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Orthodontic Treatment Types

Want information about orthodontic treatment for teenagers?

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.

Frequently asked questions about teenage orthodontics:

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 braces?
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 your problem.

Do teeth with braces need special care?
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 as possible.

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 look smart.

To keep teeth and gums healthy, regular visits to the family dentist must continue during orthodontic treatment.

Orthodontic Patient
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 treatment?
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 later?
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.

Decalcification
Note the white decalcification spots on these teeth.

Gingivitis
Note the reddened areas of gum where the gum meets the teeth.  This is gingivitis.

What happens to teeth and gums if they are not kept clean during orthodontic treatment?
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 braces on?
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.

Orthodontic Patient

Orthodontic Patient with Braces


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 breaks?
If a portion of the appliance breaks, let your orthodontist know so that arrangements can be made for repairs. 

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