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 results of orthodontic treatment can be dramatic — beautiful smiles, improved dental health and an enhanced quality of life for people of all ages. Orthodontic problems must be diagnosed before treatment begins. Proper diagnosis involves careful study of photographs, x-rays, and dental impressions. Treatment typically lasts from six to thirty months, depending on age, and the severity of the orthodontic problem.
What’s the right age for Orthodontic Treatment?
All children should receive their first orthodontic evaluation by age seven. This allows early identification of potential problems. Certain orthodontic conditions are also best treated at this age. Full braces are placed after most of the permanent teeth erupt, generally age ten to twelve.
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- APPLIANCES/RETAINERS
- TYPES OF BITES
- OTHER ISSUES
- CLASSIFICATION OF THE TEETH
APPLIANCES/RETAINERS
Removable Appliance
Removable appliances may be used to move selected teeth, to hold selected teeth in place, to influence growth of the jaws and to influence tooth eruption. They are often used in conjunction with fixed appliances.
Removable appliances cannot be used to treat all orthodontic problems. It takes skill and experience to recognize conditions that can be successfully treated with removable appliances.
Because the patient can easily remove the appliance, good compliance is required to achieve the desired outcome.
Fixed Appliance
These appliances are glued in so children are unable to easily remove them. They are used to expand the upper jaw to allow more room for permanent teeth or to correct a crossbite.
They can also be used to hold teeth in place and save room in the mouth for proper eruption of permanent teeth.
Some fixed appliances can help children stop sucking their fingers or help retrain a tongue thrust.
How do braces work?
There are two main components of braces: brackets, which are bonded directly to the tooth and arch wires that connect the brackets. Contrary to what most people think; it is the arch wire that actually moves the teeth. The brackets serve only as “handles.” The arch wire generates a steady gentle pressure to move the teeth into their proper position.
Like moving a stick through sand, as the tooth moves, the bone gives way on one side and fills in on the other. Elastics are used to make the upper and lower teeth bite together properly.
TYPES OF BITES
Crossbite
One or more of the upper teeth biting on the inside of the lower teeth characterizes a crossbite. Crossbite can occur in the front and/or the sides of the mouth. Early correction of crossbites is recommended.
Crossbites should be corrected because they can:
- Cause premature wear of the teeth
- Cause gum disease including bone loss
- Cause asymmetrical development of the jaws
- Cause dysfunctional chewing patterns
- Make your smile less attractive
- Be related to jaw joint dysfunction (TMJ)
How can a crossbite be orthodontically corrected?
If there is a single tooth crossbite, braces or a retainer may be used to move it into the correct position. If multiple teeth are in crossbite, palate expander is normally required.
Openbite
Inadequate vertical overlap of the front teeth characterizes an openbite. It is caused by oral habits such as tongue thrust, digit sucking, or when the jaws don’t grow evenly. Timing of treatment is critical to the overall success of the therapy.
Openbite should be corrected because it can:
- Cause premature wear of the back teeth
- Cause dysfunctional chewing patterns
- Make your smile less attractive
- Be related to jaw joint dysfunction (TMJ)
How can an openbite be orthodontically corrected?
Openbite can be corrected through growth modification of the jaws, extrusion of the front teeth and in some cases surgical correction of the jaws. Breaking oral habits such as digit sucking will facilitate the correction of an openbite and make the result more stable.
Overbite
Overbite is a measure of the vertical overlap of the upper and lower front teeth. Excessive overbite may be caused by disproportionate eruption of front teeth or over development of the bone that supports the teeth. Excessive overbite is commonly seen in conjunction with a Class II relationship (see below). Overbite is also known as a deep bite.
Overbite should be corrected because it can:
- Cause improper functioning of your front teeth
- Result in the lower front teeth biting into the gum tissue of the palate leading to periodontal problems
- Cause unusual wear of the lower front teeth
- Make your smile less attractive
How can an overbite be orthodontically corrected?
Overbite can be corrected through orthodontic leveling of the front and/or back teeth.
Overjet
Overjet is measure of the horizontal relationship of the upper and lower front teeth. It is often called “buck teeth” and is commonly confused with overbite. Excessive overjet may be caused by improper alignment of the molars (Class II relationship), a skeletal imbalance of the upper and lower jaw(s), flared upper incisors, missing lower teeth, crowded or tipped back lower teeth or a combination of all the above. In addition, oral habits such as thumb or finger sucking or tongue thrusting can exacerbate the condition.
Overjet should be corrected because it can:
- Prevent proper functioning of the front teeth
- Lead to premature wear
- Make your smile less attractive
Underbite
The lower teeth biting in front of the upper teeth characterize an underbite. An underbite is usually caused by undergrowth of the upper jaw, overgrowth of the lower jaw, or a combination of the two (Class III Relationship). Underbite can also be caused by tipped back upper incisors, flared lower incisors, missing upper teeth or a combination of all the above. Early correction of underbite is recommended.
Underbite should be corrected because it can:
- Prevent proper functioning of the front and/or back teeth
- Be related to jaw joint dysfunction (TMJ)
- Make your smile less attractive
How can an underbite be orthodontically corrected?
