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BRACES: GETTING IT STRAIGHT

ORTHODONTICS

Orthodontics is one of the branches in dentistry specialising in the diagnosis, prevention, and treatment of dental and facial irregularities, to improve the appearance, position, and function of crooked or abnormally arranged teeth. The technical term for these problems are called “malocclusion,” meaning “bad bite”.

Occlusion is the relationship between the upper (maxillary) and lower (mandibular) teeth, as they come into functional contact such as when you bite, chew or close your jaws together. The way occlusal (chewing) surfaces for any of your teeth to come together affects the other teeth, as well as your gums, neck, head, jaw muscles, joints, and your oral health.

Orthodontics is both a restorative and cosmetic procedure as it not only corrects malocclusion but also helps with the development of a beautiful, well-aligned smile, going as far towards making oral hygiene easier to maintain. The results of orthodontic treatment can be dramatic — beautiful smiles, improved dental health, and an enhanced quality of life for people of all ages.

1. What Is Malocclusion?

The most common oral health issue prompting orthodontic treatment is a bad bite (malocclusion) which can be caused by one or more factors:

SMALL MOUTH
A ‘small-sized’ mouth can result in a limited amount of space for teeth to grow. This can lead to crowding of teeth once the permanent teeth erupt.

TONGUE THRUSTING
Some children habitually thrust their tongue forward, pressing it against the lips with a force that can result in the protrusion of teeth, or "open bite" among other problems.

LOWER LIP BITING
Habitual lower lip biting can cause the upper teeth to protrude and the lower teeth to be inclined.

EXTRA OR NOT ENOUGH TEETH
A person can have extra teeth develop and / or protrude, or certain teeth that do not develop at all. If you have more than the normal number of teeth or not have certain permanent teeth developed, your bite can be affected.

EARLY LOSS OF PRIMARY TEETH
The early loss of baby teeth or traumatic injury to the face, mouth or jaw can also affect the way teeth develop into the way you bite.

MISALIGNED JAW & BONE STRUCTURE
Upper jaws might be smaller than lower jaws or vice versa, resulting in malocclusion. A misaligned jaw or supporting bone structure can affect the bite and create malocclusion which can lead to joint problems and pain.

UNUSUAL FUNCTIONAL HABITS
Malocclusion may be caused by unusual functional habits such as thumb sucking during and beyond infancy. Some adults still suck their fingers or thumbs, resulting in tongue thrust habits that can affect dental and facial development.

2. What Are The Benefits Of Occlusion Correction?

The correction of conditions like overbite, underbite, crooked teeth or crowding will give you straighter teeth, a better bite, a more attractive smile and healthier teeth and gums. Also, an improved facial appearance increases your self-esteem and confidence in social settings.

Crooked and/or crowded teeth make it difficult to perform proper oral hygiene, which can lead to tooth decay, gum disease and tooth loss. A bad bite can interfere with chewing and speaking, as well as cause abnormal wear on tooth enamel, excess stress on supporting bone and gum tissue, and headaches, earaches and jaw problems.

Malocclusion may result in difficulty chewing and speaking, or otherwise impact the functionality of the teeth. It may contribute to other oral health conditions such as tempro mandibular joint disorder and teeth grinding (bruxing). If left untreated, these problems may worsen and require additional dental care and cost.

3. Are Straight Teeth Necessary?

When teeth are crooked and crowded, keeping them clean becomes more difficult than if they were straight. There will be more spaces for food to collect. If brushing and flossing cannot be completed properly, tooth decay, gum disease is more likely which may result in tooth loss. Recent studies say that the periodontal infections resulting from poor oral hygiene can enter the blood stream and cause cardiac conditions.

An improper bite can interfere with your ability to chew and speak properly, as well as cause abnormal wear to the enamel of your teeth. If your teeth are protruding and/or your upper and lower teeth don't come together comfortably jaw problems also may arise.

Besides keeping your teeth in the proper alignment and allowing better oral hygiene, orthodontics keep your smile looking good and also help you keep your teeth, gums and oral cavity healthy.

