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EducationAnswers to Frequently Asked Questions

 

What is orthodontics?

Orthodontics is the branch of dentistry that specializes in the diagnosis, prevention and treatment of dental and facial irregularities. The practice of orthodontics requires professional skill in the design, application and control of corrective appliances to bring teeth, lips and jaws into proper alignment and to achieve a beautiful, healthy and natural looking smile.

 

What is an orthodontist?

All orthodontists are dentists, but only about six percent of dentists are orthodontists. Orthodontists must first attend college and then complete a four-year dental graduate program at a university dental school or other institution accredited by the Commission on Dental Accreditation of the American Dental Association (ADA). They must then successfully complete an additional two- to three-year residency program of advanced education in orthodontics. This residency program must also be accredited by the ADA. Through this training, the orthodontist learns the skills required to manage tooth movement (orthodontics) and guide facial development (dentofacial orthopedics). Only dentists who have successfully completed this advanced specialty education may be called an orthodontist.

 

At what age can people have orthodontic treatment?

Children and adults can both benefit from orthodontics because healthy teeth can be moved at almost any age. In fact, one in five orthodontic patients is an adult. Monitoring growth and development is crucial to managing some orthodontic problems. The American Association of Orthodontists recommends that all children have an orthodontic screening no later than age seven. Some orthodontic problems may be easier to correct if treated early. An orthodontic evaluation at any age is advisable if a parent, family dentist or the patient’s physician has noted a problem.

 

What causes orthodontic problems (malocclusions)?

Most malocclusions are inherited, but some are acquired. Inherited problems include crowding of teeth, too much space between teeth, extra or missing teeth, and a wide variety of other irregularities of the jaws, teeth and face. Acquired malocclusions can be caused by trauma (accidents), thumb/finger sucking or other oral habits, airway obstruction by tonsils and adenoids, dental disease or premature loss of primary (baby) or permanent teeth. Whether inherited or acquired, many of these problems affect not only alignment of the teeth but also facial development and appearance as well.

 

Why is orthodontic treatment important?

Crooked and crowded teeth are hard to clean and maintain. This may contribute to conditions that cause not only tooth decay but also eventual gum disease and tooth loss. Other orthodontic problems can contribute to abnormal wear of tooth surfaces, inefficient chewing function, excessive stress on gum tissue and the bone that supports the teeth, or misalignment of the jaw joints, which can result in chronic headaches or pain in the face or neck. When left untreated, many orthodontic problems become worse. Treatment by a specialist to correct the original problem is often less costly than the additional dental care required to treat more serious problems that can develop in later years. The value of an attractive smile should not be underestimated. A pleasing appearance is a vital asset to one’s self-confidence. A person’s self-esteem often improves as treatment brings teeth, lips and face into proportion. In this way, orthodontic treatment can benefit social and career success, as well as improve one’s general attitude toward life.

 

How long will orthodontic treatment take?

In general, active treatment time with orthodontic appliances (braces) ranges from one to three years. Interceptive, or early treatment procedures, may only take a few months. The actual time depends on the growth of the patient’s mouth and face, the cooperation of the patient and the severity of the problem. Mild problems usually require less time, and some individuals respond faster to treatment than others. Use of rubber bands and/or headgear, if prescribed by the orthodontist, contributes to completing treatment as scheduled.

How do braces feel?

Most people have some discomfort after their braces are first put on or when adjusted during treatment. After the braces are on, teeth may become sore and may be tender to biting pressures for three to five days. Patients can usually manage this discomfort well with whatever pain medication they might commonly take for a headache. The orthodontist will advise patients and/or their parents what, if any, pain relievers to take. The lips, cheeks and tongue may also become irritated for one or two weeks as they toughen and become accustomed to the surface of the braces. Overall, orthodontic discomfort is short-lived and easily managed.

 

Do teeth with braces need special care?

Patients with braces must be careful to avoid hard and sticky foods. They must not chew on pens, pencils or fingernails, because chewing on hard things can damage the braces. Damaged braces will almost always cause treatment to take longer, and will require extra trips to the orthodontist’s office. Keeping the teeth and braces clean requires more precision and time, and must be done every day if the teeth and gums are to be healthy during and after orthodontic treatment. Patients who do not keep their teeth clean may require more frequent visits to the dentist for a professional cleaning. The orthodontist and staff will teach patients how to best care for their teeth, gums and braces during treatment. The orthodontist will tell patients (and/or their parents) how often to brush, how often to floss, and, if necessary, suggest other cleaning aids that might help the patient maintain good dental health.

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, which will come in later.

Why do baby teeth sometimes need to be pulled?

Pulling 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 clear that some unerupted permanent teeth (usually the canine teeth) will either remain impacted (teeth that should have come in, but have not), or come into 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 tooth eruption has improved as much as it can on its own. After all the permanent teeth have come in, the pulling of 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.

What is a Palatal Expansion Appliance?

A child’s upper jaw may also be too narrow for the upper teeth to fit properly with the lower teeth (crossbite). When this occurs, a palatal expansion appliance can be utilized to expand the width of the upper jaw.

Can my child play sports while wearing braces?

Yes. Wearing a protective mouthguard is advised while playing any contact sports. Your orthodontist can recommend a specific mouthguard.

Will my 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.

Why are retainers needed after orthodontic treatment?

After braces are removed, the teeth can shift out of position if they are not stabilized. Retainers provide that stabilization. They are designed to hold teeth in their corrected ideal positions until the bones and gums adapt to the treatment changes. Wearing retainers exactly as instructed is the best insurance that the treatment improvements last for a lifetime.

Will my child’s tooth alignment change later?

Studies have shown that as people age, their teeth may shift. This variable pattern of gradual shifting, called maturational change, slows down after the early 20s, but continues to a degree throughout life for most people. Even children whose teeth developed into ideal alignment and bite without treatment may develop orthodontic problems as adults. The most common maturational change is crowding of the lower incisor (front) teeth. Wearing retainers as instructed after orthodontic treatment will stabilize the correction. Beyond the period of full-time retainer wear, nighttime retainer wear can prevent maturational shifting of the teeth.

What about the wisdom teeth (third molars) – should they be removed?

In about three out of four cases where teeth have not been removed during orthodontic treatment, there are good reasons to have the wisdom teeth removed, usually when a person reaches his or her mid- to late-teen years. Careful studies have shown, however, that wisdom teeth do not cause or contribute to the progressive crowding of lower incisor teeth that can develop in the late teen years and beyond. Your orthodontist, in consultation with your family dentist, can determine what is right for you.