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What is Orthodontia?
Orthodontia is the branch of dentistry that specializes in the diagnosis, prevention and treatment of irregularities of the teeth. Orthodontic appliances (braces) are used to make these corrections. Both fixed and removable orthodontic appliances are available.

Orthodontic treatment depends on the relationship between your teeth and your jaws. Some individuals have large teeth but small jaws while some have small teeth with large jaws and some have a combination of both. When the jaw size is small and the tooth size large the teeth may get crowded (irregularly aligned) on the jaws or jut out (proclined). In such cases the crowding and the proclination can be corrected through orthodontic braces after the extraction of two teeth in each jaw.
If the jaw size is large and the teeth size small it results in spacing between the teeth. The teeth may also be proclined. In such cases the teeth maybe corrected without extraction of any teeth.

Who can do orthodontic treatment?
When teeth are poorly positioned they can look unpleasant, and they are also more susceptible to periodontal (gum) diseases and dental decay. An incorrect bite can also lead to stress on your jaw joints (TMJ) or muscles, and can cause pain and discomfort. Orthodontic treatment can correct any of the problems related to proclination, crowding, spacing or improper bite (malocclusion) of the teeth. Anybody with good gingival (gum) and dental health can undergo orthodontic treatment.
Sometimes orthodontic treatment alone may not be enough to get a pleasing appearance. The shape of the face depends on the architectural framework of the facial skeleton. Jaw growth is a slow and gradual process and in some instances the upper and lower jaw or one side of the jaw to the other may grow at different rates. Orthodontic treatment can correct many problems if only the teeth are involved but if the jaws (bone) also need repositioning Orthognathic Surgery maybe required. An Oral & Maxillofacial Surgeon carries this out by repositioning one or more jaws (skeletal bones) through surgical procedures.

At what age can orthodontic treatment be done?
Orthodontic treatment can be done at any age. Usually it is started after all the permanent teeth have erupted. All the permanent teeth usually erupt by about 12 to 13 years of age. This is the best age to do the orthodontic treatment. The jaws are growing at this age and so it is easier to expand your jaws and reshape your mouth. Orthodontic treatment can easily be done at an older age, even after 40 years, if the dental and gingival health is good. But it is always better to finish orthodontic treatment by 20 years of age.

Interceptive orthodontics:
Orthodontic treatment is sometimes started at an early age, by 6 to 8 years of age. This is called interceptive orthodontics. The objective of interceptive orthodontic treatment is to make room in the child's mouth for all the permanent teeth to erupt in proper alignment. Yearly checkup of the child by the age of 6 years helps in diagnosing and early detection of any dental problem and a better treatment plan. Replacement of milk teeth occurs in chronological order depending on the development of permanent teeth below them. Preservation of milk teeth is extremely important till the eruption of permanent teeth to prevent malocclusions (incorrect bite) at a later date.

Thumb or finger sucking or tongue sucking is a habit that occurs with many infants. Your child will usually give it up naturally, by the age of four. If the sucking habit continues, beyond the time when permanent teeth start to erupt, your child may develop crooked or proclined teeth and a malformed palate (roof of the mouth). The severity of the problem depends on frequency, intensity, duration and also the position in which the finger is placed in the mouth. An appliance called a “crib plate or tongue guard” can be used as a reminder for the child to stop sucking. Parents should keep in mind that the best way to get children to stop sucking their thumbs is to praise them when they are not doing it, instead of scolding them when they are. It is also important to focus on the fact that many children suck their thumbs for comfort, so think about why your child may feel anxious or upset.
Another habit some children have is mouth breathing, which can lead to proclination of teeth or diseases of the gums. This can be corrected with a special appliance called “oral screen”, which is worn at night. But before this is used a complete ENT checkup is required to rule out any nasal blocks or adenoids.

Sometimes the upper two central incisors (front teeth) grow palataly (inside) to the lower incisors. This has to be corrected before the upper teeth have fully erupted, with the help of a special appliance called “inclined plane”. Otherwise it will retard the development of the maxilla (upper jaw) resulting in a “dish face” appearance, or may cause an anterior crossbite (incorrect bite).

Serial Extractions of milk teeth and the permanent first premolars during their eruption by the age of 8 years can facilitate the proper eruption of the permanent teeth, and prevent crowding. The growth pattern of the jaws and teeth can be predicted well in advance by studying the x-rays of the teeth and jaws. In some cases minor orthodontic correction may still be required after eruption of all the permanent teeth.

In children with cleft lip and palate correction the growth of the maxilla (upper jaw) is retarded. Some of the tooth buds may have been damaged or missing, resulting in some missing anterior teeth, depending on the region and the area of the cleft. Such children have to start orthodontic treatment by the age of 6 years, and may have to undergo treatment till 18 to 20 years of age. The orthodontist can stretch the upper jaw so that the maxilla is stimulated to grow, and all the teeth can fit properly into the dental arch. For this the orthodontist will install a special gadget on the palate (roof of the mouth) called a "palatal expander" to get your jaw to expand. Sometimes he may use an extra-oral appliance called “facebow” to pull the maxilla forward by using the forehead and the chin as anchorage. The missing teeth have to be replaced with implants or bridges. Some individual may have to undergo Orthognathic Surgery later to improve their facial profile further.

