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Braces and Orthodontic Treatment

Orthodontist is a dental specialist who specializes in treatment using braces. Braces are appliances or devices used to make these corrections. Not many of us are blessed with well arranged teeth or so called ideal occlusion. We very often come across many children and adults having teeth that are protruded teeth or crowded teeth or spaced teeth etc. These irregularities of teeth are called malocclusions and are an important factor in robbing a good smile. Orthodontics is the specialization of dentistry, which deals with correcting the bite and arrangement of teeth, therefore improves the smile and function of jaws.

Sriram Dental Older man with healthy smile

Who is an orthodontist?

An orthodontist is the dental specialist who corrects your bite and improves your smile by using various types of braces. In other words an orthodontist is a dentist who treats crooked teeth to improve your smile
Braces should always be provided by a qualified MDS specialist in Orthodontics.
Note: Many dentist claims to able to treat with braces which are not within their purview. You would be at considerable risk by submitting yourself to treatment with an unqualified Orthodontist. Orthodontic treatment if done wrongly can become irreversible.

When to start orthodontic / braces treatment?

The most confusing question for most parents, and some general dentists, is when to actually start treatment. The objective is to treat at the time when it will minimize treatment time, achieve a normal profile, and get the best long term, stable result. Some orthodontic problems start developing at the age of 6 to 7 years, and it is usually a good time to get an initial consultation, especially if the parent or general dentist suspects that a problem may be developing. Though no active treatment may be initiated at this time in most cases, some problems may need to be intercepted to prevent them from later developing into complicated situations. An example of an indication to start early treatment is the presence of a cross-bite of the front or back teeth. However, if there are no unusual circumstances, the first visit to the orthodontist should be at the age of 10 years for girls and 11 years for boys. It is important to note that in case of jaw growth deficiencies it is mandatory to initiate the treatment before the completion of active growth spurt failing which later might require a complicated Orthognathic jaw surgery.

Age limit for braces treatment:

There is no age limit for braces treatment. All of us know that we have two sets of teeth in a life time. Milk teeth in the early years and permanent teeth in later years. The transition from milk teeth to permanent teeth takes place over a period of 5 to 13 years of age. Dental problems developed during this period ranging from simple tooth decay to a complex one.
Conditions requiring braces treatment can be prevented to some extent by certain procedures. This is called preventive orthodontics.
Minor malocclusions which have appeared can be intercepted during the transition period and the severity can be reduced. This is called interceptive orthodontics.
Functional jaw orthopedics - It is important to initiate this kind of treatment with functional/orthopedic appliances before completion of pubertal growth spurt in children having excess or deficiency of upper, lower or both jaws. There is a wide spread misconception among general public and general dentist/non-orthodontist that orthodontic treatment should always be started after eruption of upper canine teeth. This is not true, incase of children with jaw discrepancy where treatment timing is critical with reference to the growth. Ideally these children should be examined by an orthodontist around 9-10 years itself to intercept the skeletal malocclusion failing which might require a complicated jaw surgery in future.
The most important is the nature and discrepancy of the problem, onset of the problem and management. So it is always better to consult a specialist (Orthodontist) when in doubt.

Bad Bite

The early warning signs of a bad bite are:

  • Upper front teeth protrude or are "bucked"
  • Top front teeth cover more than 25% of the bottom front teeth when the back teeth are biting together
  • Top front teeth grow in behind the bottom front teeth
  • A space exists between the top and bottom front teeth with the back teeth biting together
  • Crowded or overlapped teeth or extra teeth
  • Baby teeth are slow falling out
  • The centers of the top and bottom front teeth don't line up
  • Finger sucking habit continuing after 6 years of age
  • Difficulty chewing
  • Teeth wearing unevenly
  • Jaws that shift off center when the teeth bite together
  • Excessive spaces between teeth that persist after the top permanent canine teeth appear
  • Teeth or smile often hidden by hands

Bad Bite - When to start the treatment?

Things that alert you to go to an Orthodontist :
Parents are often worried about their children's teeth. It is a good idea to consult your orthodontist if you have any doubts about your child's bite. The presence of certain features should alert you to seek professional advice from an orthodontist.

  • In case of delay in emergence of the teeth. Most children start getting their baby teeth by 5-7 months of age. In case of delay beyond 1 year of age in the emergence of the teeth it is advisable to seek opinion of your dentist.
  • If the milk teeth is shed off and the permanent teeth do not replace it.
  • Teeth that are erupting too close to one another or are crowded together.
  • Teeth that are too far apart or spaced teeth
  • If the front teeth are too far forward and the lip does not cover the teeth.
  • Continued presence of habits such as finger sucking beyond 4 years of age often requires professional assistance to discontinue the habit and to rectify the damage done to the bite.
  • Normally the upper teeth are ahead of the lower teeth. In case the lower teeth are ahead of the upper it is called cross bite and should alert you to immediately seek professional advice.
  • If a space exists between the upper and the lower teeth when the teeth are brought together. This is called open bite and signifies improper bite that requires orthodontic care
  • Presence of a space in the middle between the 2 incisors. This is called midline diastema.
  • Difficulty in chewing or biting
  • Difficulty in pronunciation of certain words or lisping.
  • Children who breathe through the mouth due to some nasal problem or as a habit.
  • In case one or both the parents have had orthodontic problems in the past.
  • In case your child is habituated to the use of pacifiers for too long.

