Pre-Treatment


So you’ve decided on having orthodontic treatment! You may have a tonne of questions, hopefully we can sort some answers for you.

The 5 Signs You May Need Braces

When not addressed properly orthodontic problems can have a negative impact on your oral health, which is why we put this short report together. It’s very important to be able to identify early symptoms of orthodontic problems, especially in children, and get in for a consultation with an orthodontist as soon as possible to determine whether any action will need to be taken, either now or in the future.

Review the 5 signs that you may need braces below and if any of the signs apply to you or your child, we welcome you to book a free consultation with one of our orthodontists to help you create an orthodontic plan and determine whether any action is necessary.


1. Crowding

Crowding is the most common reason to seek orthodontic treatment, especially in kids.

Crowding basically means that there is insufficient space in the mouth for all the teeth. Without the proper room for all those teeth, the teeth crowd each other resulting in crooked teeth. Unfortunately, crowding tends to get worse over time and can make even the simple task of brushing and flossing more complicated, requiring more time and effort to clean all teeth properly. Severe crowding may result in areas that are virtually impossible to clean. This can cause plaque accumulation which in turn causes tooth decay, bad odor, gum disease, and bone loss around teeth.

Orthodontic treatment at a young age will help align and straighten teeth in order to avoid future oral pain and health issues, and reduce the risk of cavities and gum disease. However, crowding can also be fixed as an adult in order to repair any damage that’s already been caused and to avoid any future problems.


2. Overbite

An overbite refers to the vertical and horizontal overlap of the front teeth. The severity of the overbite can vary but an overbite is usually noticeable when the front teeth stick out much farther than the bottom teeth. An increased overbite may cause the following issues and oral health problems:

  • Increased risk of trauma to the front teeth
  • Significantly increase likelihood of fracturing the front teeth in cause of injury
  • Complications and reduced longevity of dental restorative work such as cosmetic fillings, crowns and veneers.

 3. Crossbite

A crossbite is an abnormal bite in which the upper tooth is behind the lower opposing tooth. If left untreated, this problem may cause:

  • Excessive wear or fracture of both teeth
  • Increased gum recession of the affected teeth
  • Inability to restore fractured or worn teeth
  • Asymmetric jaw growth

4. Underbite

An underbite is an abnormal bite in which all the upper front teeth are behind the lower front teeth. This sign is usually associated with disproportionate jaw size and may cause the following issues:

  • Imbalanced facial appearance
  • Accelerated facial ageing
  • Difficulty biting and chewing

5. Openbite

An openbite is an abnormal bite in which the front teeth do not touch. This may cause:

  • Difficulty biting
  • Speech problems, such as lisps

About to start?

If your child is about to start orthodontic treatment, chances are they’ll have a lot of questions. What will braces feel like? Will they hurt? Will they still be able to eat their favourite foods? What will their friends say?

It’s important both you and your child go into the treatment journey calm and confident.  Here are five tips to help you prepare your child for getting braces, and put them at ease about the process.


1.     Discuss treatment options with your child

There are plenty of options out there when it comes to orthodontic treatment, but it’s best to talk to your orthodontist about the most suitable options and treatment plan for your child. Usually metal braces are the best option for children and teens. As well as being reliable, they’re also a cost-effective way to straighten your child’s teeth, and your child can customise them with different colours.

Having an open discussion with your child about why they need braces and what it will achieve. Do some research together and encourage them to ask the orthodontist questions about the treatment plan and why it’s the best option for them.


2.     Talk through what they can expect before their braces are fitted

It’s perfectly normal for children to feel nervous about having braces fitted. For starters, it’s likely to be the longest amount of time they’ll have ever spent in a dental chair! You can ease some of their nerves by letting them know that fitting metal braces is a very straightforward procedure. The small brackets are glued to their teeth and then connected with a thin wire before colourful elastic o-rings are placed over the top (if they want). They’ll need to come back for appointments with the orthodontist to have the wire adjusted, which will gradually straighten their teeth.

Your child might be worried that having their braces fitted will be painful. While they may feel   a little discomfort while they’re getting used to the brackets, this will only last for a couple of days. If this is something your child experiences, we recommend Panadol or Nurofen to manage any tenderness.


3.     Stock up on soft foods

While having braces fitted shouldn’t be painful in itself, the light pressure the braces put on your child’s teeth might cause them some mild discomfort for the first couple of days. Soft foods like rice, pasta, ice cream, yoghurt or mashed potato, and liquid meals like soup will help to keep their energy up without having to chew too hard during the initial settling in period. Chilled foods also have the added benefit of soothing sore mouths, especially if the bracket starts to rub, so make sure your fridge is well-stocked!


