It’s no secret that everyone likes seeing a radiant smile, and most people would want to have attractive smiles themselves. While some people have struck gold on the genetic lottery and are born with well-aligned teeth and jaws, not everyone is blessed like that. Having misaligned teeth or jaw irregularities can significantly affect a person’s appearance and confidence, their oral health, physical and mental well-being. Dental braces is therefore one of the most sought after treatment, to transform one’s smile and overall appearance.
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Even these good-looking celebrities relied on some orthodontic treatment to improve their smile and further enhance their appearance.
What are Dental Braces?
Orthodontics is defined as the art and science of aligning teeth, since the term is made up of two Greek words – “ortho” meaning straight and “dontics” meaning teeth.
Dental braces are orthodontic appliances used to correct misaligned teeth and bite irregularities (described as malocclusion). They consist of various components that work together to apply gentle and controlled pressure on the teeth, gradually moving them into their desired positions.
Different Types of Dental Braces
TRADITIONAL METAL BRACES
The most common and widely recognised fixed orthodontic appliance. They consist of metal brackets bonded to the teeth, linked by arch wires, which are tied to the brackets using colorful elastic bands. Despite the emergence of newer options, traditional metal braces remain popular due to their affordability, durability, and effectiveness in treating a wide range of orthodontic issues. The metal brackets are now smaller and smoother in design compared to versions of the past. At the same time, the elastic bands come in a variety of colours, and the patient can choose a different colour each time the elastics are changed during their adjustment visits.
CERAMIC BRACES
These are basically a tooth-colored version of the traditional metal braces, which makes them less noticeable. However, the arch wires remain visible. This makes an excellent option for those seeking effective treatment yet want a more discreet design.
SELF-LIGATING BRACES
Self-ligating braces look very similar to traditional metal braces, but the main difference is in the design of the brackets. Instead of having the arch wire tied to the brackets with elastic bands, the self-ligating brackets have a trap door which holds the arch wire in place. This translates to less friction, which means less force is needed to move the tooth. This in turn means less discomfort for the patient, and the total treatment time is reduced significantly since the teeth tend to move faster. Moreover, it is easier to clean since the brackets are less bulky and trap less plaque than traditional brackets.
CLEAR ALIGNERS
Also known as “invisible braces,” clear aligners are a recent innovation which has revolutionized orthodontic treatment. Instead of brackets and wires, clear aligners use a series of custom-made, transparent trays to gradually shift and straighten your teeth over time. The pioneer and most well-known brand is Invisalign®, which is synonymous with clear aligners. In recent years, more brands have emerged to offer clear aligners at competitive prices, such as TrioClear® and Zenyum®.
A simulation of how teeth can be moved with aligners.
With these systems, the patient wears a set of aligner trays for approximately 1-2 weeks. Then, these are swapped out for the next set in the series. Unlike metal braces, clear aligners are removable, which makes oral hygiene easier. Nevertheless, for the treatment to be effective, the patient must wear the aligners at least 22 hours every day, only removing them for eating and brushing teeth.
Not all malocclusion can be treated effectively with clear aligners, since the types of teeth movement are limited by the design of the aligners. Additionally, patient compliance is paramount to achieve best results. Not wearing the aligners properly or even missing the regular follow-up appointments may cause the teeth to “off-track” and have deleterious results. Some patients end up needing to switch to traditional metal braces to correct the teeth movement.
Do I Need Braces?
- Yes – if you are self-conscious about your smile
- Yes – if you have difficulty cleaning your teeth because of crowding
- Yes – if you have dental malocclusion, as listed below…
Examples of Dental Malocclusion:
CROWDED TEETH
Crowding occurs when there is insufficient space in the dental arches to accommodate all the teeth properly – either the teeth are too large, or the jaw is too small. As a result, the teeth become crowded and overlap each other. Crowding can lead to tooth misalignment, increased difficulty in maintaining proper oral hygiene, and a higher risk of dental problems such as tooth decay and gum disease.
SPACING
Spacing refers to gaps or spaces between the teeth. It can occur due to missing teeth, small teeth, or an oversized dental arch. Too much spacing can affect the appearance of the smile.
EXCESSIVE OVERJET
Excessive overjet, or protrusive front teeth are sometimes described as having “Bugs Bunny teeth” where the upper front teeth jut out significantly, some even to the extent where the lips cannot overlap the teeth (known as lip incompetence). The prominent front teeth will be at higher risk of trauma. If both the upper and lower front teeth are protruded, it is known as bimaxillary protrusion.
DEEP BITE (OVERBITE)
An overbite occurs when the upper front teeth excessively overlap the lower front teeth vertically. The upper teeth may cover a significant portion of the lower teeth, leading to an imbalanced bite. Sometimes due to the nature of a deep bite, the opposing teeth may end up biting on the gums, causing discomfort and subsequently gingiva recession.
