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.
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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 four-year dental graduate program at a university dental
school or other institution accredited by the Commission on Dental
Accreditation of the American Dental
Association (ADA). They must then successfully complete an
additional two- to three-year residency program of advanced
education in orthodontics. This residency program must also be
accredited by the ADA. 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.
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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
United States and Canada. 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.
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."
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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 an orthodontic screening 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.
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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.
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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.
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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.
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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.
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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 that lasts a lifetime. Teeth and jaws in proper alignment look
better, work better, contribute to general physical health and can
improve self-confidence.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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