Orthodontic treatment involves using fixed appliances, commonly known as braces, to correct the alignment of teeth and the relationship between the upper and lower jaws. Braces apply gentle, continuous pressure to gradually guide teeth into their ideal positions. The primary goal is to establish a functional bite (occlusion) while also achieving an aesthetically pleasing smile. The teeth in both the upper and lower arches must work together to achieve a stable and healthy result.
Standard Practice for Braces Installation
It is standard practice for an orthodontist to install braces on both the top and bottom arches during a single initial appointment. This simultaneous placement is the most efficient way to begin the comprehensive correction of the patient’s bite relationship. The process involves preparing the tooth surfaces, bonding the brackets, and threading the archwires through the brackets on both arches. This entire procedure usually takes one to two hours to complete. Starting both arches at once allows the teeth to begin moving toward a coordinated alignment, which helps minimize the overall treatment time.
Factors Determining Simultaneous Versus Staged Placement
While simultaneous placement is standard, the orthodontist may choose a staged approach, placing the upper braces first and delaying the lower set by a few weeks or months. This decision is based on specific clinical needs, particularly the severity of the bite issue, known as malocclusion. A common reason for staging is a deep overbite, where the upper front teeth significantly overlap the lower ones. If the lower brackets were placed immediately in such cases, the upper teeth could bite down and repeatedly hit the lower brackets, potentially damaging the appliance or causing pain.
Starting with the upper arch allows for initial movement that creates the necessary vertical space before the lower brackets are introduced. Aligning the upper arch first helps create a stable foundation for the lower teeth to follow, as it holds a greater influence on the final alignment of the bite. Other factors necessitating a staged approach include severe crowding in one arch or the need for a preliminary appliance, such as a palatal expander. Placing the upper braces first can also ease patient adaptation, since the upper appliance often interferes less with speech and eating compared to the lower appliance.
Managing Initial Discomfort and Adjustments
Receiving a full set of braces at once means the patient will experience a period of adjustment for both arches immediately following the procedure. Initial soreness and tenderness in the teeth and gums are normal, as the newly placed archwires begin to exert pressure. This discomfort typically peaks within the first 24 to 48 hours and subsides significantly within three to five days. Over-the-counter pain relievers, such as acetaminophen or ibuprofen, can manage this initial ache.
The soft tissues of the mouth, including the cheeks, lips, and tongue, will need to adjust to the new hardware. Brackets and wires can cause temporary irritation, which is managed by applying a small piece of orthodontic wax directly onto the abrasive part of the brace. Eating soft foods like soup, yogurt, or mashed potatoes for the first few days minimizes pain while chewing. Rinsing the mouth with a warm saltwater solution several times a day helps soothe minor sores and promote healing.