Services
: Orthodontics
: Frequently Asked Questions (FAQs) on Orthodontic Treatments
At what age can people
have orthodontic treatment?
Children and adults can both benefit from orthodontics,
because healthy teeth can be moved at almost any age.
Because monitoring growth and development is crucial
to managing some orthodontic problems well, it is recommended
that children have an orthodontic screening before the
age of 7. Some orthodontic problems may be easier to
correct if treated early. Waiting until all the permanent
teeth have come in, or until facial growth is nearly
complete, may make correction of some problems more
difficult.
An orthodontic evaluation at any age is advisable if
a parent, family dentist or the patient's physician
has noted a problem.
What causes orthodontic
problems (malocclusions)
Most malocclusions are inherited, but some are acquired.
Inherited problems include crowding of teeth, too much
space between teeth, extra or missing teeth, and a wide
variety of other irregularities of the jaws, teeth and
face.
Acquired malocclusions can be caused by trauma (accidents),
thumb, finger or dummy (pacifier) sucking, airway obstruction
by tonsils and adenoids, dental disease or premature
loss of primary (baby) or permanent teeth. Whether inherited
or acquired, many of these problems affect not only
alignment of the teeth but also facial development and
appearance as well.
How long will
orthodontic treatment take?
In general, active treatment time with orthodontic
appliances (braces) ranges from one to three years.
Interceptive, or early treatment procedures, may take
only a few months. The actual time depends on the growth
of the patient's mouth and face, the cooperation of
the patient and the severity of the problem. Mild problems
usually require less time, and some individuals respond
faster to treatment than others. Use of rubber bands
and/or headgear, if prescribed by the orthodontist,
contributes to completing treatment as scheduled.
While orthodontic treatment requires a time commitment,
patients are rewarded with healthy teeth, proper jaw
alignment and a beautiful smile that lasts a lifetime.
Teeth and jaws in proper alignment look better, work
better, contribute to general physical health and can
improve self-confidence.
Why does orthodontic treatment
time sometimes last longer than anticipated?
Estimates of treatment time can only be that - estimates.
Patients grow at different rates and will respond in
their own ways to orthodontic treatment. The orthodontist
has specific treatment goals in mind, and will usually
continue treatment until these goals are achieved. Patient
cooperation, however, is the single best predictor of
staying on time with treatment. Patients who cooperate
by wearing rubber bands, headgear or other needed appliances
as directed, while taking care not to damage appliances,
will most often lead to on-time and excellent treatment
results.
How
do braces work?
In their entirety, braces work by applying continuous
pressure over a period of time to slowly move teeth
in a specific direction. As the teeth move, the bony
tooth socket reabsorbs and changes shape as pressure
is applied.
Braces are made up of the following components:
- Brackets are the
small squares that are bonded directly to each tooth
with a special dental bonding agent or are attached
to orthodontic bands. Brackets act like handles, holding
the arch wires that move the teeth.
- Orthodontic bands
are stainless steel, clear or tooth-colored materials
that are cemented with dental bonding agents or cement
to teeth. They wrap around each tooth to provide an
anchor for the brackets. The clear or tooth-colored
bands are more cosmetically appealing options but
are more expensive than stainless steel. They are
not used in all patients. Some people have only brackets
and no bands.
- Spacers are separators
that fit between teeth to create a small space prior
to placement of orthodontic bands.
Arch wires attach to the brackets and act as tracks
to guide the movement of the teeth. Arch wires can
be made of metal or be clear or tooth-colored.
- Ties are small
rubber rings or fine wires that fasten the arch wire
to the brackets. They can be clear, metal or colored.
A buccal tube on the band of the last molar holds
the end of the arch wire securely in place.
- Tiny elastic rubber bands,
called ligatures, hold the arch wires to the brackets.
- Springs may be
placed on the arch wires between brackets to push,
pull, open or close the spaces between teeth.
- Two bands on the
upper teeth may have headgear tubes on them to hold
the facebow of the headgear in place. (A headgear
is another tool used by orthodontists to aid in correcting
irregularities of the teeth; see below)
- Elastics or rubber bands
attach to hooks on brackets and are worn
between the upper and lower teeth in various ways.
They apply pressure to move the upper teeth against
the lower teeth to achieve a perfect fit of individual
teeth.
- Facebow headgear
is the wire gadget that is used to move the
upper molars back in the mouth to correct bite discrepancies
and also to create room for crowded anterior teeth.
The facebow consists of an inner metal part shaped
like a horseshoe that goes in the mouth, attaching
to buccal tubes, and an outer part that goes around
the outside of the face and is connected to a headgear
strap.
