ORTHODONTICS FOR CHILDREN AND TEENS
According to the American Association of Orthodontists, children should have their first orthodontic check-up by the age of seven. By that age, a child will have a mix of baby and permanent teeth, and the orthodontist will be able to recognize orthodontic problems (“malocclusions”), even in their earliest stages. He will also listen to concerns that parents and children may have, and also be informed about possible bad habits that can influence the development of the jaws, like thumb/digit sucking or infant swallowing. If no problem is found, the orthodontist may suggest periodic visits so that the child’s growth and development can be monitored, and ensure that permanent teeth are coming in the right time and sequence.
On the contrary, if during the first visit an orthodontic problem is diagnosed, the orthodontist will inform the parents and the child about treatment options and the best time for orthodontic therapy to begin. In many cases early intervention is preferable, so the first phase of the orthodontic treatment is initiated. In this phase, removable or fixed appliances are used to stop a bad habit, or guide the development of the jaws in a way that permanent teeth will have enough space to erupt normally. Common orthodontic problems in this phase are a very narrow upper jaw, a very unproportionate lower jaw, incoming adult teeth that are being obstructed by baby teeth, etc. So, the point of Phase 1 Orthodontics is to avoid and lessen orthodontic problems by mitigating and correcting current ones.
After completion of Phase 1, the orthodontist will give a break of 1-2 years before making decisions for the next phase. This will give mouth time to develop, so that he can be able to evaluate the case and determine which treatment is needed. In some cases, Phase 2 treatment may be unnecessary, when all orthodontic needs were addressed in Phase 1. If, however, phase 2 is needed, the child has various treatment options; traditional metallic, ceramic, lingual braces, or removable clear aligners (invisalign).
Currently, one of every five patients in orthodontic treatment is an adult. According to the American Association of Orthodontics, over 90% of adults who have had braces say they would reccomend it to others and 75% of them reported improvements in career and personal relationships after completing orthodontic treatment.
The shift of adults towards orthodontic treatment is due to increased awareness on oral health issues, but mainly because of the latest invisible orthodontic techniques. In the past, one of the biggest concerns with metallic braces was their noticeable appearance, which caused many patients to avoid getting the orthodontic care they knew they needed. Today, clear braces, lingual braces, or even the removable aligners, make orthodontics much more appealing to an adult since they don’t limit social and professional activities.
The main reason that brings adults to the orthodontist is the esthetics of their smile. However, apart from esthetics and self esteem, orthodontic treatment has numerous benefits for the patient:
- Teeth alignement contributes to better oral health. In some cases, the orthodontic treatment is recommended before periodontal treatment, because straightening of the teeth helps the patient clean more efficiently.
- Orthodontic treatment can also help prosthetic treatment, by correcting the inclination of some teeth and/or their spaces. In this way, a fixed dental prosthesis can be put, or space for impant positioning can be created.
- Teeth malocclusions can cause a temporomandibular joint disorder (TMJ), because misaligned teeth result in bite mechanics that place extreme pressure and strain on the jaw joints. Over time, the joint gradually becomes inflamed and this can cause pain when chewing or opening the mouth, earache, headache e.t.c. TMJ disorder is also related to teeth grinding and chopped teeth. Orthodontic therapy is of major importance in correcting this problem, sometimes with no other intervention or treatment needed.
Traditional metallic braces are one of the most trusted and reliable treatment choices for a wide array of orthodontic problems. They have been used for decades and thanks to the latest advancements, they are now smaller, sleeker and more effective than ever.
In this treatment choice, teeth are aligned with the use of metallic brackets and wires. The metallic brackets, made of stainless steel or titanium, are applied to the teeth and connected with a wire that is held in place using a small elastic band on each bracket. There are many choices of sleek metallic brackets, like smaller size metallic brackets with round edges, mini metallic laser-cut brackets, metallic brackets with child-friendly shapes such as a daisy, a star, a heart, or a rugby ball. This, together with the option of multicolored elastic bands, make metallic braces stylish, fun, and the Number 1 treatment choice among teenagers. Treatment time with metallic braces varies according to the patient’s special needs, but on average it usually lasts about 1-2 years.
