treatments > orthodontia (Braces)
What is orthodontic treatment?
Orthodontic treatment includes, the prevention, interception and treatment of non-ideal tooth positions (teeth which are crooked, protruded, etc.). Modern Orthodontics, however, reaches beyond the teeth, to the very jaws that contain them. Mismatches in the size and position of the jaws can be corrected if the patient is seen in her/his growing years.
To understand it better we have answered few of the commonly asked questions.
What causes orthodontic problems?
Most malocclusions are inherited, but some are acquired. Inherited problems include crowding of teeth, too much space between teeth, extra or missing teeth, and a wide variety of other irregularities of the jaws, teeth and face. Acquired malocclusions can be caused by trauma (accidents), thumb, finger or dummy (pacifier) sucking, airway obstruction by tonsils and adenoids, dental disease or premature loss of primary (baby) or permanent teeth. Whether inherited or acquired, many of these problems affect not only alignment of the teeth but also facial development and appearance as well.
Why is orthodontic treatment important?

Crooked and crowded teeth are hard to clean and maintain. This may contribute to conditions that cause not only tooth decay but also eventual gum disease and tooth loss. Other orthodontic problems can contribute to abnormal wear of tooth surfaces, inefficient chewing function, excessive stress on gum tissue and the bone that supports the teeth, or misalignment of the jaw joints, which can result in chronic headaches or pain in the face or neck.

When left untreated, many orthodontic problems become worse. Treatment by a specialist to correct the original problem is often less costly than the additional dental care required to treat more serious problems that can develop in later years.

The value of an attractive smile should not be underestimated. A pleasing appearance is a vital asset to one’s self-confidence. A person's self-esteem often improves as treatment brings teeth, lips and face into proportion. In this way, orthodontic treatment can benefit social and career success, as well as improve one’s general attitude toward life.

How do Braces work?

Having straight teeth is important. Teeth that are crooked or out of place (misaligned) affect the way a person chews and talks and how their smile looks. Because they have unnatural spaces, crooked teeth are harder to clean and are more likely to have cavities. In some cases, crooked teeth can affect the way the jaws line up and can cause pain and discomfort.

What are the types of braces?
Braces (Fig. 1) can be tooth colored (ceramic on the left) or metallic (on the right). We can add different colored bands to make them colorful (Fig. 2). Tooth colored braces help to avoid the metallic smile of metal braces.
Braces can also be lingual (normally called invisible) from the inside which are not seen when one smiles.
What is the ideal age for orthodontic treatment?

Children and adults can both benefit from orthodontics, because healthy teeth can be moved at almost any age. Because monitoring growth and development is crucial to managing some orthodontic problems well, we recommend that all children have an orthodontic screening no later than age 7. Some orthodontic problems may be easier to correct if treated early. Waiting until all the permanent teeth have come in, or until facial growth is nearly complete, may make correction of some problems more difficult.

An orthodontic evaluation at any age is advisable if a parent, family dentist or the patient’s physician has noted a problem.

Why should children have orthodontic screening no later than age 7?

By age 7, enough permanent teeth have come in and enough jaw growth has occurred that the dentist or orthodontist can identify current problems, anticipate future problems and alleviate parents' concerns if all seems normal. The first permanent molars and incisors have usually come in by age 7, and crossbites, crowding and developing injury-prone dental protrusions can be evaluated. Any ongoing finger sucking or other oral habits can be assessed at this time also. Some signs or habits that may indicate the need for an early orthodontic examination are:

early or late loss of baby teeth, difficulty in chewing or biting, mouth breathing, thumb sucking, finger sucking, crowding, misplaced or blocked out teeth, jaws that shift or make sounds, biting the cheek or roof of the mouth, teeth that meet abnormally or not at all, and jaws and teeth that are out of proportion to the rest of the face.

An orthodontic screening no later than age 7 enables the orthodontist to detect and evaluate problems (if any), advise if treatment will be necessary, and determine the best time for that patient to be treated.

Till what age can I do orthodontic treatment?
Healthy teeth can be moved at almost any age. Many orthodontic problems can be corrected as easily and as well for adults as children. Orthodontic forces move the teeth in the same way for both a 75-year-old adult and a 12-year-old child. Complicating factors, such as lack of jaw growth, may create special treatment planning needs for the adult. One in five orthodontic patients is an adult.
What are the benefits of early treatment?

