Why Seek Orthodontic Care?

         Whether to seek orthodontic care is an individual decision. Many people live their entire lives with crowding, increased overbites or other types of alignment problems without the motivation to seek orthodontic treatment.

        However, many people feel more comfortable and self-confident with properly aligned, attractive teeth, and orthodontic care can help improve appearance and build self-confidence.

Unlike strictly cosmetic procedures, orthodontic care also can benefit long-term dental health. Straight, properly aligned teeth are easier to maintain with proper oral-hygiene procedures, such as flossing and brushing. This can help reduce the risk of tooth decay as well as gingivitis, a gum-damaging infection that occurs when bacteria cluster around the junction of the teeth and gum tissue.

      In addition, people with bad bites may chew less efficiently; in severe cases (particularly when the jaws are not aligned correctly) this can result in nutritional deficiencies. Correcting bite irregularities can make it easier to chew and digest foods.

     Improperly coordinated upper and lower front teeth also can create speech difficulties, which can be alleviated through orthodontic treatment.

Finally, orthodontic treatment can help prevent premature wear of back tooth surfaces. As you bite down, your teeth withstand a tremendous amount of force. If the front teeth are not coupled together properly, it can predispose your back teeth to increased wear.

Who Can Benefit From Orthodontic Care?

      The American Association of Orthodontists recommends children undergo an orthodontic screening no later than age 7. By then, enough of the permanent teeth have emerged that it is possible to identify potential problems. Waiting for all the permanent teeth to erupt in the mouth isn't advised in many instances. Starting orthodontic treatment early in life offers many advantages. For example, while children are still growing, expansion devices can be used to modify the width of the palate. Such treatment is best done at an early age to maximize a patient's orthopedic potential.

      Many people undergo orthodontic treatment during adolescent and teen-age years, when most of the permanent teeth have come in and treatment can be most effective. About 3 million teen-agers in the United States and Canada wear braces, and millions more would benefit from treatment.

      An increasing number of adults now undergo orthodontic treatment, due to heightened dental awareness and the fact that more patients have a full complement of teeth or most teeth. However, adult treatment can be more complicated and may require a multidisciplinary approach to fully correct conditions. For example, adult patients may be more susceptible to gum problems and will need to address these or may have skeletal (jaw alignment) discrepancies that would require corrective jaw surgery. One of the biggest limitations in adult treatment is that growth has been completed. In younger patients, growth can be used to improve treatment outcomes.

Types Of Bad Bites

         Your orthodontist may describe specific bite abnormalities when discussing treatment. Problem bites usually cause both cosmetic and functional concerns. Many people tend to think of orthodontics as strictly cosmetic. However, treatment of these irregularities also plays an important role in the long-term stability of your bite and overall oral health. Common bite irregularities include:

• Crossbite — Here, the upper teeth seat significantly inside or outside the lower teeth. Crossbites often require orthodontic treatment because they can make it difficult to bite or chew.
• Crowding — If there is not enough room for the teeth, if the teeth are unusually large compared to the size of the dental arch or if the jaw is narrower than it should be, permanent teeth may not have adequate space to assume their proper alignment.
• Deep overbite — This occurs when the upper front teeth (incisors) overlap excessively over the lower teeth. In some instances, the biting edges of the upper teeth impinge upon the lower front gum tissue.
• Underbite — Crossbites of the anterior front teeth are commonly referred to as an underbite where the lower teeth are ahead of the upper teeth.
• Open bite — If your upper and lower front teeth don't meet when you bite down, this is referred to as an open bite. Since the front teeth don't share equally in the biting force, the back teeth may be subjected to a disproportionate amount of pressure. This makes chewing less efficient and could lead to premature wear of the back teeth.
• Spacing problems — Some people have missing teeth or unusually small teeth compared to the size of their dental arch. If the size of the jaw is normal, this can result in large spaces between the teeth. People who have lost one or multiple teeth may have uneven spacing because adjacent teeth may drift into the unoccupied areas.

Treatment: Braces And Retainers

        Everyone has a slightly different bite, so treatment techniques vary. Braces, the most common approach, help to slowly move the teeth by applying precise amounts of light pressure over a long period of time. As the teeth move, the bony tooth socket changes shape as pressure is being applied.

        Most orthodontic treatments occur in two phases:

• The active phase — This involves the use of braces or other appliances to move the teeth into proper alignment and coordination

• The retention phase — This involves the use of a retainer is used to hold the teeth in their new position for the long-term

                                                               Getting Braces
               You can choose between braces made of metal, ceramic or plastic. However, orthodontic treatment usually is done using stainless steel brackets. Ceramic or plastic brackets often are chosen for cosmetic reasons, but plastic brackets may stain and discolor by the end of treatment. Plastic and ceramic bands also have more friction between the wire and brackets, which can increase treatment time. Your orthodontist will discuss the available options.

     Braces work by applying continuous pressure to move teeth in a specific direction. Braces are worn on average for one to three years. As treatment progresses, teeth change position and the braces must be adjusted. A few decades ago, braces consisted of thick bands of steel wrapped around all of the teeth. With the advent of stronger bonding agents, braces have become smaller over time and orthodontic bands are rarely used on front teeth.

         When applying braces, the orthodontist will attach tiny brackets to your teeth with special dental bonding agents. He or she will then place wires called arch wires through the brackets. The arch wires, which usually are made of a variety of alloys, act as tracks to create the "path of movement" that guides the teeth. Wires made of clear or tooth-colored materials are less visible than stainless steel wires but are more expensive. Tiny elastic bands, called ligatures, can also be used to hold the arch wires to the brackets, and patients can choose from a multitude of colors at each visit.

      Expect to be uncomfortable for the first few days after getting braces. Your teeth may be sore, and the wires, brackets and bands may irritate your tongue, cheeks or lips. Most of the discomfort disappears within a week or two, although you may experience moderate pain when wires are changed or adjusted. Taking ibuprofen (Motrin, Advil) or other over-the-counter analgesics can help ease any discomfort.

                                                                Wearing A Retainer
          A retainer's purpose is to maintain tooth positions after corrective orthodontic treatment. Once your bite has been corrected, bone and gums need additional time to stabilize around the teeth. The recommended length of time for wearing a retainer varies from orthodontist to orthodontist. Most children and teen-agers wear retainers until their early to mid-20s, but your orthodontist's recommendation should be followed strictly since he or she knows your treatment best.

Risks And Limitations Of Orthodontic Care

     There are few risks involved in undergoing orthodontic treatment. In rare cases, certain patients may have allergic reactions to the metal or latex. There is also an increased possibility of complications in patients with periodontal problems, such as people with type 1 diabetes, who may be predisposed toward the breakdown of gum and supporting tissue. In such people, there is an increased risk that orthodontic treatment could jeopardize the long-term integrity of affected teeth. Your orthodontist will discuss the risks of your particular treatment.

        Achieving the desired results from orthodontic treatment often depends upon the patient's choices. Particularly with adults, an ideal treatment plan may require a multidisciplinary approach with periodontic and prosthodontic work or even corrective jaw surgeries. Many times, results are limited because the patient is not willing to undergo comprehensive treatment. However, acceptable treatment compromises often can be reached that improve a patient's condition, even if not ideally. The treatment options and expected outcomes depend upon the individual person, and the orthodontist will review them fully with you prior to initiating treatment.