What are the causes of Malocclusion (incorrect bite)?
Malocclusion (incorrect bite) developed in man mainly over the last 10,000 years. As the diet and food habits changed people got bigger. The average height of an adult male increased from 4 ft (1.3M) 10,000 years ago to about 5 1/2 feet (1.9M) today. But the human jaws and teeth did not grow at the same rate. In many cases the man’s teeth was larger than the jaws. It has been estimated that in modern man, about 70% of the general population needs orthodontic treatment.
Some Causes of Malocclusion (incorrect bite) are

What are the different orthodontic appliances used?
Orthodontic appliances can be broadly classified as:

  1. Intra-oral Orthodontic appliances:
    • Removable: mainly used for interceptive orthodontics, as prevention or retention plates, etc.
    • Fixed: Beggs, Edge-wise, Straight wire, combinations etc.
      The main differences between the various fixed orthodontic appliances are the type of brackets (braces) and wires used. The Beggs appliance produces tipping of the teeth, while the others produce bodily movement of the teeth. The best results are seen in the straight wire technique, but then extra care also has to be taken by the individual.
    • Lingual orthodontic appliance is a technique where the brackets (braces) are fixed behind (lingual) the individual's teeth. They were used before the advent of  tooth coloured (orthocosmetic) brackets. Now lingual braces are rarely used. Occasionally an orthodontist may be convinced to use lingual brackets when the patient insists that the braces should not be visible. Lingual braces are much more uncomfortable than standard braces and more painful. The treatment takes more time (almost twice as long as with standard braces). Many people have trouble talking with lingual braces, as the movement of the tongue is restricted. Today, most orthodontists do not use lingual braces due to its many disadvantages.
  2. Extra-oral Orthodontic appliances:
    Headgear, Facebow, Chincap, etc. These are usually used along with the fixed orthodontic appliances.

Is extraction of teeth required for orthodontic treatment?
Extraction of teeth for orthodontic treatment is not recommended for all the cases. Extraction is done to create space for the movement of the teeth. The main reason for crowding or proclination of teeth is due to lack of space for the proper eruption of teeth in the jaws. The first or the second premolars are usually extracted. The space created by the extraction of teeth is completely used in moving the teeth backwards. Even though healthy teeth are removed for the orthodontic treatment there is no side effect of any kind, neither on the eyesight, brain or any other part of the body. The biting efficiency is also totally restored at the end of the orthodontic treatment. Some individuals have spaces between their teeth, in such cases the teeth maybe corrected without extraction of any teeth.

What are the precautions to be taken during fixed orthodontic treatment?
Generally, teenagers do not find braces to be any big deal. Your mouth is usually sore for the first week after the orthodontic appliance is fixed, as the lips and the tongue has to get used to the extra-fittings in the mouth. Extra care and good looking-after of the orthodontic appliance is required to get the best results after the treatment, which usually takes about 1 to 2 years to complete. The appliance does not affect the way you talk or the sound of your voice.

Maintain good oral hygiene throughout the treatment. Brush your teeth after every meal, as the food particles lodge in between the appliance and the teeth. Follow the correct brushing technique. Poor oral hygiene will lead to gum diseases and decayed teeth.

Brackets are specially shaped metal or ceramic pieces that the orthodontist affixes to each tooth with the help of special tooth bonding adhesive. The required orthodontic wire is fabricated and fixed to the slots of these brackets. The brackets have to be removed from the teeth after the completion of the orthodontic treatment, hence the adhesive used is not very strong, or you will never be able to remove the brackets from the tooth. Because of this, certain simple precautions have to be taken while eating certain foods like fruits, crunchy foods, meat, fried foods, any hard food substance, etc. You should not bite any thing with your front teeth to prevent the brackets from coming off. Only the posterior (back) teeth can be used for chewing and eating.

You should not take part in any contact sports including cricket, football, hockey, etc. Do not participate in any activity where there is any chance of injury to the face or the teeth.

You have to undergo regular checkups every three weeks or whenever the orthodontist asks you to. During the treatment you may be given special orthodontic elastics or headgears, which you have to wear properly in the prescribed manner.

Your complete cooperation is needed throughout the treatment period to get good and correct results. The success of the treatment is in your hands, as the movement of the teeth to the required position is a gradual process, lasting more than one year.

After the fixed orthodontic appliance has been removed from the mouth, you will asked to wear a removable "retainer" appliance (retention plate) for 24 hours a day, for 1 year or more. This removable appliance helps in bone formation around the teeth and retains the teeth in the “new” position. The appliance can be removed from the mouth only while eating or brushing your teeth.

* My Homepage * Know your teeth * Know your Gums (Gingiva) * Eruption Dates * Six Golden Rules * Brushing\Flossing Technique * Wisdom tooth * Tooth Decay * Extraction * Dental Implant * Surgical Extraction * Orthognathic Surgery * Asymmetry of the face * Gummy Smile * Prognathism{Long Jaw} * Beggs\Straight wire{Orthodontia} * Bleaching{Tooth Whitening} * Habit Breaking * Interceptive Orthodontics * Discolouration\Veneers * Composite\Amalgam Fillings * Root Canal Treatment{RCT} * Crown{Porcelain\Castmetal} * Flap Surgery/Splinting * Bridges{Porcelain\Castmetal} * TMJ (Joint) Disorders * Bell's Palsy {Facial Paralysis} * Ankylosis{Difficulty in mouth opening} * Cleft Lip and Palate * Trigeminal Neuralgia * In a Lighter vein

This site is produced, designed and maintained by
Dr Antony George, Trichur Institute of Head And Neck Surgery (TIHANS),
Shornur Road,Trichur,Kerala-680001,India.
Ph: 0091-0487-335145, 335185
email me
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copyright ©Aug 2000. No part of this website may be transmitted or reproduced in anyway. Every effort has been made to supply correct and accurate information, but I assume no responsibility for its use.

updated Aug2002.