An orthodontist is a dentist with additional training, who specializes in aligning and straightening teeth. The best time for your child to get dental braces depends on the severity and the cause of the misalignment of your child’s teeth.
Traditionally, treatment with dental braces begins when a child has lost most of his or her baby (primary) teeth, and a majority of the adult (permanent) teeth have grown in — usually between the ages of 8 and 14. If treatment is needed during this time, interceptive or preventive care can take advantage of your child’s growth to guide the intended result as development takes place.
Some orthodontists recommend what’s called an interceptive approach, which involves using dental appliances (not always dental braces) at an earlier age, while a child still has mostly baby teeth. Then, when a child has mainly adult teeth, a second phase of treatment is started, usually with dental braces. This second phase is thought by some to be shorter than a traditional course of braces if an early treatment has been done.
Orthodontists who favor the traditional approach say that a two-phase approach to treatment actually increases the total time — and sometimes the expense — of orthodontic treatment with generally similar results. However, other orthodontists believe guidance of growth using dental appliances before the second phase of treatment makes correction easier.
The best choice for you and your child will largely depend on the severity of your child’s dental problems. Talk with your child’s dentist or orthodontist about the best course of action.
Dental braces are wire-based appliances that orthodontists use to correct crowded and misaligned teeth or jaws. Many people who need dental braces get them during their early teenage years, but adults also can benefit from wearing braces. The goal of dental braces is to properly align your teeth and jaws to produce an even bite and pleasing smile.
For minor corrections, an option is a series of customized, removable appliances called clear aligners or “invisible braces.” These may have a more acceptable appearance to some adults. If you’re considering clear aligners versus fixed braces, ask about the cost and the pros and cons for your specific needs. Many people need fixed braces to properly correct their dental problems.
Modern materials and technologies make the experience of having dental braces much more comfortable than in the past.
Why it’s done
Dental braces offer corrective treatment for:
- Overcrowded or crooked teeth
- Too much space between teeth
- Upper front teeth that overlap the lower teeth too much — either vertically (overbite) or horizontally (overjet)
- Upper front teeth that bite behind the lower ones (underbite)
- Other jaw misalignment problems that cause an uneven bite
Proper alignment of your teeth and jaws may improve not only the appearance of your teeth but also the health of your mouth and the way you bite, chew and speak.
Adults and braces
If you’re an adult with braces, you may need to wear them longer than a younger person would, but they can still produce similar results — for example, correcting crooked teeth or a misaligned jaw. Because your facial bones are no longer growing, however, there may be some problems that can’t be corrected with braces alone.
Wearing dental braces is generally a very safe procedure. However, there are some risks.
Braces create tiny spaces around your teeth that can trap food particles and promote bacteria-filled plaque deposits. Failure to remove deposits of food and plaque can lead to:
- Loss of minerals in your teeth’s outer enamel surface, which can leave permanent whitish stains on your teeth
- Tooth decay (cavities) and gum disease
Long-term risks may include:
- Shorter root lengths. During tooth movement, some of the bone in the path of the moving tooth dissolves, while new bone is laid behind it. Permanent loss of tooth root length may occur during this process, which could lead to less stable teeth. In most cases, however, this doesn’t cause any problems.
- Loss of correction. If you don’t follow your orthodontist’s instructions carefully after your braces are removed, particularly when it comes to wearing a device called a retainer, you may lose some of the correction gained while wearing your braces.
Reduce your risk of damage
To reduce the risk of damaging your teeth and braces:
- Cut down on sugary and starchy foods and beverages, which substantially contribute to plaque formation and tooth decay.
- Brush carefully, preferably after every meal, with fluoride toothpaste and a soft-bristled brush. If you can’t brush your teeth after your meal, rinse your mouth out with water.
- Rinse thoroughly to get all particles out of your braces. Check in the mirror to make sure your teeth are clean.
- Use a fluoride rinse if recommended by your dentist or orthodontist.
- Floss between braces and under wires with the help of a floss threader. Your orthodontist also may recommend a small flexible toothbrush to clean between braces and wires.
- Avoid sticky foods — such as chewing gum, chewy candies, caramel and taffy. They can pull off brackets, bands and wires.
- Avoid hard or crunchy foods — such as ice, raw carrots, hard candies, popcorn and nuts. They can break parts of your braces.
- Visit your dentist for checkups and cleaning as often as your dentist recommends, to keep your teeth and gums healthy.
- Follow instructions — lack of compliance can extend the time needed for completion and increase the chance of complications.
How you prepare
If your regular dentist notices problems with your teeth or jaws that may require treatment, he or she will likely refer you to an orthodontist — a dentist who specializes in diagnosing, preventing and treating dental and facial irregularities.
Some tooth alignment problems happen when children develop and can be guided before puberty but become more apparent once the permanent teeth begin to come through the gum (erupt). However, your orthodontist may recommend waiting until enough teeth have come through before applying braces. Most children get braces between the ages of 8 and 14 years, while their facial bones are still growing and their teeth are easier to move.
