Orthodontics

Orthodontics is a specialty of dentistry that studies and treats malpositioned teeth and jaws. The main goal of orthodontists is to prevent or properly diagnose and treat all of the dental and facial irregularities that can lead to insecurities and functional problems for a lot of individuals.

Orthodontists are doctors that need to go through additional training after they graduate from dental college. It usually takes two or three years of residence for dentists to become orthodontists.

Who needs orthodontic treatment?

The orthodontic treatment is focused on correcting all of the irregularities when it comes to teeth and jaws. A lot of people have crooked and malpositioned teeth, dental crowding in the jaws and improper bites, that can affect their appearance, chewing, dental hygiene, or even breathing and swallowing. The conditions that require this type of treatment are:

1. Underbite

Underbite is a condition where the lower jaw and the front teeth of the lower jaw are placed in front of the upper jaw and they extend forward from the upper teeth. This can be caused by different factors including the insufficient growth of the upper jaw (when the upper jaw is not developed enough and properly) or if the lower jaw shows overgrowth. The underbite can vary from a mild to a very severe type. When there is a mild underbite the lower front teeth are slightly in front of the upper ones, and they almost meet. But in the cases with severe underbite, the lower front teeth significantly overlap the upper front teeth and there is a large gap between them. The underbite is also known as mandibular prognathism, or Class III malocclusion. The most severe types are a result of a skeletal problem.

The underbite can cause a lot of insecurities for patients because it can greatly affect their appearance and physical looks. This condition can be especially hard for kids. The patients with underbite have a very prominent lower jaw, their chin is protruded together with the lower teeth. Aside from the appearance, the mandibular prognathism can result in difficulties in eating, speaking, breathing. They might also experience problems and pain in the temporomandibular joint, headaches, neck pain and earaches. Because of the difficulty in breathing, some patients breathe through their mouth, which can lead to greater risk of caries, bad breath, and bacterial infections. This condition very often causes a greater loss of teeth enamel and patients might also have trouble in providing proper oral hygiene.

The most common reason for underbite is genetics, in other words, it is a condition that is inherited from parents. The underbite can be caused by an overly-developed mandible, insufficiently developed upper jaw, or even a combination of both.

The treatment depends on the severity of the case. The best results are accomplished with young patients. Orthodontic appliances can be very helpful, especially for the mild cases, but sometimes they need to be combined with surgical treatment for the severe cases. The most common appliances that are used are the “reverse-pull” face mask, upper jaw expander and other fixed appliances depending on the patient.

2. Overbite

An overbite, or malocclusion Class II, is a condition where the upper front teeth are placed very forward over the lower front teeth. The excessive overbite can be horizontal or vertical and can be caused by dental or skeletal factors.

There are many different causes that can be a reason for this condition. Genetics is the most common one, and it happens when there is improper jaw growth present. The problem might be an overly-developed upper jaw or a lower jaw that is not developed enough. In this case, there is a skeletal overbite. Bad habits are another very common cause of this malocclusion. Overbite can be caused by thumb-sucking, sucking blankets, or other objects, prolonged use of a pacifier or a bottle, nail biting, tongue thrusting and more. Improper teeth position is a reason for a dental overbite.

The changes that an overbite can cause to the face is a chin that is pushed back and a prominent frontal segment of the upper jaw. The patient’s face is shortened. Patients experience difficulties in eating, chewing, talking. They can also have trouble breathing, and have sleep apnea. There is usually pain present in the jaws, headaches and temporomandibular joint. These patients have greater chances for gum disease and damage because of the position of the teeth, where the lower front teeth get in touch with the gum line in the back of the upper front teeth, and the upper front teeth get in touch with the front gum line of the lower front teeth. This contact can lead to gum recession, because of the constant irritation.

There are several treatment options for overbite, depending on the cause. If there is a bad habit present it should be eliminated first. The best time for a treatment is while children are still developing, but that does not mean that adults are not able to get treated. Orthodontists can use fixed or mobile appliances, and surgery is usually not necessary for this condition.

