FAQ

faq

Want a beautiful smile?

Why select an orthodontist?

Just as there are specialists in medicine (such as cardiologist, gastroenterologists, neurologists, etc.), there are specialists in dentistry. Orthodontists are dental specialists who dedicate their professional lives to correcting misaligned teeth and jaws.

Orthodontists are qualified dentists, who after graduating from dental school, go on to additional full-time university-based education in an accredited orthodontic residency program supervised by orthodontists. That training lasts at least two academic years – sometimes more. By learning about tooth movement (orthodontics) and guidance of facial development (dentofacial orthopedics), orthodontists are the uniquely trained experts in dentistry to straighten teeth and align jaws.

Orthodontists diagnose, prevent and treat dental and facial irregularities. The majority of the members of the American Association of Orthodontists (AAO) limit their practices to orthodontics and dentofacial orthopedics. Orthodontists treat a wide variety of malocclusions (improperly aligned teeth and/or jaws). They regularly treat young children, teens and adults.

Selecting an orthodontist who is a member of the AAO is your assurance that you have chosen an orthodontist: the dental specialists with at least two years of post-doctoral, advanced specialty training in orthodontics in a university-based program accredited by the American Dental Association. Specialty education includes the study of subjects in biomedical, behavioral and the basic sciences; oral biology and biomechanics.

Only orthodontists may be members of the American Association of Orthodontists (AAO).

Why straight teeth?

Straight teeth help an individual to effectively bite, chew and speak. Straight teeth contribute to healthy teeth and gums. Properly aligned teeth and jaws may alleviate or prevent physical health problems. Teeth that work better also tend to look better. An attractive smile is a pleasant "side effect" of orthodontic treatment.

An attractive smile is a wonderful asset. It contributes to self-confidence and self-image – important qualities at every age. A pleasing appearance is a vital component of self-confidence. A person's self-esteem often improves as orthodontic treatment brings teeth, lips and face into proportion. Social and career success, as well, improve a person's general attitude toward life.

You may be surprised to learn that straight teeth are less prone to decay and injury. Decay results when the bacteria in plaque (a colorless, sticky film composed of bacteria, food and saliva) feed on carbohydrates (sugar and starch) we eat or drink to produce acids that can cause cavities. Plaque can also increase the risk to periodontal (gum) disease. As for injuries to teeth, protruding upper teeth are more likely to be broken in an accident. When repositioned and aligned with other teeth, these teeth are most probably going to be at a decreased risk of fracture.

Untreated orthodontic problems may become worse. They may lead to tooth decay, gum disease, destruction of the bone that hold teeth in place, and chewing and digestive difficulties. Orthodontic problems can cause abnormal wear of tooth surfaces, inefficient chewing function, excessive stress on gum tissue and the jaw joints, sometimes leading to chronic headaches or pain in the face or neck. Treatment by an orthodontist to correct a problem early may be less costly than the restorative dental care required to treat more serious problems that can develop in years.

For children

Some children as early as 5 or 6 years of age may benefit from an orthodontic evaluation. Although treatment is unusual at this early age, some preventative treatment may be indicated.

By age 7, most children have a mix of baby (primary) and adult (permanent) teeth. Some common orthodontic problems seen in children can be traced to genetics, that is they may be inherited from their parents. Children may experience dental crowding, too much space between teeth, protruding teeth, and extra or missing teeth and sometimes jaw growth problems.

Other malocclusions (literally, "bad bite") are acquired. In other words, they develop over time. They can be caused by thumb or finger-sucking, mouth breathing, dental disease, abnormal swallowing, poor dental hygiene, the early or late loss of baby teeth, accidents or poor nutrition. Trauma and other medical conditions such as birth defects may contribute to orthodontic problems as well. Sometimes an inherited malocclusion is complicated by an acquired problem. Whatever the cause, the orthodontist is usually able to treat most conditions successfully.

Orthodontists are trained to spot subtle problems with jaw growth and emerging teeth while some baby teeth are still present. The advantage for patients of early detection of orthodontic problems is that some problems may be easier to correct if they are found and 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. For these reasons, the AAO recommends that all children get a check-up with an orthodontist no later than age 7. While your child's teeth may appear straight to you, there could be a problem that only an orthodontist can detect. Of course, the check-up may reveal that your child's bite is fine, and that is comforting news.