4. Is There A Right Age For Orthodontic Treatment?

Though some characteristics like tooth spacing, malocclusion, crowding and misalignment of jaw structure could be genetically inherited from your parents. There are conditions also may be caused by habits such as thumb-sucking, tongue thrusting, lip wedging, mouth breathing due to allergies or large tonsils and adenoids, premature loss of teeth or trauma.

Maloccusion characteristics begin to appear between the ages of six and 12 years old — the time when the permanent teeth start to erupt.

However, usually orthodontic treatment should begin after the age of 13 years in order to achieve optimal results. It is generally considered ideal to have an orthodontic evaluation once the permanent front teeth have all erupted. This enables orthodontists to anticipate problems and plan treatment accordingly.

5. Orthodontics For Adults

Generally orthodontic treatment does not have age limitation. Children are not the only ones who may benefit from dental braces. Adults also can undergo orthodontic treatment to correct alignment, spacing, crowding and malocclusion problems. The process for moving teeth is basically the same at any age, but the treatment may take longer for adults. This is due to the fact that adult facial bones are no longer growing, and certain corrections may not be possible utilizing braces alone. Depending on the specific type and severity of your alignment or malocclusion problem, tooth extraction or maxillofacial surgery may be required.

Treatment typically lasts from 12 to 30 months, depending on he severity of the orthodontic problem. Outstanding results are also highly dependent on maximum cooperation and coordination of care between you and our practice.

6. Types Of Orthodontic Correction

Your orthodontist will guide you in making the best choice of orthodontic treatment based on your unique situation and needs.

TRADITIONAL BRACES
Traditional Braces, also called orthodontic appliances, are the most common type of orthodontic correction. Braces shift the position of the teeth, or hold them in place. Fixed braces are worn all the time and can only be removed by your dentist. Removable braces/appliance can be taken out of your mouth; however, your orthodontist will advise against repeated, long-term removal of the appliance as the appliance needs to be worn continuously for optimal results.

BRACKETS
Brackets which attach the wires to the teeth, come in three varieties: metal, ceramic or plastic. Although more noticeable, metal braces are the strongest and work best for complex bite problems. Ceramic brackets, which are slightly weaker and more brittle than metal braces, are clear or tooth-colored, making them more attractive to some patients.

CERAMIC BRACES
Ceramic Braces are the same size and shape as metal braces, except that they have tooth-coloured or clear brackets that blend in to teeth. Ceramic braces are just like metal braces, except that they use tooth-coloured brackets (and sometimes tooth-coloured wires) rather than metal to straighten teeth. Generally non-staining, the tooth-coloured ceramic "blends" with your teeth, making them less noticeable than metal, but not as "invisible" as inside braces or clear aligners

CERAMIC / CLEAR BRACES
Ceramic/Clear braces made of composite materials that are weaker and more brittle than metal braces. Ceramic brackets are larger than metal brackets and require small rubber bands, or ligatures, (or built in spring clips on "self ligating" brackets) to hold them to the arch wire. Because the ligatures are white or clear, they can stain. However, staining is not a big problem because ligatures are changed every time you get an adjustment which is usually every 4 weeks. The "self ligating" clips do not require retying with wires or elastics.

As they are not as strong as metal braces, clear braces require a longer treatment time, since your orthodontist may need to apply a slower, more gradual force to ensure the strength capabilities of the clear brackets are not overtaxed. Ceramic brackets also are usually more expensive than traditional metal brackets.

Like metal braces, ceramic brackets are not removable until treatment is completed, can produce irritation and discomfort, and may complicate regular tooth care, eating and speaking.

SPACE MAINTAINERS
Space Maintainers are another form of orthodontic correction, though not as comprehensive an option as braces. If a baby tooth is lost prematurely, space maintainers keep the remaining teeth around the missing tooth gap in position. This prevents the teeth around the gap from moving into the empty space, which otherwise could cause overcrowding and crooked teeth when the permanent tooth eventually erupts. If this condition is left untreated, it could possibly require extensive and expensive orthodontic treatment later on. Small, hardly noticeable and easy to adjust to, customfit space maintainers are an easier and less expensive option for holding teeth in place.

