An Overview of Orthodontics

Orthodontics is a specialized area of dentistry that focuses on the diagnosis, prevention, and treatment of conditions affecting the alignment of the teeth and jaw. Orthodontists and some general dentists design and fit corrective devices like braces, clear aligners, expander plates, and headgear to help bring the teeth or jaw into alignment.

There are many factors that can reveal why your teeth are crooked in the first place and what orthodontic options may be appropriate for you.

Well-aligned, straight teeth may be desired for aesthetic reasons, but, more importantly, they generally indicate an overall healthier mouth. 

Misaligned teeth and jaws can be related to uneven tooth wear, gum problems, breathing difficulty, poor oral hygiene (due to hard-to-clean teeth), speech development, and damage of the jaw joint.  

Orthodontic treatment can often deliver a smile that not only addresses these issues but helps you (or your child) feel more confident.

You may simply notice that your teeth, or that of your child, are not as straight as you'd expect (or hope) them to be. Some people are more susceptible to crooked teeth, though many of these problems can be caused by what someone is exposed to, such as breastfeeding or thumb sucking/pacifier use. 

Alternatively, your dentist may detect a problem that orthodontia can help with and suggest that you consider it. Some common ones include:

• Crowded teeth
• Underbite
• Open bite
• Crossbite
• Deep bite
• Spaced out teeth
• Wisdom teeth
• Missing teeth
• Impacted teeth

The teeth and jaw relationship begins right from birth, so it’s important to pay close attention to a child’s jaw development. By the time a child is 7 years of age, it's usually quite obvious to a dentist/orthodontist if a patient will have orthodontic problems, as most of the adult teeth should be present.

Primary care and ear-nose-throat doctors may also have a hand in suggesting orthodontic treatment. Your teeth are an indication of how your jaw and face are developing, and a poorly developed jaw may contribute to issues with airway function. Today, orthodontics can be performed to actually help people breathe better.

There are some signs that indicate that you/your child aren’t breathing properly:

• Mouth breathing
• Open mouth at rest
• Daytime sleepiness
• Memory/attention problems
• Dark circles under the eyes
• Snoring
• Bedwetting
• Sleep disturbance/poor sleep

A doctor may suggest orthodontic work as part of treatment for these concerns, sometimes after other assessments have been completed, such as a sleep study.

Early treatment is best, as it prevents problems from becoming more serious. Treatment can also be more difficult once growth has stopped. That said, orthodontic treatment can start at varying ages, depending on the case.

Before you get your teeth straightened, there are several stages you need to get through to achieve the desired end result:

1. Expansion: A special orthodontic device is used to expand the width of the palate or jaw, if necessary. This helps make more room for the teeth so they can come in as straight as possible. 
2. Correction: A correction device is then fitted to help correct the existing teeth. Adjustments are made as teeth move during treatment.
3. Retention: A second device, called a retainer, is fitted and expected to be worn regularly for another 12 months to prevent teeth from moving back into their old position. In the following year, patients are usually required to wear the retainer just at night.

In cases when you need help using your jaw in a way that will help correct your bite and prevent tongue movements that cause further displacement of your teeth, functional devices may also be recommended.

Braces (also known as brackets) are one of the most common orthodontic treatments. The thought of getting braces can be a little nerve-wracking for some people, especially if you have visions of those big, chunky metal braces from the 80s. However, braces these days are vastly improved from what they were decades ago, and they can be made from stainless steel, metal, ceramic, or plastic.

While ceramic or plastic braces may look better aesthetically, you need to consider that plastic may stain and discolor by the time you reach the end of your treatment.

In some cases, it may be suitable to use invisible, removable aligners that are changed every two weeks. They allow you to brush and floss normally, unlike traditional braces.

Your or your child's lifestyle and habits, along with your budget and insurance coverage, will all need to factor into what is ultimately chosen as well.

The process of being fitted with an orthodontic appliance begins with your orthodontist determining which one is suitable for your mouth. If braces are required, the first step is placing little brackets on your teeth and bonding them to the tooth with a special adhesive. Metal bands are applied to the back teeth, and wires are placed inside the brackets.

When you are fitted, your appliance will be fine-tuned by your orthodontist or dentist to apply slight pressure on your teeth, so they move in the desired direction. Because your teeth will move during treatment, you will need to have adjustments from time to time.

What you end up spending can vary depending on the extent of the treatment, what modalities are used, and your insurance coverage.

Traditional metal or ceramic (clear) braces start around $5,000. Behind the teeth, or sublingual, braces range from $5,000 to $13,000. Clear aligners, like Invisalign, can range from $3,000 to $8,000 depending on how many adjustments are needed.

At your initial consultation, your orthodontist or dentist should discuss options and costs. You should ask any questions during this time so that it's clear what is required to achieve the final treatment outcome from a time, commitment, and financial investment standpoint.

Many orthodontic offices will allow you to set up a payment plan for treatment.