Braces are often associated with enhancing the appearance of a smile, but they also serve important medical purposes. Medically necessary braces address significant functional impairments of the teeth, jaws, or related oral structures, rather than being solely for aesthetic improvement. This distinction is important as it determines whether orthodontic treatment is considered essential for a patient’s overall health and well-being. When the primary goal is to restore normal oral function and prevent future health complications, braces move beyond cosmetic desires to become a necessary intervention.
Conditions Warranting Braces
Several specific dental and skeletal issues can necessitate orthodontic treatment. Severe malocclusions, or misalignments of the teeth and jaws, often fall into this category. These conditions include extreme overbites, where the upper front teeth significantly overlap the lower teeth, and severe underbites, where the lower jaw protrudes beyond the upper jaw, causing the lower front teeth to sit in front of the upper teeth. Crossbites, which occur when upper teeth fit inside the lower teeth, either at the front or back of the mouth, can also be medically significant. Open bites, where the front or back teeth do not meet when the mouth is closed, can severely impair biting and chewing functions.
Beyond bite discrepancies, other dental problems warranting braces include severe crowding, where there is insufficient space for all teeth to erupt properly, or significant spacing between teeth. Both crowding and large gaps can lead to issues like difficult oral hygiene or speech problems. Jaw misalignments, particularly those contributing to temporomandibular joint (TMJ) disorders, are another important consideration, as these can affect chewing, speaking, and overall oral health. Craniofacial anomalies or systemic disorders involving the dentition also require orthodontic intervention.
The American Association of Orthodontists (AAO) has proposed qualifying criteria for medically necessary orthodontic care, including specific measurements. For instance, an overjet (horizontal overlap of front teeth) of 9 millimeters or more, or a reverse overjet of 3.5 millimeters or more, can indicate medical necessity. Anterior or posterior crossbites involving three or more teeth per arch also meet these criteria. Lateral or anterior open bites of 2 millimeters or more, or affecting four or more teeth per arch, are also considered. Additionally, impinging overbites, where upper teeth bite into the opposing gum tissue, and impactions where teeth are blocked from eruption (excluding wisdom teeth), are conditions that often require treatment.
Diagnostic Assessment
Determining the medical necessity of braces involves a comprehensive diagnostic assessment by dental professionals. Licensed orthodontists or dentists conduct thorough examinations to evaluate the patient’s oral health and function. This process goes beyond visual inspection, relying on objective criteria rather than subjective aesthetic preferences. The assessment typically includes a detailed clinical examination of the teeth, gums, and jaw alignment.
Imaging techniques play an important role in this diagnostic phase. Orthodontic X-rays, such as panoramic radiographs (OPGs) and lateral cephalograms, provide detailed views of the jawbones, tooth roots, and internal tooth structures. An OPG reveals issues like missing or impacted teeth across the entire upper and lower jaws, while a lateral cephalogram offers a side profile view for information on jaw growth and relationships. In more complex cases, a 3D Cone Beam CT (CBCT) scan may be used for a comprehensive three-dimensional view. These diagnostic tools allow the orthodontist to determine if a bite problem stems from tooth positioning, jaw size discrepancies, or a combination of factors, forming the basis for a treatment plan.
Health Consequences of Untreated Issues
Leaving significant dental and jaw misalignments untreated can lead to a range of negative health outcomes that extend beyond cosmetic concerns. One common consequence is an increased susceptibility to tooth decay and gum disease. Crooked or crowded teeth create hard-to-reach areas where food particles and bacteria can accumulate, making proper cleaning difficult even with diligent brushing and flossing. This plaque buildup can lead to gingivitis, the early stage of gum disease, which can progress to more severe periodontal disease if left unaddressed.
Untreated malocclusion can also result in abnormal wear of tooth enamel. When teeth do not align correctly, certain teeth may bear excessive force during chewing or biting, leading to premature erosion, chips, or fractures. This uneven pressure can expose the sensitive inner layers of the teeth, increasing the risk of cavities and heightened sensitivity to hot or cold stimuli. Additionally, misaligned teeth and jaws can contribute to speech impediments, such as lisps or difficulty pronouncing certain sounds, because they interfere with the tongue’s proper positioning and airflow during speech production.
Chewing difficulties are another functional impairment, which can potentially lead to digestive issues if food is not adequately broken down. Chronic jaw pain, headaches, and temporomandibular joint (TMJ) disorders can also arise from an uneven bite, as misaligned jaws place undue stress on the jaw muscles and joints. In severe cases, there is potential for damage to supporting bone structures around the teeth due to uneven forces. Correcting these issues is therefore important for maintaining long-term oral health and overall well-being.