When teeth are properly aligned, and less plaque collects, these risks decline. And when teeth are properly aligned it is easier to keep teeth clean. 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 for fracture. Untreated orthodontic problems may become worse. They may lead to tooth decay, gum disease, destruction of the bone that holds 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 bone that supports the teeth, or misalignment of the jaw joints, sometimes leading to chronic headaches or pain in the face or neck. Treatment to correct a problem early may be less costly than the restorative dental care required to treat more serious problems that can develop in later years.
- Influence jaw growth in a positive manner
- Harmonize width of the dental arches
- Improve eruption patterns
- Lower risk of trauma to protruded upper incisors
- Correct harmful oral habits
- Improve esthetics and self-esteem
- Simplify and/or shorten treatment time for later corrective orthodontics
- Reduce likelihood of impacted permanent teeth
- Improve some speech problems
- Preserve or gain space for erupting permanent teeth
- 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
Often, this is a time when the doctor and staff discuss fees for orthodontic care, general payment options, and insurance benefits.
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 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).
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.
The American Association of Orthodontists recommends that all children have an orthodontic evaluation 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 (see image): 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.
Successful orthodontic treatment is a “two-way street” that requires a consistent, cooperative effort by both the doctor 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, 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.
To keep teeth and gums healthy, regular visits for check-ups and cleanings must continue during orthodontic treatment.
This is why the dentist and dental hygienist stress dental hygiene—for the good of the patient’s dental health. (See photos of decalcification and gum disease below)
Note the white decalcification spots on these teeth
Note the reddened areas of gum where the gum meets the teeth. This is gingivitis.
- A Bracket is Knocked Off: Brackets (see diagram below) are the parts of braces attached to teeth with a special adhesive. They are generally positioned in the center of each tooth. If the bracket is off center and moves along the wire, the adhesive has likely failed. Call the office to determine the course of action. If the loose bracket has rotated on the wire and is sticking out, attempt to turn it back into its normal position and schedule an appointment to have it reattached. You may wish to put orthodontic wax around the area to minimize the movement of the loose brace. If you are in pain, please call the office and inform us of the circumstance. If you are not in pain, this is not a true emergency. Please call the office at your earliest convenience to schedule an appointment to reattach the brace to the tooth. Remember, brackets can become loose as a result of chewing on hard, sticky or chewy foods or objects as well as from physical contact from sports or rough housing. Be sure to wear a protective mouth guard while playing sports!
- The Archwire is Poking: If the end of an orthodontic archwire (see diagram) is poking in the back of the mouth, attempt to put wax over the area to protect the cheek. Call to schedule an appointment and have the archwire clipped. In a situation where the wire is extremely bothersome and the patient will not be able to seen immediately, as a last resort, the wire may be clipped with an instrument such as fingernail clippers. Reduce the possibility of swallowing the snipped piece of wire by using folded tissue or gauze around the area to catch the piece you will remove. Use a pair of sharp clippers and snip off the protruding wire. Relief wax may still be necessary to provide comfort to the irritated area.
- “Ligature Wire” is Poking Lip or Cheek: Use a Q-tip or pencil eraser to push the wire (see diagram) so that it is flat against the tooth. If the wire cannot be moved into a comfortable position, cover it with relief wax. (See “Irritation of Cheeks or Lips” below for instructions on applying relief wax.) Notify the office.
- Loose Brackets, Wires or Bands: If the braces have come loose in any way, call the office to determine appropriate next steps. Save any pieces of your braces that break off and bring them with you to your repair appointment.
- Irritation of Lips or Cheeks: Sometimes new braces can be irritating to the mouth. A small amount of orthodontic wax makes an excellent buffer between the braces and lips, cheek or tongue. Simply pinch off a small piece and roll it into a ball the size of a small pea. Flatten the ball and place it completely over the area of the braces causing irritation. If possible, dry off the area first as the wax will stick better. The patient may then eat more comfortably. If the wax is accidentally swallowed it’s not a problem. The wax is harmless.
- Mouth Sores: People who have mouth sores during orthodontic treatment may gain relief by applying a small amount of topical anesthetic (such as Orabase or Ora-Gel) directly to the sore area using a cotton swab. Reapply as needed.
- Discomfort: It’s normal to have discomfort for three to five days after braces or retainers are adjusted. Although temporary, it can make eating uncomfortable. Encourage soft foods. Have the patient rinse the mouth with warm salt water. Over-the-counter pain relievers, acetaminophen or ibuprofen, may be effective.
- Lost Ligature (Rubber or Wire): Tiny rubber bands known as elastic ligatures (see diagram), are often used to hold the archwire into the bracket or brace. If an elastic ligature is lost, contact the office, who will advise you whether the patient should be seen. The same holds true for wire ligatures.
- What if the Lip Gets Caught on a Brace? Call the office immediately. Apply ice to the affected area until you have the opportunity to been seen.
- I Can’t Open My Mouth: Potential causes – problems with lower jaw joint or swelling around the soft tissues in the mouth. Call the office and inform them of your symptoms.
- Food Caught Between Teeth: This is not an emergency. It can be resolved with a piece of dental floss. Try tying a small knot in the middle of the floss to help remove the food. Or use an interproximal brush to dislodge food caught between teeth and braces.
Diagram of Braces
To help you accurately describe an emergency situation, use the diagram below, which illustrates and names each part of a typical set of braces.
The archwire is held to each bracket with a ligature, which can be either a tiny elastic or a twisted wire.
The archwire is tied to all of the brackets and creates force to move teeth into proper alignment.
Brackets are connected to the bands, or directly bonded on the teeth, and hold the archwire in place.
D. Metal Band
The band is the cemented ring of metal which wraps around the tooth.
E. Elastic Hooks & Rubber Bands
Elastic hooks are used for the attachment of rubber bands, which help move teeth toward their final position.
Supplies: With these supplies on hand, you will be prepared to handle the most common problems with braces.
- Non-medicated orthodontic relief wax
- Dental floss
- Sterile tweezers
- Small, sharp clippers suitable for cutting wire (such as a fingernail clipper)
- Interproximal brush
- Non-prescription pain reliever (acetaminophen or ibuprofen or any over-the-counter medication typically used for a headache)
- Oral topical anesthetic (such as Orabase or Ora-Gel)