Even if a problem is detected, chances are your orthodontist will take a "wait-and-see" approach, checking your child from time to time as the permanent teeth come in and the jaws and face continue to grow. For each patient who needs treatment, there is an ideal time for it to begin in order to achieve the best results. The orthodontist has the expertise to determine when the treatment time is right. The orthodontist's goal is to provide each patient with the most appropriate treatment at the most appropriate time.

In some cases, your orthodontist might find a problem that can benefit from early treatment. Early treatment may prevent more serious problems from developing and may make treatment at a later age shorter and less complicated. For those patients who have clear indications for early orthodontic intervention, early treatment gives your orthodontist the chance to:

  • Guide jaw growth
  • Lower the risk of trauma to protruded front teeth
  • Correct harmful oral habits
  • Improve appearance and self-esteem
  • Guide permanent teeth into a more favorable position
  • Improve the way lips meet

It's not always easy for parents to tell if their child has an orthodontic problem. Here are some signs or habits that may indicate the need for an orthodontic examination:

  • Early or late loss of baby teeth
  • Difficulty in chewing or biting
  • Mouth breathing
  • Thumb sucking
  • Finger sucking
  • Crowding, misplaced or blocked out teeth
  • Jaws that shift or make sounds
  • Biting the cheek or roof of the mouth
  • Teeth that meet abnormally or not at all
  • Jaws and teeth that are out of proportion to the rest of the face

If any of these problems are noted by parents, regardless of age, it is advisable to consult an orthodontist. It is not necessary to wait until age 7 for an orthodontic check-up.

Frequently asked questions about childhood orthodontic treatment:

Orthodontist with Patient

What is preventive orthodontic treatment?

Preventive orthodontic treatment is intended to keep a malocclusion ("bad bite" or crooked teeth) from developing in an otherwise normal mouth. The goal is to provide adequate space for permanent teeth to come in. Treatment may require a space maintainer to hold space for a primary (baby) tooth lost too early, or removal of primary teeth that do not come out on their own so to create room for permanent teeth.

What is interceptive orthodontic treatment?

Interceptive orthodontic treatment is performed for problems that, if left untreated, could lead to the development of more serious dental problems over time. The goal is to reduce the severity of a developing problem and eliminate the cause. The length of later comprehensive orthodontic treatment may be reduced. Examples of this kind of orthodontic treatment may include correction of thumb- and finger-sucking habits; guiding permanent teeth into desired positions through tooth removal or tooth size adjustment; or gaining or holding space for permanent teeth. Interceptive orthodontic treatment can take place when patients have primary teeth or mixed dentition (baby and permanent teeth). A patient may require more than one phase of interceptive orthodontic treatment.

What is comprehensive orthodontic treatment?

Comprehensive orthodontic treatment is undertaken for problems that involve alignment of the teeth, how the jaws function and how the top and bottom teeth fit together. The goal of comprehensive orthodontic treatment is to correct the identified problem and restore the occlusion (the bite) to its optimum. Treatment can begin while patients have primary teeth, when they have a mix of primary and permanent teeth, or when all permanent teeth are in. Treatment may consist of one or more phases, depending on the nature of the problem being corrected and the goals for treatment.

Orthodontic care may be coordinated with other types of dental treatment that may include oral surgery (tooth extractions or jaw surgery), periodontal (gum) care and restorative (fillings, crowns, bridges, tooth size enhancement, implants) dental care. When finished with comprehensive treatment, the patient must wear retainers to keep teeth in their new positions.

What is a space maintainer?

Baby molar teeth, also known as primary molar teeth, hold needed space for permanent teeth that will come in later. When a baby molar tooth is lost, an orthodontic device with a fixed wire is usually put between teeth to hold the space for the permanent tooth.

Why do baby teeth sometimes need to be removed?

Removing baby teeth may be necessary to allow severely crowded permanent teeth to come in at a normal time in a reasonably normal location. If the teeth are severely crowded, it may be that some unerupted permanent teeth (usually the canine teeth) will either remain impacted (teeth that should come in, but do not), or come in to a highly undesirable position. To allow severely crowded teeth to move on their own into much more desirable positions, sequential removal of baby teeth and permanent teeth (usually first premolars) can dramatically improve a severe crowding problem. This sequential extraction of teeth, called serial extraction, is typically followed by comprehensive orthodontic treatment after eruption of permanent teeth has brought about as much improvement as it can on its own.

