Orthodontic treatment

Teeth of the upper and lower jaw should line up nicely and fit together. If teeth do not line up neatly, or if they overlap each other, a number of problems can arise.

Orthodontics is the area of dentistry that looks at the position of teeth, and the way the teeth in the upper and lower jaws bite together. Orthodontic treatment can make teeth straight and improve how jaws bite together. Braces, aligners, retainers .

Not many people have perfectly straight teeth. Not all crooked teeth require treatment.

Why orthodontic treatment might be needed

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

• Difficulty keeping teeth clean. It is easier for food and plaque to get stuck. It may also be harder to get a toothbrush or dental floss into the correct position to clean well.
• Plaque and food left on teeth can increase the risk of tooth decay and gum disease
• Eating and chewing may be difficult when there are big gaps, or when teeth do not bite together properly. This can affect your nutrition and digestion. You may also need to move your jaw in difficult positions to get your upper and lower teeth to line up.
• Injury to the gum. If a tooth bites onto the opposite gum instead of another tooth, it may dig into the gum and cause pain or damage.
• Crooked teeth can make it difficult to swallow or get in the way of lips closing together properly. This can dry out your teeth or mouth.
• In some cases, crooked teeth can make it difficult to speak properly. You may lisp or whistle while speaking.
• Breathing problems in some people when the jaws are setback in position.
• Front teeth that stick out or are not in line with other teeth, are more likely to be injured during sports or in a fall. Other crooked teeth may even make you bite your tongue or cheek accidentally.
• Wear and tear. Biting and chewing can wear crooked teeth down in uneven and unusual ways. These areas can be difficult to repair, as fillings are more likely to break or wear down as well.
• Self-confidence. People may not feel comfortable showing their teeth when they talk or smile. Some people may not smile at all

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. Upper front teeth normally cover less than half of the lower front teeth when the teeth are biting. When the upper front teeth cover more than half of the lower teeth, this could be an excessive overbite.
• Underbite. The lower jaw normally sits behind the upper jaw at rest. When the lower front teeth sit in front of the upper front teeth, this could be an underbite. It can look like a person is sticking their lower jaw (or chin) forward.
• Protruding front teeth. This is often seen in children or adults with a history of thumb- or dummy-sucking.The upper jaw and front teeth are pushed forward so that they “stick out”. When the mouth is closed, protruding teeth may also sit in front of (or on top of) the lower lip. Protruding front teeth are more likely to be damaged in accidents or falls. They may also cause speech or eating problems. Many people will choose to correct protruding front teeth for cosmetic reasons.
• Crowded teeth. When there is not enough space in the mouth for all the teeth to fit properly, teeth will be crowded.They may overlap, grow crooked, or not erupt fully. Crowding can be caused by large teeth, a small jaw, or both.
• Spacing and gaps. When there is too much space in the mouth, there will be gaps between teeth. This can happen when teeth are missing, small or mis-shaped. A large jaw or a combination of causes may also be responsible.

Examples of orthodontic treatments

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

• Palatal expanders and functional appliances. Palatal expanders can widen the upper jaw. Functional appliances are used to correct bite problems. These are used in children when their jaw bones are still growing.
• Fixed braces. Small metal or ceramic brackets are attached (glued) to the front or back of each tooth, and a wire is tied to them. When the wires are tied into the brackets there is a constant gentle pressure placed on the teeth, causing the teeth to move.
• Clear aligners (also known as “invisible braces”). Unlike fixed braces, clear aligners are removable. Treatment involves wearing a series of custom-made clear plastic aligners on the teeth. The aligners are designed to put pressure on certain teeth, which causes the teeth to move. You usually need to wear clear aligners for 20–22 hours a day, but you can take them out to eat, drink and clean them.
• Elastics. Thesesmall rubber bands can be stretched and placed onto the braces to provide extra force to move teeth. They are usually attached between upper and lower braces and can help with correcting the bite.
• Retainers. Retainers are used to retain (hold) the teeth in their new place after treatment is completed. They stop teeth from shifting. They can be attached to the teeth (for example, a wire is glued to the inside surface of the teeth), or removable. Removable retainers are made of either plastic which sits over the teeth like a clear aligner or can be made of acrylic and wire.
• Surgery. In complex cases, surgery may be required to remove buried teeth or make it easier for them to erupt into the mouth. Surgery can also be used to correct some jaw problems.

Age for orthodontic treatment

Problems requiring orthodontic treatment can be detected by a dental practitioner.

The timing for orthodontic care can vary depending on the individual. Some orthodontic treatment must wait until the permanent teeth have finished erupting. Some treatments can start earlier, to avoid major treatment later.

Your child may be referred to an orthodontist as soon as a problem is suspected. This gives the best chance of starting treatment at the best time.

Adults of any age can have orthodontic treatment, if required.

Risks of orthodontic treatment

Some common risks of orthodontic treatment include:

• Dental hygiene problems – Braces, aligners and retainers make cleaning the teeth more difficult. This increases the chance of gum disease, tooth decay, and stains. It is important that teeth are cleaned thoroughly at least two times a day, ideally after every meal. There are special toothbrushes that can make cleaning around braces easier. Use a fluoride toothpaste to help protect teeth from tooth decay. Limit snacking and sugar-sweetened food and drinks during orthodontic treatment.
• Soft tissue injury – Braces (brackets and wires) can be sharp and poke the gums, cheeks, lips or tongue. Sharp areas can be covered by special orthodontic wax to prevent injury.
• Relapse - Teeth can move once braces are taken off. Retainers should be worn to prevent this from happening.

Your dental practitioner will discuss these and other risks with you.

Who provides orthodontic treatment?

Orthodontic treatment is provided by an orthodontist, and some dentists. An orthodontist is a specialist dentist who has done extra study in this area. They can detect, prevent and manage the problems caused when teeth are not straight or when jaws don’t bite together properly.

The orthodontist or dentist will do a thorough examination of your teeth and jaws. They will use x-rays to help look for problems too. After this, they will create a treatment care plan and explain everything to you. Once you are happy with the care plan, treatment can begin. If you are not happy with the care plan or do not understand it, it is important to let your dental practitioner know.

Costs vary depending on the type of problem and the amount of treatment needed. Ask your dental practitioner for advice.

Teeth care during orthodontic treatment

Your orthodontist or dentist will explain how to care for your teeth.

Avoid sticky or hard foods during orthodontic treatment. These include chewing gum, lollies and crusty bread. These foods can get stuck on braces, aligners and retainers and cause damage.

Avoid high sugar foods and drinks, including fruit juice. These can lead to tooth decay.

When you have braces, it is even more important to brush and clean between your teeth regularly and well. Brackets and wires trap more food particles and plaque and make it harder to clean your teeth. There are special orthodontic toothbrushes that your dental practitioner can show you.

Interdental brushes are another type of brush. They fit into small spaces around brackets, wires and between teeth. They can be particularly helpful during orthodontic treatment.

Where to get help

• Your dentist or another dental practitioner, such as an oral health therapist or orthodontist.
• Orthodontics Australia "Find an dentist".
• Speech pathologist
• Dental Health Services Victoria provides public dental services through the Royal Dental Hospital Melbourne and community dental clinics, for eligible people.
• Australian Dental Association "Find a dentist".