Orthodontics is a branch of dentistry that specializes in treating patients with improper positioning of teeth when the mouth is closed (malocclusion), which results in an improper bite.
Orthodontics also includes treating and controlling various aspects of facial growth (dentofacial orthopedics) and the shape and development of the jaw. An orthodontics specialist is called an orthodontist.
Orthodontics used to be called orthodontia - the word comes from the Greek orthos, meaning "straight, perfect or proper", and dontos, which means "teeth".
Orthodontics also includes cosmetic dentistry; when the patient's aim is to improve his/her appearance.
An orthodontist uses a range of medical dental devices, including headgears, plates, braces, etc. to help in:
- Closing wide gaps between the teeth
- Making sure the tips of the teeth are aligned
- Straightening crooked teeth
- To improve speech or eating (oral function)
- To improve the long-term health of gums and teeth
- To prevent long-term excessive wear or trauma (of the teeth)
- Treating an improper bite
What is malocclusion?
Malocclusion literally means bad bite. Some children's jaws and teeth do not develop properly. Malocclusion refers to crooked, misaligned teeth and a fault in the relation between the bottom and top set of teeth (the two dental arches). This may develop because of injury to the teeth or facial bones, frequent thumb sucking, or for reasons unknown.
Thumb sucking (or finger sucking) can result in localized deformation of the teeth and supporting bone. In order to restore a natural improvement, the thumb sucking habit has to be stopped.
Generally, malocclusions do not affect physical health, malocclusion is not a disease, it is a variation in the normal position of teeth. However, it may impact on the shape of the person's face and the appearance of their teeth, which can lead to embarrassment, a lack of self-confidence, and even depression.
Severe malocclusion may affect eating, speech and keeping the teeth clean.
UK health authorities say that approximately one third of all 12 year-olds in the country probably need orthodontic treatment.
People may require orthodontic treatment for different problems:
- The front teeth protrude - treatment not only improves the patient's appearance, but also protects the teeth from damage; people with protruding front teeth are more likely to injure them in sports, falling down, etc.
- Crowding - if the patient's jaw is narrow, there may not be enough space for all the teeth. In such cases the orthodontist may have to remove one or more teeth to make room for the others.
- Impacted teeth - an adult tooth does not emerge from the gum, or only emerges partially
- Asymmetrical teeth - the upper and lower teeth do not match, especially when the mouth is closed but the teeth are showing.
- Deep bite (overbite) - when the teeth are clenched, the upper ones come down over the lower ones too much
- Reverse bite - when the teeth are clenched, the upper teeth bite inside the lower ones
- Open bite - when the teeth are clenched, there is an opening between the upper and lower teeth.
- Underbite - the upper teeth are too far back, or the lower teeth a too far forward ("bulldog" appearance)
- Crossbite - at least one of the upper teeth does not come down slightly in from of the lower teeth when the teeth are clenched; they are too near the cheek or the tongue
- Spacing - there are gaps or spaces between the teeth, either because a tooth is missing, or the teeth simply do not fill-up the mouth (opposite of crowding)
When can orthodontic treatment start?
Treatment will not usually commence until the child is about 12 or 13 years old; when the adult teeth have come through and developed fully. In some cases treatment may start a couple of years later if teeth problems had not become noticeable beforehand.
Children with a cleft lip and palate may require orthodontic treatment before their adult teeth have developed completely.
Good oral hygiene is essential before any orthodontic work can begin. When devices are placed on the teeth, bits of food are much more likely to become stuck; the patient will need to brush much more carefully and more often to prevent tooth decay while treatment is ongoing.
Patients who have not reached good oral hygiene standards beforehand are much more likely to suffer from tooth decay after treatment begins.
Diagnosing dental problems and recommending treatment options
Assessment - the orthodontist will assess the state of the patient's teeth and make a prediction on how they are likely to develop without treatment. The following diagnostic procedures will be performed:
- A full medical and dental health history
- A clinical examination
- X-rays of the teeth and jaw
- Plaster models of the teeth
After the assessment is done, the orthodontist will decide on a treatment plan.
On the next page we look at examples of orthodontic appliances, including both fixed and removable braces.