Preparation for braces generally involves:
- Oral exam. Your orthodontist conducts a full exam of your teeth, jaws and mouth.
- X-rays. You’ll get a series of X-rays to determine the position of teeth. The most common is the panoramic X-ray, which shows all the upper and lower teeth in biting position and any teeth still developing within the jaws. Special head X-rays also may help determine the size, position and relationship of jaws to teeth. These 3D X-rays give a better idea of the true position of the teeth to each other.
- Plaster models. You’ll bite into soft material, which remains on your teeth for a few minutes. From this impression, a plaster model of your teeth (dental cast) is created and the orthodontist evaluates your bite. In some cases, this dental cast may be scanned into a digital format for further evaluation or treatment decisions.
- Potential tooth extraction. If your mouth is very overcrowded, there may be limited or no room in the jaw for all the existing teeth. Your orthodontist may recommend removing one or more permanent teeth to allow room for the remaining teeth to fit comfortably. This allows the teeth to fit together better and also allows for adequate space for cleaning.
- Other procedures. In severe cases, where tooth movement alone will not correct a bite that’s significantly out of alignment, jaw repositioning surgery is required in combination with orthodontics.
After your orthodontist has evaluated your teeth and jaws, he or she customizes a treatment plan for you. This most often involves the use of fixed braces, which are temporarily bonded to your teeth.
What you can expect
Treatment is done in three phases: the initial placement of the braces (or clear aligners), periodic adjustments and use of a retainer after the braces are removed.
Placement of braces
Fixed dental braces typically consist of these components:
- Brackets attached to the outside surfaces of the teeth. Or they can be attached to the backside of teeth, hiding them from view, but this makes them a bit harder to access. Brackets can be made of stainless steel, ceramic (clear or tooth-colored) or other materials. Modern metal brackets are smaller and less noticeable than they used to be.
- Ring-like bands that encircle the molar teeth. Before bands are applied, space is created by placing very small rubber bands (spacers) between the molar teeth. These bands are made of stainless steel or titanium. A buccal tube attached to the band of the last molar holds the end of the connecting wire in place.
- A flexible wire (archwire) that connects all of the brackets and bands. The archwire controls movement of the teeth.
- Small rubber bands (elastic ties) or metal ties to secure the wire to the brackets (though some braces have a sliding mechanism instead of ties to secure the wire). Larger rubber bands also may be used to help move teeth. Stretching elastics between the upper and lower jaws is an option to produce more corrective pressure.
- Headgear attached to the braces. Headgear is usually only worn at night, and it may be helpful in more-complex cases. Headgear is attached to headgear tubes in the mouth to produce additional pressure and to help hold or move teeth into the correct position.
- Temporary anchorage devices (TADs). Instead of headgear or rubber bands, TADs may be an option for some patients. Tiny screws are placed through the gums into the jawbone, and can then be used as anchors to apply continuous pressure to move the teeth.
Removable clear aligners
Instead of using fixed braces, certain people who need only minor corrections may benefit from a series of customized, removable appliances called clear aligners. Typically, each set of aligners is worn for one to three weeks, as close to 24 hours a day as possible — except when eating, brushing or flossing — until it’s replaced by the next set. The entire series of aligners may take up to nine months or longer, allowing better alignment.
Only plain water is OK to drink when wearing aligners. After taking the aligners out to eat or drink any other food or beverage, be sure to brush your teeth before putting the aligners back in. Floss as often as directed — at least daily.
After fixed braces are placed on your teeth, your orthodontist adjusts them periodically by tightening or bending the interconnecting wires. This puts mild pressure on the teeth and gradually shifts them into new positions. The jaw responds to the pressure by dissolving bone in the path of the moving tooth and laying down new bone behind it.
Occasionally, the orthodontist may use tension between the upper and lower jaws to help correct alignment. This is often done with elastic bands stretched between opposing teeth.
Your teeth and jaws may feel slightly sore for the first few days after an adjustment. This discomfort can usually be eased with an over-the-counter pain reliever. Tell your orthodontist if the discomfort is severe or becomes worse.
After dental braces are removed, the newly straightened teeth need to be stabilized for a period of time (retention period) to prevent them from shifting back to their original position. This is accomplished with the use of a custom-made appliance typically made of plastic or plastic and metal wires that help teeth stay in place (retainer).
Retainers are usually removable, but may be fixed. Or a combination of fixed and removable may be used.
Braces are generally very effective in realigning crooked teeth and helping correct improperly positioned jaws to create a nice smile and a healthy mouth.
On average, most people wear full braces for one to three years. Retainers may be worn indefinitely to ensure that the final results remain stable.
The person wearing the braces has an important role to play in the success of the treatment. Follow the orthodontist’s instructions precisely, especially during the retention period. When it comes to this final phase, it’s important to wear the retainer as directed or risk losing the benefits gained while wearing braces.