1. INTRODUCTION

This section presents important facts of the orthodontics treatment; you will know the benefits the treatment, what can you expect from it and learn about it.

a. What is orthodontics:

It is the branch of odontology/dentistry that identifies, treats and prevents wrong position of teeth (malocclusion). The word "orthodontics" derivates from greek roots ORTHO (straight) and DONTOS (teeth). It means "straighten teeth".

There are several causes to malocclusion and misaligned teeth. Orthodontics offers a way to correct this and improve patient's physical appearance, achieving a correct mastication, improving speech and eliminating pain, when it is present.

b. Benefits of treatment:

• Improvement of facial appearance/cosmetics
• Elimination of pain
• Adequate mastication
• Avoid dental wearing
• Eliminate bone stress and excessive/unadequate forces on the bone
• Makes it easier to get a correct oral hygiene and dental care
• Enhances self esteem and social interaction
• Restores lost functionality
• Allosws a better pronunciation and speech
• Helps to get a better respiratory function

c. Braces and your lifestyle:

After an initial adaptation period, there are several limitations to practice contact sports and play some musical instruments, but acceptation of braces is fast, and it is so common nowadays, that you, your family and friends will soon be used to see you with your braces.

d. Ortodontics for adult patients:

Although orthodontics is mostly used in children and young adults, the truth is that more than one quarter of the people using braces are adults. Teeth positioning and adjusting works the same in children, young and adult patients.

Sometimes adults require treatment to correct dental loss problems or malocclusion developed in childhood which were never corrected, and some alterations occurring in adult age.

Teeth and gums health of these patients are the most important factors leading to an orthodontical treatment, no matter the patient's age.

As bone structures in adult patients don't grow anymore, the only way to correct malocclusion is by using braces. In some cases, serious dentofacial problems can only be treated by maxillofacial surgery and orhodontics together.

f. Early treatment:

It is not possible to stablish the age a child should initiate orthodontics treatment. Each patient must be evaluated individually, and treatment must be made according his/her specific diagnosis.

It is important to visit your orthodontist as soon as possible when any symptom of dental misalignment.

In some cases, treatment must start at an early age, specially with preventive work, in order to guide teeth and maxillary development. This can allow permanent teeth to have enough space for their eruption. Orthodontist will know the best time to start an opportune treatment with fixed or removable devices.

The sooner the patient visits the orthodontist, the sooner any problem can be corrected.

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2. FREQUENTLY ASKED QUESTIONS

¿WHO NEEDS BRACES?

OVER BITE:
A condition where the front teeth overlap the lower teeth excessively is called an overbite. This problem often has its roots in the size of the jaws and poor care of children's teeth. Prolonged use of feeding bottles or pacifiers may also result in the upper teeth being pushed out.  If overbite is especially deep, corrective braces or even surgery may be required.

OPEN BITE:
An open bite is a dental disorder in which front teeth, both upper and lower are forced outwards to an extent that the teeth of the upper and the lower jaw do not touch each other, even when the mouth is closed.

OVERTJET (Protrusion):
Overjet is also called protrusion. It is where the lower teeth are too far behind the upper front teeth. This condition complicates when lower lip gets trapped between these two parts, preventing jaw bone to grow.

MISSING TEETH:
It is when one or more teeth have been lost. In some cases, resulting spaces can be closed with orthodontics or missing tooth can be replaced with an implant or bridge prosthesis.

CROWDED TEETH:
Most common problem patients have when they go to orthodontist are crooked and overlaping teeth. This condition usually occurs when teeth are too big for the dental arches or when teeth have a normal size, but maxillary bones are too small to accomodate them.

CROSS BITE:
In a "normal" jaw structure, the teeth of the upper jaw are slightly outside the lower jaw. Cross bite is a condition of the teeth where the position of one or more teeth is reversed. This situation is not self correcting, and as the tooth grows, the alignment will never correct itself, so the sooner the condition is corrected, the less difficult the treatment is.

SUBMERGED PRIMARY TEETH:
This condition occurs when temporary tooth root is not exfoliated on time, and the adjacent permanent tooth takes space from adjacent temporary tooth, pushing it backwards.

PREMATURE LOSS OF TEMPORARY (PRIMARY) TEETH:
This is a frequent problem, and one of the main causes of malocclusion. It happens when a temporary tooth is missing due to an extraction or an accident. As a consequence, spaces are lost, causing remaining teeth to move and to crowd.

TOOTH ROTATION:
It means that teeth look turned. This is a common problem, associated to dental crowding.

AXIAL INCLINATION:
It happens when dental roots have an incorrect angle from each other.

