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What is orthodontics?
Orthodontics is the branch of dentistry that specializes in the diagnosis, prevention
and treatment of dental and facial irregularities. The technical term for these
problems is “malocclusion,” which means “bad bite.” The practice of orthodontics
requires professional skill in the design, application and control of corrective
appliances, such as braces, to bring teeth, lips and jaws into proper alignment
and to achieve facial balance.
What is an orthodontist?
All orthodontists are dentists, but only about 6 percent of dentists are orthodontists.
An orthodontist is a specialist in the diagnosis, prevention and treatment of dental
and facial irregularities. Orthodontists must first attend college, and then complete
a three to five year dental graduate program at a dental school accredited by the
Commission on Dental Accreditation of the American Dental Association (ADA). They
must then successfully complete an additional two- to three-year ADA-accredited
residency program of advanced education in orthodontics. 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 call themselves orthodontists.
What is the American Association of Orthodontists?
The American Association of Orthodontists is the national organization of dental
specialists who limit their practice to orthodontics and dentofacial orthopedics.
Founded in 1900, the AAO is the oldest and largest dental specialty organization
in the world. To date, the AAO has more than 14,600 members, including more than
2,000 international members from outside North America. This membership consists
of approximately 94 percent of all orthodontists who currently practice in the United
States. Only orthodontists may be members of the AAO.
The AAO is dedicated to advancing the art and science of orthodontics and dentofacial
orthopedics, improving the health of the public by promoting quality orthodontic
care, and supporting the successful practice of orthodontics. All members must meet
the specialty educational requirements as defined by the Commission on Dental Education
of the American Dental Association.
The American Dental Association has recognized that “specialists are necessary to
protect the public, nurture the art and science of dentistry, and improve the quality
of care.”
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. Because monitoring growth and development is crucial
to managing some orthodontic problems well, the American Association of Orthodontists
recommends that all children have a check-up with an orthodontic specialist no later
than age 7. Some orthodontic problems may be easier to correct if treated early.
Waiting until all the permanent teeth have come in, or until facial growth is nearly
complete, may make correction of some problems more difficult.
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 or dummy
(pacifier) sucking, 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.
What are the most commonly treated orthodontic problems?
Crowding: Teeth may be aligned poorly because the dental arch is small
and/or the teeth are large. The bone and gums over the roots of extremely crowded
teeth may become thin and recede as a result of severe crowding. Impacted teeth
(teeth that should have come in, but have not), poor biting relationships and undesirable
appearance may all result from crowding.
Overjet or protruding upper teeth: Upper front teeth that protrude beyond
normal contact with the lower front teeth are prone to injury, often indicate a
poor bite of the back teeth (molars), and may indicate an unevenness in jaw growth.
Commonly, protruded upper teeth are associated with a lower jaw that is short in
proportion to the upper jaw. Thumb and finger sucking habits can also cause a protrusion
of the upper incisor teeth.
Deep overbite: A deep overbite or deep bite occurs when the lower incisor
(front) teeth bite too close or into the gum tissue behind the upper teeth. When
the lower front teeth bite into the palate or gum tissue behind the upper front
teeth, significant bone damage and discomfort can occur. A deep bite can also contribute
to excessive wear of the incisor teeth.
Open bite: An open bite results when the upper and lower incisor teeth
do not touch when biting down. This open space between the upper and lower front
teeth causes all the chewing pressure to be placed on the back teeth. This excessive
biting pressure and rubbing together of the back teeth makes chewing less efficient
and may contribute to significant tooth wear.
Spacing: If teeth are missing or small, or the dental arch is very wide,
space between the teeth can occur. The most common complaint from those with excessive
space is poor appearance.
Crossbite: The most common type of a crossbite is when the upper teeth
bite inside the lower teeth (toward the tongue). Crossbites of both back teeth and
front teeth are commonly corrected early due to biting and chewing difficulties.
Underbite or lower jaw protrusion: About 3 to 5 percent of the population
has a lower jaw that is to some degree longer than the upper jaw. This can cause
the lower front teeth to protrude ahead of the upper front teeth creating a crossbite.
Careful monitoring of jaw growth and tooth development is indicated for these patients.
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 do I find someone to treat an orthodontic problem?
Ask your family dentist for a referral to an orthodontist, call 1-800-STRAIGHT (787-2444)
for the names of orthodontists near you or visit the orthodontist locator service
at
www.braces.org.
I recently took my child to an orthodontist for an orthodontic
check-up. The orthodontist recommended treatment. Should I seek a second opinion?
Review the recommended treatment with your family dentist. If you would still like
to compare your comfort level with another orthodontic office or simply hear another
orthodontist's assessment of your child's problem, arrange for a second opinion.
You may have already had more than one orthodontist recommended to you by family,
friends, your dentist or the AAO's locator service. Seeking out a member of the
AAO assures that your second opinion is from an educationally qualified orthodontic
specialist. You should feel confident in the orthodontist and his or her staff,
and trust their ability to provide you the care and lifetime orthodontic value you
seek.
What does orthodontic treatment cost?