4.     Have plenty of orthodontic wax on hand

While your child gets used to their braces, the brackets might irritate or cause sores on the inside of their mouth. Orthodontic wax (also known as ‘braces wax’ or ‘dental wax’) is an easy way to make your child’s braces more comfortable. Simply roll it in your fingertips to soften it, and then press it onto the part of the bracket that’s causing the problem. The wax will form a protective layer that stops the bracket from rubbing.

As well as keeping it on hand around the house, it’s a good idea to give your child their own supply. That way, if their brackets cause discomfort while they’re at school, playing sports or with their friends, they’ll be able to deal with it quickly and independently.  Your orthodontist will usually provide as much wax as you need free of charge.


5.     Focus on the benefits of braces

While a year or two might not seem a long time to adults, for a kid it can seem like forever. Gentle reminders that wearing braces is a temporary measure can help to build your child’s confidence. If your child is frustrated by the amount of time they’ll need to wear their braces, let them know that braces are meant to be a permanent fix, not a quick one. The main thing is that they know it’ll all be worth it in the long run, when they have straight teeth and a confident smile!


Orthodontic Records

After the information gathering has been accomplished and an orthodontist is selected, the treatment process begins. The start of the braces process generally begins after the patient and parents have met with the orthodontist for an initial exam, and have decided that treatment is necessary. The next step is typically an appointment for orthodontic records.

Clinical Exam

The clinical exam is an extension of the examination performed at the initial exam. A more thorough review of the dental, soft tissue, and jaw problems are recorded to form the basis of the diagnosis.


Panoramic X-ray

A panoramic x-ray is crucial to fully visualize the entire upper and lower teeth and jaws (shown below). The x-ray gives the orthodontist information about the jaw bone, roots, jaw joint, as well as evaluating for the presence of extra teeth, impacted teeth, or missing teeth.

Panoramic X-ray

Cephalometric X-ray

A cephalometric x-ray is another x-ray taken during the records appointment. This x-ray provides important information regarding the position of the jaws and front teeth, as well as providing a baseline starting point to monitor growth in younger patients.

Cephalometric X-ray

CBCT

A newer technology in orthodontic imaging is starting to gain more popularity. Cone Beam CT, or CBCT, provides much more information that can be helpful in diagnosis and treatment planning for braces. The CBCT provides a 3-dimensional view of the teeth and jaws, so it can provide spatial information, which is especially important in Cleft Palate patients, or patients that may have impacted teeth, for example. One CBCT exposure can produce many different views for the orthodontist, including the standard panoramic and cephalometric views.

CBCT Image

Models

Models of the teeth are made by taking impressions or “molds” of the upper and lower teeth. The models of the teeth are vital for the orthodontist during the treatment planning process. An impression of the teeth is made by placing a soft alginate material in a tray, placing the tray in the mouth, and then waiting about one minute while the material sets up. Alginate feels very similar to pudding or mashed potatoes when it is first placed in the mouth. Once it starts to set up, it has a more rubbery consistency.

Impression

After it is removed from the mouth, plaster is poured into the impression. The plaster model is then trimmed to show how the teeth bite together. Some orthodontists have the plaster models scanned digitally, which provides an accurate reproduction of the model. This technology also allows accurate measurements, visualization, and storage.

Digital Models

A more recent technology has emerged that allows an orthodontist to obtain the 3D image of the teeth and bite through a digital scanning process. This process involves using a capture wand, moving it slowly around the teeth and capturing images from all angles of the teeth. The software then stiches these images together to form the digital model, thereby eliminating the need for the traditional physical impression.

Digital Impression Scanner

 

Treatment Planning and Consultation

Following the records appointment, the orthodontist will evaluate the information obtained and develop a course of treatment. Although some treatment options may have been discussed at the initial exam, a plan cannot be finalized until all the information has been reviewed.

The consultation appointment is usually scheduled a few weeks following the records appointment. This provides the time necessary to receive the models back from the lab, as well as time for the orthodontist to prepare a treatment plan. The appointment is usually about ½ hour long and will include discussion of the following: diagnosis, treatment plan, alternate treatment options, risks and complications, informed consent, and financial arrangements.

Due to the nature of the topics discussed, a parent or legal guardian will need to be present if the patient is a minor. Besides the legal necessity, a parent will likely need to know the proposed treatment options and risks to make an informed decision about treatment.

The diagnosis will generally include a discussion of the problems with the bite, crowding, spaces, impacted and missing teeth, overbite, rotations and misalignment, symmetry issues, tooth size differences, jaw position, and growth concerns etc. These should be discussed in some detail, referencing the photographs, x-rays, and models of the teeth taken during the records appointment.