Orthodontics can help to correct maxillary misalignment. This condition can be caused by incorrect teeth alignment, which can result in headaches, muscular fatigue and face and neck tension.

¿WHEN ARE BRACES NECESSARY?

There is no perfect age or moment to start an orthodontics treatment. If you notice any of the symptoms mentioned above, you should see your orthodontist as soon as possible.

All orthodontics associations recommend the age of 6 years to start evaluating a child's dental and maxillofacial conditions, and to determine if an orthodontic treament is necessary. This ensures the prompt correction of any dental problem. An early detection of any problem can lead to get the right treatment and help patient to get a correct facial bones structure when adult.

¿HOW MUCH DOES AN ORTHODONTICS TREATMENT COST?

Although the care of the teeth is one of the supposedly most expensive investments in the familiar budget, it is also one of the greatest satisfactions of the human being. Our smile becomes in something pleasant because it is our presentation card.

A healthy smile opens many doors, so many people can see that orthodontics, more than an expense, is a true investment.

Orthodontics has been one of the most expensive family needs during the last 40 years. Since 70's, cost of braces kept growing along with cost of life. Currently, this has been decreasing. During these years, quality of treatment has been improving, according to the new technologies and techniques available.

Currently, costs of an orthodontic treatment change according to patient's alterations or problems. Nowadays, most of the orthodontists offer long term payment plans, and there are many programs such as dental insurance plans, that offer payment options for these treatments.

¿HOW MUCH TIME DOES ORTHODONTIC TREATMENT TAKE?

Time of treatment depends on every patient's facial and dental growth. Usually, treatment takes from one to three years. In adult patients, treatments can also take this time, because adults are more collaborative and responsible about treatment.

¿WHY SHOULD YOU CHOOSE AN ORTHODONTIST?

An orthodontist is an odondologist who has completed a three-years specialized training, in order to guarantee his/her qualification to correct any craniofacial problem.

¿HOW OFTEN WILL I VISIT THE ORTHODONTIST?

All orthodontics treatment is divided in three sections:

1. Initial treatment
2. Maintenance treatment
3. Retention phase, starting when braces are removed.

During first stage, your visits will be each 3 - 4 weeks.

During second stage (maintenance treatment) visits will be each month.

During retention phase, appointments will be less frequent.

Tou should visit your general dentist about each four (4) months in order to keep your teeth clean and healthy.

¿CAN I PRACTICE SPORTS OR PLAY MUSICAL INSTRUMENTS?

While you are using braces, there is a short adjustment period, after which you will be able to play any musical instrument such as trumpet, flute, saxophon or clarinet without even notice you have them on. You can also practice any sport, while you wear a bucal protector specially designed for patients with braces. Any damage on your braces must be repaired by your orthodontist as soon as possibel.

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3. TESTS AND STUDIES REQUIRED.

ORTHODONTICS EXAM

Before you start your treatment, your orthodontist will perform a deep examination of your teeth and maxillary bones. You will be asked to open and close your mouth in order to see how your teeth adjust. X-rays also will be required, and photographs and plaster model of your teeth will be taken. This will help to construct your clinical/dental history. This information will be used to make a diagnosis and analize your x-rays, to compare them against world standard measures.

MEDICAL / DENTAL HISTORY

Some general information will be collected, regarding previous and current diseases, medication you are taking, and an intraoral exam will be made. This information is given to the orthodontist, who will make an effective, safe treatment.

PLASTER MODELS

In order to make an exact impresion of  upper and lower teeth, your dentist will put in your mouth a small cast full of a soft paste (algynate) used to obtain a three-dimension model of your teeth, maxillary bones and palate.

X-RAYS

Your orthodontist will need a series of radiological studies to know the current status of your denture and bones.

Usually, two types of X-rays are taken: panoramic and craneum profile/lateral.

Panoramic X-ray shows the size of teeth roots, number of teeth, bones shape and size. It also shows if there are any bone diseases, as cysts, tumors, etc.

Lateral x-ray shows soft tissues and the position of the lips. These X-ray also show upper/lower maxillary proportion and cranio-maxillary proportion.

PHOTOGRAPHS

Pictures help the orthotdontist to see, compare and monitor the treatment progress. At the end of treatment, before/after comparison can be made.

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4. YOUR DIAGNOSIS

HEALTHY (CLASS I) BITE
A healthy bite has good occlusion. Tetth are correctly aligned. Upper teeth overlap lower teeth in a proper way.

MISALIGNED BITES
These are all the inadequate positions of teeth which cause malocclusion.

Open bite:
Due mostly to thumb sucking, tongue pushing or other habits, front teeth (upper and lower) do not touch when closing the mouth.

