Why Do People Need Braces?

Braces are a common and almost expected part of puberty (and many adults get braces, too). To better understand why braces and other orthodontic devices are needed, it helps to talk a bit about the teeth first.

As you made your way through childhood, your "baby" teeth fell out one by one, to be replaced by permanent, adult teeth. Although some people's adult teeth grow in at the right angle and with the right spacing, many people's teeth don't.

Some teeth may grow in crooked or overlapping. In other people, some teeth may grow in rotated or twisted. Some people's mouths are too small, and this crowds the teeth and causes them to shift into crooked positions.

And in some cases, a person's upper jaw and lower jaw aren't the same size. When the lower half of the jaw is too small, it makes the upper jaw hang over when the jaw is shut, resulting in a condition called an overbite. When the opposite happens (the lower half of the jaw is larger than the upper half), it's called an underbite.

All of these different types of disorders go by one medical name: malocclusion. This word comes from Latin and means "bad bite." In most cases, a "bad bite" isn't anyone's fault; crooked teeth, overbites, and underbites are often inherited traits, just like brown eyes or big feet are inherited traits.

In some cases, things like dental disease, early loss of baby or adult teeth, some types of medical problems, an accident, or a habit like prolonged thumb sucking can cause the disorders.

Malocclusion can be a problem because it interferes with proper chewing — crooked teeth that aren't aligned properly don't work as well as straight ones. Because chewing is the first part of eating and digestion, it's important that teeth can do the job. Teeth that aren't aligned correctly can also be harder to brush and keep clean, which can lead to tooth decay, cavities, and gum disease. And finally, many people who have crooked teeth may feel self-conscious about how they look; braces can help them feel better about their smile and entire appearance.

If a dentist suspects that someone needs braces or other corrective devices, he or she will refer the patient to an orthodontist. Orthodontists are dentists who have special training in the diagnosis and treatment of misaligned teeth and jaws.

Most regular dentists can tell if teeth will be misaligned once a patient's adult teeth begin to come in — sometimes as early as age 6 or 7 — and the orthodontist may recommend interceptive treatment therapy. (Interceptive treatment therapy involves the wearing of appliances to influence facial growth and help teeth grow in better, and helps prevent more serious problems from developing.) In many cases, the patient won't be referred to an orthodontist until closer to the teen years.

Diagnosis

Before giving someone braces, the orthodontist needs to diagnose what the problem is. This means making use of several different methods, including X-rays, photographs, impressions, and models.

The X-rays give the orthodontist a good idea of where the teeth are positioned and if any more teeth have yet to come through the gums. Special X-rays that are taken from 360 degrees around the head may also be ordered; this type of X-ray shows the relationships of the teeth to the jaws and the jaws to the head. The orthodontist may also take regular photographs of the patient's face to better understand these relationships.

And finally, the orthodontist may need an impression made of the patient's teeth. This is done by having the patient bite down on a soft material that is used later to form an exact model of the teeth.

Treatment

Once a diagnosis is made, the orthodontist can then decide on the right kind of treatment. In some cases, a removable retainer will be all that's necessary. In other rare cases (especially when there is an extreme overbite or underbite), an operation will be necessary. But in most cases, the answer is braces.

Braces straighten teeth because they do two very important things: stay in place for an extended amount of time, and exert steady pressure. It's this combination that allows braces to successfully change the position of teeth in a patient's mouth, through periodic adjustments by the orthodontist.

Different Types of Braces

An orthodontist can outfit patients with a few different kinds of braces. Some are made of lightweight metal and go around each tooth, while other metal ones are attached to the outside surfaces of the teeth with special glue.

Clear braces can be attached to the outside surfaces of the teeth, as can ceramic ones that are the same color as teeth. Some patients can get newer "mini-braces," which are much smaller, or "invisible braces," which are affixed to the inside surfaces of the teeth. In many cases, patients can choose which kind they want.

A recent addition to treatment options, braceless orthodontics, uses a series of clear removable appliances that are custom made and worn for specified amounts of time. These appliances exert pressure on the malpositioned teeth and move them gradually into their correct position.