After all the permanent teeth have come in, the extraction of selected permanent teeth may be necessary to correct crowding or to make space for necessary tooth movement to correct a bite problem. Proper extraction of teeth during orthodontic treatment should leave the patient with both excellent function and a pleasing look.

How can a child's growth affect orthodontic treatment?

Orthodontic treatment and a child's growth can complement each other. A common orthodontic problem to treat is protrusion of the upper front teeth. Quite often this problem is due in part to the lower jaw being shorter than the upper jaw. Upper teeth may also be the primary cause of the protrusion if they stick out too far. While the upper and lower jaws are growing, orthodontic appliances can be beneficial in reducing these discrepancies. A severe jaw growth discrepancy may require orthodontics and corrective surgery after jaw growth has been completed, although this is rare.

The AAO recommends that all children have a check-up with an orthodontist no later than age 7 so that growth-related problems may be identified and so that treatment can be commenced at the appropriate time for each patient.

What kinds of orthodontic appliances are typically used to reduce the severity of jaw-growth problems?

A process of dentofacial orthopedics (guiding the growth of the face and jaws) with orthodontic appliances may be used to correct jaw-growth problems. The decision about when and which appliances to use for this type of correction is based on each individual patient's problem. Some of the more common orthopedic appliances include:

  • Headgear: This appliance applies pressure to the upper teeth and upper jaw to guide the direction of upper jaw growth and tooth eruption. The headgear may be removed by the patient and is usually worn 10 to 12 hours per day.
  • Fixed functional appliance: The appliance is usually fixed (glued) to the upper and lower molar teeth and may not be removed by the patient. By holding the lower jaw forward, it reduces the protrusion of the teeth while the patient is growing and helps bring the teeth together. The appliance can help correct severe protrusion of the upper teeth.
  • Removable functional appliance: This removable appliance holds the lower jaw forward and guides eruption of the teeth into a more desirable bite while helping the upper and lower jaws to grow in proportion to each other. Patient compliance in wearing this appliance is essential for successful improvement; the appliance cannot work unless the patient wears it.
  • Palatal Expansion Appliance: A child's upper jaw may be too narrow for the upper teeth to fit properly with the lower teeth (a crossbite). When this occurs, a palatal expansion appliance can be fixed to the upper back teeth. This appliance can markedly expand the width of the upper jaw. For some patients, a wider jaw may prevent the need for extraction of permanent teeth.

Can my child play sports while wearing braces?

Yes. But wearing a protective mouth guard is advised while riding a bike, skating, or playing any contact sports, whether organized sports or a neighborhood game. Your orthodontist can recommend a specific mouth guard. These are provided for our patients no charge.

Will braces interfere with playing musical instruments?

Playing wind or brass instruments, such as the trumpet, will clearly require some adaptation to braces. With practice and a period of adjustment, braces typically do not interfere with the playing of musical instruments.

Why does orthodontic treatment time sometimes last longer than anticipated?

Estimates of treatment time can only be that - estimates. Patients grow at different rates and will respond in their own ways to orthodontic treatment. The orthodontist has specific treatment goals in mind, and will usually continue treatment until these goals are achieved. Patient cooperation, however, is the single best predictor of staying on time with treatment. Patients who cooperate by wearing rubber bands, headgear or other needed appliances as directed, while taking care not to damage appliances, will most often lead to on-time and excellent treatment results.

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 wearing appliances as prescribed and tending to 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.

I recently took my child to an orthodontist for an orthodontic check-up. The orthodontist recommended treatment. Should I seek a second opinion?

You should review the recommended treatment with your family dentist. If you would like a second opinion, feel comfortable in arranging for one. You may have already had more than one orthodontist recommended to you by family, friends or your dentist. Seeking out a member of the AAO assures that your second opinion is from an educationally qualified orthodontic specialist. You should feel confident in the orthodontist and his or her staff, and trust their ability to provide you with the best possible care.

What is two-phase treatment?

Two-phase treatment simply means that the treatment is carried out in two stages. The first is the interceptive orthodontic phase (see above) and the second is the comprehensive orthodontic phase (see above).

Some of my children's friends have already started treatment, but our orthodontist says my child should wait a while. Why is there a difference in treatment?

