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Frequently Asked Questions
- Who can benefit from orthodontic treatment?
- When do I need to consult an orthodontist?
When does orthodontic treatment usually start?
Start younger, finish sooner?
- Am I too old for braces?
- Can’t we just do it with a retainer?
- Do you always need braces on all the teeth?
- Why do some people have to wear a headgear and/or rubber bands?
- Why is it sometimes necessary to have perfectly healthy teeth pulled? Baby teeth or permanent teeth?
- What are “ankylosed” teeth?
- What are “impacted” teeth?
- How many malocclusions (bad bites) are there?
- What are space maintainers?
- When do baby teeth usually fall out?
- What are “Functional Appliances”?
- Do braces help if I grind my teeth?
- I am told I have “TMJ”. Will braces help?
- Can teeth that have had a root canal be moved with braces?
- I had other dental work done such as crowns, a bridge, an implant or maybe a partial denture, can I still have orthodontia done?
- I am considering playing a wind instrument, should I be concerned about wearing braces?
- Can chronic mouth breathing affect one’s teeth?
- Can I wear braces when engaged with sports activities?
- What is a “Positioner”?
- How long do I need to wear my retainer(s)?
- What types of retainers are there?
- I had braces before, now my teeth have moved, do I need braces again?
- Why do some people need jaw surgery?
- What is “implant anchorage”?
- What about the need for braces with a Cleft Palate?
- What things can I do to shorten my treatment time?
- Who can benefit from orthodontic treatment?
Just about anyone at any age with poorly aligned teeth and/or improper occlusion (bite). Ask your dentist or an orthodontist if it would be beneficial for you. If you do not like the appearance of your teeth or smile, this may also be reason enough for you to find out what can be done about it.
Many adult patients may also benefit from having either partial or comprehensive orthodontic treatment done prior to having extensive restorative (bridges, crowns, implants) or periodontal therapy. Close communication and joint treatment planning between the restorative dentist/periodontist with the orthodontist can yield the best overall results.
It is always best to consider the entire mouth first, rather than just one tooth at a time if possible.
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- When do I need to consult an orthodontist?
When does orthodontic treatment usually start?
Start younger, finish sooner?
It may be best to try and answer these questions together:
The American Association of Orthodontists and Dr. Khouw recommend that children be first seen for an initial evaluation around age seven. This does not mean that treatment necessarily needs to start that young, but it allows the orthodontist to determine which children may benefit from an early stage of intervention, and which (likely most) would benefit from periodic observation during ensuing years of growth and changes in the dentition and facial structures.
Some will benefit from orthodontic treatment involving guidance of facial growth, such as in severe overbite or underbite cases, or relief of severely crowded teeth through early sequential removal of teeth where indicated, and others may have teeth erupting in such poor positions that early correction can prevent injury to teeth or gums.
Where indicated, an early treatment phase can make later treatment easier and shorter. Ultimately, it depends on the individual patient’s needs. It is up to the orthodontist and the patient (or parents) to determine what overall treatment approach would not only be best for them, but also most time and cost effective. It is therefore not necessarily true that the earlier treatment is started, the sooner it is finished, because ultimately all the permanent teeth need to be in the mouth and aligned, and a significant part of facial growth is not completed until the teenage years. However, it is better to find out sooner than later what might be indicated for your child.
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- Am I too old for braces?
That depends totally on your personal attitude. It depends on how old you feel yourself to be, but from a strictly biological standpoint people are rarely if ever too old for braces. Our oldest patient on record started treatment when she was 76 years of age, and was thrilled with having had the treatment completed a year and a half later. She always wanted straight teeth and finally had the opportunity to have it done, with the kind support of her loving husband. I cherish having had the opportunity and pleasure to work with that lovely couple and give her what she always wanted. I shall remember it for years to come.
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- Can’t we just do it with a retainer?
