What is Orthodontics?

Orthodontics is the branch of dentistry that specializes in the diagnosis, prevention and treatment of irregularities of teeth & face.The practice of orthodontics requires professional skill in the design and use of corrective appliances (braces) to bring teeth, lips and jaws into proper relation and achieve facial balance.

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What are dental braces ?

“Braces” is a generalized term given by patients to the orthodontic appliances which are used to correct the position of teeth. More often than not, wire/s is/are an essential component of braces

FIXED BRACES

The pictures above show the basic TWO types of fixed braces used by the orthodontists world over.  

SPECIAL FIXED BRACES

Strictly speaking there is nothing special about these braces. It’s just that they are not seen that commonly hence - “special”.

Space Maintainers

Sometimes, due to cavities or due to any other reason, a milk tooth has to be removed. It is a very common mistake to leave the space created, unattended. An appliance known as Space Maintainer must be given, unless one can see the permanent teeth coming in the area where the tooth was removed.

If a milk tooth is lost prematurely, there’s always a big possibility of encroachment of the adjacent teeth into the space. As the name suggests, the space maintainer, maintains the space created, so that the permanent tooth which has to come in that particular position, can do so without being blocked by the adjacent teeth

Teeth Movers

There are certain orthodontic appliances which are fixed onto the teeth and move teeth in a different plane and help the ‘regular’ fixed braces perform better and give better results. Somewhat like ‘performance enhancers’.

REMOVABLE BRACES

There is a wide variety of appliances which can be put under a common group of Removable Braces. The one shown below, on the left, is the most commonly seen and used type of removable braces It is used most importantly, as a Retainer, to hold the teeth in a corrected position after the fixed braces treatment is over.

With the appliance in the mouth, it’s only the wire which is seen on the outside, and the plastic component of the removable braces is fit snugly against the palate, gums or, teeth on the inside.

One of the possible drawbacks of the removable braces is that it can be removed by the patient at will. For any appliance to work properly, it has to be in its place for the maximum possible time. If the patient doesn’t wear it the specified number of hours in a day, the treatment will unnecessarily get prolonged, or, in some cases, will end in failure. 

There are certain removable types of braces which are very special in nature, as they not only move the teeth from an incorrect to a better position, they guide the jaws into a correct position.

The orthodontic appliances shown here are representative of the wide array of removable appliances which can be used to get teeth in the correct relationship. It’s almost impossible to show all the appliances which are available and can be used for orthodontic correction of teeth.

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Who is an orthodontist ?

Orthodontist is a specialist dental surgeon who successfully completed a prescribed post graduate degree course in the subject of orthodontics from a recognized dental institution and university. Only orthodontists are formally trained and qualified to treat a patient with abnormal relationship of teeth and jaws. Most orthodontist in India are members of the Indian Orthodontic Society, an organization that recognizes the individual as one who has successfully acquired a valid post graduate degree from a recognized dental institution and university.

Once the orthodontist finally completes his/ her course, he may set up his/her clinic and start functioning from one location to treat all his/ her patients. – Resident Orthodontist. Alternatively, the orthodontist might choose to visit multiple dental clinics on specified or variable days at specified or variable times and see the patients at those clinics. – Visiting Orthodontist. It’s a service that these orthodontists provide at a particular dental clinic; thus providing all dental treatments under one roof.

The biggest advantage in case of the Resident Orthodontist is that you have the option of visiting him at your (mutually agreed upon) convenient time. However, the Visiting Orthodontist will visit a particular clinic on particular days, perhaps, once in a week, fortnight or month (mostly, it’s the latter two) and you’ll need to schedule all your day’s activities as per the appointment. And if you miss that appointment, you’ll have to wait one more turn before any progress can take place in the treatment.

Additionally, all those who are active in their kitchen would agree to the fact that one can perhaps cook better/faster/more competently in their own kitchens, rather than when you visit somebody and cook in their kitchen. Given the operational constraints, the same logic applies to Visiting Orthodontists, as well. Finally, with time and age, all Visiting Orthodontists tend to wind up their “visits”, one day or the other.