How long each appliance in the series must be worn depends on the individual treatment plan the dentist or orthodontist creates. These appliances and the treatment plan are computer generated from the models of the teeth taken. Your dentist or orthodontist must decide if you are a candidate for this type of treatment since it is not right for everyone.

Correcting the position of the teeth often takes anywhere from 6 months to 2 or 3 years with any of the methods.

With braces, after the amount of time needed for correction has been established for the patient, the orthodontist must work on the other part of the treatment: making sure the braces exert steady pressure. To achieve this, the patient must come for regular visits, usually once a month or so. During the visits, the orthodontist attaches wires, springs, or rubber bands to the braces in order to create more tension and pressure on the teeth. Sometimes the rubber bands will connect certain teeth to one another to create a kind of opposing tension.

With some teens, the orthodontist may decide that extra tension is needed outside the mouth if braces alone aren't enough to straighten the teeth or shift the jaw. In such cases, a patient may need to wear head or neck gear with wires that attach inside the mouth and elastic that attaches the gear to the head. Many times, someone will only need to wear this type of gear while sleeping or in the evening, while at home.

It may take a while, but with the right combination and timing of wires, springs, rubber bands, and sometimes head gear, the teeth will slowly but surely move into their correct positions.

Some of the adjustments can make your mouth feel a bit sore or uncomfortable because the tension tends to make itself felt in more places than your teeth. Most of the time, taking ibuprofen or acetaminophen can help relieve the pain.

If you always have a lot of pain after your braces are adjusted, talk to your orthodontist about it; he or she may able to make the adjustments a bit differently.

Caring for Teeth With Braces

Your orthodontist will make sure that you know how to take special care of your teeth while your braces are on.

Braces, wires, springs, rubber bands, and other appliances can act like magnets for food and plaque, which can leave permanent stains on the teeth if not brushed away. Most orthodontists recommend brushing after meals with fluoride toothpaste and taking special care to remove food stuck in braces. Some orthodontists will also prescribe or recommend a fluoride mouthwash, which can get into places in a mouth with braces that a toothbrush can't.

Some people with braces find that they are more prone to canker sores (from the braces hitting the inside surface of the mouth). If this happens, an orthodontist may recommend an over-the-counter medicine that can be placed directly on the canker sore to help heal it. Wax can sometimes be applied to wires or braces that are causing irritation.

Faces After Braces

After what can seem like a long time to someone who has braces, the magic day finally comes: the orthodontist takes the braces off! After your teeth are cleaned thoroughly, the orthodontist may actually want to repeat the process of taking X-rays and impressions of the teeth. This allows the orthodontist to really check the work, and in the case of X-rays, see if wisdom teeth are now visible.

In some cases, an orthodontist may recommend that a patient have wisdom teeth removed if they do not appear to be coming in correctly after the braces have been removed. The reason? The wisdom teeth may cause the newly straightened teeth to shift and move in the mouth.

And speaking of teeth shifting and moving, a very important part of orthodontic treatment is retention, or keeping the teeth in their new place. The truth is that most teens, after wearing braces and going for adjustments for up to 2 years or longer, don't want anything to do with the orthodontist or having appliances in their mouths.

But even though the teeth have been successfully moved, they are still not completely stable — they need to settle in their corrected positions until the bones, gums, and muscles adapt to the change. This is usually accomplished with the use of retainers, which work by retaining the straight position of the teeth.

Some retainers are made of clear plastic and metal wires that cover the outside surface of the teeth, whereas others are made of rubber. Most retainers need to be worn all the time for the first 6 months, then usually only during sleeping. How long a retainer must be worn depends on the patient — one person might wear it for a few months, while another might have to wear it for several years.

Whatever the timeframe, retainers are very important; without them, the teeth could shift back into their old, crooked positions, making all the orthodontist's work and your years of patience useless!

The most important things to remember when you're feeling frustrated about having a face full of braces? That during every school photo where you can't be persuaded to open your mouth because of your braces, there are millions of other people experiencing the same thing.

And that no matter what, your braces will come off eventually — and you'll be left with a wonderful, straight smile.

Reviewed by: Kenneth H. Hirsch, DDS
Date reviewed: January 2011