Orthodontics

Why do people have malocclusion?

Numerous are the causes of malocclusion. The following are some of the more common causes.

Heredity- The genes are probably the most important factors. Many disorders in the arrangement of the teeth are inherited.

Thumb sucking and other habits- Children at times tend to develop habits such as sucking of the thumb or fingers, lip sucking, lip biting etc. Presence of thumb sucking or finger sucking till 2-3 years age does not usually produce any ill effects on the teeth and the jaw bones. Continued sucking of the thumb beyond 4 years of age very often causes protrusion of the teeth and other abnormalities in the bite.

Use of pacifiers- Children who have used pacifiers for too long tend to develop some problems of the bite

Injuries- Injuries to the teeth or the bone during childhood may cause abnormalities of the bite.

Dental decay and diseases of the gums - They may sometimes cause drifting of the teeth and therefore problems of the bite.

Is orthodontic treatment necessary for all children?

No. when there is spacing between teeth, crowding or proclination of teeth orthodontic treatment is advised

Things that alert you to go to an Orthodontist

Parents are often worried about their children's teeth. It is a good idea to consult your orthodontist if you have any doubts about your child's bite. The presence of certain features should alert you to seek professional advice from an orthodontist.

Teeth that are erupting too close to one another or are crowded together.

Teeth that are too far apart or spaced teeth

If the front teeth are too far forward and the lip does not cover the teeth.

Continued presence of habits such as finger sucking beyond 4 years of age often requires professional assistance to discontinue the habit and to rectify the damage done to the bite.

Normally the upper teeth are ahead of the lower teeth. In case the lower teeth are ahead of the upper it is called cross bite and should alert you to immediately seek professional advice.

If a space exists between the upper and the lower teeth when the teeth are brought together. This is called open bite and signifies improper bite that requires orthodontic care

Presence of a space in the middle between the 2 incisors. This is called midline diastema.

Difficulty in pronunciation of certain words or lisping.

Children who breathe through the mouth due to some nasal problem or as a habit.

At what age is orthodontic treatment done ideally?

Ideally it is indicated when all the permanent molars have erupted or in the process of shedding at about 11 or 12 years. Some children may need them even earlier. When the children have a prominent mandible this should be corrected much earlier during the growth phase about 9 or 10 years. When there is a cross bite i.e. the reverse of normal upper tooth placed inside and lower tooth placed outside it can be corrected as when the tooth erupts.

What happens if the treatment is delayed?

At an early age the braces are less painful and the treatment duration is shorter. Advancing age makes the jaws harder and therefore makes it difficult to mold the jaws and to move the teeth. As mentioned in the earlier section, in younger individuals it is possible to prevent and intercept the developing problems. But orthodontic treatment can be carried out at any age.

How long does orthodontic treatment take?

The duration of treatment depends from person to person and from one orthodontist to other. Most jaw molding and jaw corrections carried out during the growing age takes 1-11/2 years. Orthodontic treatment with braces often takes 2 - 2 1/2 years. The orthodontist would advice you on how long the treatment is going to take after studying the case.

Do braces hurt and cause sores in the mouth

Initially for a few days after the braces are fixed, the mouth tends to be sore and some pain can be expected. Much depends on the pain perception of the individual and his pain tolerance. However pain is expected for a few days after braces are fixed and every time your orthodontist tightens them. Sores may develop on the cheeks or lips or the tongue after the braces are fixed. These often heal in a few days. You can use orthodontic wax to screen an area of the braces that are sharp and hurting.

In addition warm salt water rinsing of the mouth help heal the sores. If the braces are damaged and therefore hurting the cheeks or lips you should immediately seek orthodontic consultation.

Should sports activities be avoided?

Well having the braces should not prevent you from carrying on normal daily activities. However care should be taken during sports activities as you may fall and injure the mouth and teeth. Tell your orthodontist about your sports activities so that he prepares a mouth guard for you. The mouth guard should protect you from inadvertent injuries during sports. It is advisable to avoid contact sports such as boxing, wrestling, karate, judo etc where injury to the jaws and mouth can occur.

Will I experience any difficulty in talking?

Most orthodontic braces do not interfere with talking. However the orthodontist may at times give you a removable plate to wear. This could cause difficulties in speaking for a few days. However you get used to it very soon and start talking normally.

Are there any restrictions in eating when the braces are on?

Initially once the braces are fixed the mouth tends to be sore for a few days. During this period it is better to have soft food. You should be careful in avoiding hard, crunchy and sticky food such as toffee, nuts, chocolates and gums as they may break the braces that are fixed to your teeth. When you are eating fruits like apple make sure you cut them into pieces before you eat them. It is better to avoid meat with bones.

Do the braces come off?

