating, drinking and brushing. Leaving a retainer folded in a napkin at a restaurant or in a public restroom can be very costly if lost because a replacement must be created. A brightly colored case serves as a great reminder.
Don’t drink while wearing a retainer – It is tempting to drink while wearing a retainer because of the unobtrusive nature of the device. However, excess liquid trapped under the trays can vastly intensify acid exposure to teeth, increasing the probability of tooth decay.
Don’t eat while wearing a retainer – It can be difficult and awkward to eat while wearing a removable retainer and it can also damage the device. Food can get trapped around a Hawley retainer wire or underneath the palate, causing bad breath. When worn on the upper and lower arches simultaneously, VFR retainers do not allow the teeth to meet. This means that chewing is almost impossible.
Clean the retainer properly – Removable retainers can become breeding grounds for calculus and bacteria. It is essential to clean the inside and outside thoroughly as often as possible. Hawley retainers can be cleaned with a toothbrush. Because harsh bristles can damage the PVC surface of a VFR, denture cleaner or a specialized retainer cleaner is recommended for this type of device.
Wear the retainer as directed – This phase of treatment is critical. The hard work has been done, the braces are off and now it is tempting not to wear the retainer as often as the orthodontist recommends. Retainers are needed to give the muscles, tissues and bones time to stabilize the teeth in their new alignment. Failure to wear the retainer as directed can have regrettable consequences, such as teeth returning to their original position, added expense and lost time.
The following are the most commonly used terms in orthodontics. If you have any questions about orthodontics or would like to schedule an appointment, please contact our office.
Anterior Teeth: The upper and lower six front teeth on each arch.
Appliance: Any orthodontic device which moves or retains teeth. Appliances may also alter the positioning of the jaw.
Arch: The entire upper or lower jaw.
Archwire: The metal wire that connects orthodontic brackets. This wire guides the teeth into their new alignment.
Band with bracket: Metal bands (rings) that are generally cemented around the back teeth.
Braces: Fixed orthodontic appliances designed to align teeth.
Brackets: The tiny metal, ceramic or clear brackets that are affixed to each individual tooth on the arch.
Brushing: This is a crucial part of home dental care. Orthodontists recommend those wearing braces to brush after every meal and snack to eliminate bacteria and plaque.
Buccal: The outer (cheek) side of posterior teeth in the lower and upper arches.
Cephalometric Radiograph: A side x-ray of the face and head used to show growth and development.
Chain: Elastics connected together and placed around the brackets to stabilize the archwire and gently close spaces.
Class I Malocclusion: Molars are correctly aligned, but there is an anterior/posterior crossbite, an openbite or overcrowding on the arches.
Class II Malocclusion: Also known as an overbite. The upper front teeth are positioned further forward than the lower teeth.
Class III Malocclusion: Also known as an underbite. The lower front teeth are positioned further forward than the upper front teeth.
Closed Bite: The upper front teeth completely overlap the bottom teeth causing a deep overbite.
Congenitally Missing Teeth: Some permanent teeth fail to develop and erupt due to genetic factors.
Crossbite: A malocclusion in which the upper back teeth bite inside or outside the lower back teeth, or the lower front teeth bite in front of the upper front teeth.
De-banding: The removal of orthodontic bands from the teeth.
De-bonding: The removal of affixed orthodontic brackets from the teeth.
Diagnostic Records: Records used to assess, plan and implement treatments. These records usually include medical and dental history, radiographs, panoramic radiographs, bite molds and intraoral/extraoral photographs.
Digital Radiograph: Digital x-rays of the teeth which can be viewed, stored and transmitted via computer.
Elastics: Some braces may require that elastic rubber bands be attached to exert additional pressure to an individual tooth or a group of teeth.
Eruption: The way in which teeth surface through the gums inside the mouth.
Fixed Orthodontic Appliances: Orthodontic appliances which are affixed to the teeth by the orthodontist and cannot be removed by the patient.
Flossing: An essential part of home care that removes debris and plaque from above and below the gumline.
Functional Appliances: Orthodontic appliances that use the muscle movement created by swallowing, eating and speaking to gently move and align the teeth and jaws.
Gingiva: The gums and soft tissue around the teeth.
