How Do Braces Work?

How are patients treated with dental braces? How do they work?

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.

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.

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