Braces

What causes malocclusion

Malocclusion means improper alignment between upper and lower teeth when closing the jaws.

Normal occlusion refers to the ideal alignment of the upper and lower teeth.  All upper teeth slightly overlap the lower teeth with the buccal cusps of the upper molar teeth fit the grooves of the opposed lower molar teeth. This ideal occlusion helps protect the cheeks and lips while chewing and makes chewing more efficiency.

Classification of malocclusion:
Class 1 Malocclusion

Class 1 malocclusion:
The most common type of malocclusion with posterior teeth meet normally, but the anterior teeth are crowded, spaced apart, open-bite, over-bite and cross-bite.

Occasionally, posterior cross-bite may occur.  A cross bite can be individual tooth or groups of teeth.

Posterior crossbite is The eruption and function of the upper posterior teeth either outside or inside of the lower posterior teeth.

An anterior crossbite is the eruption and function of lower front teeth in front of upper front teeth.


Class 2 Malocclusion
Class 2 malocclusion: (overbite, deep bite, closed bite, retrognathism) -  the upper jaw and teeth severely overlap the lower jaw and teeth.

Class 3 malocclusion: (underbite, prognathism), the protrusion of the lower jaw causes, the lower jaw and teeth to overlap the upper jaw and teeth.

Class 3 Malocclusion
Most malocclusions are hereditary, such as crowding teeth due to smaller than standard jaws, too much space between the teeth due to jaw enlargement, extra teeth, a malformed tooth, impacted tooth or missing teeth.

Other malocclusion caused by:
  • Bad habit such as thumb or finger sucking in early age, prolonged use of pacifier and bottle, 
  • Cleft palate
  • Tongue thrusting
  • Accidentally Injured the teeth or jaws
  • Early or late loss of baby teeth and permanent teeth resulting in overcrowding or spacing of teeth and an abnormal bite of upper and lower teeth.
  • Tumors in the jaw bones
Why is it important to have braces?
  1. It's hard to clean and maintain crowded teeth
  2. Malocclusion may cause TMJ problem later
  3. Abnormal bite may cause abnormal wear of certain tooth surfaces
  4. Difficulty in chewing food
  5. Speech difficulty
  6. Prevent cracked tooth, too much stress due to an uneven bite can cause broken tooth
  7. Mouth breathing
  8. High occurrence of cheek and tongue biting during chewing
Without proper orthodontic treatment; malocclusion becomes worse and may require additional dental care.

When should you have an orthodontic check-up
According to American Association of Orthodontists: children should have orthodontic exam before age seven.  At this age, the Orthodontist may identify developing problems and treatment can begin if there is any malocclusion at the appropriate time, provide children the best opportunity for a healthy, beautiful smile and gain self-confidence.  Due to advanced technology; malocclusions can be treated successfully at almost any age.

Other benefits of early treatment of malocclusion include:
  1. May prevent more serious problems from developing 
  2. Make a treatment of malocclusion at a later age shorter and less complicated
  3. The chance to guide growth of the child's jaw
  4. Avoid the risk of trauma to protruded front teeth
  5. Improve how the upper and lower lips meet and improve an  appearance
  6. Guide permanent teeth into the right position
  7. Correct harmful habit to the teeth before it becomes too complicated
  8. The Orthodontists can provide each patient with malocclusion the most appropriate treatment at the most appropriate time
You may find the Orthodontist in your area at The American Board of Orthodontics.

What are the clues that may indicate the need for orthodontic treatment
  1. Grinding or clenching the teeth
  2. Baby teeth loss too early or too late according to tooth eruption charts
  3. An unsymmetrical facial appearance
  4. Difficulty/discomfort chewing or biting food
  5. Upper and lower teeth don't meet properly
  6. Breathing through the mouth
  7. Upper teeth protruding more than normal range
  8. Thumb sucking
  9. Complain about Biting the cheek or the tongue
  10. Crowded teeth
  11. Lower/upper jaws are too far forward or back
How do braces work
Before the orthodontic treatment begins, the dentist may:
  • Extract one or more teeth if they are too crowded 
  • Re-shape or place a crown as necessary
  • Repair old restoration if needed
  • Fill all cavities
  • Treatment of the gums (cleaning, deep cleaning) as necessary
  • In a rare case, surgery to the jaw bones may be required 
There are two types of orthodontic appliances:
  1. Fixed appliance
  2. Removable appliance 
Both appliances use gentle pressure to move crowded teeth into their proper positions. To achieve the best results; orthodontic patients require to following Orthodontist’s instructions, keep scheduled orthodontic appointments and maintaining excellent oral hygiene. The treatment for malocclusion last approximately one to three years depends on the severity of the problem, and it's complexity.

During the correction of malocclusion; the patients need to see their general dentists for overall care of the teeth and oral health. To accomplish the best cleaning result use water irrigation.  The reason being water irrigation is an efficient tool for cleaning around appliance where there is a minimum access for dental floss.  Proper care of the teeth will prevent a cavity.

Fixed orthodontic appliance
Fixed orthodontic appliance comprised of (see illustration):
A. Ligature: holds the archwire to each bracket
B. Archwire: creates force to move the tooth gently to a proper position
C. Brackets: hold the archwire in place on the tooth or the band
D. Metal band: wraps around the tooth, use as an anchor to the bracket
E. Elastic hooks & rubber bands: rubber band hooks to elastic hook, help move teeth to their position




Appliance used in orthodontic treatment
1. Braces 
Braces have two components: brackets and wires which, usually, attached to the front part of the teeth, but some can be behind the teeth.  Brackets made of metal or tooth-colored ceramic. The function of braces is moving teeth to the correct position through periodically adjusting the wire.



