Orthodontic Treatment

Orthodontic treatment uses appliances, tooth removal, or surgery to fix the way teeth and jaws are aligned. There are many ways to treat poor bite (malocclusion). Expert opinions differ about when to start treatment. Your dentist or orthodontist may give you a choice between early or later treatment or may prefer one specific approach.

The general categories of orthodontic devices (appliances) are functional and fixed.

Functional appliances use the muscle action from speaking, eating, and swallowing to create forces that move teeth and align the jaws.

  • Some functional appliances are removable, while others are bonded to the teeth.
  • A functional appliance may fit between the upper and lower teeth (a splint) or may span across the mouth between the molars, pressing the bone outward.

Fixed orthodontic appliances are sets of wires and brackets cemented to the teeth. These are commonly called braces . Over a period of about 24 to 28 months, the wires are tightened and adjusted, gradually applying enough force to move the teeth (bone remodeling).

Retainers are removable appliances made of molded plastic and wire. They hold the teeth in place after braces are taken off. If the teeth start to move back out of position, the orthodontist may bond a short retaining wire to the back of some teeth. This wire will hold the teeth in place.

Child and teen treatment

The aim of treatment in the childhood and teen years is to move permanent teeth into place. The orthodontist will time the treatments to match your child's natural growth spurts.

Treatment for crowding, the most common malocclusion problem, may mean removing (extracting) some permanent teeth. But orthodontists avoid removing permanent teeth when they can.

The malocclusion treatments for children and adolescents are:
  • Extraction (serial removal). Removing some baby teeth may ease severe crowding.
  • Growth modification. This involves wearing fixed or functional appliances during the day and night to move the jaw into a better position.
  • Fixed appliances (braces) gradually move the teeth. For children and teens, this treatment phase usually lasts about 24 months; for adults, about 28 months.
  • Retainers. Retainers hold the teeth in place after orthodontic treatment. Some orthodontists recommend that retainers be worn for many years, because teeth have a natural tendency to drift out of place.
  • Space maintainers, made of metal or plastic. Spacers keep the surrounding teeth from moving (drifting) into open spaces created when teeth are pulled or lost in an accident.

Adult treatment

Orthodontic treatment for malocclusion is a popular option for adults, due in part to better technology. In the past, wide silver bands held braces in place. Today they are less obvious. Instead of the wide bands, a small metal or ceramic fastener is bonded to each tooth, and a narrow wire passes through the fasteners.

New options include:
  • Clear plastic instead of silver wires.
  • Lingual braces. These braces attach to the back of the front teeth.
  • Removable clear plastic aligners.These are molded specifically for you.
  • Lingual braces and aligners don't work for everyone. They aren't options for children. Your orthodontist can tell you the best choices for your situation.

Orthodontic treatment for adults may also involve:
  • Removal (extraction) of teeth to create more space.
  • Orthognathic surgery of the jaw.
  • A retainer, after braces are removed.
  • Adjustments, such as grinding of high tips of teeth, to prevent continued or increased malocclusion for adults.
Most adults have little or no jaw growth. This means that surgery is the only way to correct jaw-related bite problems. Some adults may benefit from simply camouflaging, or hiding, a jaw-related problem. Using braces, the orthodontist can move the teeth so that they fit together, despite the jaw discrepancy. But surgery is the best way to treat more severe jaw problems.

The following dental information pages answers many questions that you may have on braces and orthodontic treatment. Orthodontist is a dental specialist who specializes in treatment using braces.

At what age should orthodontic treatment begin?

Although orthodontic treatment can be done at any age they are best carried out in young children of 8-15 years age. During this age it is possible for the orthodontist to foresee any dental problems that are likely to occur and can take preventive measures. This is called preventive orthodontics. It is also possible to intercept disorders of the bite at an early stage so that it does not mature to a big dental problem. This is called interceptive orthodontics. The jaws are actively growing by 8-10 years of age and therefore are the ideal time to mould the jaws. The permanent teeth start erupting by 6-7 years of age and complete erupting by 12-14 years (all except the wisdom teeth). This would therefore be the ideal time to start treatment.

What happens if the treatment is delayed?

At an early age the braces are less painful and the treatment duration is shorter. Advancing age makes the jaws harder and therefore makes it difficult to mold the jaws and to move the teeth. As mentioned in the earlier section, in younger individuals it is possible to prevent and intercept the developing problems. But orthodontic treatment can be carried out at any age.

How long does orthodontic treatment take?

The duration of treatment depends from person to person and from one orthodontist to other. Most jaw molding and jaw corrections carried out during the growing age takes 1-11/2 years. Orthodontic treatment with braces often takes 2 - 2 1/2 years. The orthodontist would advice you on how long the treatment is going to take after studying the case.

How does orthodontic treatment work?

The jaws in a growing child can be molded by application of some pressure on them. They can be made to become bigger, longer, shorter, wider etc. by using appropriate type of braces.

The teeth that are embedded in the jaws can be moved around until they are in the right place by applying a force on them by using braces.

Do braces hurt and cause sores in the mouth

Initially for a few days after the braces are fixed, the mouth tends to be sore and some pain can be expected. Much depends on the pain perception of the individual and his pain tolerance. However pain is expected for a few days after braces are fixed and every time your orthodontist tightens them. Sores may develop on the cheeks or lips or the tongue after the braces are fixed. These often heal in a few days. You can use orthodontic wax to screen an area of the braces that are sharp and hurting.

In addition warm salt water rinsing of the mouth help heal the sores. If the braces are damaged and therefore hurting the cheeks or lips you should immediately seek orthodontic consultation.

Should sports activities be avoided?

Well having the braces should not prevent you from carrying on normal daily activities. However care should be taken during sports activities as you may fall and injure the mouth and teeth. Tell your orthodontist about your sports activities so that he prepares a mouth guard for you. The mouth guard should protect you from inadvertent injuries during sports. It is advisable to avoid contact sports such as boxing, wrestling, karate, judo etc where injury to the jaws and mouth can occur.

Will I experience any difficulty in talking?

Most orthodontic braces do not interfere with talking. However the orthodontist may at times give you a removable plate to wear. This could cause difficulties in speaking for a few days. However you get used to it very soon and start talking normally.

Are there any restrictions in eating when the braces are on?

Initially once the braces are fixed the mouth tends to be sore for a few days. During this period it is better to have soft food. You should be careful in avoiding hard, crunchy and sticky food such as toffee, nuts, chocolates and gums as they may break the braces that are fixed to your teeth. When you are eating fruits like apple make sure you cut them into pieces before you eat them. It is better to avoid meat with bones.

Do the braces come off?

Sometimes a part of the braces comes off. This may occur when you bite on a piece of hard food. The orthodontist will then have to fix it for you. It is advisable to immediately seek an appointment if a part of the braces falls off. It is better to take care of the braces by following the do's and don'ts so that they do not break frequently as this delays the treatment.

What happens if you swallow a loose piece of braces?

Accidental swallowing of a small piece of the braces that becomes loose usually does not cause any harm. They are likely to pass down the digestive tract and make their exit. However accidental inhalation is a more serious problem and may require medical attention to remove them. However such incidences are rare.