3. Open bite

An open bite is a condition where the upper and lower front teeth do not get in touch when the mouth is closed. This causes a gap between the front teeth, that can vary from a couple of mm to a very noticeable gap. This can cause problems in esthetics for patients, but it can also be a reason for difficulties in eating, chewing, speaking and breathing.

There are three groups of factors that can contribute to an open bite: dental factors, skeletal and bad habits. Thumb sucking, tongue thrusting, sucking the lower lip are very common among children and should be removed to prevent an open bite. The skeletal open bite is genetic and inherited. The hyperdivergent open bite is an example for a skeletal open bite, where the jaws grow in opposite directions of each other.

If the open bite is not caused by skeletal factors it usually self-corrects. Anyway, every child with such problem should visit an orthodontist to determine the right reason for the open bite and to choose the proper treatment for the future. The course of the treatment will depend on the cause and the age of the patient. For kids, the treatment usually includes a variety of appliances to remove the bad habits. For adult patients, surgery is necessary in most of the cases.

4. Crossbite

A crossbite is a condition where one tooth or a group of teeth does not have the proper position to the teeth of the opposing jaw. If there is a normal bite, the upper teeth should overlap the lower teeth. But if there is a crossbite, the opposite happens, one or more teeth of the lower jaw overlap the upper teeth. The crossbite can be frontal or posterior, and it can be unilateral or bilateral.

Crossbite is very common and people that have this malocclusion can have difficulties in eating, breathing, temporomandibular pain, chewing and more.

This condition can be genetically inherited, but more often it appears as a result of jaws that do not match in size, and there is not enough space for teeth in the jaws. Other factors that can cause crossbite are large adenoids and tonsils.

This is a condition that needs to be diagnosed on time and treated as soon as possible. The most common orthodontic appliances that are used to treat crossbite are palatal expanders, Delaire masks, quad helix, braces, removable expanders and more. Surgery can also be very helpful in some cases.

5. Teeth crowding

Overcrowding of the teeth happens when there is not enough space in the jaw for all of the teeth to be properly fitted. It is one of the most common problems in modern orthodontics. Because of the lack of space teeth start to move in different directions or rotate. Crowding can happen if the jaws are too small, the teeth are too big, both of these combined or when there is a premature loss of primary teeth. The crowding can cause difficulties in oral hygiene, greater risk of cavity and gum disease, and improper functions. Orthodontic treatment will depend on the age of the patient and the individual case. It might include fixed or removable orthodontic appliances, or for the more difficult cases even tooth extraction.

6. Spaced teeth

There are patients that have spaces between their teeth. The causes include large jaws, small teeth, teeth extraction, missing teeth, impacted teeth and more. In most of the cases this is a cosmetic problem for patients and orthodontics can be one of the solutions for the problem.

7. Misaligned dental midlines

The dental midline is an imaginary line between the two lower frontal teeth and between the two upper frontal teeth. Both of these lines should pass through the center of the upper and lower arches. There are cases where these lines do not match and do not pass through the center of the arches. This can cause problems with the way that jaws function and esthetic problems.

Types of orthodontic appliances and braces

The orthodontic appliances can be divided into two large groups: fixed and removable. Both of these groups include active, passive and functional appliances.

Fixed appliances

Closeup Braces on Teeth. Woman Smile with Orthodontic Braces.The fixed braces are the most commonly used orthodontic appliances. They are placed on the teeth and patients are not able to remove them. While wearing the braces, patients are able to eat properly, maintain oral hygiene, speak, chew and more without feeling any discomfort. They might feel mild pain and discomfort in the beginning of the treatment, but it is only temporary and can be treated with painkillers. The braces are useful in correcting different types of orthodontic conditions by moving teeth in the desired position. The can correct rotated teeth, intruded or extruded, close spaces between teeth and even correct mild skeletal discrepancies. The fixed braces consist of brackets that are bonded to the surface of the teeth. These brackets are connected with an archwire that is used to apply force for teeth movement. Special ligatures are used to connect each bracket with the archwire.

The length of the treatment depends on the case and it can last from 12 months up to 30 months, or even more if it is necessary. All of the patients need to schedule regular check-ups, once a month, or once every two months with their orthodontist. During the treatment, patients need to maintain a very strict level of oral hygiene.

