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A Great Smile is Unforgettable - Straight Talk about Braces

By: Scott I Stein, D.D.S.


Why Straighten Teeth?

Straight teeth help an individual to effectively bite, chew and speak. Straight teeth contribute to healthy teeth and gums. Properly aligned teeth and jaws may alleviate or prevent physical health problems. Teeth that work better also tend to look better.

An attractive smile is a pleasant "side effect" of orthodontic treatment. An attractive smile is a wonderful asset. It contributes to self-esteem, self-confidence and self-image—important qualities at every age. A pleasing appearance is a vital component of self-confidence. A person's self-esteem often improves as orthodontic treatment brings teeth, lips and face into proportion. In this way, orthodontic treatment can benefit social and career success, as well as improve a person’s general attitude toward life.

You may be surprised to learn that straight teeth are less prone to decay and injury. Plaque is a colorless, sticky film composed of bacteria, food and saliva. Decay results when the bacteria in plaque feed on carbohydrates (sugar and starch) we eat or drink to produce acids that can cause cavities. Plaque can also increase the risk for periodontal (gum) disease. As for injuries to teeth, protruding upper teeth are more likely to be broken in an accident. When repositioned and aligned with other teeth, these teeth are most probably going to be at a decreased risk for fracture.

Untreated orthodontic problems may become worse. They may lead to tooth decay, gum disease (see photo below), destruction of the bone that holds teeth in place, and chewing and digestive difficulties. Orthodontic problems can cause abnormal wear of tooth surfaces (see photo below), inefficient chewing function, excessive stress on gum tissue and the bone that supports the teeth, or misalignment of the jaw joints (see photo above). This can sometimes lead to chronic headaches or pain in the face or neck. By correcting a problem early, treatment by an orthodontist may be less costly than the restorative dental care required to treat more serious problems that can develop in later years.

Why Select an Orthodontist?

Just as there are specialists in medicine (such as cardiologists, gastroenterologists, neurologists, etc.), there are specialists in dentistry. Orthodontists are dental specialists who dedicate their professional lives to correcting misaligned teeth and jaws.

Orthodontists are qualified dentists, who after graduating from dental school, go on to additional full-time university-based education in an accredited orthodontic residency program supervised by orthodontists. That training lasts at least two academic years—sometimes more. By learning about tooth movement (orthodontics) and guidance of facial development (dentofacial orthopedics), orthodontists are the uniquely trained experts in dentistry who straighten teeth and align jaws.

Orthodontists diagnose, prevent and treat dental and facial irregularities. The majority of members of the American Association of Orthodontists (AAO) limit their practice to orthodontics and dentofacial orthopedics. Orthodontists treat a wide variety of malocclusions (improperly aligned teeth and/or jaws). They regularly treat young children, teens and adults.

Selecting an orthodontist who is a member of the AAO is your assurance that you have chosen a trained orthodontist: the dental specialist with at least two years, of advanced specialty training in orthodontics in a university-based program accredited by the American Dental Association. Specialty education includes the study of subjects in biomedical, behavioral and basic sciences; oral biology; and biomechanics.

Only orthodontists may be members of the American Association of Orthodontists (AAO).

Want information about orthodontic treatment for children? (Through age 12)

Some children, as early as 5 or 6 years of age, may benefit from an orthodontic evaluation. Although treatment is unusual at this early age, some preventative treatment may be indicated.

By age 7, most children have a mix of baby (primary) and adult (permanent) teeth. Some common orthodontic problems seen in children can be traced to genetics (that is they may be inherited from their parents). Children may experience such problems as dental crowding, too much space between teeth, protruding teeth, extra or missing teeth, and sometimes jaw growth problems.

Other malocclusions (literally, "bad bite") are acquired. In other words, they develop over time. They can be caused by thumb or finger-sucking, mouth breathing, dental disease, abnormal swallowing, poor dental hygiene, the early or late loss of baby teeth, accidents or poor nutrition. Trauma and other medical conditions (such as birth defects) may contribute to orthodontic problems as well. Sometimes an inherited malocclusion is complicated by an acquired problem. Whatever the cause, the orthodontist is usually able to treat most conditions successfully.

Orthodontists are trained to spot subtle problems with jaw growth and emerging teeth while some baby teeth are still present. The advantage of early detection of orthodontic problems is that some problems may be easier to correct if they are found and treated early. Waiting until all the permanent teeth have come in, or until facial growth is nearly complete, may make correction of some problems more difficult. For these reasons, the AAO recommends that all children get a check-up with an orthodontist no later than age 7. While your child’s teeth may appear straight to you, there could be a problem that only an orthodontist can detect. Of course, the check-up may reveal that your child’s bite is fine, and that is comforting news.

