What Is Orthodontics (or Orthodontic Treatment)? Part 2

This is Part 2 of an informative article from Dr. Tara Gostovich, an orthodontic specialist, with offices in Englishtown and Malboro, NJ.

When can orthodontic treatment be started?
Treatment will not usually be started until the child’s adult teeth have come through and developed fully; at about age 12 or 13. In some cases treatment may be started a few years later if teeth problems were not apparent at an earlier age.

If a child has a cleft lip and palate, they may require orthodontic treatment before their adult teeth have developed completely.

Good oral hygiene is essential before any orthodontic work can be started. When braces (or other orthodontic devices) are placed on the teeth, particles of food are much more likely to become stuck. The patient will need to brush much more thoroughly and carefully, and also more often, to prevent tooth decay while orthodontic treatment is commencing.

Patients who have not established good oral hygiene habits before treatment are much more likely to suffer from tooth decay after treatment begins.

Diagnosing dental problems and recommending treatment options
An orthodontist will assess the state of the patient’s teeth and make a prediction of how they are likely to develop without orthodontic treatment. The following diagnostic procedures will most likely be performed:

A full medical and dental health history

A clinical examination

X-rays of the teeth and jawbone

Plaster models of the teeth

After the initial assessment is completed, the orthodontist will decide on a treatment plan.

Orthodontic appliances
There are two types of orthodontic appliances: fixed and removable ones.

Fixed appliances – These are the most common devices used in orthodontics. They are used when precision is important. Although the patient can eat normally with fixed appliances, some foods and drinks will need to be avoided, such as carbonated drinks, hard sweets and candies, and sticky foods, such as toffee or gummies. People who play contact sports need to tell their orthodontist, so that special gum guards or shields can be made.

Examples of fixed appliances include:

▪ Braces – consisting of brackets and/or wires and bands. Bands are fixed firmly around the teeth and serve as anchors for the appliance, while brackets are usually adhered to the front of the teeth.

Arch-shaped wires pass through the brackets and are fixed to the bands. As the arch wire is tightened, tension is applied to the teeth, which gradually moves them into their proper position.
A patient will see their orthodontist once a month so that their braces can be adjusted. The overall treatment course may last from several months to several years.

Children and teens tend to choose the colored braces, while adults will usually choose the clear styles.

▪ Fixed space maintainers – If a child loses a “baby” tooth, a space maintainer will prevent the two teeth on either side of the resulting space from moving into that space until the adult tooth comes in. A band is fixed to one of the teeth next to the space, and a wire goes from that band to the other tooth.

▪ Special fixed appliances – These may be recommended to control thumb sucking or tongue thrusting. Patients might find them uncomfortable, especially when they are eating. Orthodontic experts say they should be used only if they are really necessary.

Removable appliances – These are typically used for treating minor problems, such as preventing thumb sucking or correcting slightly crooked teeth. They should only be removed when eating, brushing or flossing. Sometimes, the orthodontist may advise the patient to remove the appliance during certain activities, such as playing a wind instrument, or cycling.

Examples of removable appliances include:

▪ Aligners – A viable option instead of traditional braces for some adult patients. They are virtually unnoticeable by others and can be taken out when patients eat, brush their teeth, or floss.

▪ Headgear – Headgear consists of a strap around the back of the head, which is attached to a metal wire in the front, or face bow. The goal is to slow down upper jaw growth, and keep the back teeth in position while the front teeth are pulled back.

▪ Lip and cheek bumpers – Specially-designed to relieve the pressure of cheeks or lips on the teeth.

▪ Palatal expander – An appliance designed to make the upper jaw arch wider. The expander consists of a plastic plate that is placed in the palate (the roof of the mouth). The plate has screws which exert pressure on the joints in the bones, forcing them to spread outward, thereby expanding the size of the palatal area (roof of mouth area).

▪ Removable retainers – These are placed on the roof of the mouth, and are designed to prevent the teeth from moving back to their original (crooked) positions. If modified, the retainers may also be used to stop children from sucking their thumbs.

▪ Removable space maintainers – An alternative to fixed space maintainers.

▪ Splints (jaw repositioning appliances) – Splints are placed in either the upper or lower jaw to help the jaw close properly. Splints are commonly used in the treatment of TMJ (temporomandibular joint disorder) syndrome.