Each treatment plan is specific for that child and his/her specific problem. In some cases, children mature early (e.g.: get their permanent teeth early) and in some cases early treatment is indicated to prevent a more severe problem from occurring. Your orthodontist is the best person to decide the most optimum treatment plan. If you have questions, you should discuss them with your orthodontist.

What do the initials mean after an orthodontist's name?

The initials after an orthodontist's name indicate the academic education of the orthodontist. For instance, DMD and DDS indicate that the individual is a graduate dentist. M.S. or MSc indicates that the individual has achieved a Masters in Science degree, usually associated with orthodontic training. DipOrtho indicates the individual is an orthodontist.

Are there board-certified orthodontists?

Yes, these orthodontists have completed the American Board of Orthodontics Specialty Certification exams and have met these qualifications. Board-certified orthodontists are known as Diplomates of the American Board of Orthodontics. The American Board of Orthodontics is the only orthodontic specialty certifying board recognized by the American Dental Association.

My child has an allergy to nickel. Can my child still have orthodontic treatment?

Yes, there are appliances available which are nickel-free. Please tell your orthodontist if your child has any allergies.

For teens

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.

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 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. For more information see "Orthodontic Emergencies and Other Problems".

My child wants to get his/her tongue pierced. Will this interfere with orthodontic treatment?

Tongue-piercing jewelry may contribute to breakage of appliances and to tooth and gum damage from contact with the stud.

For adults

Today, orthodontic treatment is a viable option for almost any adult. It is well recognized that when left untreated, many orthodontic problems may become worse. When you have a malocclusion ("bad bite"), your teeth may be crowded, excessively spaced or may not fit together correctly. Such conditions may lead to dental health problems. Crowded teeth are hard to clean and, given time, may contribute to tooth decay, gum disease and even tooth loss. Bad bites can also result in abnormal wearing of tooth surfaces, difficulty chewing and damage to supporting bone and gum tissue. Poorly aligned teeth can contribute to pain in the jaw joints.

Abnormal tooth wear in an adult

You'll be pleased to learn that orthodontic treatment will fit in with your current lifestyle – you can sing, play a musical instrument, dine out, kiss, and even have your picture taken. One in five orthodontic patients is an adult. The AAO estimates that more than 1,000,000 adults in the United States and Canada are receiving treatment from orthodontists who are members of the AAO. To learn about correction of a specific problem, please consult your family dentist for a referral to an orthodontist or find AAO member orthodontists near you through the Orthodontist Locator service.

The rate of toothlessness has declined over recent decades. Our great-grandparents, for the most part, lost their teeth around age 40. Today's 25-year-old has the potential of another 75 years of keeping and using their teeth. This is a major change in dental health care (and life expectancy). Teeth that do not fit well often wear down more quickly-another reason to make sure that your teeth are in good alignment and well maintained in your adult years.

Frequently asked questions about adult orthodontics:

Adult Orthodontic Patient

Can orthodontic treatment do for me what it does for children?


Yes. Healthy teeth can be moved at any age. Many orthodontic problems can be corrected as easily for adults as for children. Orthodontic forces move the teeth in the same way for both adults and children, but adult treatment may take longer due to the maturity of the bone. Complicating factors, such as lack of jaw growth, may create different treatment planning needs for the adult. This is why a consultation with an orthodontist, the dental specialist who aligns teeth and jaws of patients of all ages, is essential.

How does adult treatment differ from that of children and adolescents?


Adults are not growing and may have experienced some breakdown or loss of their teeth and the bone that supports the teeth. Orthodontic treatment may then be only a part of the patient's overall treatment plan. Close coordination may be required among the orthodontist, oral surgeon, periodontist, endodontist and family dentist to assure that the treatment plan is managed well. Below are the most common characteristics that can cause adult treatment to differ from that of children.

No jaw growth: Jaw discrepancy problems, including both width and length, in the adult patient may require jaw surgery. For example, if an adult's lower jaw is too short to match properly with the upper jaw, a severe bite problem results. The amount that the teeth can be moved in some cases, with braces alone, may not correct this problem. Establishing a proper bite relationship could require jaw surgery, which would lengthen the lower jaw and bring the lower teeth forward into the proper bite.

Gum or bone loss (periodontal breakdown): Adults are more likely to have experienced damage or loss of the gum and bone supporting their teeth (periodontal disease). Periodontal disease is a chronic bacterial infection that affects the gums and bone supporting the teeth. The word periodontal literally means "around the tooth." Many people are unaware that they have gum disease because there is usually little or no pain.

