Orthodontics
The diagnosis, prevention, and treatment of dental and facial irregularities caused by misalignment of the teeth and jaw.
About 70% of people experience some form of malocclusion (literally "bad bite"), or poor positioning of the teeth. In Class I malocclusion the bite is even; that is, the top teeth line up with the bottom ones, but the teeth are crooked, crowded, or turned. In Class II malocclusion, also called "buck teeth," there is an overbite, in which the upper teeth extend past the top of the lower teeth, and in Class III malocclusion there is an underbite, in which the lower teeth extend past the bottom of the upper teeth. Untreated malocclusion can cause periodontal disease, digestive problems (due to the inability to chew food properly), and facial distortion. An orthodontist, who has at least two years training after dental school, performs dental manipulations to straighten the teeth and their relationship to the jaw.
There are two types of orthodontic treatment, which take place at different phases of dental development and involve different techniques. Interceptive orthodontics
take place at around ages six to eight, before the permanent teeth emerge and while the jaw is growing the fastest. The goal of interceptive treatment is to make room for the permanent teeth, and a treatment usually lasts from three to 14 months. The orthodontist may expand the palate (roof of the mouth) and begin to correct over- and underbites. Appliances used to correct these problems may include a palatal expander, to enlarge the mouth, or a facebow, to make more room for crowded teeth. A facebow, a wire apparatus attached to the teeth and around the back of the head, is used to push the molars back to make room for front teeth, and must be worn 12 hours a day. Good interceptive treatment, like the use of these appliances, can reduce the length of full orthodontic treatment or even prevent the need for such treatment.
The second phase, full orthodontics, takes place between ages 12 and 18, after the permanent teeth have emerged. Braces (orthodontia) are the primary appliance used to correct the bite and properly align the permanent teeth. Orthodontists disagree on the optimal age to initiate full orthodontia. The teeth become more firmly embedded in the mouth as the adolescent grows, yet the jaw is continuing to grow and change. The interaction between these factors influences the effect of braces. The length of time the braces must be worn varies between a year and two and a half years. After the braces are removed, a removable retainer must be worn continuously for approximately a year and then inserted several nights a week. Ideally a retainer will be worn periodically until jaw growth stops at around age 24.
Full orthodontic treatment usually costs anywhere from $3,000 to $7,000, although less expensive treatment may be obtained through dental schools. On the adolescent's first visit to the orthodontist, a full examination will be performed in order to discover any special problems and recommend orthodontic treatment, if any. During the records appointment, χ rays, a casting of the bite, and photographs of the face will be taken. Using these records, the orthodontist will build a model of the mouth and determine a treatment plan. The plan and associated costs will be presented during the consultation appointment. At this time any concerns should be raised and questions should be asked about how the braces will affect the child's lifestyle. If the patient opts to get the braces, the orthodontist will insert separators between the back molars to be worn for two weeks.
Brace installation takes about two and a half hours. Teeth must be polished, measured, and dried before braces are installed. Braces are made in several designs and styles, varying in type of metal, length of time worn, degree of comfort, cost, and the "profile" they present. Lower profile braces are more comfortable and less visible to others. The lowest profile braces are lingual braces, worn behind the teeth. Lingual braces are not recommended for the average adolescent as they create speech problems and must be worn twice as long as regular braces. Components of the braces can be colored or flavored. Braces themselves consist of bands that are cemented around the back molars, buccal tubes that attach to the bands, and wires that attach to the tubes. Brackets are glued onto the front and side teeth, along with plastic ligature to hold the wires. Rubber bands may also be attached to make particular adjustments.
As the teeth shift during the first few days after installation, wires that rub against the mouth may need to be adjusted or cut. Wax can be applied to lessen the abrasion against the lips. Special mouthguards are available for athletics and for playing wind instruments. Salt water eases the pain, which will disappear after several days. Regular maintenance of the braces involves a visit to the orthodontist every three to six weeks for examination, tightening, or replacement of wires.
With current innovations in materials and design, braces are much less painful and intrusive than in the past. The primary variable in determining the effectiveness of full orthodontic treatment is patient involvement. Extra care must be taken to brush the teeth after every meal in order to remove food particles that lodge in the braces. The orthodontist can also prescribe a gel that reduces plaque and gum bleeding, which the patient can apply after brushing. A disinfecting mouthwash should also be used to inhibit growth of bacteria and control bad breath. Rubber bands must be taken out before meals and replaced with new ones afterwards, and must also be replaced before sleep. Headgear and/or a retainer must be worn according to the orthodontist's prescription. If this is not done, the teeth can take longer to correctly align or corrections that have been achieved can be reversed.
