Orthodontics is a branch of dentistry that treats malocclusion, a condition in which the teeth are not correctly positioned when the mouth is closed. This results in an improper bite.
An orthodontist specializes in making the teeth straight.
Treatment can be cosmetic, to improve a person’s appearance, but it often aims to improve oral function, too.
An orthodontist can carry out work that aims to achieve the following:
- closing wide gaps between the teeth
- aligning the tips of the teeth
- straightening crooked teeth
- improving speech or chewing ability
- boosting the long-term health of gums and teeth
- preventing long-term excessive wear or trauma of the teeth
- treating an improper bite
Treatment can improve the appearance of the teeth, but it can also lead to better chewing and speech function and help protect teeth from damage or decay, in some cases.
To achieve these goals, the orthodontist uses a range of medical dental devices, including headgear, plates, and braces.
Orthodontic devices can be fixed or removable.
These are the most common devices used in orthodontics. They are used when precision is important.
A person can eat normally with fixed appliances, but some foods and drinks need to be avoided, such as carbonated drinks, hard candy, gum, and other sticky foods.
People who participate in contact sports need to tell their orthodontist, as they may need special gum shields.
Examples of fixed orthodontic appliances include:
These consist of brackets, wires, and bands. Bands are fixed firmly around the teeth and serve as anchors for the appliance, while brackets are usually connected to the front of the teeth.
Wires in the shape of an arch pass through the brackets and are fixed to the bands. As the arch wire is tightened, tension is applied to the teeth. Over time, this moves them into proper position.
Follow-up involves monthly visits to adjust or tighten the braces. Treatment may last from several months to a number of years.
Both clear and colored braces are available.
If a child loses a baby tooth, a space maintainer will stop the two teeth at either side of the spaces from moving into it until the adult tooth comes through. A band is fixed to one of the teeth next to the space, and a wire goes from the band to the other tooth.
Removable space maintainers
These are an alternative to fixed-space maintainers.
Special fixed appliances
These can help control tongue thrusting or thumb sucking. They may be uncomfortable, especially when eating, and so they are only used if necessary.
Removable orthodontic appliances
These may be used to treat minor problems, such as preventing thumb sucking or correcting slightly crooked teeth.
The appliance should only be taken out when cleaning, eating, or flossing. Sometimes, the orthodontist may advice the patient to remove them during certain activities, such as playing a wind instrument or cycling.
Examples of removable appliances include:
Aligners: This alternative to braces may be useful for adults. They are virtually unnoticeable by other people, and they can be removed to brush the teeth, floss, or eat. An aligner is used for 2 to 3 weeks, then changed for a tigher one.
Headgear: A strap around the back of the head is attached to a metal wire in the front, or face bow. The aim is to slow down upper jaw growth, and keeping the back teeth in position while the front ones are pulled back.
Lip and cheek bumpers: These are specially made to relieve the pressure of cheeks or lips on the teeth.
Palatal expander: This appliance is designed to make the arch of the upper jaw wider. It consists of a plastic plate with screws that is placed on the palate, or roof of the mouth. The screws put pressure on the joints in the bones, forcing them outward. This expands the size of the area in the roof of mouth.
Retainers: These are used after treatment to stop the teeth from moving back to their original positions. If modified, they may also be used to stop children from sucking their thumbs.
There are two types of removable retainer:
- A Hawley retainer is made of metal and acrylic. The acrylic fits on the roof of the mouth and the wire surrounds the anterior teeth.
- The other is made of clear plastic. It fits over the teeth and looks like an Invisalign aligner.
Permanent retainers are glued, or bonded, to the back of the teeth. It is usually recommended for lower anterior teeth because of the high risk of reverting back to their former position.
In some cases, orthodontists recommend both a fixed permanent one on the lower anterior teeth and the clear plastic aligner-type which then would fit over the entire lower arch.
Splints, or jaw repositioning appliances
These are placed either in the top or lower jaw. They help the jaw close properly. Splints are commonly used for temporomandibular joint disorder (TMJ). TMJ is a condition that can cause pain and dysfunction in the muscles that are involve in jaw movement.
Whatever your device or treatment, it is important to follow both the health professional’s instructions and oral hygiene guidelines with care, to ensure the best outcome.
If the jaws and teeth do not develop properly, malocclusion can result. The teeth will be crooked and misaligned, and the bottom and top sets of teeth may not line up.
Malocclusion is not a disease and it does not affect physical health. It is a variation in the position of teeth. However, it may impact the shape of the face and the appearance of the teeth, resulting in embarrassment, a lack of self-confidence, and even depression.
Reasons include injury to the teeth or facial bones and frequent thumb or finger sucking, among others.
Severe malocclusion may affect eating, speech, and keeping the teeth clean.
Orthodontic treatment can help treat or improve the following:
Protruding front teeth: Treatment can improve the appearance and protects the teeth from damage during sports injuries or falls.
Crowding: In a narrow jaw, there may not be enough space for all the teeth. The orthodontist may remove one or more teeth to make room for the others.
Impacted teeth: This can happen when adult tooth does not emerge from the gum or bone, 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, or overbite: When the teeth are clenched, the upper ones come down too far over the lower ones.
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 are too far forward.
Crossbite: At least one of the upper teeth does not come down slightly in front 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 do not fill-up the mouth. This is the opposite of crowding.
An orthodontist can also help solve problems such as the grinding or clenching of teeth and clicking or moving of the jaw.
Thumb or finger sucking can causes the teeth and supporting bone to become misshappen. To see a natural improvement, the thumb-sucking habit must first be.
Treatment usually starts around the age of around 12 or 13 years, when the adult teeth have come through and developed fully.
If problems do not emerge until later, the treatment may begin at a later date. In 2014, nearly 1.5 million adults received orthodontic treatment in the United States, according to the American Assocation of Orthodontists (AAO).
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, food particles are more likely to become stuck. The individual will need to brush much more carefully and more often to prevent tooth decay during treatment.
Without good oral hygiene practices, there is a risk of tooth decay during treatment. The orthodontist may also recommend avoiding fizzy drinks, sugary snacks, and other items that can lead to tooth decay.
The orthodontist will assess the state of the person’s teeth and predict how they are likely to develop without treatment.
The assessment will involve:
- taking a full medical and dental health history
- carrying out a clinical examination
- taking x-rays of the teeth and jaw
- making plaster models of the teeth
Next, the orthodontist will decide on a treatment plan.
Your dentist will usually be able to recommend an orthodontist, or they may be able to do this work themselves. A small number of dentists are also trained and qualified as an orthodontist. According to the AAO, only 6 percent of dentists are also orthodondists.
A dentist specializes in the broader area of oral health, including preventing infections, and dealing with the teeth, jaw, nerves, and other aspects.
An orthodontist deals specifically with the bite and straightness of teeth. You should check that your chosen professional is qualified to undertake orthodontal treatment before going ahead.
The AAO keeps a list of registered orthodontists. You can access it here.