Over bite:
It happens when the upper front teeth overlap the lower front when closing the mouth. Some times overbite is so deep, that lower teeth touch palate.

Over jet:
It is the distance between the upper and lower front teeth, when the upper are bucked out and the lower are more refracted inside towards the tongue.

Class II bite:
A class II bite occurs when the lower teeth are behind the upper teeth. The upper front teeth and jaw project further forward than the lower teeth and jaw. It can be due to insufficient growth of the lower jaw, an over growth of the upper jaw, or a combination of the two.

Spaces:
It is when teeth are proportionally smaller than maxillar. This creates a space between teeth, which is called diastema.

Class III bite:
This condition occurs when the lower teeth are ahead of the upper teeth. Lower teeth and jaw project further forward than the upper teeth and jawsIt is usually due to an overgrowth in the lower jaw, undergrowth of the upper jaw, or a combination of both.

Anterior cross bite:
It occurs when one or more of the anterior upper teeth erupts behind front lower teeth.

Posterior cross bite:
This means that upper palate is too narrow, and posterior upper teeth bite inside lower teeth.

Crowded teeth:
This is the most common problem. It is usually caused by teeth which are too big in proportion to dental arches.

TMJ Disorders (TMD):
Disorders of temporomandibular joint are related to the jawbone joint. Symptoms of TMD include headaches, neckache or stiff neck, earaches (actually pain in front of the ears), jaw aching, difficulty opening or staying open at the dentist's office, pain in the joint on opening the mouth, inability to open the jaws wide, pain on chewing, sensitive teeth, tendency to dislocate the jaw, and clicking, popping or grinding noises when opening or closing the mouth.

Sensitive Teeth:
In some cases  patient can feel pain when his teeth get in touch with each other or with cold/hot materials.

 

SURGERIES

Sometimes malocclusions are caused by the way maxillary are aligned. In some cases surgery is the best option. Treatment requires orthodontist to work with oral/maxillofacial surgeon in order to achieve te desired results.

Before surgery
Braces must be placed to create a new alignment of teeth. This stage is known asl pre-surgical stage. When patient is ready, surgeon makes a final evaluation before programming patient for surgery.

After surgery
Once the patient has been operated, orthodontic treatment must continue to finish corrections. Surgery changes patient's appearance and improves self-esteem.

 

POTENTIAL RISKS

Only a qualified specialist will determine if there is any risk, and in case it happens, he will be able to solve it. Patient must commit to attend all appointments so the specialist can follow his/her case.

Decay and decalcification
Ortgodontic devices don't cause decay, but if braces don't receive a daily proper cleaning and care, food can get trapped between teeth. This problem can be avoided by means of a proper diet and an adequate oral hygiene.

Tooth loss of vitality
If a patient has a tooth that has been affected by a trauma or an accident, orthodontic treatment will increase risk od degeneration of dental nerve or tooth decoloration/stainign. This problem can be treated with a root canal treatment or dental whitening.

Dental Resorption
It is the shortening of dental roots. This condition can occur with or without braces. Orthodontist and dental specialists are the indicated professionals to treat this condition.

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5. ABOUT YOUR BRACES

Braces can hurt the internal face of lips. A broken wire can also cause injuries to cheeks and lips. If this happens, patient can use soft wax or silicone to avoid these injuries.

REGRESSION OR COLLAPSE

Colapse can occur when teeth that have been corrected return to their original position. After the end of  orthodontic treatment teeth will usually tend to move back, but they will remain in their new position if retaining devices are used properly. Some regressions are impossible to avoid.

PARTS AND DEVICES USED IN AN ORTHODONTIC TREATMENT

Elastics:
They are an important part of any orthodontic treatment. They apply constant forces that move teeth to their new position. Elastics must be properly used so proper results are obtained.

Headgear:
Headgear is used for patients that have overbites that cannot be corrected by the use of just braces and rubber bands / elastics.  The gear attached to the head and works to stop the growth of the upper jaw, while waiting for the lower jaw to catch up.  This is usually used for kids and teenagers as they experience growth spurts.

The headgear can be worn to bed and during the day to control the overbite from getting worse and actually corrected it.  You may notice some pain and discomfort, however it is usually minimum and worth the end result.

Nance Button:
It is a device placed on palate. It is used to maintain spaces in mixed denture, and when it is necessary to make upper pre-molars exodontias, allowing to preserve spaces that will be used to move anterior teeth backwards.

Lingual Arch:
The Lingual Arch is intended to maintain arch length. This simple retainer prevents both mesial and lingual tipping of the molars while maintaining the arch length. The most common design is composed of an arch wire soldered to two bands.

