Most patients begin
orthodontic treatment between ages 9 and 16, but this varies
depending on each individual. Because teenagers are still
growing, the teen years are often the optimal time to correct
orthodontic problems and achieve excellent results.
Most orthodontic problems are inherited. Examples of
these genetic problems are crowding, too much space between
teeth, protruding upper teeth, extra or missing teeth and
some jaw growth problems.
Other malocclusions (crooked teeth) are acquired. In
other words, they develop over time. They can be caused
by thumb-sucking or finger-sucking as a child, mouth breathing,
dental disease, abnormal swallowing, poor dental hygiene,
the early or late loss of baby (primary) teeth, accidents,
poor nutrition or some medical problems.
Sometimes an inherited malocclusion is complicated by an
acquired problem. But whatever the cause, the orthodontist
is usually able to treat most conditions successfully.
Treatment is important because crooked or crowded teeth are
hard to clean, and that may contribute to tooth decay, gum
disease, and tooth loss. A bad bite can also cause abnormal
wear of tooth surfaces, difficulty in chewing and/or speaking,
excess stress on supporting bone and gum tissue, and possible
jaw joint problems. Without treatment, problems may become
worse. Orthodontic treatment to correct a problem may
prove less costly than the additional dental care required
to treat the problems that can develop in later years.
Then there’s the emotional side of an unattractive smile.
When you are not confident in the way you look, your self-esteem
suffers. Teen-agers whose malocclusions are left untreated
may go through life feeling self-conscious, hiding their smiles
with tight lips or a protective hand.
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. Orthodontic wax applied to an offending bracket
will help relieve discomfort. Overall, orthodontic discomfort
is short-lived and easily managed. Once patients have
become accustomed to their braces, they may even forget they
have them on.
Are there less noticeable
Today’s braces are generally less noticeable than those of
the past. The brackets are smaller and are bonded directly
to the teeth, minimizing the “tin grin.” Brackets can
be metal or clear depending on the patient’s preference.
In some cases, brackets may be bonded behind the teeth (lingual
braces). 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. Another option may be the
use of a series of plastic tray aligners instead of traditional
braces to correct some problems. Your orthodontist will
advise which type of orthodontic appliance will best correct
Do teeth with braces need
Yes. Patients with braces must be careful to avoid hard,
sticky, chewy and crunchy 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 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.
A good reason to keep teeth, gums and braces clean during
orthodontic treatment is that clean, healthy teeth move more
quickly! This will help keep treatment time as short
Patients who are active in contact sports, whether in organized
programs or just games in the neighborhood, should wear a
mouth guard. Talk with your orthodontist about the kind
of mouth guard to use while braces are on.
What is patient cooperation
and how important is it during orthodontic treatment?
Good “patient cooperation” means that the patient not only
follows the orthodontist’s instructions on oral hygiene and
diet, but is also an active partner in 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 prescribed by the orthodontist,
avoid foods that might damage braces 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
To keep teeth and gums healthy, regular visits to the family
dentist must continue during orthodontic treatment.
How long does treatment take?
Although every case is different, generally speaking, patients
wear braces from one to three years. Treatment times vary
with factors that include the severity of the problem, patient
growth, gum and bone response to tooth moving forces and how
well the patient follows the orthodontists’ instructions on
dental hygiene, diet and appliance wear (patient cooperation).
Patients who brush and floss thoroughly and regularly; avoid
hard, sticky, crunchy and sticky foods; wear their rubber bands
and/or headgear as instructed; and keep their appointments usually
finish treatment on time with good results. After the
braces are removed, most patients wear a retainer for some time
to keep or “retain” the teeth in their new positions.
The orthodontist will determine how long the retainer needs
to be worn. Most patients remain under the orthodontist’s
supervision during the retention phase to ensure that the teeth
stay properly aligned.
Why are retainers needed after orthodontic
After braces are removed, the teeth can shift out of position
if they are not stabilized. Retainers are designed to hold
teeth in their corrected, ideal positions until the bones
and gums adapt to the treatment changes. Wearing retainers
exactly as instructed is the best insurance that the treatment
improvements last longer. It is normal for teeth to change
with increasing age.
Will tooth alignment change
Studies have shown that as people age, their teeth may shift.
This variable pattern of gradual shifting, called maturational
change, probably slows down after the early 20s, but still
continues to a degree throughout a lifetime for most people.
Even children whose teeth developed into ideal alignment and
bite without treatment may develop orthodontic problems as
adults. The most common maturational change is crowding of
the lower incisor (front) teeth. Wearing retainers as instructed
after orthodontic treatment will stabilize the correction
and can prevent most of this change.
What about the wisdom teeth
(third molars) - should they be removed?
Research suggests that wisdom teeth do not necessarily cause
teeth to shift. In most cases, removal of wisdom teeth
is done for general dental health reasons rather than for
orthodontic health. Your orthodontist, in consultation
with your family dentist, can provide guidance regarding removal
of wisdom teeth.
What happens to teeth and gums if they
are not kept clean during orthodontic treatment?
Note the white decalcification
spots on these teeth.
Note the reddened areas of gum
where the gum meets the teeth. This is gingivitis.
Teeth can develop white spots, called “decalcification,”
when an individual’s teeth are susceptible or when oral hygiene
has been poor. If plaque is not regularly removed, the
patient can develop gum disease. This is why the orthodontist,
orthodontic staff, the dentist and dental hygienist stress dental
hygiene—for the good of the patient’s dental health. (see
photos of decalcification and gum disease at right)
What can I do
to get my braces off sooner?
Follow the instructions your orthodontist gives you with regards
to oral hygiene (keeping your teeth and gums clean) and wearing
your appliances (e.g.: elastics, headgear, etc.) Your
cooperation may help speed up your treatment.
What will I look like with
Much will depend on the kind of braces used for your treatment.
Many patients have silver-colored brackets and wires while
others may have tooth-colored brackets or clear plastic aligners.
Braces are much less noticeable today than they were
when each tooth had a metal band around it. These
are photos of a patient the day his braces were placed.
Do you have any suggestions
on what foods I CAN eat?
Choose foods that are softer. Right after you get braces
or whenever they are adjusted, you may want foods that require
little or no chewing such as soup and macaroni and cheese.
Cut or tear sandwiches and pizza rather than biting into them.
What happens if something
If a portion of the appliance breaks, let your orthodontist
know so that arrangements can be made for repairs.