Orthodontic treatment

Teeth of the upper and lower jaw should fit neatly together. When they don’t, it can increase the risk of tooth decay and gum disease. Orthodontics is an area of dentistry that diagnoses and improves the arrangement of the teeth and jaw using devices such as braces and plates.

Why orthodontic treatment might be needed

Crooked, crowded and overlapping teeth can cause a range of problems, including:

• tooth decay and gum disease – teeth that are very close together can be harder to clean properly. A build-up of plaque can lead to tooth decay and gum disease
• injury to the gum – if a tooth doesn’t meet with its partner on the opposite jaw properly, it may dig into the gum and cause damage
• it may be difficult to eat or chew properly, or affect your ability to speak properly, swallow or dries out your mouth.
• teeth that stick out may be more likely to be injured or traumatised during sports or in a fall.
• wear and tear – if teeth don’t come together properly the action of chewing can wear them down unevenly
• self-confidence – teeth problems can make people feel embarrassed and they may not feel comfortable to smile.

Diagnosis of teeth and jaw alignment problems

Problems with teeth and jaw alignment are identified using

• a visual examination and photographs
• x-rays of the teeth and jaws
• impressions or scans of the teeth.

Examples of orthodontic problems

Some common orthodontic problems are:

• excessive overbite – when the top teeth bite over the bottom teeth more than usual. With teeth closed, you would usually expect to see about half of the lower teeth. If you see less than half, this could be an excessive overbite
• underbite – when the bottom jaw sits further forward than normal. When teeth are closed, the lower front teeth sit in front of the upper front teeth
• protruded teeth – when the upper jaw sits further forward than the lower jaw. With the teeth together, you would expect the upper teeth to sit on the inside of the lower lip. If they sit over the lower lip, this might be a sign of protruded teeth. A person with protruded teeth is more at risk of tooth damage or loss from accidents and may have speech or eating problems. Many people also choose to correct protruded teeth for cosmetic reasons
• crowded teeth – when there is not enough space for teeth to be straight and they overlap, grow crooked, or cant come out fully. This Can be caused by large teeth, a small jaw, or both.
• spacing and gaps – when there is too much space available. This can be caused by small teeth, misshaped teeth, missing teeth, teeth that don’t come out fully, a large jaw or a combination of causes.

Examples of orthodontic treatments

A range of orthodontic devices may be used to move teeth, or to keep them in place. These include:

• fixed braces – tiny brackets are attached to the front or back of each tooth, and a wire is tied to them. The constant gentle pressure of the wire slowly moves the teeth
• clear aligners – also known as ‘invisible braces’, clear aligners are a series of clear pieces of custom-moulded plastic that sit over the teeth and slowly move them. While you usually need to wear clear aligners for 20–22 hours a day, you are able to take them out to eat, drink and clean them
• elastics – these small rubber bands are stretched between upper and lower braces for extra force to move teeth
• plate – a plastic device that sits in the mouth and uses wires and springs to move teeth, or to hold them in place. Unlike fixed braces, a plate can be taken out of the mouth.
• surgery – in severe cases, surgery may be required to remove buried teeth, or make it easier for them to come out. Surgery can also be useful when there is a problem with the jaws, or to improve the outcome of orthodontic treatment.

Age for orthodontic treatment

problems that may benefit from orthodontic treatment can be detected at an early age by an oral health professional . Most orthodontic treatment is done after all the permanent teeth have come through,. Some treatment can be started earlier,which can help avoid major treatment later on. . Adults of any age can have treatment as well if they have orthodontic problems.

Risks of orthodontic treatment

Some of the risks of orthodontic treatment include:

• dental hygiene problems – this makes cleaning the teeth more difficult and increases the chance of gum disease, tooth decay, stains and discolourations. It is important that teeth are cleaned thoroughly after every meal, at least twice a day, and to reduce snacking and unhealthy food and drinks during orthodontic treatment to avoid these problems
• soft tissue injury – braces may dig into the gums or cheeks, injuring them
• relapse – the corrected teeth can move again once braces are taken off. retainers are worn after braces have been taken off is to prevent this from happening.

Who provides orthodontic treatment?

Orthodontic treatment is provided by an orthodontist, and some dentists. An orthodontist is a dentist who has done additional study to specialise in the diagnosis, prevention and treatment of problems in the alignment of teeth and jaws.

The orthodontist or dentist will take detailed records of your teeth and jaw, diagnose any problem, plan the treatment and carry out the care as required.

Costs vary depending on the type of problem and the amount of treatment needed. Ask your oral health professional for advice.

Teeth care during orthodontic treatment

Talk to your orthodontist or oral health professional about how to care for your teeth during treatment.

For example, if you’ve got braces, it’s even more important to brush, floss, and clean between your teeth regularly, as the brackets and wires can retain or trap more food particles and plaque. If using string or tape is too tricky, there are other methods to help keep the teeth and gums clean, such as floss threaders for braces or interdental toothbrushes.

Interdental toothbrushes are small brushes that have been designed to get into small spaces including around brackets and the gaps between teeth. They can be particularly helpful when undergoing braces treatment.

Where to get help

• Your oral health professional who may be a dentist, oral health therapist or orthodontist.
• Orthodontics Australia ‘Find an Orthodontist’ toolTel. (02) 9965 7250
• Speech pathologist
• Dental Health Services Victoria provides public dental services through the Royal Dental Hospital Melbourne and community dental clinics, for eligible people. For more information about public dental services Tel. (03) 9341 1000, or 1800 833 039 outside Melbourne metro
• Australian Dental Association ‘Find a Dentist’ search function or Tel. (03) 8825 4600