Underbite can be corrected by growth modification of the jaws, extraction of teeth and in some cases surgical movement of the jaws.
Gummy Smile
When some children smile, they may show an excessive amount of gum tissue. This is called a gummy smile and may be due to a few different problems:
- Gum irritation and overgrowth from braces. This is more likely to happen if the teeth appear short before the braces are placed on the teeth. This problem results not from the quality of the orthodontic care, but is a result of the pre-treatment gum and bone thickness.
- Altered passive eruption. The gum and bone normally recede as a part of the normal eruption of the teeth. When this normal recession doesn’t occur, the gums cover too much of the teeth and make them appear “too short.” The teeth are usually not “too short.” They are usually of normal size but are buried under the gum and bone.
- If there are habits such as thumb sucking or grinding (bruxism), excessive pressures or tooth wear can alter the appearance of the teeth. The problems may be able to be corrected with orthodontics, surgical procedures or with dental restorations such as crowns or veneers.
- Skeletal developmental problems affect the growth of the jaws and the teeth. If orthodontics is instituted at seven to nine years of age, the growth of the jaws can often be controlled and the cosmetics can be improved.
- Before treatment it is critical to properly evaluate the problems and get an accurate diagnosis. Some cosmetic issues can be easily corrected while others like skeletal problems can be more difficult.
Impacted Teeth
An impacted tooth is one that has failed to erupt normally into the mouth and remains partially or totally covered by the gums and/or bone. Impactions can be caused by improper position of the developing tooth bud, premature loss of primary teeth and crowding. Wisdom teeth are the most commonly impacted teeth, but canines and premolars are also commonly impacted.
This problem should be corrected because it can:
- Cause damage to the root structure of adjacent teeth
- Leave unwanted spaces
- Lead to improper functioning of the teeth
- Cause asymmetric alignment of the teeth
How can impacted teeth be orthodontically corrected?
Usually the impacted tooth is exposed and orthodontically moved into the correct position. Correction of impacted teeth often involves a minor surgical procedure performed by an oral surgeon working closely with our practice. This will allow us to guide the impacted tooth into the proper position.
Missing Teeth
Missing teeth can be the result of congenital absence (the tooth fails to develop), trauma or dental extractions.
This problem should be corrected because it can:
- Cause improper functioning of teeth
- Cause premature wear of teeth
- Cause asymmetric alignment of the teeth
- Make your smile less attractive
How can missing teeth be orthodontically corrected?
Depending upon the situation, the space can be closed with braces or opened for tooth replacement. A bridge or dental implant is used to replace the missing tooth if a space is created.
Crowding of the Teeth
Crowding is the lack of space for all the teeth to fit normally within the jaws. The teeth may be rotated or displaced. Crowding occurs when there is disharmony in the tooth to jaw size relationship, or when the teeth are larger than the available space. Crowding can be caused by early or late loss of primary teeth, improper eruption of teeth or a genetic imbalance between jaw and tooth size.
Crowding should be corrected because it can:
- Make it much more difficult to properly clean all the surfaces of your teeth
- Increase the chances of dental decay (because of inadequate cleaning)
- Increase the chances of gum disease (because of inadequate cleaning)
How can crowding be orthodontically corrected?
Extra space can be created by expansion of the arches or extraction of teeth. Once space is created, braces are used to align the teeth. Correction of crowding can help prevent dental decay and periodontal disease by improving the ability to remove plaque from the teeth.
Spacing of the Teeth
Spacing, the opposite of crowding, is an excess of available space resulting in gaps between the teeth. This generally occurs when the teeth are smaller than the available space. Protrusive teeth, missing or impacted teeth or abnormal gum tissue attachments can also cause spacing.
Spacing should be corrected because it can:
- Result in gum problems due to the lack of protection by the teeth
- Prevent proper functioning of the teeth
- Make your smile less attractive
How can spacing of the teeth be orthodontically corrected?
Moving the teeth together and properly aligning them within the jaws can close the spaces.
CLASSIFICATION OF THE TEETH
The classification of bites is broken up into three main categories: Class I, II, and III. This classification refers to the position of the first molars and how they bite together.
Class I
Class I is a normal relationship between the upper and lower teeth and jaws or balanced bite.
Class II
Class II is where the lower first molar is posterior (or more towards the back of the mouth) than the upper first molar. In this abnormal relationship, the upper front teeth and jaw project further forward than the lower teeth and jaw. There is a convex appearance in profile with a receding chin and lower lip. Class II problems can be due to insufficient growth of the lower jaw, an over growth of the upper jaw or a combination of the two. In many cases, Class II problems are genetically inherited and can be aggravated by environmental factors such as finger sucking. Class II problems are treated via growth redirection to bring the upper and lower teeth and jaws into harmony.
Class III
Class III is where the lower first molar is anterior (or more towards the front of the mouth) than the upper first molar. In this abnormal relationship, the lower teeth and jaw project further forward than the upper teeth and jaws. There is a concave appearance in profile with a prominent chin. Class III problems are usually due to an overgrowth in the lower jaw, an under growth of the upper jaw or a combination of the two. Like Class II problems, they can be genetically inherited.