CLEAR ALIGNERS
Clear Aligners, an alternative to traditional braces, are a series of clear (invisible), customised removable appliances. Unlike metal braces, aligners do not trap food particles and plaque between your teeth. Each aligner is worn for approximately two weeks, only to be removed for eating, brushing and flossing. A recommended option for adults with mild spacing problems, invisible aligners are not suitable for children and adolescents with non-permanent teeth.

Clear Aligners are a series of clear, removable aligners custom-fit to your teeth to provide virtually irritation-free treatment with minimal adjustment discomfort. Clear aligners are nearly invisible, minimally invasive and resistant to clouding from wear. With clear aligners, there are no brackets to come off or wires to break and poke. Clear aligners can be removed for eating, drinking and special events, making it easier to brush and floss.

Straight teeth and a beautiful smile may no longer need to come from a mouth full of unattractive wire and bracket braces. Enhancing self-esteem and physical confidence, invisible braces offer an aesthetic and barely visible alternative to conventional wire/bracket braces. The clear aligners are manufactured using advanced computer technology that predicts tooth movement, making it possible for the removable orthodontic appliance to gradually straighten teeth.

However, since clear aligners are removable, they may require more motivation and self-discipline to wear consistently, and they are easier to misplace or lose. Lost clear aligners may result in treatment delay and additional replacement costs.

While fairly comfortable, clear aligners can cause discomfort or mild pain, particularly at the beginning when new aligners are placed and exert pressure on the teeth to move them. Clear aligners are available only from dentists who are trained to offer them.

Clear aligners are made after your dentist takes three-dimensional impressions of your teeth, X-rays and photographs of your teeth and facial features and sends them to a laboratory that fabricates your custom-fit clear aligners using computerised technology. These aligners are then sent to your dentist to be given to you.

The Clear aligners are provided in sets. The number of aligners will depend on your specific orthodontic problem. You will wear each new aligner set for a specified amount of time, removing them only to eat, drink, brush and floss. With each new aligner set, your teeth slowly adjust and gradually realign to your desired smile. At periodic visits, your dentist will provide the next aligner set and evaluate your progress throughout treatment. Revision aligners are often requested at the end of the first series of aligners to correct any unfinished detailing.

While Clear aligners may not be suitable for certain misalignment cases or the complex bite problems that are better addressed by traditional braces, Clear aligners can be used to treat the following orthodontic conditions:

• Overbite or overjet
• Crowded or widely spaced teeth
• Crooked teeth

Clear aligners are designed for adults and older teenagers; they are not recommended when baby teeth remain. Children and younger teenagers faced with orthodontic problems will require traditional metal braces with brackets/wires on the front of the teeth. However, only your dentist can determine if you are suitable for Clear aligners. The clear aligner treatment was designed primarily for adults due to the need for absolute and rigid cooperation; the trays are worn 22 hours per day and should not be forgotten or lost.

Pros & Cons
of Different
Orthodontic
Treatments

METAL BRACES / TRADITIONAL BRACES

These are the metal brackets and wires that most people picture when they hear the word ‘braces’.

PROS:
Least expensive type
• Coloured bands give patients a chance to express themselves
CONS:
Most noticeable type of braces

CERAMIC BRACES

These are the braces and wires that most people picture when they hear the word braces, but instead of metal brackets, these brackets are made of ceramic and therefore are closer to the colour of your teeth. They are less noticeable than metal brackets.

PROS:
Less noticeable than metal braces
CONS:
More expensive than metal braces
• Brackets can stain easily if patients don't care for them well

CLEAR ALIGNERS

Consists of a series of custom-made, mouth guard-like clear plastic aligners. The aligners are removable and are replaced every 2 weeks.

PROS:
Invisible
• More comfortable than conventional braces
CONS:
Will not work for serious dental problems
• More expensive option
• They can be easily lost and are costly to replace

LENGTH OF TREATMENT

The length of treatment depends on your unique situation and the type of orthodontic treatment you choose. Typically, braces are worn from 18 to 24 months, though they are sometimes worn longer.

Metal braces work the best because they are made from the strongest materials. Ceramic braces, while strong and better looking, often take more time because they are not as strong as metal braces.

The times of treatment with clear aligners vary. For example, Clear aligners treatment typically require 20 to 30 aligners for upper and lower teeth, usually averages between 9 to 15 months to complete.

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