Even if a problem is detected, chances are your orthodontist will take a "wait-and-see" approach, checking your child from time to time as the permanent teeth come in and the jaws and face continue to grow. For each patient who needs treatment, there is an ideal time for it to begin in order to achieve the best results. The orthodontist has the expertise to determine when the treatment time is right. The orthodontist’s goal is to provide each patient with the most appropriate treatment at the most appropriate time.

In some cases, your orthodontist might find a problem that can benefit from early treatment. Early treatment may prevent more serious problems from developing and may make treatment at a later age shorter and less complicated. For those patients who have clear indications for early orthodontic intervention, early treatment gives your orthodontist the chance to:

  • Guide jaw growth
  • Lower the risk of trauma to protruded front teeth
  • Correct harmful oral habits
  • Improve appearance and self-esteem
  • Guide permanent teeth into a more favorable position
  • Improve the way lips meet

It's not always easy for parents to tell if their child has an orthodontic problem. Here are some signs or habits that may indicate the need for an orthodontic examination:

  • Early or late loss of baby teeth
  • Difficulty in chewing or biting
  • Mouth breathing
  • Thumb sucking
  • Finger sucking
  • Crowding, misplaced or blocked out teeth
  • Jaws that shift or make sounds
  • Biting the cheek or roof of the mouth
  • Teeth that meet abnormally or not at all
  • Jaws and teeth that are out of proportion to the rest of the face

If any of these problems are noted by parents, regardless of age, it is advisable to consult an orthodontist. It is not necessary to wait until age 7 for an orthodontic check-up.

Frequently asked questions about childhood orthodontic treatment:

1. What is preventive orthodontic treatment?

Preventive orthodontic treatment is intended to keep a malocclusion ("bad bite" or crooked teeth) from developing in an otherwise normal mouth. The goal is to provide adequate space for permanent teeth to come in. Treatment may require a space maintainer to hold space for a primary (baby) tooth lost too early, or removal of primary teeth that do not come out on their own so to create room for permanent teeth.

2. What is interceptive orthodontic treatment?

Interceptive orthodontic treatment is performed for problems that, if left untreated, could lead to the development of more serious dental problems over time. The goal is to reduce the severity of a developing problem and eliminate the cause. The length of later comprehensive orthodontic treatment may be reduced. Examples of this kind of orthodontic treatment may include correction of thumb- and finger-sucking habits; guiding permanent teeth into desired positions through tooth removal or tooth size adjustment; or gaining or holding space for permanent teeth. Interceptive orthodontic treatment can take place when patients have primary teeth or mixed dentition (baby and permanent teeth). A patient may require more than one phase of interceptive orthodontic treatment

3. What is comprehensive orthodontic treatment?

Comprehensive orthodontic treatment is undertaken for problems that involve alignment of the teeth, how the jaws function and how the top and bottom teeth fit together. The goal of comprehensive orthodontic treatment is to correct the identified problem and restore the occlusion (the bite) to its optimum. Treatment can begin while patients have primary teeth, when they have a mix of primary and permanent teeth, or when all permanent teeth are in. Treatment may consist of one or more phases, depending on the nature of the problem being corrected and the goals for treatment.

Orthodontic care may be coordinated with other types of dental treatment that may include oral surgery (tooth extractions or jaw surgery), periodontal (gum) care and restorative (fillings, crowns, bridges, tooth size enhancement, implants) dental care. When finished with comprehensive treatment, the patient must wear retainers to keep teeth in their new positions.

4. What is a space maintainer?

Baby molar teeth, also known as primary molar teeth, hold needed space for permanent teeth that will come in later. When a baby molar tooth is lost, an orthodontic device with a fixed wire is usually put between teeth to hold the space for the permanent tooth.

5. Why do baby teeth sometimes need to be removed?

Removing baby teeth may be necessary to allow severely crowded permanent teeth to come in at a normal time in a reasonably normal location. If the teeth are severely crowded, it may be that some un-erupted permanent teeth (usually the canine teeth) will either remain impacted (teeth that should come in, but do not), or come in to a highly undesirable position. To allow severely crowded teeth to move on their own into much more desirable positions, sequential removal of baby teeth and permanent teeth (usually first premolars) can dramatically improve a severe crowding problem. This sequential extraction of teeth, called serial extraction, is typically followed by comprehensive orthodontic treatment after eruption of permanent teeth has brought about as much improvement as it can on its own.

After all the permanent teeth have come in, the extraction of selected permanent teeth may be necessary to correct crowding or to make space for necessary tooth movement to correct a bite problem. Proper extraction of teeth during orthodontic treatment should leave the patient with both excellent function and a pleasing look.