2.  Aligners
Aligners are removable custom-shaped clear plastic or acrylic orthodontic appliance. Aligners move teeth toward their desired positions through series of new aligners every few weeks until reaching treatment goals. Aligners must be worn daily and only remove to eat, brush and floss. 



3. Retainers
Retainers can be removable or fixed. The function of retainers is to keep teeth in their new positions after removing the braces. Removable retainers use wires or clear plastic similar to aligners. Fixed retainers use wires bonded to the back of the upper or lower teeth.


How to care for an orthodontic appliance
  • Brush with toothpaste or vinegar until no plaque or food particles
  • Soak in denture cleaner if calculus builds on the surface or routinely soak once a month
Some of the orthodontic terms
Appliance: any attached or removable orthodontic device designed to move the teeth, change the position of the jaw, or hold the teeth in their finished positions after removing the braces.

Buccal tube: a small metal part of the bracket welded to the facial side of the molar band. The use of the tube is to hold the archwire, lip bumper, headgear facebow or other orthodontic appliances that use to move the teeth.

Chain: a stretchable series of elastic o-rings connected and placed around each bracket, it's function to hold the archwire in place and help move the teeth.

Anterior tooth: front tooth (from left canine to right canine)

Posterior tooth: back tooth (from canine to the last molar)

Ectopic eruption: tooth that erupts in an abnormal position

Eruption: the process of teeth entering the mouth

Extraction: the removal of tooth

Facebow: a wire appliance an internal wire bow and an external wire bow used with a night brace or headgear. The inner bow attaches to the buccal tube on the upper molar bands inside the mouth; the outer bow attaches to the breakaway safety strap of the night brace. The function of Facebow is to move the upper first molars back and creating room for crowded or protrusive anterior teeth.

Functional appliance (orthopedic, orthopedic corrector, activator, bionator, Frankel, Herbst or twin block appliances): orthodontic appliances that utilize the action of muscle produced while speaking, eating and swallowing.  This action creates a force to move the teeth and align the upper and lower jaws.

Gingiva (gums): soft tissue around the teeth

Gummy Smile: an excessive appearance of gums when smiling.

Headgear: an orthodontic appliance used to provide traction for growth modification and tooth movement.

Herbst Appliance: a fixed or removable orthodontic appliance used to move the lower jaw forward. An expansion screw may be used simultaneously to widen the upper jaw.

Impaction: a partially erupted tooth or a tooth that doesn't erupt into the mouth.

Interceptive Treatment: treatment, usually, performed on patients with the mixed dentition of primary (baby) teeth and permanent teeth to intercept a developing problem.

Interproximal Reduction (reproximation, slenderizing, stripping, enamel reduction or selective reduction): Removal of a small amount of enamel from between the teeth to make space for bands.

Labial: The surface of the teeth that face the lips.

Ligation module: small donuts shaped elastic o-ring used to hold the archwire in the bracket.

Lingual: the side of the tooth that is adjacent to the tongue

Lip Bumper: an internal wire bow that attaches to the buccal tubes on the cheek portion of the lower molar bands.  Lip bumper used to move the lower molars backward and the bottom front teeth forward, creating space for crowded front teeth. The front portion of the bow has a bumper or an acrylic pad that rests against the inside of the lower lip. The muscles from lower lip apply pressure to the bumper creating a force that moves the molars backward.

Lip Incompetence:  lips cannot close while in resting position due to protrusive front teeth or excessively long faces

Malocclusion: the upper teeth and lower teeth do not meet properly.

Mandible: lower jaw

Maxilla: upper jaw

Mixed dentition: the stage (approximately 6-12 years) in children's teeth that have both primary (baby) teeth and permanent teeth in the mouth at the same time

Mouth guard: a removable appliance worn to protect the teeth from damaging or wearing off due to clenching or grinding teeth at night.

Open Bite: There are two types of open-bite
  1. An anterior open bite occurs when the upper and lower front teeth do not touch when the back teeth meet
  2. A posterior open bite occurs when the upper and lower back teeth do not touch when the front teeth meet.

Orthopedic Appliance:  a removable functional orthodontic appliance designed to guide the growth of the jaws and face.

Panoramic X-ray (radiograph): an X-ray that shows both upper and lower teeth in one film.

Palatal Expander:  a fixed or removable orthodontic appliance used to expand the upper jaw to make it wider.

Removable Appliance:  an orthodontic appliance that can be removed from the mouth by the patient.

Safety Strap:  the strap that prevents facebow (part of the headgear) from becoming loose and may cause injury.

Separators: an elastic o-ring or small wire loop used to create space between the tooth before cementing the band to the tooth.

Space Maintainer: a fixed orthodontic appliance used to maintain space for an embed permanent tooth after a primary (baby) tooth has been prematurely loss due to accident or decay.

Supernumerary teeth: extra teeth that is genetic malformed or erupt in abnormally occurrence

Tongue Crib: a fixed orthodontic appliance used to stop habits, or undesirable tongue forces exerted on the teeth and bone.

Tongue Trust:  a condition when a tongue pushes against the teeth.  This action generates forces while swallowing that may lead to an open bite.