Straightening teeth is called orthodontics. It is a treatment that takes years. When wearing braces for so long a time, it begins to feel as if you are swimming against a strong current, but, there is no way to hurry the process.
In children, orthodontics must be done slowly and cautiously to avoid damaging the roots of the teeth. If the teeth are moved too rapidly the damage is permanent. For adults, the teeth must be moved even slower and the process takes even longer.
Placing braces in children at too young an age is a bad idea. It makes the treatment unnecessarily longer and costly, and in the end, there is no real gain. For the typical case, the best starting age is 12 to 14 years during which the last baby teeth are ready to fall out and the final adult teeth are growing in.
What causes an unacceptable bite or crooked teeth?
The answer is genetics. It is genes that determine the position of the teeth, the size of the teeth and the size of the mouth. Genes make teeth too big or too small. Genes will produce too many teeth or too few teeth. Genes also determine the size of the mouth. If a mouth is too big relative to the size of the teeth there will be spaces between the teeth. If a mouth is too small, there will be crowded teeth. When the genes don’t work well together the following can happen:
The teeth will be too big or too small for the mouth. The result is crowding, or, the opposite, spaces between the teeth.
There can be missing teeth or extra teeth present in the mouth. There can also be teeth permanently ‘stuck’ in the bones in the top or bottom of the mouth.
The palate might be too small. The jaw might be too big. This leads to what is called a ‘prognathic’ jaw, or a jaw that sticks out.
A too-small jaw or excessive growth of the palate will cause ‘buck teeth’ (see the pictures below).
Sometimes braces will be needed due to reasons other than genetics. For instance childhood habits including long-term thumb-sucking, nail biting, or uncontrolled habits such as sticking out the tongue during swallowing (known as tongue thrust). All these will result in tooth and bone problems and result in a need for orthodontic treatment.
There is great beauty and complexity to the human skull. Orthodontists create x-rays like this (called cephalometric) and use these pictures to make detailed measurements to serve as a guide toward proper tooth alignment.
A small palate or a large jaw will cause the lower teeth to stick out. This is called class III bite. (a ‘class three bite’)
A large palate or small jaw can result in upper teeth overlapping the lower teeth. This is called a class II bite. (a ‘class two bite’)
Orthodontics is a challenge but it can lead to a lifetime of confidence brought by an improved smile.
Why remove teeth?
Very often, teeth have to be removed (extracted) before placing braces. Your orthodontist (the braces dentist) will send you to the general dentist or oral surgeon to remove one to four teeth before starting treatment. Extractions are often necessary to obtain a pleasing result.
A frequent request made by orthodontists is to remove four teeth (upper right and left, lower right and left). These teeth are called ‘premolars’. They are small, round teeth on the side of the mouth. Premolars are easy to remove. The roots are usually thin and straight and taking them out is not difficult for patients either young or old.
Why start with ‘orthodontics’? Why move teeth? There are four reasons children and adults need properly aligned teeth.
To give a beautiful smile and increase confidence.
For a pain-free TMJ. The ‘TMJ’ is the area in front of your ear. It is where the jaw connects to the head. This connection is very delicate.
If your teeth are uneven, and your bite just doesn’t feel right, then the TMJ can become inflamed or damaged.
You might hear sounds in your ears when opening the jaw, including ‘clicking’, ‘popping’, and in the worst case scenario, the jaw might stick in the open position, permanently, and won’t close at all until an oral surgeon manipulates it closed.
Crooked teeth catch bacteria which causes tooth decay.
Crooked teeth are often a source of gum disease. Red, swollen gums are frequently seen around crooked teeth.
Orthodontic treatment uses a variety of permanently cemented or removable acrylic and wire devices to move teeth and to maintain teeth in place after they are moved.
These include: permanent braces; clear, removable, ‘Invisalign’ trays; and a large selection of removable or permanently placed wire and acrylic devices. There are many types of orthodontic devices. Here is a sample list:
Removable devices:
Hawley retainer: This removable wire piece is placed after braces are removed to prevent the teeth from relapsing and becoming crooked again. It may be necessary to wear the Hawley for years after braces.
Bionator: Used to bring together top and bottom front teeth that don’t close all the way.
Bite block: To fix top teeth that cover the bottom front teeth.
Frankel device: To help the jaw grow properly.
Activator: To help the jaw grow.
Permanent devices:
Palatal expander: To widen the palate and correct a poor bite.
Braces: Are traditionally made of metal. There are now acrylic/ceramic braces that offer a more esthetic look. Another option is braces placed on the back of the teeth. They often are considered uncomfortable and difficult to clean.
