Dental Braces
(Orthodontics)

Why do people need dental braces?

Dental braces are used to straighten crooked teeth, align upper and lower jaws, improve the aesthetics of smiles and faces, and relieve pressure on temporomandibular joints. Orthodontics refers to the use of devices to move teeth or underlying bone.

Teeth can be moved at any age. "Ideal" results can be achieved in most children but only in a small percentage of adults. This is because in children both the bone around the teeth (alveolar process) and the jaw bones can be molded by braces as the child is growing. In adults the jaw bones can be altered only by surgery. Therefore, it is recommended that orthodontic intervention be considered as soon as a problem in teeth alignment is noticed by the child, parent, or dentist.

The ideal age for starting orthodontic treatment ranges from 3 to 12. In children, the goal of orthodontic treatment is not only to create straight well-aligned teeth, but also to improve the facial profile that will remain stable throughout adolescence and adulthood. Orthodontic treatment in adults is more difficult. Those who undergo treatment should be aware that they will probably need to wear a retainer at night the rest of their lives if they want to maintain the results of the treatment.

Sometimes braces are used as the end treatment of temporomandibular joint (TMJ) therapy. Problems of TMJ are usually aggravated by the lower jaw being positioned too far back so that the blood vessels and nerves of the TMJ are compressed. TMJ splint therapy is used initially to relieve this pressure and to reduce pain. The splint actually moves the lower jaw to a new position. If the patient does not want to wear a splint for the rest of his/her life, then the teeth must be moved to stabilize the jaws in this new position. This movement of teeth can be done by dental braces.

Orthodontic appliances can also be used to help a child overcome the infantile habits of sucking a thumb, finger, or pacifier. Sucking habits are usually not a major concern unless they are perpetuated after age 6 or 7, when the permanent incisors and molars start to erupt into the mouth. If these habits persist in the presence of permanent teeth, then permanent changes in the teeth and jaw bones are produced. Sucking habits can create open bites where the upper and lower front teeth do not meet. They can lead to protrusive teeth and upper lips and protrusive- looking faces in general. Excessive sucking causes the muscles of the cheeks to constrict the upper dental arch. This contributes to a loss of space for the tongue to rest, and subsequent abnormal tongue posture or tongue thrusting habits. Sucking also causes the maxillary sinuses to constrict, which aggravates breathing and allergy problems.

A variety of devices is used for different age groups. Some devices are only for infants to treat congenital defects such as cleft palates. Others are utilized only on baby teeth or in children who have both baby and permanent teeth (mixed dentition). Still others are employed when all the permanent teeth have erupted. Some orthodontic appliances used in children are actually orthopedic devices that redirect jaw bone growth.

How are patients treated with dental braces?

Teeth can be moved by a number of various removable appliances or by fixed braces, depending on the kind of problem that was originally present. Every patient is different and should be individually evaluated by the family dentist or by a specialist in straightening teeth, called an orthodontist. The decision to use removable and/or fixed appliances will depend on the clinician's training and experience and on the person's specific dental problems.

Patients fitted with removable appliances must wear these devices the number of hours prescribed by the clinician in order to achieve the desired results. The patient will need to maintain accurate records of daily wear and care for the appliance so as not to lose it or break it. Some removable appliances are also called "functional appliances" because their primary benefits are achieved when they are worn during eating.

Fixed braces usually include metal bands that are cemented to the molars, and metal brackets that are directly bonded, or glued, to the enamel of front teeth (incisors and bicuspids). Therefore, fixed braces should not be removable by the patient. A stainless steel archwire is used to connect the bands and brackets in each arch (one for the upper teeth and one for the lower teeth). It is the archwire that moves and straightens teeth. Sometimes, rubber bands are utilized to align the upper jaw (the maxilla) with the lower jaw (mandible). The patient is instructed to wear these rubber bands at least 14 hours a day and to change them twice a day. A headgear can be used to keep the upper jaw back as the lower jaw grows to catch up. The headgear is comprised of a facebow, or wires that fit into the molar bands, and a neckband that is worn behind the head.