6. How can a child's growth affect orthodontic treatment?

Orthodontic treatment and a child’s growth can complement each other. A common orthodontic problem to treat is protrusion of the upper front teeth. Quite often this problem is due in part to the lower jaw being shorter than the upper jaw. Upper teeth may also be the primary cause of the protrusion if they stick out too far. While the upper and lower jaws are growing, orthodontic appliances can be beneficial in reducing these discrepancies. A severe jaw growth discrepancy may require orthodontics and corrective surgery after jaw growth has been completed, although this is rare.

The AAO recommends that all children have a check-up with an orthodontist no later than age 7 so that growth-related problems may be identified and so that treatment can be commenced at the appropriate time for each patient.

7. What kinds of orthodontic appliances are typically used to reduce the severity of jaw-growth problems?

A process of dentofacial orthopedics (guiding the growth of the face and jaws) with orthodontic appliances may be used to correct jaw-growth problems. The decision about when and which appliance to use for this type of correction is based on each individual patient's problem. Some of the more common orthopedic appliances include:

  • Headgear: This appliance applies pressure to the upper teeth and upper jaw to guide the direction of upper jaw growth and tooth eruption. The headgear may be removed by the patient and is usually worn 10 to 12 hours per day.
  • Fixed functional appliance: The appliance is usually fixed (glued) to the upper and lower molar teeth and may not be removed by the patient. By holding the lower jaw forward, it reduces the protrusion of the teeth while the patient is growing and helps bring the teeth together. The appliance can help correct severe protrusion of the upper teeth.
  • Removable functional appliance: This removable appliance holds the lower jaw forward and guides eruption of the teeth into a more desirable bite while helping the upper and lower jaws to grow in proportion to each other. Patient compliance in wearing this appliance is essential for successful improvement; the appliance cannot work unless the patient wears it.
  • Palatal Expansion Appliance: A child's upper jaw may be too narrow for the upper teeth to fit properly with the lower teeth (a crossbite). When this occurs, a palatal expansion appliance can be fixed to the upper back teeth. This appliance can markedly expand the width of the upper jaw. For some patients, a wider jaw may prevent the need for extraction of permanent teeth. 

8. Can my child play sports while wearing braces?

Yes. But wearing a protective mouth guard is advised while riding a bike, skating, or playing any contact sports, whether organized sports or a neighborhood game. Your orthodontist can recommend a specific mouth guard.

9. Will braces interfere with playing musical instruments?

Playing wind or brass instruments, such as the trumpet, will clearly require some adaptation to braces. With practice and a period of adjustment, braces typically do not interfere with the playing of musical instruments.

10. Why does orthodontic treatment time sometimes last longer than anticipated?

Estimates of treatment time can only be that - estimates. Patients grow at different rates and will respond in their own ways to orthodontic treatment. The orthodontist has specific treatment goals in mind, and will usually continue treatment until these goals are achieved. Patient cooperation, however, is the single best predictor of staying on time with treatment. Patients who cooperate by wearing rubber bands, headgear or other needed appliances as directed, while taking care not to damage appliances, will most often lead to on-time and excellent treatment results.

11. What is patient cooperation and how important is it during orthodontic treatment?

Good "patient cooperation" means that the patient not only follows the orthodontist's instructions on wearing appliances as prescribed and tending to oral hygiene and diet, but is also an active partner in orthodontic treatment.

Successful orthodontic treatment is a "two-way street" that requires a consistent, cooperative effort by both the orthodontist and patient. To successfully complete the treatment plan, the patient must carefully clean his or her teeth, wear rubber bands, headgear or other appliances as prescribed by the orthodontist, avoid foods that might damage braces and keep appointments as scheduled. Damaged appliances can lengthen the treatment time and may undesirably affect the outcome of treatment. The teeth and jaws can only move toward their desired positions if the patient consistently wears the forces to the teeth, such as rubber bands, as prescribed. Patients who do their part consistently make themselves look good and their orthodontist look smart.

To keep teeth and gums healthy, regular visits to the family dentist must continue during orthodontic treatment.

12. Some of my children's friends have already started treatment, but our orthodontist says my child should wait a while. Why is there a difference in treatment?

Each treatment plan is specific for that child and his/her specific problem. In some cases, children mature early (e.g.: get their permanent teeth early) and in some cases early treatment is indicated to prevent a more severe problem from occurring. Your orthodontist is the best person to decide the most optimum treatment plan. If you have questions, you should discuss them with your orthodontist.

13. What do the initials mean after an orthodontist's name?

The initials after an orthodontist's name indicate the academic education of the orthodontist. For instance, DMD and DDS indicate that the individual is a graduate dentist. M.S. or MSc indicates that the individual has achieved a Masters in Science degree, usually associated with orthodontic training. DipOrtho indicates the individual is an orthodontist.