Palate Arch:
It is used to widen maxillary arch.

Habit Corrector :
This is an appliance used to prevent tongue-thrusting or thumb-sucking..

Trans-Palatal Arch:
Trans-Palatal Arch is a thin wire that goes across the roof of the mouth from first molar to first molar. Most people get a TPA to maintain arch width and aid in molar movement that wires alone can't achieve.

Bionator:
A Bionator is a myofunctional appliance that repositions the mandible in a forward and, if necessary, centered position. Its main use is to correct a Skeletal Class II pattern with a retruded mandible. It can be used to treat a variety of conditions. It can increase vertical dimension and eliminate deep overbites. Another variant can close openbites. It can be used to treat TMJ dysfunction when the mandible is posteriorly-locked. It can widen moderately narrow maxillary and mandibular arches, correct excessive overjet, correct improper upper and lower lip relationships, and eliminate tongue thrusting and sucking habits.

Expansion Plates:
It is a removable device, used to correct crowding and to widen maxillary arch.

¿HOW DO MY TEETH MOVE?
Treatment must begin with spacers, so bands can be placed around molars. Braces are placed on the teeth that will be moved.  Then, arches are placed to provide a guide for teeth new location. Constant pressure applied to teeth, gradually adjusts or changes their location. Final result is a proper bite alignment and a beautiful smile.

¿WHAT CAN I EAT?
One of the main concerns is the way of eating. Soft food, such as pasta and soups are recommended. Cutting food in small pieces is advisable.

Patient should avoid hard or sticky foods, such as hard vegetables, lollipops, pop corn, caramel, chewing gum, chicken bones, ice, etc.

TEAM WORK:
Your orthodontic treatment is a teamwork. Orthodontist and his team diagnose your condition, plan the treatment and apply it. Your commitment is to punctually attend to all your appointments, keep your teeth and braces clean, take good care and proper use of your braces and any other appliance.

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6. TAKING CARE OF YOUR BRACES

BRUSHING:

Brushing your teeth is usually very important, but when you are using braces, you must take special care. You must use a soft orthodontic toothbrush (central bristles are shorter than side bristles). Hold your toothbrush at a straight angle and start with the outside of the teeth. Brush the outside of your teeth using small circular motions, making sure to include the outside of your the back teeth too. Angle the toothbrush upwards on the bottom teeth so that you can clean the area between the gums and teeth. Repeat on the upper teeth by angling the toothbrush down. Thoroughly brush the upper and lower chewing surfaces of the back teeth on both sides. Brush the inside of upper and lower teeth, making sure to include the inside of your back teeth too. After this, use a interdental toothbrush to clean clean around the braces and underneath the orthodontic wires.

FLOSSING:

After brushing, floss in between your teeth. When you are flossing in between your teeth, remember to gently floss up and down under the gums. Be sure to floss all of your teeth including the back ones.

A floss threader will help you get the dental floss underneath your archwires. Tear off about 18 inches of dental floss and pull it through the loop of the floss threader. Insert the pointed end of the bridge threader gently underneath your archwire. Pull it all the way through until the floss is under your archwire. Once the dental floss is inserted, gently floss in between your teeth.

Dental floss with a stiff end is also available. It is pre-cut and is very easy to insert underneath archwires. Simply take the stiff end of the dental floss and insert it underneath your archwire. Pull it gently through.

ORAL RINSE / MOUTHWASHES:

Mouthwashes added with fluoride should be used to prevent caries. It is a usefool tool to avoid growth of plaque. It is intended to be used after brushing and flossing.

CARE OF ORTHODONTIC APPLIANCES

You can help your orthodontist to achieve a successful result in your treatment, by having in mind these simple recommendations:

• Attend all your appointments with your orthodontist.
• Keep your braces clean
• Keep your teeth and mouth clean
• Be careful with what you eat
• Cooperate with your orthodontist

EMERGENCY PROCEDURES

If any piece of your braces or appliances is accidentally broken or removed, take it with you and visit your orthodontist as soon as possible.

GENERAL PAIN OR DISCOMFORT

Orthodontic treatment can cause discomfort, toothache or headache. You can use analgesics such as Acetaminophen or Ibuprophene.

Broken wires can hurt your bucal mucous. If this happens, apply a small ball of dental wax or silicone on wire tip. You can also use a pencil eraser.

LOSS OF A TOOTH

Sometimes, orthodontic treatments imply to extract a dental piece. This is not a probles, because remaining teeth will be relocated to their new position.

