Orthodontics, the branch of dentistry concerned with the growth of the teeth, jaws and face, is in high demand.
Orthodontic treatment is about making the best of your teeth; it's about improving the harmony of your mouth and jaws. Once you can bite together correctly, you can eat more comfortably and care for your teeth and gums more easily. And your smile will benefit immensely!
Most courses of orthodontic treatment begin with a referral from a general dentist to a specialist.
These are some of the most common reasons for a referral:
- protruding upper front teeth - one of the most common dental problems
- crowding - a narrow jaw may mean there is not enough room for your teeth, resulting in crowding. Conversely, some patients have significant gaps between their teeth
- asymmetry - particularly when the centre lines of the upper and lower front teeth do not match, perhaps because the teeth have drifted or the position of the jaw has shifted
- a deep bite - when your upper teeth cover the lower teeth too much
- a reverse bite - when your upper teeth bite inside the lower teeth
- an open bite - when your front teeth remain apart when your back teeth meet; the tongue is often still visible between the upper and lower front teeth
- impacted teeth - in some patients, secondary teeth come through in the wrong position or do not erupt at all. Orthodontic treatment can help bring these teeth into the correct position.
Every patient needs tailor-made treatment, planned by the orthodontist and agreed with you, the patient. In order to decide what treatment is required for you, your orthodontist will need to carry out a full assessment of your teeth which is likely to include x-rays, impressions (moulds of the teeth) and photographs. Treatment can take more than two years so it is important you are happy from the outset with what is recommended. Braces are almost always needed.
Those which are used most often are:
a fixed brace - this is the most common type of brace today, often known as "train tracks". Brackets are glued onto the teeth and linked by wires. Small elastic hoops are often used to hold the wire in position. The wires exert gentle pressure to move the teeth into a new position. The brackets can be metal, ceramic or even gold and the elastic hoops come in many colours.
a removable brace - this is sometimes used for correcting a simple problem, such as moving a single tooth or expanding the dental arch. It has a plastic baseplate with wires and springs attached. Removable braces need to be worn all the time except for cleaning or sport.
functional appliances - these are used to harness the growth of the jaws and improve way the upper and lower teeth meet. There are several designs all of which fit on to both the upper and lower teeth and hold the lower jaw forward. They are mostly removable but should be worn as near to full-time as possible
retainers - at the end of treatment, all patients should wear retainers to hold their teeth in the new position. These can be removable or fixed and are an important part of treatment
The benefits of orthodontic treatment can include the following:
- removal of dental crowding (or sometimes closing gaps)
- alignment of the upper and lower dental arches
- correction of the bite of the teeth so that the front teeth meet on closing and the back teeth mesh together
- reducing the likelihood of damage to prominent teeth
- enhancing facial aesthetics
- accommodating impacted, unerupted or displaced teeth
- preparation for advanced dental treatment, such as crowns, bridges or dental implants
- reversing the drifting of the teeth in older patients who have suffered from advanced gum disease
Extractions - are they necessary?
Extractions as part of orthodontic treatment are required somewhat less frequently than in the past on account of advances in orthodontic techniques. There has been widespread adoption of braces which take advantage of the growth of the patient's jaw to correct the bite, possibly also creating small amounts of additional space in the dental arch. These braces, known as functional appliances, are routinely used now by most orthodontists and can often avoid the need for extractions. Other advances have likewise reduced the proportion of cases where extrctions are recommended.
It is sometimes asserted that these techniques are appropriate in all cases and that narrow jaws can always be widened to bring overcrowded teeth into line without extractions. But the evidence is that this approach, applied uncritically, can lead to excessive prominence of the teeth greatly increasing the risk of subsequent relapse.
There is little doubt that well-planned orthodontic treatment can both improve the bite and enhance a patient's overall appearance. Every course of treatment needs to be tailored to the needs of the individual patient. For many patients, in order to get the best appearance and long-term result, extractions will still be part of the process.
In reaching a decision on extractions, a full assessment of the patient's face, teeth and state of development is essential. A meaningful opinion cannot be given on whether extractions will be required in the absence of such an assessment. Any offer to treat without extractions made before such an assessment should be regarded with considerable caution.
Orthodontics for adults
Many things that are possible in adolescents are equally possible in adults.
Crooked teeth can be straightened out in much the same way, although it may take a little longer to get there.
The main differences arise because adults are not growing so orthodontist cannot harness the natural growth of the jaws to correct problems like prominent upper teeth.
In adults the more difficult problems of this type cannot be corrected with braces alone and may need jaw surgery.
If you don't want to wear metal braces...
Ceramic brackets are tooth coloured or translucent. They are less conspicuous than metal brackets and therefore often favoured by adults. However they do have a number of drawbacks which need to be taken into account. The brace tends to become discoloured over the course of time by contact with foods and may become less pleasing in appearance. The brackets are more prone to breakage than metal brackets; the wires slide through the slots less freely so treatment may take longer; the brackets tend to be abrasive and may cause wear to teeth in the opposite jaw if they should make contact when biting; the brackets can sometimes be difficult to remove with a slightly higher risk of damage to the tooth surface. The brackets are also more costly than metal brackets, and with all the associated problems the overall treatment can be expected cost significantly more. Having said all this, if appearance is at a premium, ceramic brackets may still be the first choice for many patients.
These are attached to the lingual surface of the teeth, i.e. the surface towards the tongue. In this position they are virtually invisible. The technique involves special skills and needs considerable experience on the part of the orthodontist to achieve good results. Only a limited number of orthodontists offer this technique and you may need to search for a suitable practitioner who has the requisite experience. The main drawbacks are that it can cause soreness of the tongue and affect speech. Fees are always much higher than for conventional fixed braces because of the higher material costs, greater surgery time involved and the extra training needed.
They blend modern technology with the long-standing concept of using clear flexible splints to ease teeth into line. A succession of splints is worn, each splint bringing the teeth a little closer to the desired position. The splints are effectively invisible and are therefore an attractive option from the standpoint of appearance.
Aligners can be very effective if all that is required is to align mildly irregular teeth. However there are several drawbacks. In the more severe cases, notably those where extractions are required, aligners lack the necessary control of the teeth to give consistently good results and often lead to disappointment. Likewise they are not well suited to correcting problems like prominent upper incisor teeth.