How Often Will
I Need to See the Orthodontist During Treatment?
Your orthodontist will want to see you about every
month to 6 weeks or so in order to make sure that the
braces are exerting steady pressure on your teeth. To
create more tension and pressure on your teeth, your
orthodontist will make adjustments in the wires, springs,
or rubber bands of your braces. In some cases, braces
alone aren't enough to straighten the teeth or shift
the jaw. In these situations, an external appliance,
such as a headgear may need to be worn at home in the
evening or through the night.
Will Braces Cause Pain?
Some of the adjustments your orthodontist may make
to your braces may make your mouth feel sore or uncomfortable.
When needed, over-the-counter pain relievers like Motrin
or Tylenol can help relieve the pain. If you always
experience a lot of pain after your braces are adjusted,
talk to your orthodontist about it; he or she may be
able to make the adjustments a bit differently.
Why do baby teeth sometimes
need to be pulled?
Pulling baby teeth may be necessary to allow severely
crowded permanent teeth to come in at a normal time
in a reasonably normal location. If the teeth are severely
crowded, it may be clear that some unerupted permanent
teeth (usually the canine teeth) will either remain
impacted (teeth that should have come in, but have not),
or come in to a highly undesirable position. To allow
severely crowded teeth to move on their own into much
more desirable positions, sequential removal of baby
teeth and permanent teeth (usually first premolars)
can dramatically improve a severe crowding problem.
This sequential extraction of teeth, called serial extraction,
is typically followed by comprehensive orthodontic treatment
after tooth eruption has improved as much as it can
on its own.
After all the permanent teeth have come in, the pulling
of permanent teeth may be necessary to correct crowding
or to make space for necessary tooth movement to correct
a bite problem. Proper extraction of teeth during orthodontic
treatment should leave the patient with both excellent
function and a pleasing look.
What Care Can I Expect After
the Braces Come Off?
After your braces are taken off, your teeth will be
thoroughly cleaned. Your orthodontist may want to take
another set of x-rays and bite impressions to check
how well the braces straightened your teeth and to see
if any wisdom teeth have developed. If wisdom
teeth are beginning to come in after your braces
have been removed, your orthodontist may recommend the
wisdom teeth be pulled to prevent your newly straightened
teeth from shifting position in your mouth.
Your orthodontist will also fit you with a retainer.
A retainer is a custom-made, removable appliance that
help teeth to maintain their new position after braces
have been removed. Retainers can also be used to treat
minor orthodontic problems. The use of a retainer is
a very important part of post-braces care. Retainers,
which are typically made of rubber or clear plastic
and metal wires that cover the outside surface of the
teeth, need to be worn all the time for the first 6
months and then usually only during sleep. The time
frame for wearing a retainer will vary from patient
to patient. The reason why a retainer is needed is that
even though braces may have successfully straightened
your teeth, they are not completely settled in their
new position until the bones, gums, and muscles adapt
to the change. Also, after long periods of time, teeth
tend to shift.
What kinds of
orthodontic appliances are typically used to correct
jaw-growth problems?
Correcting jaw-growth problems is done by the process
of dentofacial orthopedics. Some of the more common
orthopedic appliances used by orthodontists today that
help the length of the upper and lower jaws become more
compatible include:
Headgear: This appliance applies pressure
to the upper teeth and upper jaw to guide the rate and
direction of upper jaw growth and upper tooth eruption.
The headgear may be removed by the patient and is usually
worn 10 to 12 hours per day.
Herbst: The Herbst appliance is usually
fixed to the upper and lower molar teeth and may not
be removed by the patient. By holding the lower jaw
forward and influencing jaw growth and tooth positions,
the Herbst appliance can help correct severe protrusion
of the upper teeth.
Bionator: This removable appliance
holds the lower jaw forward and guides eruption of the
teeth into a more desirable bite while helping the upper
and lower jaws to grow in proportion with each other.
Patient compliance in wearing this appliance is essential
for successful improvement.
Palatal Expansion Appliance: A child's
upper jaw may also be too narrow for the upper teeth
to fit properly with the lower teeth (a crossbite).
When this occurs, a palatal expansion appliance can
be fixed to the upper back teeth. This appliance can
markedly expand the width of the upper jaw.
The decision about when and which of these or other
appliances to use for orthopedic correction is based
on each individual patient's problem. Usually one of
several appliances can be used effectively to treat
a given problem. Patient cooperation and the experience
of the treating orthodontist are critical elements in
success of dentofacial orthopedic treatment.
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