Headgear: A removable appliance comprised of a brace and external archwire. This device modifies growth and promotes tooth movement.
Impressions: Teeth impressions are taken to allow the orthodontist to see exactly how a patient’s teeth fit together.
Interceptive Treatment: Treatment performed on children who have a mixture of adult and baby teeth. Early treatment can help reduce the need for major orthodontic treatment in the future.
Invisalign®: A newer, removable type of dental aligner that is completely transparent and doesn’t interfere with eating because it’s removable. Not all patients are candidates for Invisalign®.
Ligating Modules: An elastic donut-shaped ring which helps secure the archwire to the bracket.
Ligation: Securing the archwire to the brackets.
Lingual Side: The side of the teeth (in both arches) that is closest to the tongue.
Malocclusion: Literally means “bad bite” in Latin, and refers to teeth that do not fit together correctly.
Mandible: The lower jaw.
Maxilla: The upper jaw.
Mouthguard: A removable plastic or rubber device that protects teeth and braces from sporting injuries.
Open Bite: Upper and lower teeth fail to make contact with each other. This malocclusion is generally classified as anterior or posterior.
Orthodontics: The unique branch of dentistry concerned with diagnosing, preventing and correcting malocclusions and jaw irregularities.
Orthodontist: A dental specialist who prevents, diagnoses and treats jaw irregularities and malocclusions. Orthodontists must complete two or three additional years of college after dental school and complete a residency program.
Palatal Expander: A removable or fixed device designed to expand the palate in order create room on either the upper or lower arch.
Panoramic Radiograph: An extraoral (external) x-ray that shows the teeth and jaws.
Plaque: The sticky film of saliva, food particles and bacteria that contributes to gum disease and tooth decay.
Posterior Teeth: Back teeth.
Removable Appliance: An orthodontic brace or device that can be removed at will by the patient. It must be worn for the designated amount of time each day to be effective.
Separators: A wire loop or elastic ring placed between the teeth to create room for the subsequent placement of bands or orthodontic appliance.
Space Maintainer: A fixed appliance used to hold space for permanent (adult) tooth. This is usually used when a baby tooth has been lost earlier than anticipated.
Wax: Orthodontic relief wax is a home care remedy used to alleviate irritations caused by braces.
Wires: Attached to the brackets to gently move the teeth into proper alignment.
Straighter teeth perform chewing, biting and speaking functions more effectively than crooked teeth. In addition, a straight smile boosts confidence, is aesthetically pleasing to look at, and can help stave off a wide variety of dental ailments.
There are several types of malocclusion including overbite, underbite, crossbite, and overcrowding. Each of these alignment problems negatively impacts the functionality and cosmetic appearance of the teeth.
Periodontitis – Periodontitis or gum disease begins with a bacterial infection. The bacterial infection is caused by inadequate oral hygiene. Crooked teeth are hard to clean effectively, which means that debris, plaque and bacteria can build up in hard-to-reach areas. Straight teeth are much easier to clean and are at less risk of contracting gum disease.
Temporomandibular Disorder (TMJ) – Crooked teeth can lead to improper jaw alignment, which in turn causes a painful condition known as TMJ. Severe headaches, jaw pain, lockjaw and the grinding of teeth characterize this debilitating disorder.
Tooth injury – Straight teeth creates a strong wall, which means injuries are less likely to occur. Crooked teeth are weaker and often protrude, making them far more vulnerable to external injury.
Uneven wear – Crooked teeth cause some of the teeth to work harder than others when biting and chewing. Straight teeth share the workload evenly, meaning less risk of injury and better aesthetics.
Teeth can be straightened using either orthodontic braces or customized aligning trays. Orthodontic braces are usually affixed to the teeth for a set duration. The brackets and archwires are tightened regularly by the orthodontist and removed when treatment is complete. Fixed braces can be placed on the front side or back side of the teeth and are effective for most types of malocclusion.
Aligning trays are fully removable and are used where the malocclusion is less severe, and the teeth need to move a shorter distance. These trays are replaced every few weeks for the duration of the treatment, and have proven to be equally effective for straightening teeth.
If you have questions about orthodontics and straightening teeth, please ask your orthodontist.