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7. SPECIAL RECOMMENDATIONS TO ORTHODONTIC TREATMENT PATIENTS

Patients with braces must follow these recommendations:

• Patient must take proper care of braces and appliances, and use them as directed.
• Cost of the treatment doesn't include complementary dentistry treatments as exodontia, root canal treatments, periodontal treatment, fillings, crowns, prosthesis, oral hygiene, etc.
• Patient should visit dentist every 4 months.
• Orthodontic treatments don't have a finishing date. Orthodontist must take the time it requires to get a proper result.
• In case you can't attend your appointment, you should cancel it at least 24 hours before.
• Payments must be made punctually.
• You must brush and floss your teeth before your appointment.
• If an element is broken or missing, you must schedule an appointment as soon as possible to change or repair it.
• When use of rubberbands/elastics is indicated, you must use them as told by your orthodontist, and avoid to play with them.
• Remember you must brush your teeth more often, and everytime you eat.
• If you practice any sport, remember to wear a bucal protector
• During the first days of treatment, temporary pain or discomfort is usual.
• Once your braces are put on, you must use wax or silicone to avoiy injuries on lips and cheeks mucous.
• Avoid hard foods that can break, dettach ortgodontical elements.

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8. SPECIAL RECOMMENDATIONS TO PATIENTS WITH REMBOVABLE TREATMENTS

After taking dental impressions, these are sent to a laboratory specialized on orthodontic appliances, where your removable devices are designed.

You shoud follow this recommendations to care your appliances:

• Patient must take proper care of braces and appliances, and use them as directed.
• Use of appliances must  be as indicated by your orthodontist.
• Device must be kept in its hard case when not in your mouth. Avoid to keep in napkins or clothings.
• You must keep your appliance in your mouth all the time, except to eat and brush your teeth.
• Brush your appliance with odorless soap or tooth paste.
• Remember you must brush your teeth more often, and everytime you eat.
• Devices are designed ONLY for your use. Nobody else should wear them.
• If you practice any contact sport, it is advisable to remove your appliance and store it in the proper case.
• These devices are intended to move bones and teeth in your mouth. The more you use them, the better your problem is treated.
• You will salivate more intensely.
• Your orthodontist will adjust your appliances everytime you have an appointment.
• Sometimes, appliances can get loosen. Keep it in your mouth as much as you can until your next appointment.
• If your appliance is lost or broken, it must be made again. You will be charged for laboratory costs.
• Tell your orthodontist about any discomfort you have with your appliance.

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9. SPECIAL RECOMMENDATIONS FOR SURGICAL PATIENTS.

When you are ready for your maxillofacial surgery, you must remember:

BEFORE SURGERY

• Have a light, small meal for breakfast the day of your surgery.
• Wear comfortable clothes.
• Take somebody to accompany you.
• Avoid any medication containing aspirin from one week before surgery. Don't self-medicate.
• Brush your teeth before surgery.
• Don't take any sedative medication before the surgery. Doctor will determine if you need it.
• If you can not attent to surgery, please call and cancel it at least 48 hours in advance, so your surgery turn can be assigned to another patient.

AFTER SURGERY

• After surgery, it is normal to feel some pain. Take the medication prescripted by your doctor as indicated in the recipe.
• Put ice on surgery area. This will decrease swelling.
• Avoid gaggling or strong washmouths during the first days. It can cause hemorrhage.
• Slight bleeding is normal during the first day after surgery.
• Liquid or soft diet must be observed during the first days.
• A good oral hygiene avoids possible infections.
• Avoid repetitive spitting. It can cause hemorrhage.
• Attend all post-surgical controls.

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10. AFTER REMOVING BREACES

Once braces are retired, pasive orthodontics start. This stage defines stability of your teeth and permanent results of your treatment.

Retainers:
El This is a removable device intended to keep the adjust process by keeping your teeth in the best position.

Retainer must be kept clean. Each time you use it, brush it with toothpaste or soft odorless soap. Keep it in fresh places to avoid deformation caused by heat. Don't chew bubblegum with your retainer on. Take it to every control appointment.

Positioners:
Plastic device that keeps correct position of teeth. It requires the same care as retainers.

Keeping your smile
Once your braces are removed, your cooperation and care are required. You must use retainer or positioner as indicated by your orthodontist. You should also visit your orthodontist at least once a year, and keep visiting your dentist at least twice a year in order to keep your oral health.

Human being's teeth were made to last all life. Mouth is one of the body areas that most dramatically reveals our age. Aging signs, such as teeth loss and decay, are usually caused by untreated orthodontical problems.

Your smile is an excellent reason to get an orthodontic treatment done, but the greatest benefit is to ensure that you will have a healthy smile for the rest of your life

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