Real “retainers” are to retain teeth in a given position, and rarely meant to move them into different positions. However, people tend to call any removable orthodontic appliance a “retainer”, and this creates confusion. There are indeed some removable appliances that can be designed to move teeth, albeit with some limitations. They generally cannot provide the same control over tooth movement as fixed braces can. Thus, for more complex tooth movements, such as bodily tooth movement, treatment with fixed brackets is superior. The same limitations apply to the use of so called “aligners” with Invisalign treatment. They can be very useful in some carefully chosen situations, where more limited objectives exist, but they are no equal replacement for treatment with fixed brackets, either on the outside (labial) or the inside (lingual) surfaces of the teeth.
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- Do you always need braces on all the teeth?
No, it depends on the problem and what the objectives are at any given time. In most cases requiring comprehensive treatment however, it usually works best when all teeth are repositioned (and thus braced). Ultimately the teeth have to align well and fit properly relative to one another. Your orthodontist is the best person to determine what is best for you.
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- Why do some people have to wear a headgear and/or rubber bands?
Depending on what the situation calls for, a headgear, like any other auxiliary orthodontic appliance, may be called for to achieve certain objectives, whether it is to influence growth of the jaws, or make more space for teeth- or both. Rubber bands (elastics) stretched between teeth are prescribed to exert a pulling force between them. It goes without saying that it is very important for the patient to follow instructions from the orthodontist with the wear of headgear and/or elastics in order to make treatment progress as best and quickly as possible.
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- Why is it sometimes necessary to have perfectly healthy teeth pulled? Baby teeth or permanent teeth?
In the case of permanent teeth, this is sometimes necessary to provide space for other teeth, either because of severe crowdedness or protrusion of teeth. This is entirely dependent on the specific treatment objectives for the individual patient by the treating orthodontist. You can rest assured that the doctor does not take such a decision lightly and will consider all aspects of treatment very carefully, as well as any other options that might be available as an alternative treatment solution. This can involve such things as the use of auxiliary appliances (e.g. headgear) or even newer treatment methods using the temporary use of implant or mini screw anchorage.
As far as baby teeth are concerned, they too may need to be removed to provide space as part of a so-called serial extraction sequence, or because they are over-retained and not loosening when they should. The latter can cause impaired eruption of the underlying permanent teeth.
In the case of tooth ankylosis (fusion to the surrounding bone) of either permanent or baby teeth, extractions are frequently indicated. Such teeth cannot be moved with conventional orthodontic means. They may not only affect eruption of other teeth, but also positions of adjacent or opposing teeth. They can also affect the growth of the jaw bone where they are located.
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- What are “ankylosed” teeth?
These are teeth, baby or permanent, that for some unknown reason become fused to the surrounding bone. Trauma such as a severe blow to a tooth, or re-implantation after a tooth was evulsed, are known reasons for possible ankylosis of teeth. It is not that uncommon for certain baby teeth to become ankylosed-for as yet unknown reasons.
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- What are “impacted” teeth?
One usually refers to impacted teeth as teeth that are somehow prevented from erupting normally into the oral cavity. This could occur from being blocked by other teeth, or because they formed and grew into an abnormal direction, or sometimes they can become blocked by other obstructions such as a cyst, an extra tooth or tooth-like structure. In rare instances they may even ankylose (become fused) before having fully erupted. People often hear of impacted wisdom teeth (third molars) because those frequently lack enough space in the dental arch to erupt normally. Another tooth that is known to become impacted occasionally is the upper permanent canine. This tooth normally erupts in the teenage years. If it has not, you may want it checked by your dentist or orthodontist.
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- How many malocclusions (bad bites) are there?
In a word: many. The almost infinite variations in possible abnormalities of the jaws and teeth make for a great deal of variations. The orthodontist generally categorizes them in different “Classes”, characterized by deviations in the three planes of space: front to back (sagittal), side to side (transverse) and up and down (vertical). They can result in excessive overbites, underbites, crossbites or any combination. Furthermore, teeth can be crowded or spaced depending on too much or too little space in the dental arch.
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- What are space maintainers?
