Orthodontics, Properly Aligned Teeth Bring Huge Benefits to Appearance, Health, and Life-Style.
It is said that approximately 25% of the population are in need of orthodontic treatment to one degree or another. The orthodontist, sometimes with the assistance of an oral surgeon (orthognatic surgery), treats both tooth alignment and facial growth of the head and neck. But most often the orthodontist treats the alignment of the teeth and the bite or occlusion.
An orthodontist is a general dentist who has an additional advanced degree plus advanced training in orthodontics and is a specialist who limits his practice strictly to this specialty. Orthodontists treat malocclusion or poorly aligned teeth in the upper (maxillary) and lower (mandibular) jaws. The purpose is to improve the patient’s aesthetic appearance, to improve their occlusion or bite, to improve their speech, and to improve their oral function including swallowing. Orthodontia is an out-dated term which includes all aspects of the practice of orthodontics. Ortho means “to correct” and dontis refers to “teeth.” The orthodontist is that specialist who corrects the alignment of the teeth.
To emphasize, not only do orthodontists correct an improper bite, they also improve the overall appearance of the teeth. This alone aids the chewing function. If the mouth is too crowded, sometimes extractions become necessary, usually those are the first bicuspids, but it could be other teeth. Orthodontics may also help the speech of the patient. Included in this treatment is usually the closing of unsightly spaces, properly aligning crooked teeth. All the above have a very important long-term, secondary affect in maintaining the health of the gums and bone, but also reducing the amount of future decay by making the teeth much easier to properly clean. There may be a socio-economic affect which also involves the choosing of a mate.
There are two types of orthodontic appliances.
Fixed appliances, primarily used, are permanently cemented on the teeth until removed by the orthodontist. They are often called dental braces or simply braces, and may be metal brackets bonded to the teeth, or porcelain brackets which are tooth-colored, or even colored brackets (teenagers often utilize their school colors). Bands may also be utilized usually only on the back teeth. These appliances allow for exacting precision. An arch wire plus springs and elastics are added to the brackets, or sometimes possibly a head gear.
The aforementioned arch wires which are shaped similarly to the desired final arch curvature, are placed within the brackets and tubes of the bands. They are are then with very tiny wire, tightened, adding small amounts of pressure over time which slowly moves the teeth to the desired final arch curvature. These wires are tightened on each visit. The numbers of visits required is dependent upon the difficulty of the case and the age of the patient. So the treatment may take only several months and up to two or three years. The typical length of treatment time is one to two years.
Removable orthodontic appliance generally are used for minor corrections or minor tooth movement. They of course rely on the patient’s co-operation in wearing them all the time other than eating. That is one of the positives about the removable appliance is that it is much easier to eat if you can remove it.
FIXED APPLIANCES FOR SPECIAL PURPOSES
Fixed appliances for special purposes means that they are non-removable, but they are usually only needed for a short period of time. Examples may be a space maintainer which sometimes holds the space open until the permanent tooth erupts. Or a thumb guard to prevent thumb-sucking falls in this category. There are appendages to the appliance which take up the desired space for the thumb. Also included in the fixed group are appliances which correct tongue thrust thereby preventing or correcting a speech impediment.
A crossbite, where the upper back teeth are slightly inside the lower back teeth can often be corrected rather quickly using what are called transocclusal elastics. These are small rubber bands attached to the back teeth of both arches on the side where there is a crossbite.
Treatment planning is paramount prior to initiation of the usage of appliances. The treatment must reach a stable condition for the teeth, that is functional, healthy, and aesthetic. Non of these aspects should be compromised. The patient must be apprised of the expected results of the treatment plan concerning the bite, duration of treatment, end result, and cost. Alternative treatments may be discussed.
If a patient has too many cavities, has poor oral hygiene, or truly does not want the treatment, the orthodontist is inclined to preclude treating this patient. Healthier and good teeth which are crooked are superior to unhealthy straight teeth. The patient must maintain meticulous oral hygiene in order to avoid decalcification or “chalky teeth” in areas which are not kept clean.
There are many types of malocclusions. Orthodontic treatment is required to correct a maloclusion, a condition in which the teeth are not correctly positioned when the teeth are closed together. It is often said that the “bite is off”. Some are related to the relationship between the upper and lower front teeth, where others are related to how the back teeth fit together or do not fit together. There may be simple crowding or the upper front teeth are way in front of the lowers or vice versa. The front teeth may not even touch and the back teeth may be inside or outside their counterparts in the wrong direction. There are many complicated classifications and indexes which more accurately describe maloclusions.
Once the orthodontic treatment is complete, the patient must wear a retainer for a few years after treatment. The lower consist of an arch wire on the tongue-side of the lower teeth. It is fixed or usually cemented to the lower cuspids. The upper teeth are usually retained by a removable appliance that is usually only worn at night. It is said that the teeth have a “memory” and are inclined to return to their original position if the patient is not in earnest about wearing their retainers.
Some non-radical orthodontic cases can be treated with Invisalign clear plastic retainers. There are other brands also. These clear plastic trays move the teeth incrementally in non-complicated cases, and a new tray is created as the teeth move. They are fairly aesthetic and can be removed while eating or on special occasions. They have become quite popular but cannot treat complicated cases.
As you can see, there are many approaches to orthodontic treatment. It behooves all to have the necessary treatment as it may improve the overall health of the teeth, may be involved in your personal socio-economics, and easily may play a part in selecting your mate.
Life Member of American Dental Association, Emeritus Fellow of the Academy of General Dentistry, American Association of Implant Dentists