Periodontal disease can affect one tooth or many teeth. It begins when the bacteria in plaque (the sticky, colorless film that constantly forms on your teeth) causes inflammation in the gums.

Gingivitis

The mildest form of the disease is called gingivitis. The gums redden, swell and bleed easily. Gingivitis is often linked to inadequate oral hygiene. Gingivitis is often reversible with professional treatment and good oral home care.

Untreated gingivitis can advance to periodontitis, a more severe form of gum disease. With time, plaque can spread and grow below the gum line. Toxins produced by the bacteria in plaque irritate the gums. The toxins stimulate a chronic inflammatory response in which the body, in essence, turns on itself, and the tissues and bone that support the teeth are broken down and destroyed. Gums separate from the teeth, forming pockets (spaces between the teeth and gums) that become infected. As the disease progresses, the pockets deepen and more gum tissue and bone are destroyed. Eventually, teeth can become loose and may have to be removed.

Advanced periodontitis
Note the loss of gum tissue, which makes teeth appear longer

The good news is that teeth that are properly aligned are less prone to gum disease.

Special treatment by the patient's dentist or a periodontist may be necessary before, during and/or after orthodontic treatment. Bone loss can also limit the amount and direction of tooth movement that is advisable. Adults who have a history of or concerns about periodontal disease might also see a periodontist (a dental specialist who treats diseases of the gums and bone) on a regular basis throughout orthodontic treatment.

Worn, damaged or missing teeth: Worn, damaged or missing teeth can make orthodontic treatment more difficult. Teeth may gradually wear and move into positions where they can be restored only after precise orthodontic movement. Damaged or broken teeth may not look good or function well even after orthodontic treatment unless they are carefully restored by the patient's dentist. Extra space resulting from missing teeth that are not replaced may cause progressive tipping and drifting of other teeth, which worsens the bite, increases the potential for periodontal problems and makes any treatment more difficult.

I have painful jaw muscles and jaw joints - can an orthodontist help?


One of the problems commonly associated with jaw muscle and jaw joint discomfort is bruxing, that is, habitual grinding or clenching of the teeth, particularly at night. Bruxism is a muscle habit pattern that can cause severe wearing of the teeth, and overloading and trauma to the jaw joint structures. Chronically or acutely sore and painful jaw muscles may accompany the bruxing habit. An orthodontist can help diagnose this problem. Your family dentist or orthodontist may place a bite splint or nightguard appliance that can protect the teeth and help jaw muscles relax, substantially reducing the original pain symptoms. Sometimes structural damage can require joint surgery and/or restoration of damaged teeth. Referral to a TMJ specialist may be suggested for some of these problems.

My family dentist said I need to have some missing teeth replaced, but I need orthodontic treatment first - why?


Your dentist is probably recommending orthodontics so that he or she might treat you in the best manner possible to bring you to optimal dental health. Many complicated tooth restorations, such as crowns, bridges and implants, can be best accomplished when the remaining teeth are properly aligned and the bite is correct.

When permanent teeth are lost, it is common for the remaining teeth to drift, tip or shift. This movement can create a poor bite and uneven spacing that cannot be restored properly unless the missing teeth are replaced. Tipped teeth usually need to be straightened so they can withstand normal biting pressures in the future.

My teeth have been crooked for many years - why should I have orthodontic treatment now?


It's never too late! Orthodontic treatment, when indicated, is a positive step-especially for adults who have endured a long-standing problem. Orthodontic treatment can restore good function. And teeth that work better usually look better, too. A healthy, beautiful smile can improve self-esteem, no matter the age.

Is orthodontic treatment affordable?


Patients are finding that braces are more affordable today than ever. The cost of orthodontic treatment will depend on many factors, including the severity of the problem, its complexity and the length of treatment. Your orthodontist will be glad to discuss the cost with you before treatment begins. Most orthodontists have a variety of convenient payment plans. Often there are combined plans available for parents and children who have treatment at the same time. In addition, many dental insurance plans now include orthodontic benefits. Dollar for dollar, when you consider the lifetime benefits of orthodontics it is truly a great value.

I am pregnant and want to begin orthodontic treatment. Is this OK?