As the name implies, these are appliances designed to maintain space between teeth, hopefully inserted before space is lost by drifting of the teeth. After space has become lost, space maintainers only maintain whatever space is left. If more space is needed, space gaining appliances are needed to regain the needed space. Space maintenance is often needed if premature loss is incurred by early removal of a back baby tooth due to excessive decay or an abscess. When in doubt, ask your dentist or an orthodontist if a space maintainer is indicated, as it clearly depends on other factors as well.
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- When do baby teeth usually fall out?
There is a great deal of variation among individuals. But for the most part, the front baby incisors are the first to exfoliate and be replaced by the permanent ones (usually before age nine).
The lower baby cuspids (canines) or “ eye teeth”- third ones from the front center, usually loosen up around eleven, the ones behind them thereafter and the last baby molar ( in front of the six-year molar) as a teenager. This is a baby tooth which sometimes becomes over retained. When it starts looking lower than the permanent tooth behind it, you may want your dentist to check it out.
In the upper arch, variation is equally common, but there the baby first molar (fourth one from the centerline) is usually the first one to loosen up and fall out. Unlike in the lower jaw, the upper permanent canine (cuspid or “eye tooth”) is often the last one to erupt. That is one reason why in cases where there is insufficient space, these teeth erupt high on the outside (“fangs”) or sometimes become impacted in the roof of the mouth. Age thirteen/fourteen should show signs of this tooth coming in, if not, check with your dentist or an orthodontist.
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- What are “Functional Appliances”?
Such appliances generally refer to the multitude of appliances developed in many different parts of the world, mostly by European orthodontists who want to try and alter jaw growth and development. They may be used as a precursor to additional treatment with braces later, and are more commonly employed with younger children. They rarely are the only appliance necessary to correct a malocclusion, but sometimes can achieve remarkable changes on their own. They are not for everybody, no magic appliances nor a panacea. Careful case selection by the orthodontist and patient compliance with wear as instructed is the key to success.
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- Do braces help if I grind my teeth?
There are many factors that can cause people to grind their teeth, many unknown. An improper bite can be one of the factors, but rarely is the only cause. Careful evaluation by the dentist or orthodontist of the bite in function may be helpful in determining if it plays a contributory role. Stress is one of the most common denominators in people who grind their teeth. Careful equilibration by the dentist or the use of a specially designed orthotic in conjunction with stress management may be something to be tried before braces.
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- I am told I have “TMJ”. Will braces help?
Like tooth grinding, so-called “TMJ” can have many causes, stress being a prime factor. TMJ really is an acronym for Temporo Mandibular Joint - the jaw joint. It being the most complex joint in our body, many things can affect its function. Hence it should be no surprise that the way the teeth function together is (only) one of them. Function and condition of the surrounding soft tissues, including muscle and ligaments, arthritic changes to the cartilage and bony elements caused by systemic factors, habits (such as clenching or grinding) and last but not least trauma such as by a jarring blow to the jaw can all cause or contribute to TMD, a better word to describe temporo-mandibular joint dysfunction. So there is no simple answer to this question. Get an examination by your dentist or an orthodontist for more information.
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- Can teeth that have had a root canal be moved with braces?
The quick answer is yes, unless the tooth is ankylosed. Whether or not it is appropriate should be decided by your dentist or an orthodontist.
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- I had other dental work done such as crowns, a bridge, an implant or maybe a partial denture, can I still have orthodontia done?
Implants cannot be moved by braces. But natural teeth can. So except for the implants all teeth including ones with crowns can be moved. However, repositioning those teeth will likely mean the need for having crowns, bridges or partial dentures redone when orthodontic treatment is performed. This is something to discuss with your dentist and the orthodontist the dentist works with.
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- I am considering playing a wind instrument, should I be concerned about wearing braces?
Not necessarily, depending on what instrument, frequency of play, it may or may not be a factor. Consult an orthodontist.
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- Can chronic mouth breathing affect one’s teeth?