The biggest possible advantage of a Visiting Orthodontist – he/she makes orthodontic treatment available in all the small towns and, places where orthodontic services are not easily available. The patients from these places need not travel great distances, where orthodontic treatment is more readily available, to get their teeth set correctly.

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All dental graduates, having a degree of M.D.S. (Master of Dental Surgery) in the subject of Orthodontics, from an approved university within India or abroad, are Orthodontic specialists. Additionally, all active members of Indian Orthodontic Society (IOS), American Association of Orthodontics (AAO) & World Federation of Orthodontists (WFO) are Orthodontic Specialists. The members of these associations have to meet the exacting standards of education and experience required for membership. 
DIPLOMATE position of Indian Board of Orthodontics or American Board further signifies a person who has put in the required number of years in the practice of Quality Orthodontics and passed the stringent requirements of the 'Review Board'. 
Degrees like F. R. S. H. , M. R. S. H. , F. I. C. D. , F. A. C. D. , etc. are not Orthodontic Qualifications and does not signify any Orthodontic Proficiency. 

 To look for an orthodontist in your area, click here

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Though welcome, it is not essential. You may call & take an appointment with your neighbourhood orthodontist for the treatment.

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What is an orthodontic problem?

If the teeth are crooked (not arranged in a perfect arc), or they are jutting out (even though they maybe arranged beautifully in an arc), you have an orthodontic problem (in your mouth!!).

Commonly seen orthodontic problems, as stated by patients –

Crooked teeth, Dracula teeth, Buck teeth, Tiger teeth, Squirrel teeth, Rabbit teeth

Orthodontic problem can be broadly classified under the following heads, though it might present itself as a combination of one or more of the given types.

·         Crowding – crooked teeth, Dracula teeth, Tiger teeth

·         Proclination – buck teeth, teeth jutting out

·         Spacing – gaps are present in between the front teeth

·         Deep bite – the upper front teeth cover more than ¼ of the lower front teeth

·         Open bite – the front teeth do not meet and there’s a gap between teeth

·         Reverse bite – the lower front teeth come to lie ahead of the upper front teeth

CROWDING – crooked teeth, Dracula teeth

It is the condition where the teeth present are not arranged in a proper arc. Instead, they may be placed one behind the other or out of line. Crowding can happen if the size (length) of the jaw is insufficient to accommodate all the teeth in a proper arc or, the teeth fail to come (erupt) into the mouth in the proper sequence.

Teeth can be brought into a proper position, using fixed or removable types of appliances (braces), depending on the case. In many cases, teeth are removed to accommodate the remaining teeth in proper position. 

To see treatment results of crowding case, click here

PROCLINATION – buck teeth, teeth jutting out.

This is a situation, where the upper teeth are projecting far ahead of the lower teeth. There could be many reasons, causing the teeth to project out. It could be that the lower teeth are far too behind, while the upper teeth are at their normal position. Alternatively, if the upper jaw, into which the upper teeth are embedded, is projecting out more than the normal, the upper teeth will be seen projecting out. In some cases both, the upper & lower teeth along with the jaws are placed forward.

The treatment will differ from case to case, depending on the exact cause behind the situation. Removal of teeth may or may not be necessary, depending on the case.

To see treatment results of proclination case, click here

SPACING – gaps are present in between the front teeth.

This is a situation where spaces are seen between the teeth. The spaces can be just between the two front teeth or between all the front teeth.

Just like in any other case, the treatment is planned after a thorough study and analysis of the case with the help of radiographs (X- ray films) and the duplicated model of the patient’s teeth. In these cases, most of the times, removal of teeth is not advised, unless there are other complications. Additionally, to play it safe, many a times, permanent retention is given to such patients 

To see treatment results of spacing case, click here

DEEP BITE – the upper front teeth cover more than ¼ of the lower front teeth.

This is a situation where the upper front teeth overlap more than ¼ of the lower front teeth.  Some cases, it may be so bad that the upper front teeth impinge onto the outside of the lower front teeth and the lower front teeth impinge on the inside of the upper front teeth.

