Orthodontic intervention is a specialized area of dentistry focused on diagnosing, preventing, and addressing irregularities of the teeth and jaw. Its purpose is to ensure proper bite function, promote oral health, and enhance facial appearance by guiding dental development and correcting misalignments.
Identifying the Need for Treatment
Several signs and specific dental conditions, known as malocclusions, can indicate a need for orthodontic intervention. One common issue is dental crowding, where there is insufficient space in the jaw for all teeth to align properly, causing them to overlap or twist. This can make effective cleaning difficult, potentially increasing the risk of tooth decay and gum disease. Conversely, excessive spacing, or diastema, involves noticeable gaps between teeth, often due to a mismatch between tooth size and jaw size, missing teeth, or an oversized tissue (frenum) connecting the lip to the gum.
Misaligned bites also frequently warrant assessment. An overbite occurs when the upper front teeth significantly overlap the lower front teeth, sometimes leading to the upper teeth biting into the gums. In contrast, an underbite is characterized by the lower teeth protruding beyond the upper teeth. A crossbite involves upper teeth sitting inside the lower teeth, which can affect a single tooth or multiple teeth in the front or back of the mouth.
An open bite is another condition where the upper and lower front teeth do not meet when the jaws are closed, leaving a vertical gap. Beyond visual indicators, functional problems like difficulty chewing or biting, jaw pain, or clicking sounds in the jaw joint can signal underlying alignment issues. For children, the early or late loss of baby teeth can disrupt the natural eruption path of permanent teeth, potentially leading to crowding or impaction.
Phases of Orthodontic Care
Orthodontic care often follows a strategic timing approach, particularly for younger individuals, divided into two distinct phases. Phase 1, also called early interceptive treatment, typically begins when a child has a mix of primary (baby) and permanent teeth, generally between ages 7 and 10. This initial phase addresses foundational developmental issues of the jaw and bite, guiding jaw growth, creating space for permanent teeth, and preventing more severe problems later.
After Phase 1, there is often a resting period, allowing for natural growth and the eruption of remaining permanent teeth. During this time, the orthodontist monitors the child’s dental development to assess changes from the first phase and plan for subsequent treatment.
Phase 2, known as comprehensive treatment, usually commences once most or all permanent teeth have erupted, typically during adolescence, around ages 11 to 14. This phase focuses on the precise alignment of individual teeth and achieving a finely-tuned bite relationship between the upper and lower jaws. The goal is to establish a stable, functional, and aesthetically pleasing outcome.
Common Orthodontic Appliances
Orthodontic treatment utilizes various appliances, each designed to apply controlled forces to move teeth or influence jaw position. Traditional braces, available in metal and ceramic options, consist of small brackets bonded to each tooth, connected by a thin archwire. Metal braces are durable and effective in correcting misalignments. Ceramic braces function similarly but use clear or tooth-colored brackets and sometimes wires, offering a less noticeable appearance. Both types gradually shift teeth into their desired positions through continuous, gentle pressure adjusted by the orthodontist.
Clear aligners, such as Invisalign, offer a discreet alternative to fixed braces, comprising a series of custom-made, transparent plastic trays. Each aligner is worn for about one to two weeks, applying gentle pressure to gradually move teeth by a fraction of a millimeter at a time. These aligners are removable for eating, drinking, and oral hygiene, relying on consistent wear for effective results.
Palatal expanders are orthodontic devices designed to widen the upper jaw (maxilla) by applying gentle, outward pressure to its two halves. They are custom-fitted over several upper back teeth and include a screw mechanism periodically adjusted to create more space. This expansion can help correct crossbites, alleviate dental crowding, and create room for permanent teeth to erupt.
After active orthodontic treatment, retainers are used to maintain the newly achieved tooth positions. Fixed retainers involve a thin metal wire bonded permanently to the back of the front teeth, providing continuous support. Removable retainers are custom-made devices, such as clear plastic trays or traditional Hawley retainers, which can be taken out for eating and cleaning. Both types prevent teeth from shifting back as surrounding bone and tissues stabilize.