CROSSBITE
Crossbite refers to a misalignment of the upper and lower teeth when the jaws are closed. Usually, the upper teeth will sit outside the lower teeth in a normal bite, but in a crossbite, the lower teeth are positioned outside of the upper teeth. Crossbites can affect one side of the mouth (unilateral crossbite) or both sides (bilateral crossbite). If it affects the front teeth, it is sometimes also called an underbite or reverse overjet, and the lower jaw will appear more prominent, like a “bulldog” appearance. This condition is sometimes associated with jaw asymmetry and lower jaw overgrowth (mandibular prognathism).
OPEN BITE
An open bite is characterized by a lack of vertical overlap between the upper and lower front teeth when the jaws are closed. This condition creates a space or gap between the upper and lower teeth. Open bites can affect speech patterns, cause difficulties in biting certain foods, and impact facial aesthetics. Some open bites are formed naturally, but
more commonly occur because of thumb-sucking and use of pacifiers in older children above 3 years of age.
It is important to note that individuals may exhibit a combination of these malocclusions or have variations in their severity. The specific type and severity of malocclusion are assessed by the dentist during consultation, and an appropriate treatment plan is tailored to address the specific needs of each individual. For cases where there is a significant mismatch in the upper and lower jaw sizes, or even asymmetry, sometimes orthognathic surgery is required as there is a limit to the amount of tooth movement that can be achieved with braces alone to treat the malocclusion. As such, a referral to a specialist team consisting of an oral maxillofacial surgeon and an orthodontist may be necessary.
Are Dental Braces Uncomfortable?
Braces can cause some discomfort or mild soreness initially and after each adjustment appointments. However, the level of discomfort experienced varies from person to person and throughout the course of treatment.
Initial Adjustment Period:
When braces are first placed or right after they are adjusted, it is common to experience some discomfort or soreness. This discomfort typically arises from the pressure exerted on the teeth and surrounding tissues as the teeth begin to shift. The soreness can last for a few days to a week as the mouth adjusts to the braces. It is recommended that the patient take on a soft diet in the meantime, to reduce the amount of discomfort while they adapt to the presence of their braces.
Irritation and Soreness of the Soft Tissues:
Braces consist of metal brackets or wires that may rub against the cheeks, lips, or tongue, causing irritation or soreness. Dental or orthodontic wax can be used to alleviate the discomfort by providing a protective barrier between the braces and soft tissues. Simply place some wax over any rough-feeling brackets or wire for immediate relief.
Roll the wax into a ball and apply on any part of the braces that feel sharp and irritating.
Dietary Adjustments:
Certain foods, such as hard, sticky, or chewy items, can pose challenges and discomfort when braces are present. It is advised to avoid such foods during treatment to prevent damage to the braces and reduce discomfort. Biting on hard foods can also dislodge the metal brackets, which means the patient has to return to the dentist sooner to replace the metal bracket, else the teeth movement will be delayed further, and total treatment time will be increased.
Oral Hygiene Challenges:
Maintaining proper oral hygiene with braces requires extra effort and time. It can be more challenging to brush and floss around the brackets and wires, leading to potential soreness or gum sensitivity. However, good oral hygiene practices are essential to prevent oral health issues and discomfort associated with plaque buildup.
If the oral hygiene remains poor and the patient develops a lot of tooth decay or gum disease, the orthodontic treatment may have to be stopped and the braces removed to have these addressed. This will leave the patient with unsatisfactory results which may leave them worse off than before braces treatment. Thus, it is absolutely critical for the patient to be motivated in their cleaning, to prevent this from happening.
Typical presentation of decay and white spots caused of poor oral hygiene during braces treatment – all these will form adjacent to the metal brackets, because of the food trapping.
Do bear in mind that any discomfort experienced with braces is typically manageable and temporary. Over time, as the mouth adapts and the teeth gradually move into alignment, the level of discomfort generally decreases. Ultimately, the long-term benefits of braces in achieving a properly aligned and healthy smile usually outweigh the temporary discomfort associated with the treatment.
Are Dental Braces Suitable for Everyone?
In general, braces are suitable for everyone, including older adults. However, since orthodontic treatment carries some risks including root resorption, bone loss and difficulty in maintaining oral hygiene, there are some individuals who may not be suitable candidates for braces:
Unmotivated Patient with Poor Compliance
Your angsty teenager may not be a great patient for braces if he isn’t too fussed about his teeth or anything in particular.
- This usually applies to teenagers or young adults who are “forced” to do braces because of parental pressure. Their general lack of interest in their teeth may lead them to have poor oral hygiene, exacerbated by the presence of the brackets, which may lead to rampant decay and white spot lesions. Additionally, with clear aligners, they may not wear their aligners correctly or for the necessary amount of time, leading to undesirable teeth movements.