One of the biggest concerns with traditional braces is their noticeable appearance, which causes many patients to avoid getting the orthodontic care they need. Clear braces are revolutionary, because they offer the reliability and guaranteed results of traditional braces with none of their cosmetic drawbacks.
Clear braces shift the teeth using the same method as traditional ones : brackets are applied to the teeth, a wire is used to connect them, and it applies a gentle force that gradually brings the teeth into alignment. These brackets are made of a transparent material that is much less noticeable than traditional metallic ones: porcelain or the latest polycrystalline alumina (Clarity Advanced braces). Clarity advanced braces create a far better aesthetic result as they are completely clear and resistant to staining from coffee, mustard, red wine etc. The wires and elastics are made of clear or tooth-colored material as well. The end result is a much less noticeable treatment that easily blends with the teeth’s natural color. Apart from the superior aesthetic result, clear braces also have a very smooth surface and rounded tips, so they offer great comfort to the patient.
The drawback of clear braces, especially the ceramic ones, is that they are slightly more brittle than the metallic braces, so the patient should be careful to avoid sticky or hard foods that could damage them. Also, clear brackets and wires can sometimes be discolored if they are exposed to food or drinks with dark pigments, such as coffee or wine. This drawback is faced with the latest half ceramic-half metal Clarity Advanced braces, that are stain resistant.
This method is a totally different orthodontic approach to the traditional bracket and wire system. Instead of fixed appliances, it uses a series of custom-made removable clear plastic aligners to gradually straighten the teeth. Each set of aligners represents a unique stage of the treatment, which is progressed to the next one after the patient wears them for about 2 weeks for 22 hours a day. There are many removable aligners systems, such as Invisalign, Clear-Correct, ClearPath, eCligner, etc. The most well known system worldwide is the Invisalign system, and this is why the whole clear aligner technique is named after it.
Invisalign technique has some limitations. First of all, it is not the best choice for correcting all types of malocclusions. In comparison to conventional braces, removable systems don’t offer the dentist the same level of detailed control over creating some types of tooth movements. This is why problems like severely rotated teeth, deep overbites, skeletally based malocclusions and open bites are better treated with bracket and wire orthodontics. In general, Invisalign technique is typically thought of as best suited for treating mild to moderately complex malocclusions. However, applications for clear aligner therapy are constantly expanding, so we expect that in the near future it will be able to cover the whole spectrum of orthodontic problems .
Another limitation of the Invisalign technique is that teeth must be in excellent health before orthodontic therapy begins. Any new or replacement dental restorations placed during Invisalign treatment may alter the fit of the aligners. Because of this, any planned dental work should be placed either before or after, but not during, treatment process. This also means that children or adults with poor dental hygiene may not be good candidates for this treatment choice.
Finally, the main feature that makes Invisalign so attractive to patients is also one of its biggest weaknesses. The aligners are removable; this provides patient with comfort, easier chewing and self esteem, but requires his cooperation, and that can be a huge disadvantage. Since no progress can be made unless the patient wears the aligners 22 hours per day, treatment’s success relies merely on patient’s motivation and dependability. That means the Invisalign system is not the best choice for any individual where there is some question about their ability or desire to comply with the orthodontist’s directions.
With this method, brackets are fixed on the inside (lingual) surfaces of the teeth and are therefore invisible. Overall, lingual braces can correct the same types of malocclusion as conventional ones. They are fabricated specifically for each patient, based on the anatomy of the lingual (inside) surfaces of his teeth and this is why they are much more expensive than stock metallic or ceramic braces.
The most obvious advantage of this technique is that braces are virtually invisible; they can hardly be seen unless someone closely watches the patient speak. Another advantage is that, by fixing braces on the lingual surfaces of the teeth, buccal surfaces are left intact. In the end of the treatment, when braces are removed, any possible white spots (signs of decalcification under the brackets due to poor oral hygiene) will be seen on the inner surfaces of the teeth, so they will not cause an esthetic problem. But perhaps the biggest advantage of lingual braces over other invisible solutions, like Invisalign, is that they remain on the teeth and therefore are functioning the whole day. This makes orthodontic treatment faster and, because not relied on patient’s dependability, with a much higher success rate.