Sometimes a part of the braces comes off. This may occur when you bite on a piece of hard food. The orthodontist will then have to fix it for you. It is advisable to immediately seek an appointment if a part of the braces falls off. It is better to take care of the braces by following the do's and don'ts so that they do not break frequently as this delays the treatment.

What happens if you swallow a loose piece of braces?

Accidental swallowing of a small piece of the braces that becomes loose usually does not cause any harm. They are likely to pass down the digestive tract and make their exit. However accidental inhalation is a more serious problem and may require medical attention to remove them. However such incidences are rare.

Does it hurt when the braces are being fixed?

It does not hurt when the braces are being fixed. The soreness and pain start after a few hours. You can ask the dentist to prescribe a pain reliever for you like aspirin. You can use wax over areas of the braces that hurt the lips or cheeks. Sometimes the wire starts piercing the cheeks from the end of the braces after a few days or weeks of treatment. This is because the teeth have already started moving. So you can go to the orthodontist and have the wire trimmed.

How long does it take to fix the braces?

The braces take about 11/2 - 2 hours to fix. So keep yourself free to be with your dentist for a few hours. You can even take half day off from office or school.

Do I have to go back to the orthodontist after the fixation?

The orthodontist schedules an appointment after 4-6 weeks. The follow-up orthodontic appointment is every 4 weeks. During these appointments the dentist may change the wires as the desired results are achieved and may even tighten the braces. Teeth move very slowly (about 1mm /month). The force applied on the tooth by the braces should be tolerable by the teeth and the comfort of the patient. So the tightening is done gradually at regular appointments so that the teeth and the surrounding tissues are not hurt.

Does it hurt while removing the braces?

Once the treatment is completed the orthodontist will remove the braces. It does not cause any pain to remove the brackets. They are easily removed by using special pliers.

Do I have to wear elastics?

Many a times the orthodontist advises you to wear some rubber bands. These are called elastics and are meant to deliver forces on the teeth to move them to the desired position. The orthodontist would advice you on how to wear them. They are to be removed while eating and replaced with new ones. Many orthodontists advice fresh elastics every 24 hours. The elastics come in various sizes and you should wear the ones prescribed by the dentist. Do not be over enthusiastic and wear more number of elastics. This can harm the teeth. Your orthodontist knows what is best for you. You can ask the orthodontist for flavored rubber bands.

What happens if i don't change the rubber band?

For one the teeth would stop moving. Thus the duration of the treatment would be prolonged. Old rubber bands also snap off and cause a little pain in the mouth.

What happens if I swallow the rubber band?

Accidental swallowing of a rubber band will not hurt you. They come off the next day in your feces.

Any special oral hygiene procedures during the treatment ?

Regular brushing and flossing should be carried out. Try to brush your tooth after every meal and before sleeping. The braces trap foodstuff under them and predispose to dental decay and gum problems. Thus good hygiene is a must when the braces are on. The dentist may prescribe a special orthodontic toothbrush for you. Fluoridated toothpaste may also be prescribed by your orthodontist to help prevent dental decay.

What are retainers?

Once the braces are removed the orthodontist will give you a retainer. A retainer is a removable type of braces that you can remove and replace in the mouth. These should be worn for a few months throughout the day and later for a few hours a day. The orthodontist would advice you on how long you have to wear them. Another type of retaineris a fixed one that is fixed on the back side of the front teeth. These cannot be removed by the patient.

Why use retainers?

One of the greatest challenges faced by the orthodontists is the relapse of treatment. This means that the teeth tend to go back to the original position. This occurs due to a number of factors. This is avoided by wearing the retainers that holds the teeth in the corrected position. The retainers give time for the bone and other tissues around the teeth to adapt to the new position. In case you are too absent minded and tend to loose your retainer or misplace them or forget to wear them you can ask the orthodontist to give you a fixed retainer that you cannot remove. Some patients have to wear the retainer permanently.

What are face bows?

The orthodontist may prescribe the use of a face bow. The face bow is a steel framework in the form of a bow that is inserted into small tubes fixed on the molar teeth. The outer part of the bow is attached to elastic straps that are anchored on to the neck or the head. The purpose of the headgear is to aid your braces in keeping the back teeth in their position or even to push them further back. Some orthodontists don't prescribe the use of these headgears as they may at times snap off and rarely even pierce the eye. In case your orthodontist feels that you have wear one, take care to protect them by avoiding playing etc. with them. They are often worn for 8-12 hours a day.

Am I too old for orthodontic treatment?

Well to be honest you can have braces at any age provided of course that your gums and surrounding tissues are in a healthy state and you maintain good oral hygiene. As you get older your tissues become less elastic and the bone gets harder. So the duration of the treatment is likely to be more and you tend to have more pain during the treatment.

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