The Examination
As a first step in orthodontic treatment, you will be examined and your dental and medical
history will be completed. Measurements of your teeth, jaws, joints, face and profile with
x-rays will be evaluated, and study models will be made. After the complete examination, your
dentist will explain the details of your particular bite problem, and what type of treatment is
indicated to correct it.
The Treatment
The next phase (the active phase) is the placement of orthodontic appliances. There are two
types of appliances that are used in different circumstances - removable and fixed.
Removable appliances can be removed by the patient, and fixed appliances are attached to
the teeth and are not removable. Generally, appliances are placed to stimulate the jawbones
to grow and increase in size and width, during growth spurts. They may cover the tissue on
the roof of the mouth on the upper jaw, or be attached to teeth on the lower jaw. Braces are
fixed to individual teeth and connected together with wires. Braces are much smaller and
more esthetic today (some are clear) than they once were. Sometimes they can even be
placed on the inside surfaces of teeth so they don't even show.
It is the orthodontic wire that does the actual work of moving the teeth. These wires apply
constant forces over a long period of time causing the teeth to move through the bone. The
newer wires being used today decrease the number of visits and the overall length of time in
braces. Wires are adjusted during regular visits, so that the teeth are moved correctly and
efficiently. Tenderness of the teeth during the first week in braces and following adjustment
visits is normal and to be expected. This tenderness subsides after several days and can be
helped by taking pain medication. A soft diet during these times may also be beneficial.
Treatment time varies with the amount of correction required, but in general ranges between
12 - 24 months. During treatment, routine dental care must be maintained for cleanings,
check-up visits and fluoride treatments. It is more difficult to clean teeth once braces are on,
so regular cleaning appointments and good oral hygiene are more important than ever, to
prevent dental decay.
Retention
After treatment is completed, retainers will be used to hold the teeth in their new position.
Some retainers are designed to be removable, while others are cemented in place. This
retention phase is important to prevent the teeth from relapsing back to their original position.
Orthodontic treatment is a long process but can improve both the functionality and appearance of your teeth. Having straight, beautiful teeth is a gift for a lifetime.
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The eruption of teeth occurs in a sequence as part of the natural development of the mouth.
The primary (baby) teeth erupt into the mouth very early in life, followed by the growth of the
permanent (adult) teeth in early childhood. Generally, the lower front teeth erupt first, followed
by the upper front teeth. Most often, the front teeth erupt before the back teeth.
The baby teeth are important in chewing food, but they also function to maintain space in the
mouth for the adult teeth which are developing in the jawbone under them. When the baby
teeth are erupting into the mouth, "teething" is quite common. During teething, the child
experiences sore and tender gums, and in some children, this can be a painful and upsetting
event. Soothing the gums by gently rubbing them, or having the child chew on a cold teething
ring can help to alleviate the discomfort.
Once the adult teeth are ready to erupt into the mouth, the baby teeth will start to loosen. The
root of the baby tooth is resorbed (melted away) by the erupting adult tooth, and once there is
no root left, the baby tooth will fall out, providing space for the adult tooth. The adult tooth will
then start to appear into the mouth while it finishes the development of its root structure.
In some situations, a baby tooth may be lost before the adult tooth is ready to erupt.
Depending on the stage of development of the adult tooth, the eruption of the adult tooth may
be faster or slower. If the root structure is forming, the adult tooth may erupt faster, however, if
the root structure has not yet started forming, eruption of the adult tooth may be slower. This
may affect the adjacent teeth, which can tip or move into the space that exists.
Depending on the size of the jawbone and the size and position of the developing adult teeth,
there may not be enough room in the mouth to properly accommodate all of the teeth. The
teeth may erupt out of their normal positions, leading to crowding. Orthodontic treatment is
recommended to prevent the problem from becoming worse. This interceptive treatment may
involve the removal of baby teeth to make room for the adult teeth as they erupt into the
mouth, in a well-planned sequence.
In some situations, the baby teeth may not loosen, and may remain in the jawbone for a long
time. This is usually caused by the absence of the adult tooth underneath, which is generally a
genetic condition. These retained baby teeth may stay in the mouth for many years, but
eventually are lost and require replacement with bridges or implants.
Closely monitoring the eruption sequence of your child's teeth can help to prevent more
extensive problems later. If your child's teeth appear to not be developing correctly, consult
your dentist.
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As part of the development phase of children, many preschoolers have a need to suck their
thumbs, fingers or other objects. This sucking habit is normal and should only cause concern
if this sucking habit continues past the age of five. Prolonged sucking may affect the
development of the teeth.
When the adult teeth start to grow into the mouth, a sucking habit may cause extra pressure
on the upper front teeth, causing them to stick out (also known as "buck teeth"). An open bite
may develop in the front of the mouth, preventing the upper and lower front teeth to bite
together. This open bite can also create a tongue-thrusting habit, where the tongue is pushed
forward into the space between the upper and lower teeth during swallowing. A
tongue-thrusting habit can be very difficult to break and can also interfere with normal
development of the teeth.
A prolonged sucking habit can also lead to other dental problems. A cross-bite may develop in
the back teeth due to extra force from muscles that are active during sucking. The back teeth
may also grow further down into the mouth, since they do not touch during sucking. This can
result in chewing problems and can also create a narrow facial appearance.
If a child has a prolonged sucking habit, it is best to try to break the habit as early as possible.
Some children find it very difficult to stop sucking, even though the development and
appearance of their teeth has been affected. Discussing the need to break the habit is the first
step in convincing the child of the necessity of breaking the habit. Rewards may be used to
encourage breaking the habit - reprimands or punishment are usually not effective.
If communication with the child and encouragement do not help in breaking the habit, a dental
appliance can be introduced as a reminder. This type of appliance is generally cemented onto
the teeth and has a metal framework which reminds the child to stop sucking, and helps to
break the habit.
After the sucking habit has been broken, orthodontic treatment is usually required to correct
the dental problems that were caused by the habit, to restore function and appearance of the
teeth.
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