Braces are a common and almost expected part of growing up (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
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
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
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
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.
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, models, and computers.
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
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.
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
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
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
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. Wisdom teeth that are not coming in correctly can also become painful,
infected, or cause damage to nearby teeth.
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.