14. Are there board-certified orthodontists?

Yes, these orthodontists have completed the American Board of Orthodontics Specialty Certification exams and have met these qualifications. Board-certified orthodontists are known as Diplomates of the American Board of Orthodontics. The American Board of Orthodontics is the only orthodontic specialty certifying board recognized by the American Dental Association.

15. My child has an allergy to nickel. Can my child still have orthodontic treatment?

Yes, there are appliances available which are nickel-free. Please tell your orthodontist if your child has any allergies.

16. How can I fit the orthodontist's fee into my family budget?

Orthodontic costs and payment options can be discussed with your treating orthodontist. Your orthodontist will be able to provide you with information about insurance and other possible funding options.

17. Want information about orthodontic treatment for teenagers?

Most patients begin orthodontic treatment between ages 9 and 16, but this varies depending on each individual. Because teenagers are still growing, the teen years are often the optimal time to correct orthodontic problems and achieve excellent results.

Most orthodontic problems are inherited. Examples of these genetic problems are crowding, too much space between teeth, protruding upper teeth, extra or missing teeth and some jaw growth problems.

Other malocclusions (crooked teeth) are acquired. In other words, they develop over time. They can be caused by thumb-sucking or finger-sucking as a child, mouth breathing, dental disease, abnormal swallowing, poor dental hygiene, the early or late loss of baby (primary) teeth, accidents, poor nutrition, or some medical problems.

Sometimes an inherited malocclusion is complicated by an acquired problem. But whatever the cause, the orthodontist is usually able to treat most conditions successfully.

Treatment is important because crooked or crowded teeth are hard to clean, and that may contribute to tooth decay, gum disease, and tooth loss. A bad bite can also cause abnormal wear of tooth surfaces, difficulty in chewing and/or speaking, excess stress on supporting bone and gum tissue, and possible jaw joint problems. Without treatment, problems may become worse. Orthodontic treatment to correct a problem may prove less costly than the additional dental care required to treat the problems that can develop in later years.

Then there's the emotional side of an unattractive smile. When you are not confident in the way you look, your self-esteem suffers. Teen-agers whose malocclusions are left untreated may go through life feeling self-conscious, hiding their smiles with tight lips or a protective hand.

18. Want information about adult orthodontic treatment?

Today, orthodontic treatment is a viable option for almost any adult. It is well recognized that when left untreated, many orthodontic problems may become worse. When you have a malocclusion ("bad bite"), your teeth may be crowded, excessively spaced or may not fit together correctly. Such conditions may lead to dental health problems. Crowded teeth are hard to clean and, given time, may contribute to tooth decay, gum disease and even tooth loss. Bad bites can also result in abnormal wearing of tooth surfaces, difficulty chewing and damage to supporting bone and gum tissue. Poorly aligned teeth can contribute to pain in the jaw joints.

You'll be pleased to learn that orthodontic treatment will fit in with your current lifestyle – you can sing, play a musical instrument, dine out, kiss, and even have your picture taken. One in five orthodontic patients is an adult. The AAO estimates that more than 1,000,000 adults in the United States and Canada are receiving treatment from orthodontists who are members of the AAO. To learn about correction of a specific problem, please consult your family dentist for a referral to an orthodontist or find orthodontists near you using the Rochester Health Dentist Directory (search under the specialty: Orthodontics and Dentofacial Orthopedics)

The rate of toothlessness has declined over recent decades. Our great-grandparents, for the most part, lost their teeth around age 40. Today’s 25-year-old has the potential of another 75 years of keeping and using their teeth. This is a major change in dental health care (and life expectancy). Teeth that do not fit well often wear down more quickly—another reason to make sure that your teeth are in good alignment and well maintained in your adult years.


Source: www.braces.org
On-Line Resources:
American Association of Orthodontics


About the Author 

Scott I Stein, D.D.S. Scott I Stein, D.D.S.

Scott I Stein, D.D.S. is an orthodontic specialist practicing in the Canal Park Building overlooking the scenic Erie Canal in Pittsford, NY. He is also a Clinical Professor in the Department of Orthodontics at The Strong Memorial Hospitals' Eastman Dental Center where he lectures on orthodontic biomechanics and the orthodontic aspects of orthognathic surgery. Dr. Stein is a native Rochesterian who grew up in Brighton, received his dental degree from the University of Buffalo and was elected to Omicron Kappa Upsilon (OKU) the national dental honor society. He earned his Certificate in Orthodontics from the University of Rochester's Eastman Dental Center Department of Orthodontics. Dr. Stein has lectured on various orthodontic topics around the country including Children's National Medical Center in Washington D.C., Monroe Community College, and The University of Buffalo. He has been involved in several research projects that have resulted in articles which have been published in the refereed orthodontic literature.

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