Orthodontics is the specialized field of dentistry focused on correcting a “malocclusion,” the technical term for misaligned teeth or an improper bite relationship between the upper and lower jaws. While many cases involve aesthetic improvement, the necessity for intervention is primarily determined by functional problems that affect long-term oral health and jaw function. This article provides guidance on identifying the signs of a problematic bite, understanding the optimal timing for evaluation, and recognizing the potential long-term consequences of neglecting treatment.
Identifying Dental Conditions That Require Braces
Specific bite and alignment discrepancies impact a child’s ability to chew, speak, or maintain hygiene. One of the most frequent issues is severe dental crowding, which occurs when the dental arch lacks sufficient space for all the permanent teeth to erupt correctly. This can cause teeth to overlap, rotate, or become impacted beneath the gum line, creating areas that are extremely difficult to clean effectively.
Malocclusion also encompasses issues relating to the alignment of the jaws, often categorized by how the upper and lower teeth meet. An overjet, sometimes called protrusion, is where the upper front teeth stick out significantly past the lower teeth, while a deep bite (or overbite) involves the upper teeth vertically overlapping the lower teeth excessively. Conversely, an underbite occurs when the lower jaw or lower teeth project forward beyond the upper teeth.
Further functional problems include a crossbite, where some upper teeth sit inside the lower teeth when the mouth is closed, and an open bite, where the front or side teeth do not meet at all. These bite problems indicate a functional imbalance that can cause uneven wear on teeth and strain on the entire chewing system. Addressing these specific conditions is necessary to establish a stable and functional bite.
Optimal Age for Orthodontic Evaluation and Treatment
The American Association of Orthodontists (AAO) recommends that children have their first orthodontic evaluation no later than age seven. By this age, most children have a combination of permanent and baby teeth, allowing the specialist to assess the developing bite and jaw structure.
This early screening allows the orthodontist to identify subtle problems with jaw growth or emerging teeth before they become severe. An evaluation at age seven rarely results in immediate full braces, but it provides the opportunity to monitor development. Interceptive treatment, known as Phase I, typically occurs between ages six and ten and focuses on guiding the growth of the jaws.
The goal of Phase I is to correct significant skeletal issues, such as a severe crossbite or a jaw discrepancy, while the child is still growing. This phase often uses appliances like palatal expanders to create space for permanent teeth or functional appliances to modify jaw position. Following a resting period to allow the remaining permanent teeth to erupt, Phase II treatment begins, involving braces or aligners to precisely align all permanent teeth into their final correct positions.
The Health Risks of Leaving Malocclusion Untreated
Misaligned or crowded teeth create numerous hidden surfaces and tight spaces that are nearly impossible for a toothbrush and floss to reach. This increased difficulty in maintaining effective oral hygiene significantly raises the risk of chronic issues like tooth decay and periodontal (gum) disease.
Bite problems that cause uneven contact between the upper and lower teeth lead to abnormal wear patterns over time. For example, a severe crossbite or deep bite can cause certain teeth to constantly grind against each other, leading to enamel erosion, chipping, and even fracturing of the tooth structure. Such damage can eventually necessitate expensive restorative dental work, like crowns or root canals.
Untreated severe malocclusion can place excessive strain on the temporomandibular joints (TMJ), which connect the jaw to the skull. This chronic pressure may contribute to the development of temporomandibular disorders, characterized by chronic headaches, jaw pain, and difficulty opening or closing the mouth. Discrepancies like a large overjet also leave the front teeth vulnerable to traumatic injury from falls or impacts, as they protrude unprotected beyond the lips.
Understanding Modern Orthodontic Treatment Options
The most traditional option is metal braces, which use stainless steel brackets bonded to the teeth and connected by a thin, flexible archwire. Modern metal brackets are significantly smaller and more comfortable than those used in the past.
For a less noticeable appearance, ceramic braces offer a similar mechanical function but utilize clear or tooth-colored brackets that blend with the natural tooth color. Clear aligner systems, such as Invisalign, are another popular removable option, using a series of custom-made, transparent plastic trays to gradually shift the teeth. The selection of the appropriate appliance is determined by the specific biomechanical needs of the case, the severity of the malocclusion, and the patient’s compliance.
The duration of comprehensive treatment, or Phase II, typically lasts between 12 and 30 months, depending on the complexity of the movements required. Following the removal of braces or the final aligner, the crucial retention phase begins. Teeth have a natural tendency to shift back toward their original positions, a phenomenon known as relapse.
The retention phase requires the consistent use of a retainer. Retainers come in two main forms: removable types, such as Hawley retainers or clear thermoplastic retainers, and fixed retainers, which are thin wires bonded permanently to the back surfaces of the front teeth. Lifelong or long-term retainer wear is generally recommended to ensure the final alignment remains stable over time.