Pregnancy brings on bodily changes that can affect the mouth. Soft tissues such as gums become much more susceptible to infection. The possible need for x-rays during the pregnancy is not advised. Discuss this question with your medical practitioner/physician and orthodontist before you start orthodontic treatment.

My orthodontist wants to do something called enamel stripping to make my teeth smaller. I have never heard of this. Is this something new? Is it safe?

This procedure goes by many names: enamel stripping; interproximal reduction; slenderizing; reproximation and selective reduction. The goal is to remove some of the outer tooth surface (enamel) to acquire more space for your teeth. The procedure has been used in orthodontic treatment since the 1940s and has been shown to be safe and effective. Some studies among patients who have had this procedure show that it neither makes teeth more susceptible to tooth decay nor does it predispose patients to gum disease. For detailed information, please read the AAO brochure "Interproximal Reduction: Reducing Tooth Widths for Form, Function and Stability."


I see ads for perfect teeth in only one or two visits to the dentist. Will that give me straight teeth?

Crooked teeth should be evaluated by an orthodontist so that the most appropriate treatment plan can be suggested.

For parents/ guardians

Achieving a healthy beautiful smile is a team effort that involves the patient, parent, orthodontist and family dentist as well as other dental specialists as needed. Your role is essential in ensuring that dental hygiene is satisfactory, that your child regularly sees the family dentist at least every six months during the orthodontic treatment and that your child follows the orthodontic treatment plan. If difficulties arise, you should discuss these with your orthodontist as soon as possible so that effective problem-solving can take place.

If your child should experience a loose bracket or wire, there are some steps you can take to make your child comfortable until the orthodontist can repair the problem. For information, please see "Orthodontic Emergencies and Other Problems".

Help your child make good food choices during orthodontic treatment. Remember that your child needs to avoid foods that are hard, sticky, crunchy and chewy.

The cost of orthodontic treatment will depend on many factors, including the severity of the problem, its complexity and the length of treatment. Your orthodontist will be glad to discuss the cost with you before treatment begins. Patients are finding that braces are more affordable today than ever. Most orthodontists have a variety of convenient payment plans. In addition, many dental insurance plans now include orthodontic benefits. Dollar for dollar, when you consider the lifetime benefits of orthodontics it is truly a great value.

Want to know more?

What is an orthodontist?

Orthodontists are qualified dentists, who after graduating from dental school, go on to additional full-time university-based education in an accredited orthodontic residency program supervised by orthodontists. That training lasts at least two to three academic years-sometimes more. By learning about tooth movement (orthodontics) and guidance of facial development (dentofacial orthopedics), orthodontists are the uniquely educated experts in dentistry to straighten teeth and align jaws.

Orthodontists diagnose, prevent and treat dental and facial irregularities. Orthodontists limit their practices to orthodontics and dentofacial orthopedics. That means that orthodontic treatment is what they do, and that is all they do. Orthodontists treat a wide variety of malocclusions (misaligned aligned teeth and/or jaws). They regularly treat young children, teens and adults.

Selecting an orthodontist who is a member of the American Association of Orthodontists (AAO) is your assurance that you have chosen an orthodontist: the dental specialist with at least two to three years of post-doctoral, advanced specialty education in orthodontics in a university-based program accredited by the American Dental Association. Specialty education includes the study of subjects in biomedical, behavioral and basic sciences; oral biology; and biomechanics.

Only orthodontists may be members of the American Association of Orthodontists (AAO).

What happens at my first visit?

This is a time for orthodontists to listen to patient concerns and to provide an orthodontic examination. The orthodontist will likely be able to indicate whether or not treatment is needed and if needed, when the best time to start treatment would be. Typical steps prior to beginning treatment include gathering orthodontic records to provide specific information to tailor a treatment plan for that patient.

Often, this is a time when the doctor and patient/parent discuss basic orthodontic care, and fees. There is no charge for this inital examination.

What are diagnostic records?

Diagnostic records include x-rays, photographs, and impressions made of the teeth. These "molds" are used to develop models for closer examination of the teeth and how the upper and lower teeth relate to each other. X-rays are taken to look at the root structure of the teeth and how the jaw bones and teeth relate to each other. At times additional imaging of the temporomandibular joints is helpful. Typically facial photographs and intra-oral photographs are taken to evaluate facial proportions, facial aesthetics and the health of the teeth and gums. These diagnostic records collectively enable the orthodontist to develop an appropriate treatment plan for the patient.

