There is usually some discomfort with the use of any orthodontic devices. The patient may feel pressure in the teeth as the underlying bone remodels. The cheeks or lips may be scratched by wires or other parts of the braces. In fixed braces, teeth pressure usually lasts 2-4 days after each adjustment. The patient is advised to eat soft foods and use mild pain relievers aspirin or acetaminophen (Tylenol) if needed. Soft orthodontic wax can also be used temporarily to cover new brackets until the cheeks become accustomed to them. Sores on the cheeks or lips may be protected by the use of Orabase GEL or Vaseline.

The average length of orthodontic treatment is approximately 2-3 years. However, there may be more than one phase of treatment. Very young children, ages 3-7, may only have expansion appliances for 4-8 months to correct narrow dental arches. In older children, phase I treatment usually starts around age 7-9 during "mixed dentition," when both baby and permanent teeth are present in the mouth. Removable or fixed appliances are used for 12-24 months to expand the jaws, to relieve crowding, and/or to align recently erupted permanent molars and incisors. The appliances are then removed or the child is given a retainer to wear for several years while the rest of the baby teeth fall out on their own. Around ages 10-13, Phase II treatment is begun for another 18-24 months to finish alignment of all the permanent teeth. Sometimes phase I and phase II are done consecutively without a rest period in between. In cases where there is only minor crowding or small problems, a one-phase treatment is started around ages 10-13 and usually lasts 18-36 months.

Prolonged treatment with fixed braces is generally discouraged because of hygiene problems or because the patient and/or parents become weary toward the end of treatment. Therefore, some removable appliances or rest periods may be used intermittently to give the patient a break from fixed braces.

When the patient is wearing fixed braces, oral hygiene is of utmost importance to avoid dental cavities and gum diseases. The patient is encouraged to use an electric toothbrush in addition to manual brushing. He/she is taught how to floss under the archwire on a daily basis. Both thorough home oral hygiene and 6-month dental cleanings by the dentist or dental hygienist are mandatory because fixed braces attract and collect food and plaque. For further information, please read the Gum Disease article.

Are teeth extractions part of orthodontic treatment?

Whether or not to extract any teeth and, if so, which ones should be discussed by the clinician and the patient on an individual basis. The current trend is towards nonextraction of permanent teeth whenever possible. Minor crowding can usually be relieved without any dental extractions by using fixed or removable appliances to expand the jaws.

Most patients seek orthodontic evaluations because they notice dental crowding in their mouths. Moderate to severe crowding can require extraction of teeth to relieve crowding. Which teeth to extract is controversial. Traditionally, the four first bicuspids (two from the upper arch and two from the lower arch) are extracted. Removal of the first bicuspids is easy to perform and is especially beneficial for those patients with protrusive looking faces. However, some dentists are now recommending removal of the second molars instead of the bicuspids to relieve crowding. The option to extract second molars is favored in some cases because it allows for a fuller smile with ten incisors and bicuspids in each arch as opposed to eight incisors and bicuspids. It also makes room for the wisdom teeth (third molars) to develop properly. In the absence of second molars, wisdom teeth generally erupt into the position of the second molars. Thus, the often difficult surgical extractions of wisdom teeth are avoided by allowing them to grow and erupt into the space of the extracted second molars. In the few cases where the wisdom teeth do not erupt into the vacated second molar positions properly, minor orthopedic appliances can be used at the time of their eruption to guide them into desired alignment.

What are retainers?

After active orthodontic treatment, most patients will need to wear a retainer for some time. Retainers are devices that help maintain the straight teeth alignment that was achieved by braces. Whether the retainer is fixed or removable and how long the patient needs to wear it varies greatly. These decisions are usually made by the dentist. A retainer can be a fixed wire bonded to the backs of the lower front teeth or it can be a removable plastic device with a single wire in the front. Some dentists believe that as the wisdom teeth erupt (around ages 16-25 years), they can push the front teeth and disrupt the alignment achieved by braces. Therefore, they recommend that the retainer be worn until the wisdom teeth have fully erupted into the mouth or have been extracted. Other dentists believe that the presence or absence of wisdom teeth have no effect on future relapse of front teeth crowding. These dentists believe that future teeth crowding may occur simply as a result of the growth of the mandible. Some studies have also shown that in cases where the second molars had been extracted and replaced by third molars (wisdom teeth), there was less relapse or crowding of the front teeth after completion of orthodontic treatment.

Dental Braces At A Glance

• Orthodontics is the use of devices to move teeth or adjust underlying bone.
• The ideal age for starting orthodontic treatment is between ages 3 to 12 years.
• Temporomandibular joint (TMJ) problems can be corrected with splinting or dental braces.
• Teeth can be moved by removable appliances or by fixed braces.
• Crowding of teeth can require extraction of teeth.
• Retainers may be necessary long after dental braces are placed, especially with orthodontic treatment of adults.