Orthodontics is the branch of dentistry which deals with the causes, prevention and treatment of irregularities in the position of the teeth. In the past, whenever anyone suffered problems with teeth, their only option was to keep the teeth as long as they could until they lost them through decay, gum disease or accident. Fortunately today, through proper care at home and with professional treatment, most people are able to keep a healthy and sound set of teeth throughout their lifetime. Orthodontic treatment plays an important role in healthy teeth. Not only does it deal with the health of our teeth and gums (since crooked teeth and poor jaw alignment are prime causes of decay and gum disease), it also deals with the esthetics of the mouth, for orthodontic treatment can transform severe problems into beautiful, shining smiles. The benefits naturally follow. Following are some commonly asked questions surrounding orthodontics.

Orthodontists limit their practices to treating abnormalties in the alignment of the teeth and jaws. An orthodontist first becomes a general dentist and after 2 to 3 years of additional graduate study becomes a certified orthodontic specialist.

How do I know if I or my child needs braces? If you or your child have crowded, spaced, protruding or otherwise misaligned teeth, you may be a candidate for braces. There also may be functional problems such as difficulty in chewing, thumb or finger sucking, mouth breathing, tongue thrusting and TMJ (Temporomandibular Joint) problems. A consultation with an orthodontist would be helpful if you have any of the problems mentioned above. Most orthodontists offer a no charge, no obligation evaluation so don’t put off finding out abour your tooth alignment.

What age should my child or myself have an orthodontic evaluation? Most orthodontists and the American Association of Orthodontists recommend that a child should have an orthodontic evaluation by the age of 7 years. If there is a problem recongnized by your family dentist or if you have any concerns, you should make a consultation appointment. The early examination will not necessarily result in immediate treatment, but will help put your mind at ease. If early treatment is necessary, it may prevent future tooth extractions, decrease treatment time and save money in the long run.

How long does orthodontic care take to correct a problem? Treatment time depends on the severity of the orthodontic problem, the age of the patient, growth potential and other factors such as missing teeth, gum disease, cavities, and your general dental and medical health. In general, most orthodontic cases can be resolved in 14 to 24 months. There are new orthodontic technologies such as Wilckondontics Accelerated Osteogenic Orthodontics (AOO) that dramatically reduce treatment time up to 70%. AOO requires a surgical procedure and may not be suitable for all cases. Another new technique, the Invisalign procedure, generally requires the same treatment time as conventional care.

Patients experience some discomfort after adjustments. This usually lasts for only a few days. Aspirin is usually recommended for most discomfort.

No. However, if a patient fails to keep their braces adequately clean there is a chance of decalcification or decay. This can cause unsightly markings on the enamel surfaces of the teeth. The result will be extra costs to repair the damage. To avoid problems like this, it’s important to remember to keep your teeth and braces ‘squeaky clean.’

Sweets and soft drinks should be avoided. Also, no chewing on ice cubes or foods that are sticky, hard or gooey.

Nothing at all may happen!……if you have good oral hygiene and see your family dentist on a regular basis. However, straight aligned teeth and a well-balanced bite make it easier to properly clean your teeth. A well-balanced bite makes chewing easier and may help prevent future TMD (jaw joint problems). Ask your general dentist and orthodontist how straight teeth would help you.

The three most common types of orthodontic problems are Class I, Class II and Class III malocclusions. Class I malocclusion (Fig A) the bite relationship is within normal limits with no excessive overbite or underbite present. Class I problems include spacing, crowding, crossbites, openbites and excessive protrusion of the upper and lower teeth (Fig B). Class II problems (Fig C) involve excessive overjet and/or overbite where the upper jaw protrudes in front and over the lower jaw. Class III malocclusion (Fig D) the patient has an underbite or the lower jaw is projected out in front of the upper jaw. Your dentist and orthodontist will give you more detail if you ask.

Legend

• A: Class I Normal Bite
• B: Class I With Protruded Teeth
• C: Class II Overbite Problem
• D: Class III Underbite Problem

There are four main types of orthodontic appliances (Braces). Most patients wear stainless steel braces (metal braces), ceramic braces (clear less noticeable braces), gold braces and Lingual (behind the teeth) braces. Ask your dentist or orthodontist to show you the type of braces that will work best for your orthodontic problem.