The advantages of this modern technique are obvious, but lingual braces do have drawbacks as well. Many patients complain about tongue irritation from the constant contact between metal and tongue. Even the smaller bracket profile developed to lessen this irritation still does not eliminate it completely. Some patients also report speech changes with lingual braces. Typically, any pain, discomfort and speech impairments dissipate 3-4 weeks after wearing the braces; however there are patients that never get fully used to them. Other disadvantage of lingual braces is that they, much more than the traditional ones, impair oral hygiene; with front-facing braces the patient can better see and clean areas that need attention. This automatically makes any individual with poor oral hygiene a bad candidate for this technique. Finally, not every orthodontist will offer the option of lingual braces, as the procedure requires additional training and certification.
To conclude, invisible orthodontics with lingual braces is in our days a very trustworthy but expensive technique, usually preferred by adult patients. The specialized orthodontist should inform the patient about the pros and cons and help him weigh his options if lingual braces are best for him.
1. Which is the appropriate age for the first visit to an orthodontist?
According to AAO, first orthodontic visit should be made by the age of seven years. This offers the orthodontist the possibility of early intervention in case of skeletal abnormalities of the jaws, or of bad habits that can lead to them, such as finger sucking or infant swallowing. On the contrary, a belated first orthodontic check-up in the age where growth is completed and all the permanent teeth have erupted, usually limits the orthodontist’s treatment choices and sometimes makes tooth extractions unavoidable.
2. Why shouldn't I wait for my child's permanent teeth to erupt and then go to the orthodontist? Is Phase 1 Orthodontics so important?
Yes. Early orthodontic intervention is of great importance for the following reasons:
- The severity of growing skeletal abnormalities is prevented or limited. On the contrary, when skeletal growth is completed, the orthodontist’s choices are limited to treatments including tooth extractions, or even surgical intervention when skeletal abnormalities are very severe.
- It is highly possible that tooth extractions won’t be necessary in Phase 2.
- Young patients are more likely to adapt easily to the orthodontic appliances used in Phase 1 and cooperate better.
- Younger children are not shy and generally do not have the inhibitions of teenagers.
- In some cases, Phase 2 treatment may not be needed if a child’s needs are completely addressed during Phase 1
- The earlier the orthodontic treatment is initiated, the earlier it is finished. Even if Phase 2 is needed, we avoid most of the difficult-to-handle years of adolescence and teenagers are more confident and pleased with their appearance.
- Early orthodontic intervention corrects skeletal problems, so the aesthetic result of the face achieved is far greater.
3. How will I feel wearing braces, will it be painful?
During the first week after getting braces you may experience pressure and soreness of teeth and gums, especially when chewing, pain on the inside of your cheeks and sometimes discomfort or cuts on your tongue. Typically, this pain can be managed with over-the-counter painkillers, like acetaminophen (Depon or Panadol). Most people get used to their braces in about a month and after six months they don’t even notice them. However, after each orthodontic visit you may feel some pain or soreness for a few days, as the orthodontist tightens the braces to move your teeth.
4. Can braces damage my teeth?
Braces themselves are unlikely to cause damage to your teeth. However, there are few potential dental issues that can arise during orthodontic treatment with braces, but, luckily enough, there are ways of avoiding them:
- DEMINERALIZATION : When food particles come together in an acidic environment, the acids break down the surface of the teeth. If tooth demineralization occurs, you can be left with white scars around where your braces were. To prevent this, you should try to brush after every meal and steer clear of sugary and sticky foods.
- GINGIVITIS : It is the first stage of gum disease and may progress to periodontitis if left untreated. To prevent this, it is imperative to maintain gum health by flossing twice a day. It may be more difficult, but your orthodontist will give you some tips and tricks for doing it.