Treatment after a proper case study, mostly does not involve extraction of teeth. In some extreme cases, surgery of the jaws may be needed. Permanent or prolonged retention might be advised at the end of active treatment.

To see treatment results of deep bite case, click here

OPEN BITE – the front teeth do not meet and there’s a gap between teeth

This is a situation where one sees a gap between the front teeth because the upper and lower front teeth do not overlap each other or come in contact, when the upper and lower back teeth are touching. Normally, when we chew food, the upper & lower back teeth come in contact with each other. Simultaneously, the front upper and lower teeth almost touch each other. In open bite cases, the overlapping or contact of the front teeth is not seen. The gap between the front teeth can be caused by thumb sucking habit or because of the tongue resting between the teeth, or because of the incorrect relation of the jaws.

The treatment is directed to eliminate the reason which resulted in the gap, while simultaneously getting the teeth in proper alignment. 

To see treatment results of open bite case, click here

REVERSE – the lower front teeth come to lie ahead of the upper front teeth.

Normally, when one closes the teeth, the upper front teeth tend to lie ahead of the lower front teeth. Also, the upper back teeth – grinders, normally lie outside the lower back teeth.  However in certain cases, few or all the lower front teeth come to lie ahead of the upper front teeth – a situation which is orthodontically known as a “Cross bite” or “Class 3”. If any of the upper back teeth come to lie on the inside of the lower back teeth, a “Cross bite” situation arises.

The difficulty or ease with which a cross bite can be corrected, will depend to a large extent as to whether the problem lies solely with the teeth or there’s some problem with the underlying jaws as well.

Class 3 cases, need to be detected early, so that steps can be taken to correct the problem pronto, or at least minimize the damage that might occur as the patient grows. Surgery, to cut and correctly reposition the jaws, might be needed in Class 3 cases where the jaws are disproportionately matched. The treatment may or may not involve removal of teeth.

To see treatment results of reverse bite case, click here

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Why Do Dental And Facial Irregularities Occur?

The correct term for dental irregularities is malocclusion. Malocclusion can be in conjunction with, or without, facial irregularities

Most malocclusions are inherited - crowding of teeth, too much space between teeth, extra or missing teeth, cleft palate and a wide variety of other irregularities of the jaws and face. 
Many malocclusions are acquired - can be caused by thumb or finger sucking, tongue thrusting, the airway being restricted by tonsils and adenoids, dental diseases like cavities and early loss of milk or permanent teeth.
Whether inherited or acquired, many of these problems, affect not only alignment of the teeth but facial appearances and oral functions like chewing, speech and mastication, as well as the longevity of dentition.

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How do I know if I really need braces?

If you see your teeth looking like any of the pictures in the earlier section, you need orthodontic attention. To confirm it you need to visit an orthodontist. If you visit a dentist, he/she’ll direct you to an orthodontist or ask his Visiting Orthodontist to do the needful, as it is not his/her forte!

In certain cases, the dentist might advise, orthodontic treatment, as a part of his/her planned dental treatment, to deliver a better positioned restoration

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Why should I get orthodontic treatment done? 

The number one reason is – to enhance the health of the individual, not just the dental health.In the bargain, one gets – normal functions of all structures beside the teeth, improved looks & smile

Crooked and crowded teeth are difficult to clean and maintain causing tooth decay & eventual gum disease and tooth loss.

Teeth jutting out are more prone to fracture.

Teeth overlapping each other more than normal (Deep Bite cases), can damage the gums of the upper & lower front teeth.

Other orthodontic problems can cause abnormal wear of tooth surfaces, excess stress on supporting bone.

Certain other dental conditions can cause or be simultaneously be found with misalignment of the jaw joints with resultant chronic headaches or pains in the face or neck. When left untreated, many orthodontic problems become worse.

A pleasing appearance is a vital asset to one's self confidence. A person's self-esteem often improves as treatment brings teeth, lips and face into harmony. In this way, orthodontic treatment can be beneficial to social and career success as well as improve one's general attitude towards life and the quality of life itself.

