What is orthodontics?

Orthodontics is the branch of dentistry that focuses on the diagnosis, prevention and treatment of dental and facial irregularities.

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. However it is a good idea to have a child assessed either by the family dentist or by a specialist shortly after the permanent teeth start to erupt (age 7 -8) to see if there are any problems developing. A decision can then be made as to whether early intervention is appropriate or whether it is better to wait until all the permanent teeth erupt (about age 12).

What causes crooked teeth?

Most malocclusions (poorly aligned teeth)) 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 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.

What are the most commonly treated orthodontic problems(malocclusions)?

• Crowding: Teeth may be aligned poorly because the dental arch is small and/or the teeth are large. The bone and gums over the roots of extremely crowded teeth may become thin and recede as a result of severe crowding. Impacted teeth (teeth that should have come in to the mouth, but have not), poor biting relationships and undesirable appearance may all result from crowding.
• Overjet or protruding upper teeth: Upper front teeth that protrude beyond normal contact with the lower front teeth are prone to injury, often indicate a poor bite of the back teeth (molars), and may indicate an unevenness in jaw growth. Commonly, protruded upper teeth are associated with a lower jaw that is short in proportion to the upper jaw. Thumb and finger sucking habits can also cause a protrusion of the upper incisor teeth.
• Deep overbite: A deep overbite or deep bite occurs when the lower incisor (front) teeth bite too close or into the gum tissue behind the upper teeth. When the lower front teeth bite into the palate or gum tissue behind the upper front teeth, significant bone damage and discomfort can occur. A deep bite can also contribute to excessive wear of the incisor teeth.
• Open bite: An open bite results when the upper and lower incisor teeth do not touch when biting down. This open space between the upper and lower front teeth causes all the chewing pressure to be placed on the back teeth. This excessive biting pressure and rubbing together of the back teeth makes chewing less efficient and may contribute to significant tooth wear.
• Spacing: If teeth are missing or small, or the dental arch is very wide, space between the teeth can occur. The most common complaint from those with excessive space is poor appearance.
• Crossbite: The most common type of a crossbite is when the upper teeth bite inside the lower teeth (toward the tongue). Crossbites of both back teeth and front teeth are commonly corrected early due to biting and chewing difficulties.
• Underbite or lower jaw protrusion: About 3 to 5 percent of the population has a lower jaw that is to some degree longer than the upper jaw. This can cause the lower front teeth to protrude ahead of the upper front teeth creating a crossbite. Careful monitoring of jaw growth and tooth development is indicated for these patients.

Why is orthodontic treatment important?

For most children or adults, the main downside of crooked and crowded teeth is that they are perceived as unsightly. Orthodontic treatment therefore can often greatly improve a person's self image and confidence.

Crooked teeth can also be hard to clean and maintain. This may contribute to conditions that cause not only tooth decay but also eventual gum disease and tooth loss. Other orthodontic problems can contribute to abnormal wear of tooth surfaces, inefficient chewing function, excessive stress on gum tissue and the bone that supports the teeth, or misalignment of the jaw joints, which can result in chronic headaches or pain in the face or neck.

The value of an attractive smile should not be underestimated. A pleasing appearance is a vital asset to one's self-confidence. A person's self-esteem often improves as treatment brings teeth, lips and face into proportion.

In general, active treatment time with orthodontic appliances (braces) ranges from 18 months to abaout 30 months. 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, 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.

What records are necessary before orthodontic treatment is started?

Diagnostic records are made to document the patient's orthodontic problem and to help determine the best course of treatment. As orthodontic treatment will create many changes, these records are also helpful in determining progress of treatment. Complete diagnostic records typically include a medical/dental history, clinical examination, plaster study casts of the teeth, photos of the face and teeth, a panoramic or other X-rays of all the teeth, a facial profile X-ray, and other appropriate X-rays. This information is used to plan the best course of treatment, help explain the problem, and propose treatment to the patient and/or parents.

How is treatment accomplished?

Custom-made appliances, or braces, are prescribed and designed by the orthodontist according to the problem being treated. They may be removable or fixed (cemented and/or bonded to the teeth). They may be made of metal, ceramic or plastic. By placing a constant, gentle force in a carefully controlled direction, braces can slowly move teeth through their supporting bone to a new desirable position.

How have new "high tech" wires changed orthodontics?

In recent years, many advances in orthodontic materials have taken place. Braces are smaller and more efficient. The wires now being used are no longer just stainless steel. They are made of alloys of nickel, titanium, copper and cobalt, and some of the wires are heat-activated. (The nickel-titanium alloy was originally engineered by NASA to automatically activate antennae or solar panels of spacecraft orbiting into the sun's rays.)

How do braces feel?

Most people have some discomfort after their braces are first put on or when adjusted during treatment. After the braces are on, teeth may become sore and may be tender to biting pressures for three to five days. Patients can usually manage this discomfort well with whatever pain medication they might commonly take for a headache. The lips, cheeks and tongue may also become irritated for one to two weeks as they toughen and become accustomed to the surface of the braces. Overall, orthodontic discomfort is short-lived and easily managed.

Do teeth with braces need special care?

Keeping the teeth and braces clean requires more precision and time, and must be done every day if the teeth and gums are to be healthy during and after orthodontic treatment. Patients who do not keep their teeth clean may require more frequent visits to the dentist for a professional cleaning.

How important is patient cooperation during orthodontic treatment?

To successfully complete the treatment plan, the patient must carefully clean his or her teeth, wear rubber bands, headgear or other appliances as prescibed, and keep appointments as scheduled. Damaged appliances can lengthen the treatment time and may undesirably affect the outcome of treatment. The teeth and jaws can only move toward their desired positions if the patient consistently wears the forces to the teeth, such as rubber bands, as prescribed.

Please summarise the steps in having orthodontic treatment?

Assessment and Records

• Data collection
• X-rays
• Study casts
• Photos

Plan of Treatment discussed, costed and agreed

• Active treatment - usually between 18 and 30 months
• Retention phase - it is vital to wear retainers after the completion of treatment to ensure that there is no relapse.