The treatment plan is designed to address the issues discussed in the diagnosis. The specific appliances and treatment recommendations, the length of treatment, and the need for cooperation by the patient are also discussed.

Alternative treatment options, including non-treatment, will also be discussed. It is important to be aware of all the options prior to deciding on a specific treatment course. There may be significant advantages and disadvantages to the various options, which may help in the decision-making process (see below regarding risks and limitations). Some patients may have many options, whereas others may have only a couple. This will vary depending on the circumstances involved with each patient. If there is any confusion, ask the orthodontist for clarification.

The final item discussed involves the financial arrangements. A contract that contains the fee and payment information will need to be discussed, agreed on, and then signed by the patient or parent.


Risks and Limitations of Braces

Any medical or dental procedure is not without risks. While the risks of braces may not be as significant as a severe reaction to an anesthetic in surgery, there are rare complications that can result in considerable problems. The following is a summary of a few possible complications from braces, although an orthodontist should be consulted for specific risks and limitations for a particular patient.


Results and Outcome

While every treatment is performed with the intention of improving the bite and alignment, there are limitations between individuals that may be beyond the control of the patient and orthodontist. This would include growth and development of the jaws, which ultimately has an effect on the tooth/bite position. Areas that are under the control of the patient (i.e. cooperation) will also affect the final outcome, but will be beyond the control of the orthodontist.


Length of Treatment

Most comprehensive orthodontic treatment plans will last approximately two years. There is significant variability in each patient in how fast the teeth move, as well as cooperation and growth issues. Therefore, the orthodontist will give an estimate on treatment length for each individual, but this may change as the treatment progresses.


Relapse

Relapse is the movement and shifting of teeth after the braces are removed. Patients are usually provided retainers following treatment to prevent relapse (more detail on retainers and retention). If the retainers are not worn as instructed by the orthodontist, the risk of relapse is very high, especially immediately after the braces are removed. There is a tendency for teeth to move even a few years after braces, which is due to normal age related changes. These changes occur to varying degrees in almost every patient. Long term use of retainers would be needed to prevent this from happening, or else slight misalignment would need to be accepted.


Root Resorption

Root resorption is a shortening of the roots during braces. In some patients it can be seen as nothing more than a slight blunting of the root tips. This will generally not result in any long term problems for those teeth. A rare situation will develop in some patients where up to one-half or more of the root shortens away. This could significantly affect the long-term health and stability of the affected teeth. The exact cause is not completely known at this time, and there is no effective way of predicting if it will occur. Although, it is known that braces over a long period of time (i.e. over 2-3 years) will increase the chances of root resorption. Many orthodontists will take initial, mid-treatment, and final panoramic x-rays to determine if root resorption has occurred during treatment.


Decalcification and Cavities

The importance of excellent oral hygiene cannot be stressed enough for patients that have braces. The results of improper care are devastating to the health and appearance of the teeth. White marks (decalcification) and cavities can form on the teeth rather quickly if food and plaque is not removed on a regular basis. Prevention by thorough brushing, flossing, a low sugar diet, and use of a daily fluoride rinse can significantly reduce the chances of decalcification.


Periodontal Problems

Besides the risk of cavities, the health of the tissues and supporting bone around the teeth can also be affected by oral hygiene. Patients that have active periodontal disease are not good candidates for orthodontic treatment. Treatment followed by evaluation for stable periodontal health is needed before treatment begins. Frequent evaluation and maintenance visits during treatment may also be recommended to monitor the gum tissue and health of the supporting tissues. Consult with an orthodontist, general dentist, and/or periodontist for more specific recommendations.


Ankylosis

Another rare but serious complication during braces is ankylosis. Ankylosis is a fusion of the tooth root to the bone. If a tooth has fused to the underlying jaw bone, braces will be unable to move the tooth. In fact, all of the surrounding teeth will start to move around the ankylosed tooth. This is a serious complication that would not allow proper alignment of the teeth and bite. A history of trauma where a tooth had completely come out of the mouth and been reimplanted by a dentist has a high rate of ankylosis. Other than that, it is difficult to predict whether a tooth has become ankylosed prior to braces. X-rays and clinical examination may provide diagnosis of ankylosis only in certain situations.

While the risks may cause significant problems if they do occur, the probability of occurrence is usually low. Therefore, most patients find that the risks are not significant enough to forego treatment. Each patient/parent must weigh the risks and benefits, and decide for themselves if they warrant foregoing treatment.