Small gaps near the gum line are called Black Triangles. These gaps may be present prior to wearing braces or may develop as the teeth straighten, a minor side effect of repositioned teeth. Black Triangles are present due to the anatomical shape of your teeth. Teeth that are triangular-shaped are wider at the bottom and narrower at the top. Tooth contact points are usually at the halfway point of each tooth. As each tooth becomes narrower at the top there may not be sufficient gum tissue present in the gap area. Therefore, a gap or Black Triangle will be present. Your doctor can remove these gaps in most cases. Ask your doctor to discuss your options if you have gaps.

TADS or Temporary Anchorage Devices are micro implants or pins that are painlessly inserted into the bone around teeth. One or more TADS are used to create an anchored in the bone point to attach elastics (rubber bands). If an orthodontic rubberband is hooked up to one lower tooth and one upper tooth both teeth will move. A TAD will not move, only the tooth or teeth the to which the force is applied. When TADS were introduced to orthodontics it was paradigm shift.

Orthodontic cases that often required surgical intervention can now be treated without surgery because of the new anchor systems.

Legend

• A: TAD in the upper jaw.
• B: TAD between upper teeth on X-ray.
• C: TAD used in upper jaw to retract front teeth.
• D: TAD used to move lower teeth forward

Orthodontists and Maxillofacial surgeons often work together as a team. Some orthodontic problems cannot be corrected with braces alone. If a patient has a skeletal problem such as a severe underbite (Class III malocclusion) orthognathic surgery or jaw surgery may be necessary for the best correction. If your problem requires surgery your primary care doctor will discuss it with you.

The pictures below show a patient that had her lower jaw surgically advanced.

You may have had one or more teeth previously extracted or you may not have developed all of your tooth buds as a child. The orthodontist and general dentist often work together as a team to replace missing teeth. Initially the orthodontist will move your teeth into the best possible position so you can have your dentist provide teeth in the missing areas. When possible a dental implant is the best treatment of choice. In addition, the dentist or prosthodontic specialist may recommend a permanent or removable bridge. If you are young and still growing the orthodontist may give you a retainer with a prosthetic tooth or teeth. Your dental team will determine what is the best treatment for your situation.

Implant + Crown

Implant + Crown in the bone

Wrench used to place implantWrench used to place implant

When your orthodontic treatment is complete your doctor will recommend retainers. Just because your teeth are straight does not mean they will remain straight forever. If the doctor could take off your braces and pour concrete around every tooth they would remain straight. Teeth are affected by muscles, swallowing, breathing, tongue movements and other natural forces. Therefore, at the completion of orthodontic treatment the teeth HAVE to be retained. Immediately after orthodontic movement the teeth are still slightly loose. The bone around the teeth needs to mature and harden. This takes several months to years. If you wear your retainers as instructed you will minimize the tendency for your teeth to return to their original crooked positions. Even with 100% compliance you may still experience changes. Often patients return 5 or 10 years later for correction of recurrent crowding. Just as the plastic surgeon has patients return for touch-up surgery you may need touch-up orthodontics. Luckily many of these cases can be corrected with clear aligners.

Clear Essix Retainer

Hawley Type Retainers

NO! Wisdom teeth are only one of many reasons why everyone’s teeth constantly change position throughout life. Think of the wisdom tooth as a non-active obstacle in the back of your mouth. If the back molars in front of the wisdom teeth wanted to move backward the wisdom tooth acts as a backstop. As your lower jaw completes its terminal or final growth all of your teeth slowly drift forward. The technical term for these phenomena is mesial drift. Wisdom teeth may grow (not push) into a back molar and cause root damage (resorption), but there is no scientific evidence that documents a pushing effect. There are several other theories that attempt to explain why teeth constantly change positions. Wearing your retainers as instructed is the only way to minimize adverse changes in your front teeth.

YES! However, when you move teeth in one dental arch the tooth movement will directly affect the positions of the opposing teeth. If your doctor prescribes braces for one arch only he will, more likely than not, give you a Clear Essix appliance or retainer for the other arch. The purpose is to stabilize the non-moving dental arch while the lower teeth are being moved.

Essix Appliance Stabilizes Upper Teeth, When Braces Applied To Lower Teeth

AFTER! If your doctor recommends veneers they should be placed after your teeth are moved into the best possible positions. Often your bite may have to be corrected prior to any cosmetic dentistry. When building a new house you want to have the best possible foundation. This is the same concept used by your doctors when providing veneers, crowns, bridges and other types of cosmetic dentistry.

Veneers Used To Hide Spaces