When should I begin treatment?

The American Association of Orthodontists recommends that all children get a check-up with an orthodontist no later than age seven. Although few orthodontic problems need to be corrected at that age, an early exam allows the orthodontist to offer advice and guidance as to when the appropriate age to start treatment would be. Let your orthodontist guide you as to when to start treatment. Feel free to ask questions about the timing of treatment.

How long will my treatment take?

The length of treatment varies depending on the complexity of the orthodontic problem that requires correction, growth and tissue response to treatment as well as the level of patient cooperation during their treatment. Orthodontic care requires a team approach in which the family dentist, the orthodontist and the patient play key roles.

What are the stages of treatment?

Generally, there are two or three stages of orthodontic treatment. Most patients will benefit from an active corrective stage followed by a retention stage. Some patients will benefit from two active treatment stages often referred to as two-phase treatment. The goals of each stage should be discussed with the orthodontist so that patients and/or parents have realistic expectations.

How are teeth moved?

Teeth respond to the gentle forces that are applied to them. "Braces" are a combination of "brackets" and "wires". Brackets are the part of the braces that attach to the teeth. Brackets are the "handles" that help control movement of the teeth. Braces require a wire called an "archwire" that connects the brackets and provides the forces to steer the teeth in the proper direction. It's actually the wires that move teeth. The interaction of brackets and archwires enables the orthodontist to have three-dimensional control over the movement of the teeth. In many cases, additional forces are needed to help balance the underlying jaw structure and to help the upper and lower teeth fit properly together to make the bite right. Examples of these extra forces include: elastics (rubber bands) hooked to teeth; headgear; functional appliances; and palatal expanders.

Are there different types of braces?

Braces differ from one another in many ways. How they attach to the teeth varies. Most attach on the cheek side of the teeth, while some attach on the tongue side. These are called "lingual" braces. Braces vary in appearance. Some braces are clear, nearly invisible, while others are made of stainless steel and may or may not have colored elastics around them. All braces are designed to enable the orthodontist to move teeth in three dimensions. The mechanics or techniques used for moving teeth vary as well. Talk with your orthodontist about his or her approach to orthodontic treatment.

Orthodontic Care?

What is expected of me during treatment?

Like other types of health care, patient cooperation with the directions of the orthodontist are key in determining the length of treatment and the quality of the outcome. Patients cannot sit back and relax and let the braces do all the work for them. In many instances, patients' cooperation is needed to help make sure the bite is right. Aligned teeth within each jaw won't stay optimally aligned unless the teeth of each jaw fit properly together. Patient compliance with elastic wear, functional appliance wear or headgear wear can be very important in insuring a successful outcome. In addition, you must continue to see your dentist at least every six months, or more often if recommended, for check-ups and professional cleanings. Proper cleaning of the teeth to remove food debris and plaque is important to prevent cavities, gum disease and permanent scarring of the enamel.

Keeping braces from breaking or wires from getting bent will speed treatment. Avoiding hard, sticky, and chewy foods, including ice, will go a long way in preventing broken braces. Pen and pencil chewing should also be avoided. In general, you should expect to be an active partner in the development of your new smile. It is your smile, after all.

How do I take care of my braces?

Extra time is needed with toothbrushing to make sure that all areas around the braces have been cleaned properly. Specialized brush tips are available to help get in between the braces and under the wires. Floss-threaders are helpful in passing floss under archwires to facilitate flossing of the teeth. Oral irrigators are often helpful to dislodge food debris from around the teeth. Over-the-counter mouth rinses can be used in conjunction with oral irrigators to help reduce the level of bacteria around the teeth. Extra time is needed with toothbrushing. Specialized brush tips help get in between braces and under wires. The goal is to remove plaque from around the teeth and gums. It is the bacteria in plaque that is responsible for causing inflamed gum tissue (gingivitis), permanent scarring of enamel (decalcification), as well as tooth decay. Remember, braces don't cause these problems, they just make cleaning the teeth more difficult.

Gingivitis
Note the reddened areas of gum where the gum meets the teeth. This is gingivitis. Decalcification
Note the white decalcification spots on these teeth. Avoiding hard, sticky, crunchy and chewy foods will also keep your braces intact and help to make your treatment flow smoothly.

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