Healthy Smile without BracesThere are more different types of fixed braces. The most common ones are the conventional metal fixed braces that have been used for a very long time in orthodontics. Almost all of the parts of the braces are made of metal (stainless steel) and do not provide great esthetics, but they get great results. A lot of kids refuse to have them because they are very noticeable and placed on the front of the teeth. Another type of fixed braces are the ceramic ones, where most of the parts are made of hard ceramic material. They are much more esthetic than the metal ones and they can be also as effective as them. They are also a bit more difficult to be removed that the metal ones. The self-litigating fixed appliances are one of the latest advances in orthodontics. They can be made out of metal or ceramics, and they have a special mechanism that is used to hold the archwire, without the need of ligatures. The studies still haven’t been able to show if these braces are more effective compared to the conventional ones, but they were able to show that they can save more time for the orthodontist. The fixed braces can also be placed on the inside, lingual surface of the teeth. This is a technique that has gained a lot of popularity lately because the braces are not visible and placed on the front surface of the teeth. They are more expensive that the other types of braces, it is harder for patients to maintain proper oral hygiene, and some patients might find it difficult to speak with these braces.

There are two other groups of fixed appliances. The first one is the special fixed appliances that are mostly used in treating bad habits such as tongue thrusting or thumb sucking. The fixed space maintainers are used when teeth are lost prematurely, and their main goal is to save the space, for the permanent tooth to erupt.

Removable orthodontic appliances

Woman wearing orthodontic silicone trainerThe removable appliances are mobile and the patient is able to take them out of the mouth. These appliances are easier to be cleaned compared to the fixed ones. During the treatment, the patients are required to wear them for most of the day, and they should strictly follow the orders of their orthodontist. They can be active and passive. The active ones include mechanical and functional appliances, and the passive ones include retainers and space maintainers. Most of the removable appliances are used in mixed dentition, to intercept the development of malocclusions, but they can also be used at any age for the proper case and patient. These appliances include removable space maintainers, aligners, palatal expanders, lip and cheek bumpers, jaw repositioning appliances and more.

The removable appliances are far less used compared to the past because of their limitations. They can be used only for mild malocclusions, they do not provide bodily movement, they can only be used for single tooth rotations, and the most important thing is that the success of the treatment mostly depends on the cooperation of the patient.

Functional appliances

The functional orthodontic appliances can be fixed or removable and are used to remove abnormal function of the perioral muscles and to stimulate and modify the proper growth of the jaws. They provide best results if they are used during the period of growth of the child. To ensure a successful course of treatment it is necessary for the patient to fully cooperate and follow the instructions.

Retainers

After the end of the orthodontic treatment, most of the time patients are required to wear retainers that help them retain the position of the teeth. The results that are achieved with the therapy might not stay for life because teeth, bone, and gums are subjected to changes. The retainers can be fixed or removable. The fixed retainers are placed across the back surface of the teeth and they usually consist of a wire that is bonded to the teeth. It stays fixed to the teeth, and it cannot be removed by the patient. Providing proper oral hygiene might be a bit more difficult with the fixed retainers, but they get better results compared to the mobile ones. The removable retainers are easier to clean but the success totally depends on the patient. The patient needs to wear it according to the instructions given by the doctor.

What are the benefits of orthodontic treatment?

Aside from getting a beautiful, straight smile, there are a lot of other benefits from orthodontics treatment. Many people might feel less self-confident because of their smile, so the orthodontic treatment will have a great impact on improving their self-image. Crooked teeth can lead to troubles in keeping proper oral hygiene, which can increase the chances of caries and gum disease. By straightening the teeth, patients will be able to completely remove all of the plaque that is present on the teeth’s surfaces and improve their oral health. Due to the malpositioned teeth and jaws, there might be an excessive loss of tooth substances, that in most of the cases is uneven. If there is a malocclusion present, there are usually also different functional problems present. Malocclusions can lead to trouble in speaking, chewing, digestion problems and more. By correcting the bite, all of these problems tend to improve or disappear. Crooked teeth or malpositioned jaws often cause pain located in the jaws, temporomandibular joint, headaches, neck aches and facial pain. To solve these problems jaws and teeth need to be treated with orthodontic appliances.