Orthodontics

Orthodontics is the branch of dentistry concerned with the normal structure and development of the teeth, jaws, and facial complex, as well as the diagnosis and treatment of abnormalities affecting these structures. The aim of orthodontics is to prevent orthodontic problems whenever possible, correct them when they occur, establish proper function and aesthetics, and maintain the results achieved through treatment.

Maintaining oral hygiene is more difficult when the teeth are crowded or misaligned. As a result, gum disease and tooth decay may develop more easily. In addition, when crowding or an improper bite is present, chewing may be less effective and this may contribute to functional problems.

If the upper and lower teeth do not fit together properly, excessive forces may be placed on the jaw joint or on individual teeth, potentially causing painful and difficult-to-treat problems. When the front teeth are positioned too far forward or backward, certain sounds may also be difficult to pronounce correctly, leading to speech problems.

In some cases, the problem may involve not only the teeth but also the skeletal structures. If the upper jaw, lower jaw, or both jaws are not positioned correctly, the patient may have difficulty chewing and speaking. Significant facial or skeletal asymmetry may also be present.

In such cases, orthodontic treatment may be combined with a surgical procedure involving the upper and/or lower jaw. This treatment, known as orthognathic surgery, can help adults who have completed their growth achieve a more appropriate jaw relationship and dental bite while improving impaired functions.

A dentist who specializes in orthodontics is called an orthodontist. Orthodontic diagnosis requires a detailed clinical and radiographic examination. Photographs, radiographs, and dental models or digital scans are carefully evaluated to identify the patient’s main orthodontic problem and develop an appropriate treatment plan.

WHY DO TEETH BECOME CROWDED?

Both genetic and environmental factors influence the development and positioning of the teeth and jaws.

Habits such as mouth breathing, thumb sucking, lip or tongue sucking, nail biting, biting pens or pencils, and prolonged use of bottles or pacifiers may contribute to dental crowding and jaw-development problems.

Children who continue to use a pacifier or bottle after approximately four years of age, or who habitually breathe through the mouth because they cannot breathe properly through the nose, may develop persistent changes in the upper and lower jaws. For this reason, regular dental monitoring during childhood is important.

In adults, tooth loss may also cause neighboring teeth to tilt into the empty space, while opposing teeth may over-erupt, leading to changes in tooth alignment and bite.

IS THERE A RELATIONSHIP BETWEEN THE JAW JOINT AND ORTHODONTICS?

Premature tooth loss, movement of adjacent teeth into extraction spaces, and excessive over-eruption of opposing teeth may disturb the bite and contribute to problems involving the temporomandibular joint.

Repetitive habits such as nail biting may also place unnecessary strain on the jaw joint. An improper bite may be associated with symptoms such as jaw discomfort, teeth grinding, and excessive tooth wear.

An orthodontist can assess the bite and jaw relationship and determine whether correcting the occlusion may help prevent or reduce problems associated with the jaw joint.

AT WHAT AGE SHOULD A CHILD HAVE AN ORTHODONTIC EXAMINATION?

Children should generally have an orthodontic evaluation by around the age of 7.

Problems such as narrow jaws, crossbites, or shifting the jaw to one side when closing the mouth can often be managed more successfully when identified at an early stage.

UP TO WHAT AGE CAN ORTHODONTIC TREATMENT BE PERFORMED?

As long as the tissues surrounding the teeth are healthy, teeth can be moved orthodontically at almost any age.

There is no strict upper age limit for correcting crowding or spaces between the teeth. Orthodontic treatment may be performed in both children and older adults, provided that the gums and supporting bone are healthy.

HOW CAN YOU TELL IF YOU MAY NEED ORTHODONTIC TREATMENT?

You may benefit from an orthodontic examination if:

• Your upper and lower teeth do not meet properly.
• Only a small number of teeth make contact when you bite.
• You experience difficulty biting or chewing.
• You have an impacted or unerupted tooth.
• Your teeth are crowded or misaligned.
• You have missing or extra teeth.
• Your smile appears asymmetrical because of tooth position.
• You have a problem with the position of your upper or lower jaw.
• Habits such as thumb sucking or nail biting have affected your bite.
• You have large spaces between your teeth.
• You experience jaw-joint problems that may be related to your bite.

HOW LONG DOES ORTHODONTIC TREATMENT TAKE?

The total duration of orthodontic treatment depends on the type and severity of the problem, the patient’s biological response, attendance at appointments, compliance with treatment, and the treatment plan.

Teeth generally move gradually, often by less than approximately 1 mm per month, although this varies depending on the individual tooth, type of movement, and biological factors. For many comprehensive orthodontic treatments, the average treatment period may be around 18–24 months.

Treatment may take longer when growth modification, orthognathic surgery, or the orthodontic eruption of impacted teeth is required. Following a detailed clinical and radiographic assessment, the orthodontist can provide a more individualized estimate.

IS ORTHODONTIC TREATMENT PAINFUL?

Attaching orthodontic brackets to the teeth with special adhesives is generally painless. However, mild soreness or pressure may occur when the teeth begin to move.

This discomfort usually lasts for a few days and gradually decreases. Pain sensitivity differs from person to person; some individuals experience little or no discomfort, while others may notice more pressure or tenderness.

HOW SHOULD I BRUSH MY TEETH WHILE WEARING BRACES?

Special toothbrushes, interdental brushes, and dental floss products are available to help clean around orthodontic brackets and wires.

These products come in different sizes and can be used to clean around the braces, along the gum line, between the teeth, and on the chewing surfaces after meals.

Oral irrigators, which use a pressurized stream of water, may also support oral hygiene. However, they should generally be used as an additional cleaning method rather than as a complete replacement for brushing and interdental cleaning.

The most important point is to clean slowly and carefully, checking each tooth individually in the mirror to make sure that plaque and food debris have been removed.

WHAT TYPES OF ORTHODONTIC APPLIANCES ARE AVAILABLE?

1. Metal Brackets:
These are fixed metal orthodontic attachments bonded to the teeth. They are typically silver or gray in appearance and are widely used because of their durability and effectiveness.

2. Clear or Ceramic Brackets:
These brackets are closer to the natural color of the teeth and are therefore less noticeable. They are more aesthetic than metal brackets but may be more fragile.

3. Lingual Brackets:
These are metal brackets attached to the inner surfaces of the teeth. Because they are positioned behind the teeth, they are much less visible from the front.

4. Clear Aligners:
Clear aligners are removable transparent appliances used to gradually move the teeth. No conventional brackets are bonded to the teeth, although small tooth-colored attachments may sometimes be required. A series of aligners is worn and replaced at scheduled intervals throughout treatment.

CAN MY TEETH MOVE AGAIN AFTER ORTHODONTIC TREATMENT?

Maintaining the position of the teeth after active orthodontic treatment is an essential part of achieving long-term stability.

After braces or aligners are removed, a thin fixed wire called a retainer may be bonded to the inner surfaces of the teeth. In some cases, removable retainers that cover the teeth are also used.

This stage, known as retention, allows the soft tissues and supporting bone around the teeth to adapt to their new positions. Without appropriate retention, there is a risk that the teeth may gradually shift again.

Your orthodontist will determine the most suitable type of retainer and how long it should be used based on your individual treatment needs.