Orthodontic braces

Also known as: Dental braces, orthodontic treatment

Anatomy or system affected: Mouth, teeth

Definition: A system, usually consisting of brackets and wires, placed in the mouth to move teeth by applying steady pressure. Orthodontic braces are used to straighten teeth, correct their spacing, and correct the contact between the teeth of the upper and lower jaws.

Indications and Procedures

Orthodontic braces are designed to correct cosmetic and structural imperfections of the teeth and jaw, such as crooked teeth and malocclusions. Braces apply constant, even pressure to move teeth into position for optimal spacing and alignment.

Dentists describe three types of malocclusion using the Angle Classification Method. Class 1 cases have an appropriate relationship between the upper and lower teeth, but the teeth may be crowded or rotated. In class 2 cases, the mandible is especially recessed relative to the maxilla; this is called an overbite. In class 3 cases, the mandible is more forward than the maxilla; this is called an underbite.

Malocclusions may result from physiological conditions such as early or late loss of baby teeth, tumors of the mouth or jaw, and jaw fracture. They may also result from habits such as nail biting, lip biting, and long-term sucking on thumbs, fingers, or pacifiers.

Dentists typically recognize malocclusions when a child’s permanent teeth erupt between the ages of six and twelve. Orthodontic treatment is most effective while the child’s jaw and teeth are still growing, between the ages of eight and fourteen.

Orthodontic treatment is most commonly performed by an orthodontist, a dentist with specialized training in the diagnosis and treatment of malocclusions. The patient's dentist refers them to the orthodontist who gathers data on a patient from which to make a diagnosis, customize a treatment plan, and measure treatment progress. These data come from a clinical examination, complete medical and dental histories, X-rays of the teeth (including those that have not yet erupted), X-rays of the face, impressions of the upper and lower teeth from which to make models, and photographs of the teeth and face. From the diagnosis and treatment plan, the orthodontist designs appropriate braces to correct the position and alignment of the teeth.

Braces that are attached to the teeth apply more pressure on the teeth than braces that are removable, and these fixed braces are used to achieve more difficult results. Braces consist of wires and springs that are positioned by brackets cemented onto the teeth or metal bands that wrap around individual molars. Elastic ties hold the wires to the brackets. Every four to six weeks, the nickel-titanium wires must be modified to keep the teeth moving, and the elastic ties are replaced. This adjustment is likely to cause temporary discomfort.

Braces are generally worn for eighteen to twenty-four months, although treatment can range from six months to three years. This period is dependent upon the severity of the malocclusion being corrected, the growth of the teeth and face, the health of the mouth, and the compliance of the patient in wearing elastics or headgear consistently.

Uses and Complications

When the size of the mouth is small relative to the size of the adult teeth, the teeth become crowded and may overlap, grow crooked (tipped forward or backward or twisted), erupt in the wrong position, or become trapped in the bone and not erupt.

Crowding also occurs when baby teeth fall out earlier or later than usual, interfering with the normal eruption of the adult teeth. Crowded teeth are difficult to keep clean by brushing, increasing the risk of tooth decay and gum disease. Therefore, relieving the crowding as a result of orthodontic treatment promotes oral health.

Orthodontic braces may also be used to correct other conditions that result from malocclusions, such as clicking, popping, and pain due to temporomandibular joint (TMJ) syndrome, difficulty chewing, speech impediments, overbite, underbite, and mouth breathing that can contribute to snoring and sleep apnea. In addition, straight, evenly-spaced teeth improve a smile, which can increase a person’s self-confidence.

Untreated malocclusions can lead to additional problems such as chipped or broken teeth, inadvertent biting of the lips, cheeks, and tongue, abnormal wear on tooth surfaces, trauma to the teeth and jaw muscles, bone loss, and loosening or loss of teeth.

Braces create spaces that easily trap food and bacteria, so it is especially important for a person wearing braces to brush regularly with a fluoride toothpaste, floss carefully, rinse with a fluoride mouthwash, and continue with regular dental visits.

Patients commonly feel discomfort when the braces are first attached and after each adjustment. This may interfere with eating. The lips, cheeks, and tongue may become irritated during the initial adaptation.

Foods that are sticky or especially hard may damage the braces. Sticky foods to be avoided include taffy, caramel, toffee, and bubble gum. Hard foods to be avoided include raw carrots, ice, nuts, and popcorn. If a bracket or wire comes loose, then the orthodontist needs to repair or replace it promptly.

Patients who wear braces and participate in contact sports should wear an appropriate protective mouth guard while playing.

Perspective and Prospects

Orthodontics as a specialty of dentistry arose in the 1880s, although people have long sought methods for straightening teeth. Norman W. Kingsley, J. N. Farrar, and Edward H. Angle are considered to be founders of this field.

Traditional braces with metal brackets and rugged metal wires are highly visible, which may make children self-conscious. Some orthodontists offer thin metal wires and ceramic brackets that are translucent and approximate the color of the natural teeth for a less noticeable appearance. Children who are not adverse to attention, however, may choose colored elastic ties for a more noticeable appearance.

Increasing numbers of adults are choosing to wear braces. Orthodontic treatment usually takes longer in adults because their teeth and bones are no longer growing, but many cosmetic and functional problems may still be corrected. Lingual braces can be placed on the side of the teeth to minimize their appearance. Clear plastic aligners such as Invisalign are also popular among adults because their presence is less noticeable than traditional braces. Self-ligating braces became a new technology in orthodontics in the twenty-first century. This method eliminated the need for elastic bands, increased patient comfort, and were less visible. All advances in orthodontic braces focused on efficiency, cost, and comfort.

Bibliography

“The Evolution of Orthodontic Technology and Techniques 2023.” Valley Smiles, 7 Mar. 2023, valleysmilesphx.com/evolution-of-orthodontic-technology-and-techniques. Accessed 31 July 2023.

Gill, Daljit S. Orthodontics at a Glance. Wiley-Blackwell, 2008.

Graber, Lee W. Orthodontics: Current Principles and Techniques. 6th ed., Mosby, 2016.

Mitchell, Laura. An Introduction to Orthodontics. 4th ed., Oxford UP, 2013.

Nanda, Ram S. Biomechanics in Orthodontics: Principles and Practice. Quintessence Publishing, 2010.

Proffit, William R. Contemporary Orthodonics. 5th ed., 2012.

Singh, Gurkeerat, ed. Textbook of Orthodontics. 3rd ed., Jaypee Brothers, 2015.