All About Orthodontia

What Is Orthodontia?

Orthodontia (or-thuh-DON-shee-uh) is the branch of dentistry that helps fix problems with how the teeth and jaws line up. For example, some teeth may grow in crooked or overlapping. Some may grow in rotated or twisted. Some people's mouths are too small, crowding the teeth and shifting them into crooked positions.

Orthodontists — dentists who diagnose and treat misaligned teeth and jaws — can help with all these problems and more using braces and other tools.

Why Do People Need Braces?

Braces help straighten teeth. As you made your way through childhood, your "baby" teeth fell out one by one, replaced by permanent adult teeth. Some people's adult teeth grow in at the right angle and with the right spacing. But many people's teeth don't. They can grow in cooked, crowded, or overlapping.

A person also could have an upper jaw and lower jaw that are different sizes. When the lower half of the jaw is too small, it makes the upper jaw hang over when the jaw is shut. This is called an overbite. When the opposite happens (the lower half of the jaw is larger than the upper half), it's called an underbite.

When teeth don’t line up as they should, this can interfere with chewing. Teeth that aren't aligned correctly also can 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.

What Happens at the Orthodontist’s Office?

When someone has problems with how their teeth or jaw are positioned, their regular dentist may send them to an orthodontist (or-thuh-DON-tist) for braces.

The orthodontist will diagnose what the problem using several different methods, often including X-rays, photographs, impressions, models, and computers.

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

And finally, the orthodontist might need to make an impression the patient's teeth. To do this, the patient bites down on soft material that forms an exact model of the teeth.

When a diagnosis is made, the orthodontist will decide on the right kind of treatment. In some cases, removable retainers or other equipment is all that's needed. 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 apply steady pressure. Braces successfully change the position of teeth this way and are adjusted slowly over time by the orthodontist.

What Are the Types of Braces?

Many braces are made of lightweight metal and 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. These braces are less noticeable than metal ones, but can stain easily and are often more expensive. Some patients get braces on the inside surfaces of the teeth. These can be expensive and are harder to keep clean than traditional braces. 

Braceless orthodontics use a series of custom-made clear, removable appliances that are worn for set amounts of time. They slowly put pressure on the teeth to move them gradually into their correct position. This type of treatment isn’t right for everyone. Your dentist or orthodontist will let you know if it might work for you.

Correcting the position of the teeth can take from 6 months to 2 or 3 years with any of these methods.

Patients must come for regular visits, usually once every month or two. During the visits, the orthodontist attaches wires, springs, or elastic bands to the braces to add more tension and pressure on the teeth and get them to move into position.

With some teens, the orthodontist may decide that extra tension is needed outside the mouth. If so, the 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. Often, they 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, elastic bands, and sometimes head gear, the teeth will slowly but surely move into their correct positions.

Some adjustments can make your mouth feel a bit sore or uncomfortable. Taking ibuprofen or acetaminophen usually can help ease any pain.

If you have a lot of pain after your braces are adjusted, talk to your orthodontist about it. They might be able to make the adjustments a bit differently.

How Do I Take Care of My 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, 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 also prescribe or recommend a fluoride mouthwash, which can get into places in a mouth with braces that a toothbrush can't. It’s important to go to the regular dentist for full cleanings too.

Some people with braces find that they get canker sores from the braces hitting the inside surface of the mouth. If this happens, an orthodontist may recommend an over-the-counter medicine to put directly on the canker sore to help heal it. Wax applied to wires or braces that cause irritation also might help.

What Happens After Braces Come Off?

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 cleaning your teeth, the orthodontist may want to repeat the process of taking X-rays and impressions of the teeth. This lets them check their work, and in the case of X-rays, see if wisdom teeth are now visible.

In some cases, the orthodontist may recommend removing the wisdom teeth if they don’t appear to be coming in correctly after the braces are off. Crooked wisdom teeth may cause the newly straightened teeth to shift and move in the mouth. They also can get painful or infected, or cause damage to nearby teeth.

And speaking of teeth shifting and moving, a very important part of orthodontic treatment is keeping the teeth in their new place. Even though the teeth have been successfully moved, they’re still not completely stable. They need to settle in their corrected positions until the bones, gums, and muscles adapt to the change. To help with this, someone might wear a retainer, which works by “retaining” (keeping) the straight position of the teeth.

Some retainers are made of clear plastic and metal wires that cover the outside surface of the teeth. Others are made of clear plastic. Most need to be worn all the time (other than for eating) for the first 6 months, then only during sleeping. How long someone wears a retainer varies — 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.

If you're feeling frustrated about having braces, remember that they will come off eventually — and you'll have a wonderful, straight smile.