For those patients who have clear indications for early orthodontic intervention, early treatment presents an opportunity to:

guide the growth of the jaw, regulate the width of the upper and lower dental arches (the arch-shaped jaw bone that supports the teeth), guide incoming permanent teeth into desirable positions, lower risk of trauma (accidents) to protruded upper incisors (front teeth), correct harmful oral habits such as thumb- or finger-sucking, reduce or eliminate abnormal swallowing or speech problems, improve personal appearance and self-esteem, potentially simplify and/or shorten treatment time for later corrective orthodontics, reduce likelihood of impacted permanent teeth (teeth that should have come in, but have not), and preserve or gain space for permanent teeth that are coming in.

What is the length of treatment?
Complete orthodontic treatment with fixed braces, usually lasts two years. This is a general approximation. Several variables beyond the control of the orthodontist like regularity of elastic wear, maintenance of the orthodontic appliance, regularity of appointments, etc. significantly influence the length of treatment. Treatment is usually followed by a period of retention.
What is retention?
Following active orthodontic treatment, a period of retention is almost always required. During this period, teeth and surrounding tissues are allowed to settle in their new positions, in a controlled manner. The length of retention varies widely; sometimes lifetime retention is required. Patient compliance with instructions during this period are particularly critical in determining the success (or otherwise) of treatment.
Is there any guarantee that my teeth will be straightened?
Unfortunately no. Anybody who claims to tame nature is only fooling him/herself and others. But the improvement from the original condition is significant enough and permanent enough to warrant orthodontic treatment.
Is orthodontic treatment painful?
Teeth often feel 'sore' in the first few days of treatment and also after activations of the appliance. This soreness is akin to the soreness you feel in your muscles when you work out after ages. It can't really be called pain, but rather, a tenderness. Modern pain killers are effective enough to take care of this problem. A lot also depends on the pain threshold of the patient and their attitude to treatment.
Are extractions a must for orthodontic treatment?
Absolutely not. In the days gone by maybe, but these days, every attempt is made to treat without unnecessary loss of teeth.
What happens to the space/s created by extracting teeth?
Although they look frighteningly large at the outset, these space close in the course of orthodontic treatment. No, they don't disappear into thin air. The orthodontist uses the space to correct the positions of the teeth.
Does orthodontic treatment cause cavities in my teeth/ does it lead to discoloration of my teeth?
The questions are related. It is important for the patient to keep his/her teeth spotlessly clean during treatment. Failure to do so can lead to food particles and plaque collecting next to the appliances. Bacteria which thrive in such media cause caries and discolouration, not the appliance/treatment itself.
Do I have to live on soft food during treatment?
Not at all. You can eat practically normally. You only need to avoid a few food items like hard candy, peanuts, chikki, aerated drinks, etc. You also need to change the way you eat (a bit). For instance, instead of biting into an apple, you need to slice it before you eat it. But only soft foods and soups, absolutely not.
How often do I need to visit the orthodontist during treatment?
Once again, there is no rule of thumb. Those undergoing treatment with fixed appliances generally need to come in every 5-6 weeks, once the appliances are on. With removable appliances you need to come in a bit more often. Once you are in retention, you need to come in once in three months. Those with fixed retainers can make do with yearly visits.
What if I need to take a vacation?
No problem. Since your appointments are usually, once every 5-6 weeks, most vacations are covered in this period. Even if you are away longer, it isn't usually a problem. You need to take extra care not to damage your appliance during your vacation, you may not find an orthodontist handy.
If I move to another city/country during treatment, can I continue treatment there?
This shouldn't be a problem, unless you are moving to a really remote location. Just make sure to carry a letter of referral from your orthodontist and also any records taken at the start of treatment, such as radiographs, study models, etc.
Can I play sports while wearing braces?
Yes. Wearing a protective mouthguard is advised while playing any contact sports. Your orthodontist can recommend a specific mouthguard.
What is relapse?
No matter how well the treatment is done, no matter how perfect your teeth look on the day your braces are removed, once the appliances are removed, some amount of change towards the original condition is inevitable. This is called relapse. The patient plays a huge role in minimising relapse, by wearing the retainers religiously, as prescribed by the orthodontist. The age at which treatment is done can affect the amount of relapse. Generally, older the patient, greater the amount of relapse. If a large amount of relapse is certain, permanent retention may be the solution.
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