- Missing the regular adjustment appointments can cause teeth to shift unexpectedly and sometimes lead to poor outcomes. It is thus important that the patient commits to a regular follow up schedule with the same dentist, and not abscond. If there are any upcoming changes in your schedule, such as moving overseas, even on a short-term basis, you should postpone starting your braces treatment.
Individuals with Gum Disease
- Patients with gum disease will have bone loss and receded gums. With braces, the teeth movement will worsen the gum condition and lead to more bone loss and more gum recession, which will result in unaesthetic results such as black triangles between the teeth, longish-looking teeth and even shaky teeth.
This is an example of the gum loss which can occur after braces treatment has been completed, in a patient who had gum disease. The teeth appear longish due to the lack of gum coverage over the roots, and black spaces in between the teeth are also visible.
High Caries Risk Individuals
- This is defined as patients who have had multiple decayed teeth with multiple restorations present, or those who constantly have new cavities within the past year. For these individuals, braces are not recommended since the fixed orthodontic appliances will further increase their risk for tooth decay.
History of Dental Trauma
- For individuals who suffered from dental trauma prior, especially on the anterior teeth, braces may cause these teeth to turn necrotic (devitalisation) or trigger a root resorption. While a dead tooth can be easily treated with root canal treatment, external root resorption is very unpredictable and challenging to treat, and the teeth may be weakened significantly and the lifespan shortened. At times, the patient may be completely unaware or unable to recall the dental trauma, and end up needing a root canal treatment only after braces treatment has been started.
Read more: What is a Root Canal Treatment?
Multiple Missing Teeth
- If you have had a few teeth extracted, or have multiple congenitally missing teeth, braces may not be suitable because the orthodontic teeth movement is also reliant on having a certain number of teeth present for anchorage. Other options to improve your smile, such as bridges or dental implants, might prove to be more practical.
Read more: What Are My Replacement Options If I Have Missing Teeth?
What is the Duration of Braces Treatment?
The timing to complete an orthodontic treatment varies for every individual and depends a lot on the severity of the malocclusion. On average, braces usually require 2-3 years to complete. For correction of minor relapses, sometimes less than 12 months is required.
In general, use of self-ligating brackets will make the treatment faster, sometimes reducing total treatment time by up to 4 to 6 months.
Once your braces treatment is started, you will need to be reviewed every 4-6 weeks to monitor the teeth movement progress, and adjustments can be made to ensure the movements are within physiological norms.
When you are at the end of your braces treatment, a set of retainers will be made. You will need to wear your retainers regularly to ensure your teeth remains well-aligned and the result of your orthodontic treatment is preserved.
Why Are Retainers Important?
Many people will assume that once they have completed their braces journey, their beautiful, well-aligned teeth will remain that way forever. Unfortunately, that is far from the reality. Teeth will always move, even without braces, and they tend to move towards their original position. Orthodontic relapse is when the teeth have shifted back to their original misaligned positions, and is especially prevalent in cases with spacing, and crowding on the lower teeth.
Clear retainers known as Essix retainers look very much like clear aligners. However, they are made of much durable material than aligners since they are meant to last the patient for many years. Some retainers can also be made of thicker material to act as night guards for patients who grind their teeth at night.
Retainers play a crucial role in orthodontic treatment even after braces are removed. They are custom-made dental appliances designed to maintain the corrected position of teeth, ensuring long-term stability and preventing relapse. They work by providing a controlled force that keeps the teeth in their corrected positions while the supporting structures such as the periodontal ligaments and jaw bone gets remodelled, even after braces is completed. The period right after the braces is removed is when the teeth are most prone to movement, and therefore almost constant retainer wear, except during eating and brushing, is highly recommended. After some time, the retainer wear can be limited to night time only.
What happens if you forget to wear your retainers regularly? You might find the retainers difficult to put on, with a lot of pressure on your teeth. Sometimes, the retainers no longer can fit because the teeth have moved too much to be pushed back to their original corrected position, and you may need to make a new set of retainers.
While braces are only for 2-3 years (sometimes more), retainers are essentially, for life. It is much cheaper to continue wearing your retainers, and getting new ones made after a few years, than starting another round of orthodontic treatment to correct the relapse.
Conclusion
Orthodontic treatment has evolved significantly over the years, with a range of braces to suit individual needs and preferences. Whether it be traditional metal braces, ceramic braces, self-ligating braces, or clear aligners, each option brings its own advantages. By seeking orthodontic treatment, you can achieve a healthy, beautiful smile while reaping the associated benefits of improved oral health, enhanced self-confidence, and long-term dental stability.