Types of braces

Things that alert you to go to an Orthodontist :
Parents are often worried about their children's teeth. It is a good idea to consult your orthodontist if you have any doubts about your child's bite. The presence of certain features should alert you to seek professional advice from an orthodontist.

  • Metal braces - these are high quality steel braces.
  • Ceramic braces - these are tooth colour braces, which may not be visible at a distance. These are used when patients don’t want their braces to be obviously seen.
  • Self Ligating Braces - This is the most preferred type of braces now due to better oral hygiene maintenance and lesser number of treatment visits. Both metal and ceramic materials are available as self ligating braces [ &]
  • Invisalign / clear aligners - this is the most advanced method of moving the teeth without braces. [ &]

Why do we need braces?

  • Improves your smile - A good smile adds up to the personality of an individual. A fabulous smile makes you attractive and also improves one's confidence levels. Braces improve your smile and therefore improve your appearance.
  • Improves chewing - Teeth are an important part of the digestive system. Chewing of food by the teeth is the beginning of the digestive process before the food is passed on to the tummy. So having a good bite improves the function of the teeth.
  • Prevents other dental problems - Crooked teeth prevent maintenance of good oral hygiene. This can lead to other dental problems such as dental decay and gum diseases.
  • Psychological benefits - Not having a good smile can adversely affect the appearance and therefore the mental well being of an individual. It tends to make one an introvert and highly self-conscious.
  • Risk of trauma - Teeth that are protruding out increase the risk of trauma to them. This is more so in children during play or due to an accidental fall.

What is malocclusion?

Malocclusion can be said to be a deviation from the normal or abnormal arrangement of teeth. Numerous are the causes of malocclusion. Some common causes are listed below,

  • Heredity - The genes are probably the most important factors. Many disorders in the arrangement of the teeth are inherited.
  • Thumb sucking and other habits - Children at times tend to develop habits such as sucking of the thumb or fingers, lip sucking, lip biting etc. Presence of thumb sucking or finger sucking till 2 to 3 years age does not usually produce any ill effects on the teeth and the jaw bones. Continued sucking of the thumb beyond 4 years of age very often causes protrusion of the teeth and other abnormalities in the bite.
  • Use of pacifiers - Children who have used pacifiers for too long tend to develop some problems of the bite.
  • Injuries - Injuries to the teeth or the bone during childhood may cause abnormalities of the bite.
  • Dental decay and diseases of the gums - They may sometimes cause drifting of the teeth and therefore problems of the bite.

What does braces do?

Braces use steady, gentle pressure over time to move teeth into their proper positions. They don't look like they're doing much just sitting there, but in fact, during every moment in your orthodontic treatment period, there's something happening in your mouth, something good for you. The brackets we place on your teeth and the main arch wire that connects them are the two main components. The bracket is a piece of specially shaped metal or ceramic that we stick on each tooth. Then we bend the arch wire to reflect your 'ideal" bite- what we want you to look like after treatment. The wire threads through the brackets and, as the wire tries to return to its original shape, it applies pressure to actually move your teeth. Picture your tooth resting in your jaw bone. With pressure on one side from the arch wire, the bone on the other side gives way. The tooth moves. New bone grows in behind. It may look like nothing is happening but we're making a new smile here. Thanks to new materials and procedures, all this happens much quicker than ever before.

Functional Jaw Orthopedics/Growth Modification [FJO]

FJO deals with children who has deficiency /excess growth of upper/lower jaws. Growth modification of jaws is known as DENTOFACIAL ORTHOPAEDICS.
Growth modification techniques otherwise called as Functional Jaw Orthopedics are special procedures used between 9 and 12 years during which time the active Growth of the jaws take place. These techniques are used early during the active growth period of children just before their puberty using special appliances namely Rapid Maxillary Expansion (HYRAX) Screws, cross bite correction appliance ,Bionators, Frankles Appliances, Twin Blocks, Face mask etc. The Growth modification helps in achieving balanced Jaws on which if irregular or protruded teeth present can be treated using braces as the next stage of treatment.
Diagnosis is made by Clinical Examination and Face X-rays. If the jaw growth is excess it could be restricted or if the growth is short can be stimulated to grow using some special appliances. These procedures eliminate the need for Orthognathic Surgeries at a later date in majority of cases used apart from braces to either restrict the excessive growth of the jaws or stimulate the under grown jaws. These techniques are used early during the active growth period of children just before their puberty using special appliances namely Bionators, Frankles Appliances, Twin Blocks, Face Masks, Rapid Maxillary Expansion. The Growth modification helps in achieving balanced Jaws on which if irregular or protruded teeth present can be treated Functional Jaw Orthopedics.
If the Jaw growth related problem is diagnosed after the Growth is over then using both Braces and Orthognathic Surgical Procedures. These procedures are either done in the Upper Jaw or Lower Jaw or combined Upper and Lower Jaws. Sometimes Chin Surgeries and Nose Surgeries may be needed.

Micro Implants

Micro implants in Orthodontics is used as an adjunctive to retract severely protruded teeth beyond the scope of braces. By using micro implants in orthodontic the need for surgical Orthodontics has reduced to a great percentage. These implants are TITANIUM and does not cause any excessive discomfort and can be easily removed once their action is over.

  • Initial Consultation.
  • Records like Plaster models, X-rays, Photographs are done.
  • Based on the clinical examination, History and Records a thorough treatment plan is arrived and explained to the patient and parents.
  • Braces are bonded using Direct or Indirect Bonding techniques.
  • Instructions are given to patients.

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