The actual cost of treatment depends on several factors, including the severity
of the patient's problem and the treatment approach selected. You will be able to
thoroughly discuss fees and payment options before any treatment begins. Most orthodontists
offer convenient payment plans to patients. Generally, treatment fees may be paid
over the course of active treatment. Arrangements commonly offered in orthodontic
offices may include an initial down payment with monthly installments, credit card
payment, finance company agreements, and other innovative ways to make treatment
affordable. Insurance plans or other employer-sponsored payment programs, such as
direct reimbursement plans, may be helpful.
Dental schools with graduate orthodontic programs usually offer treatment to a limited
number of patients at a reduced cost. The Dental School Listing includes telephone
numbers and Web site addresses for dental schools with orthodontic graduate programs.
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 take only 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.
While orthodontic treatment requires a time commitment, patients are rewarded with
healthy teeth, proper jaw alignment and a beautiful smile. Teeth and jaws in proper
alignment look better, work better, contribute to general physical health and can
improve self-confidence.
What are orthodontic study records?
Diagnostic records are made to document the patient's orthodontic problem and to
help determine the best course of treatment. As orthodontic treatment will create
many changes, these records are also helpful in determining progress of treatment.
Complete diagnostic records typically include a medical/dental history, clinical
examination, plaster study models of the teeth, photos of the patient's face and
teeth, a panoramic or other X-rays of all the teeth, a facial profile X-ray, and
other appropriate X-rays. This information is used to plan the best course of treatment,
help explain the problem, and propose treatment to the patient and/or parents.
The profile X-ray, or cephalometric film, shows the facial form, growth pattern,
and inclination of the front teeth (if teeth are tipped or tilted), which are essential
in planning comprehensive treatment. Panoramic or other dental X-rays are used to
locate impacted teeth, missing teeth, and shortened or damaged tooth roots, to determine
the amount of bone supporting teeth, and to evaluate position and development of
permanent teeth that have not yet come in, among other things. From the necessary
records, a custom treatment plan is created for each patient.
How is treatment accomplished?
Custom-made appliances, or braces, are prescribed and designed by the orthodontist
according to the problem being treated. They may be removable or fixed (cemented
and/or bonded to the teeth). They may be made of metal, ceramic or plastic. By placing
a constant, gentle force in a carefully controlled direction, braces can slowly
move teeth through their supporting bone to a new desirable position.
Orthopedic appliances, such as headgear, bionator, Herbst and maxillary expansion
appliances, use carefully directed forces to guide the growth and development of
jaws in children and/or teenagers. For example, an upper jaw expansion appliance
can dramatically widen a narrow upper jaw in a matter of months. Over the course
of orthodontic treatment, a headgear or Herbst appliance can dramatically reduce
the protrusion of upper incisor teeth (the top four front teeth) or retrusion of
the lower jaw (a lower jaw that is too far behind the upper jaw), while making upper
and lower jaw lengths more compatible.
Are there less noticeable braces?
Today’s braces are generally less noticeable than those of the past when a metal
band with a bracket (the part of the braces that hold the wire) was placed around
each tooth. Now the front teeth typically have only the bracket bonded directly
to the tooth, minimizing the “tin grin.” Brackets can be metal, clear or colored,
depending on the patient’s preference. In some cases, brackets may be bonded behind
the teeth (lingual braces). Modern wires are also less noticeable than earlier ones.
Some of today’s wires are made of “space age” materials that exert a steady, gentle
pressure on the teeth, so that the tooth-moving process may be faster and more comfortable
for patients. A type of clear orthodontic wire is currently in an experimental stage.
How have new "high tech" wires changed orthodontics?
In recent years, many advances in orthodontic materials have taken place. Braces
are smaller and more efficient. The wires now being used are no longer just stainless
steel. They are made of alloys of nickel, titanium, copper and cobalt, and some
of the wires are heat-activated. (The nickel-titanium alloy was originally engineered
by NASA to automatically activate antennae or solar panels of spacecraft orbiting
into the sun’s rays.) These new kinds of wires cause the teeth to continue to move
during certain phases of treatment, which may reduce the number of appointments
needed to make adjustments to the wires.
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 to 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.
How important is patient cooperation during orthodontic
treatment?
Successful orthodontic treatment is a “two-way street” that requires a consistent,
cooperative effort by both the orthodontist and patient. To successfully complete
the treatment plan, the patient must carefully clean his or her teeth, wear rubber
bands, headgear or other appliances as prescibed by the orthodontist, and keep appointments
as scheduled. Damaged appliances can lengthen the treatment time and may undesirably
affect the outcome of treatment. The teeth and jaws can only move toward their desired
positions if the patient consistently wears the forces to the teeth, such as rubber
bands, as prescribed. Patients who do their part consistently make themselves look
good and their orthodontist look smart.
To keep teeth and gums healthy, regular visits to the family dentist must continue
during orthodontic treatment. Adults who have a history of or concerns about periodontal
(gum) disease might also see a periodontist (specialist in treating diseases of
the gums and bone) on a regular basis throughout orthodontic treatment.