Chronic mouth breathing can be a symptom of other abnormalities such as enlarged tonsils or adenoids. These in turn can affect habitual tongue posture. This in turn is thought by many to contribute to abnormal growth and shape of the facial structures including the jaws. (“adenoid facies”). When this happens, the way the teeth fit together will likely be affected too. Furthermore, chronic mouth breathing can have a drying effect on the gums, causing the gums to become red and swollen. This is something you may want to consult an orthodontist about, and in some instances he may refer you to an otolaryngologist ( ENT physician). Other nasal constrictions can cause mouth breathing as well, such as nasal polyps, septal deviations and chronic allergies.
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- Can I wear braces when engaged with sports activities?
Yes, but wearing specially designed mouth guards to be compatible with the braces is recommended. Your orthodontist will have the right one for you.
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- What is a “Positioner”?
As the word implies, it is an appliance, usually made of relatively soft resilient material, specially constructed for you to slightly reposition your teeth. It may be prescribed by the orthodontist after the braces come off to fine tune the fit or your teeth. It resembles a mouth guard somewhat. Like with all orthodontic appliances, it will only work if worn enough as instructed by your orthodontist. Not doing so is short changing yourself.
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- How long do I need to wear my retainer(s)?
A simple answer would be forever- if you expect the teeth to stay exactly where they were when your braces came off. The body constantly changes, and the jaws and teeth are part of it and no exception. Changes with growth, function, habits, changes caused by teeth being removed, periodontal deterioration, genetic factors, fillings, crowns or other dentistry may all affect the tooth alignment. Only plaster teeth don’t move. Just as an orthodontist can move teeth over and over again, retreat misaligned teeth, so can other factors move teeth, and they frequently will. Some changes are more likely to occur than others, depending on how the teeth were before treatment.
On the other hand, some minor changes may be acceptable to you as a patient in exchange for not having to wear retainer(s) forever. That is a risk-reward decision for you to make. You may want to consult your orthodontist on this. There is no one easy answer.
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- What types of retainers are there?
Many, ranging from removable to fixed ones. Some are visible, others less so or totally invisible- such as a retainer wire bonded to the inside of the teeth. You can consult your orthodontist which is the right one for you.
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- I had braces before, now my teeth have moved, do I need braces again?
Not necessarily so, depending on how much and how they moved. Very often, minor realignment can be done with simpler appliances such as clear aligners or other removable appliances. Ask an orthodontist.
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- Why do some people need jaw surgery?
Sometimes the disharmony between jaws and/or other facial structures is severe enough to require surgical modification if the optimal result in overall fit of the teeth as well as facial esthetics is desired. Only a qualified orthodontist (after careful analysis of the face and jaws) can determine this for you. If this should be the case, then they will likely work together with a specially trained maxillo-facial surgeon.
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- What is “implant anchorage”?
The orthodontist may suggest the use of temporary implants or little screws inserted in the jaw or palate to help move teeth that otherwise cannot be moved in a desired direction, for lack of other “anchorage”. Hence the word “implant anchorage”. Such devices are usually made of bone compatible material such as titanium, same as in implants used to replace missing teeth.
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- What about the need for braces with a Cleft Palate?
Such congenital anomalies affecting the jaws will most likely call for the need of orthodontic treatment for several years during growth and maturation of the facial structures. The orthodontist will work together with other members of the Cleft Palate Team.
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- What things can I do to shorten my treatment time?
Thought you would never ask! Plenty: first and foremost follow the orthodontist’s instructions to the letter, wear appliances ( maybe a headgear?) or rubber bands as instructed, do not miss appointments, do not break appliances or get archwires bent out of shape and take proper care of your teeth and gums. Follow a proper diet, avoid decay causing foods and drinks (many if not most soft drinks have high sugar contents and are acidic!). See your family dentist on a regular basis too to have teeth checked for cavities, or have regular cleanings done.
These are fundamental rules to follow if you want a good result in the shortest time possible- which also depends on the problem. As the Nike ad says: Just do it!
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