- TOOTH DECAY : Plaque, the biofilm that develops on your teeth because of oral bacteria, is harmful to your teeth since it can lead to tooth decay. Plaque then hardens to form tartar, which can stain your teeth a yellowish or brown color. Avoid plaque and tartar buildup with daily brushing and flossing. Your regular dental check-ups (3-4 times a year), will also help to prevent plaque and decay.
5. Will I have the perfect smile after the orthodontic treatment?
Yes, as long as you are pleased with the size and shape of your natural teeth. The orthodontic treatment aligns your teeth, but does not affect their morphology and color. So, if you are not totally satisfied with your smile after the orthodontic treatment, cosmetic dentistry with the aid of contemporary 3D printing techniques will help you achieve the smile you dream of.
6. Isn’t it unacceptable to extract healthy teeth during orthodontic treatment?
It depends on the case. Early intervention with Phase 1 Orthodontics typically makes tooth extractions in Phase 2 unnecessary. However, if Phase 1 is skipped, tooth extractions are in some cases unavoidable. One such case is, for example, a very narrow jaw of a teenager with very crooked teeth, where the orthodontist usually extracts 2 teeth to find space for the other teeth to be aligned. Before treatment, the specialized orthodontist has to inform the parents about possible treatment choices and their impact on the orthodontic result. On the other hand, parents should carefully choose an experienced orthodontist to whom they will trust their child’s smile.
7. Can an adult be orthodontically treated regardless of how crooked his teeth are?
Yes. Provided that periodontal tissues and teeth are healthy, each case can be orthodontically treated, regardless of age and severity of malocclusion.
8. Are lingual braces as effective as traditional braces?
Yes. Overall, lingual braces can correct the same types of malocclusion as conventional ones.
9. Are Invisalign clear aligners as effective as braces?
Yes, but not in all cases of malocclusion. In comparison to conventional braces, removable systems don’t offer the dentist the same level of detailed control over creating some types of tooth movements. This is why problems like severely rotated teeth, deep overbites, skeletally based malocclusions and open bites are better treated with bracket and wire orthodontics. In general, Invisalign technique is typically thought of as best suited for treating mild to moderately complex malocclusions. However, applications for clear aligner therapy are constantly expanding, so we expect that in the near future it will be able to cover the whole spectrum of orthodontic problems .
10. Do all the orthodontists have the knowledge to apply the lingual braces technique?
No. Not every orthodontist will offer the option of lingual braces, since the procedure requires additional training and certification. Our orthodontist Dr Tsagiannis is specially certified and experienced in this technique, and can help you weigh your options in order to decide whether you should choose lingual braces.
11. Is orthodontic treatment result stable?
Yes, provided that a fixed or removable retainer is placed for a period of time or forever. In fact, as it has been shown, the entire craniofacial environment including dentition undergoes continual changes and this is why the majority of the orthodontists nowadays recommend permanent life-time retention with fixed retainers.
12. Why do I need to wear a retainer after braces?
Once braces come off, the bone and the surrounding tissues need time to acclimate to their new position. During this time, dental relapse can occur. The orthodontic retainer, either a fixed or a removable one, serves as the only defense in preventing aligned teeth from returning to their old placement. Many orthodontists may recommend wearing retainers for the same length of time the patient wore braces; in some other cases the retainer is fixed for life. It is important to note that each orthodontic case is unique and this determines the time that the retainer is needed. Fixed retainers offer the best results in avoiding dental relapse, but require a bit more maintenance care, much like the patient experienced while wearing braces.
13. Do I need to extract my wisdom teeth after completing the orthodontic therapy? Will they ruin the result?
In the past, it was believed that gradual crowding of front teeth with age, a very common phenomenon in almost every individual, is caused by wisdom teeth that push in a forward direction. Today we know that this is not true. Even patients lacking wisdom teeth appear to gradually lose front teeth alignment, due to constant changes craniofacial system is undergoing with time. Therefore, the decision to extract wisdom teeth or not, is mainly based on the space available for them in the jaws. Lack of space can cause them to erupt at unusual angles, to decay the front teeth, or to become impacted and potentially cause complications.