Orthodontics (braces)

Orthodontics is one of the oldest specialties in dentistry. In the 1960s it wasn't unusual for a patient to wait over a year just to get a consultation for braces. This was due to the limited number of orthodontists and the relatively inefficient techniques used at the time. Today there are more orthodontists, and the new appliances used allows them to see more patients simultaneously. A main difference is that new systems don't require nearly as much of the tedious custom wire bending as as the old ones did. This allows the orthodontist to see a higher number of patients, and allows him or her to finish cases much faster. Another advance (made during the 1970s) is the ability to "bond" brackets directly to the teeth instead of having to band every single tooth. This eliminates the "metal mouth" look, because bonded brackets cover a much smaller surface area of the tooth. Furthermore, the brackets can now be requested in porcelain, which can give you the ultimate in aesthetics for your braces.

Removable braces

There also have been a lot of advancements in "removable" braces. This method has been more popular in Europe and has slowly made its way to the United States. These techniques are most commonly used to correct a severe bony alignment between upper and lower jaws, such as a severe over- or underbite. Most orthodontists believe that removable appliances get the best results when the patient is treated young, around age eleven or twelve for boys and thirteen to fourteen for girls. These appliances are sometimes uncomfortable to wear. Patient compliance can be a problem, as some appliances need to be worn 24 hours a day for several months. Removable appliances are generally not recommended for straightening severely crowded teeth. Fixed braces provide the orthodontist with more control and are usually a more efficient way to line up teeth.

Removable appliances can also be used to expand dental arches, making more room for teeth. This usually works better on the upper arch, as the bone there is more moldable. Expanding the arch is also better done at an earlier age. This alternative could avoid the need to take out teeth at a later date when the bone hardens. Your orthodontist should be able to advise you as to what is best for you or your child.

Surgery with braces

Surgery, in combination with braces, is used for many different problems, but mainly to correct overbites or underbites that cannot be fully corrected with braces alone. This is usually necessary in cases of a poor relation between the upper and lower jaws. Braces can only move teeth, and are very limited in their ability to move the bone underneath. Sometimes, as mentioned previously, these jaw problems can be corrected with the use of special removable appliances at the right age. However after a certain age (i.e., sixteen or older), surgery is the only way to correct these severe bone/jaw problems. The common technique is usually to get braces first while the orthodontist and a surgeon decide on what is best for you. You then have your surgery and come back to the orthodontist, where he finalizes your braces treatment and then give you retainers.

FAQ

Can't I use a retainer to fix my crooked teeth?

In general the answer is no. The use of a retainer to fix crooked teeth is very limited. If space is available, a retainer may be used to move one or more teeth a very minor amount. As the word implies, retainers are used to retain tooth placement AFTER your braces are removed.

For how long do I have to wear my retainers after braces?

Every case is different, but the general recommendation is to wear them twenty four hours a day for six months and then at night only for another six months. After that you might want to use them two or three nights a week. If you ever stop wearing them completely, your teeth will probably get a little crooked again. Retainers should be taken off to eat and to brush and floss.

How long will I have to wear braces for?

The answer depends on many factors. The duration of treatment can range anywhere from a few months for a limited case, to well over four years for a child starting at age eight. The average treatment is usually about two years. A lot of the treatment time depends on whether you show up regularly for your monthly appointments and follow all instructions given to you by your orthodontist. This is especially true regarding the wear of any prescribed elastics, headgear or removable appliances, et cetera.

Do my wisdom teeth cause my front teeth to get crooked?

There is really no conclusive evidence that wisdom teeth cause tooth crowding, hence they should not be taken out for this reason alone. There may be other reasons however to extract your wisdom teeth. (see section on wisdom teeth).

Do braces hurt?

The word that better describes your feelings after getting braces is discomfort. Your braces will feel rough on your lips and tongue when they are initially placed. Your orthodontist will give you some soft wax to put on the rough areas until your lips get used to the braces. This usually takes anywhere from two to three weeks. You will also experience some discomfort when a wire is changed or a wire is tightened. This will usually last about two to three days. You may want to take some aspirin or Advil to alleviate this pressure feeling. This will also tend to happen if you start to wear elastics.