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When do I start orthodontic treatment?

It is always recommended, that the FIRST orthodontic check up is done when the child is seven years old. Follow it up regularly. You’ll be made well aware about the intricacies of the orthodontic problem, by the orthodontist, as it develops, and help prevent the same, if possible. 

Though not always necessary (it can be earlier or later), an OPTIMAL AGE TO START ORTHODONTIC TREATMENT IS BETWEEN 9 & 11 YRS OF AGE. Early intervention, frequently, makes the completion of treatment at a later age easier and less time consuming 

YOU NEED NOT WAIT FOR ALL MILK TEETH TO FALL, before starting Orthodontic treatment. 

YOU NEED NOT WAIT FOR THE CHILD TO BE 12 YEARS PLUS OF AGE, to start orthodontic treatment.

THERE IS NO AGE LIMIT OR CONSTRAINTS, TO START ORTHODONTIC TREATMENT. 

If orthodontic treatment is the solution, and the teeth & gums are healthy, it CAN BE DONE AT ANY AGE.

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How does one get an Orthodontic treatment done? 

The doctor will examine the patient & advise about the tentative treatment plan.Doctor will take the measurement of the teeth of the patient, take a set of photographs & advise for a set of radiographs (X-ray pictures).

After doing a case study i.e. studying and analyzing the X-ray pictures, photographs and the measurement of the teeth, the orthodontist will explain the entire treatment plan

Once the treatment has started, the patient might need to visit the doctor, initially, once a week or twice a week, for the first two or three visits.

Appointments can last ten minutes to one hour or more, depending on the work that has to be done. Later on, once the braces are fitted onto the patient’s teeth, the patient needs to visit the clinic once a month, on an average. In some cases, like outstation patients, the braces can be adjusted such that the patient needs to visit the doctor once in 6-8 weeks, or, as and when required.

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What are the different kinds of orthodontic treatment? 

There are three basic type of orthodontic treatment

1. Preventive
2. Interceptive. Both the types of treatment are done in preteen years of life.
3. Corrective. This can be done at any age & involves procedures to get teeth in their appropriate positions from their incorrect

PREVENTIVE TREATMENT involves steps like getting a space maintainer put. If a milk tooth has to be removed due to cavities or otherwise, to prevent loss of space for the developing permanent tooth, space maintainer must be put 

INTERCEPTIVE TREATMENT is needed in cases where the patient might have developed a thumb sucking habit. In cases where the orthodontist can observe that the developing tooth is moving in an incorrect direction, he/she can design appliance to guide it in the correct direction. 

CORRECTIVE TREATMENT is what most of the orthodontists do, routinely. Either, the patients fail to report at a stage where prevention or interception could have helped, or the condition is such that either of the measures taken would be of not much use. 

ADULT TREATMENT is no different from the corrective treatment. With patients in the age group of 25 years plus, the rate of tooth movement is seen to be relatively slow, as compared to that patients in the adolescent & early adulthood years. As long as the teeth & gums are in a healthy condition, orthodontic treatment can be done at any age. There is no upper limit of orthodontic treatment age. 

SURGICAL TREATMENT might be needed in certain severe adult cases, where the teeth are incorrectly positioned because the jaw bones, on which the teeth are attached, are themselves in an incorrect position. The surgery is done in conjunction with the orthodontic treatment. A co-ordinated team effort of the oral & maxillo-facial surgeon and the orthodontist is essential in the successful outcome of these severe cases.

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Is it necessary to remove teeth, as a part of orthodontic treatment? 

Though not all , most of the cases, present themselves to the orthodontist at a stage when getting the teeth in the correct positions necessitates the removal of one or more (up to four) permanent teeth. The idea behind removing a few permanent teeth is, to create space, to allow movement of the other remaining teeth to their correct positions.

Many cases can be completed without the need of removal of permanent teeth. The orthodontist, at the beginning of the treatment, or during the course of the treatment, will be the best person to advise you on the need or otherwise of permanent teeth removal.

Wisdom tooth removal is subjective & may not be necessary for orthodontic treatment. However, the orthodontist may advise removal of the wisdom molar teeth, at the end of orthodontic treatment, if he/she feels that it could compromise the integrity of the result attained at the end of the orthodontic treatment.

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How long does orthodontic treatment take? 

A lot depends what is done to get the teeth in the correct position.On an average with fixed braces, treatment can take 18 - 24 months. However certain cases may be completed in lesser time. At the same time it may take longer in a few cases to complete the treatment. The actual time depends on the growth of the patient's mouth and face, the co-operation of the patient and the severity of the problems. Mild problems may require less time and some individuals respond faster to treatment than others. 

Certain cases are treated in stages. After an initial treatment is carried out for a shorter duration, it is followed by another phase of treatment of a longer duration, to finally get the teeth in their correct positions. Few months interval might be there between the two stages. 

With removable braces, the treatment time may vary, depending on the braces & the co-operation of the patient in wearing the braces. 

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What care & precautions are necessary during orthodontic treatment 

If it need be listed, there are four major precautionary measures, patients are advised.

1. Brush to clean the gums, teeth & braces AFTER EVERY MEAL. With braces in place, it should take about 4 – 6 minutes.
2. Do not put ANYTHING hard & sticky, in the mouth, if a hassle-free treatment is what one is looking at.
3. Do not bite into ANYTHING with the front teeth (like what one does when having a pizza, or, biting an apple).
4. Keep all the appointments given & between those appointments, remember to follow the instructions given by the orthodontist.

An assessment of the general health of the teeth of gums must be done at regular intervals to keep them healthy.

Successful orthodontic treatment is a partnership of efforts between all of those involved, namely, the patient, the patient’s family, the orthodontist & the dentist. Only through this co-operative effort, the treatment goal is achieved - a healthy mouth and a beautiful smile.

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All orthodontists have their own regime when it comes to financial transactions. It is always advisable to ask at the time of the first consultation with the orthodontist, about the mode & methods of payment.

In general, the orthodontist will charge you for the initial consultation & your case study. For the charges towards the orthodontic appliance & the orthodontic treatment, the payment is most of the times, done in installments (Few exceptions exist, though, depending on the type of treatment rendered). Of course, charges for the dental treatment rendered if done with some other dentist, will be payable to the dentist directly. If the dental treatment is provided within the same setup, the orthodontist will apprise you of the financial implications thereof.

In general, the metal braces are less expensive than the transparent braces, which in turn are less expensive than the invisible braces. Depending on the actual appliance, the cost of removable braces varies.

There are no “standard menu card rates” for the service rendered by orthodontist for the treatment. It’s always advisable to clear all doubts, before commencing the treatment, regarding the total charges, initial payment, possibility of any extra charges during the course of the treatment, etc.

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What happens at the end of the orthodontic treatment ?

After the completion of active treatment, i.e., once the teeth have come in their proper/correct positions, the braces fixed on the teeth are carefully removed by the orthodontist. If the removable braces were used to get the teeth proper, the orthodontist gives you the good news, that’s it.

However, now comes the most important part, where the teeth which are now in their correct positions, needs to be held together for some time to assure that the teeth will stay there. For that purpose, retainers are given to the patient with proper instructions on its use. As the name suggests – it retains the teeth in the corrected position

The retainers can be of two basic types

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Do teeth go back to the before treatment positions after the braces are removed ?

 NO!

A lot depends on the co-operation of the patient, during the treatment, as well as, after the treatment, when he/she has been advised to wear the retainers. In an unco-operative patient, achieving the best possible results is always a question mark. (Just like a heart patient, advised to stay off cigarettes and refuses to quit!) After the braces, which were fixed on the teeth, were removed, the patient is advised to wear the retainers. However if he doesn’t wear the same, the end result achieved at the end of the active treatment will always be compromised. (What happens, if you do not follow doctor’s instructions – not to lift heavy things for the next few weeks, after the plaster cast around your arm is removed?)

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How long do I wear the retainers? 

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