Most malocclusions are inherited, but some are acquired and even accentuated by environmental influences. Inherited problems include crowding of teeth, too much space between teeth, extra or missing teeth, and a wide variety of other irregularities of the jaws, teeth and face.
Acquired malocclusions can be caused by accidents, thumb, finger or dummy (pacifier) sucking, airway obstruction by tonsils and adenoids, dental disease or premature loss of baby or permanent teeth. Many of these problems not only affect the alignment of the teeth but also facial development and appearance.

What are the most commonly treated Orthodontic problems ?

Orthodontic problems may be skeletal (involving either or both the jaws) or dental (involving the teeth). Some of the commonly encountered dental malocclusions include-

Crowding

Teeth may be aligned poorly (crooked) because the disparity in the size of teeth and the size of the jaw. The bone and gums over the roots of extremely crowded teeth may become thin and recede as a result of severe crowding. Impacted teeth (teeth that should have come in but have not), poor biting relationships and undesirable appearance may all result from crowding.

Over-jet or protruding upper teeth

Upper front teeth that protrude beyond their normal position (Buck teeth) are prone to injury. They often indicate a poor bite of the back teeth (molars), and may indicate unevenness in jaw growth. Commonly, protruded upper teeth are associated with a lower jaw that is short in proportion to the upper jaw. Thumb and finger sucking habits can also cause a protrusion of the upper incisor teeth.

Deep overbite

A deep overbite or deep bite occurs when the lower incisor (front) teeth, bites too close or into the gum tissue behind the upper teeth. When the lower front teeth bite into the palate or gum tissue behind the upper front teeth, significant bone damage and discomfort can occur. A deep bite can also contribute to excessive wear of the incisor teeth.

Open bite

An open bite results when the upper and lower incisor teeth do not touch when biting down. This open space between the upper and lower front teeth causes all the chewing pressure to be placed on the back teeth. This excessive biting pressure and rubbing together of the back teeth makes chewing less efficient and may contribute to significant tooth wear.

Spacing

If teeth are missing or small, or the dental arch is very wide, space between the teeth can occur. The most common complaint from those with excessive space is poor appearance.

Cross-bite

The most common type of a cross-bite is when the upper teeth bite inside the lower teeth (toward the tongue). Cross-bites need immediate correction as they may affect the growth of the jaws.
Malocclusions may also be caused due to skeletal problems. They include.

Lower jaw protrusion /retrusion or Upper jaw protrusion / retrusion

Careful monitoring of jaw growth and tooth development is indicated for these patients. While correction of these relationships may be possible with growth modulation in young children many may require surgical intervention at a later date.

Crooked and crowded teeth are hard to clean and maintain. This may contribute to conditions that cause not only tooth decay but also eventual gum disease and tooth loss. Other orthodontic problems can contribute to abnormal wear of tooth surfaces, inefficient chewing function, excessive stress on gum tissue and the bone that supports the teeth, or misalignment of the jaw joints, which can result in chronic headaches or pain in the face or neck.

When left untreated, many orthodontic problems become worse. Treatment by a specialist to correct the original problem is often less costly than the additional dental care required to treat more serious problems that can develop in later years.

Why should children have a check-up with an orthodontic specialist ?

By age 7, enough permanent teeth have come in and enough jaw growth has occurred that the dentist or orthodontist can identify current problems, anticipate future problems and alleviate parents' concerns if all seems normal. Cross-bites, crowding and developing injury-prone dental protrusions can be evaluated. Any ongoing finger sucking or other oral habits can be assessed at this time also.

What are some early signs of orthodontic problems ?

If you see crooked teeth, gaps between the teeth or overlapped teeth, your child may need orthodontic treatment. Ask your child to bite all the way down, keeping their lips open. Do the front top teeth line up with the bottom? Do the top teeth protrude out away from the bottom teeth? Do the top front teeth cover more than 50% of the bottom teeth? Are the top teeth behind the bottom teeth? If you see any of these conditions, get in touch with an Orthodontist. Look at the alignment of your child's jaw. Does the jaw shift off center when your child bites down? If you see any mal-alignment or shifting of the jaw, your child may have a skeletal/functional problem. Other common signs include early or late loss of primary teeth, difficulty in chewing or biting, Mouth breathing, Finger or thumb sucking habits beyond age 5, Speech difficulty or biting the cheek or roof of the mouth. These are only some of the more obvious signs. Other signs may be much more subtle and require a trained professional to detect.

Early treatment presents an opportunity to guide the growth of the jaw, regulate the width of the upper and lower dental arches (the arch-shaped jaw bone that supports the teeth). It also guides incoming permanent teeth into desirable positions. It lowers the risk of trauma (accidents) to protruded upper incisors (front teeth) and corrects harmful oral habits such as thumb- or finger-sucking. Early treatment reduces or eliminates abnormal swallowing or speech problems and improves personal appearance and self-esteem. It potentially simplifies and shortens treatment time for later corrective orthodontics. It reduces the likelihood of impacted permanent teeth (teeth that should have come in, but have not), and preserve or gain space for permanent teeth that are coming in.

What are some of the advantages of early (phase1) treatment ?

Phase I treatment is generally indicated when there is a skeletal discrepancy. Certain type of orthodontic appliances including expansion appliances, headgear and herbst appliances can prevent the later removal of permanent teeth to correct overcrowding and also prevent certain surgical procedures to align the upper and lower jaws. Early treatment can also decrease the time necessary for the 2nd phase (full braces) of treatment. Leaving a malocclusion untreated until all of the permanent teeth erupt could result in a jaw discrepancy too severe to allow achievement of an ideal result with braces alone.

Does early treatment eliminate the need for braces later ?

Not generally, but it does greatly reduce the treatment time of the 2nd phase of treatment and also allows for a much more ideal and esthetic result.

What are orthodontic study records ?

Diagnostic records are made to document the patient’s orthodontic problem and to help determine the best course of treatment. As orthodontic treatment will create many changes, these records are also helpful in determining progress of treatment. Complete diagnostic records typically include a medical/dental history, clinical examination, plaster study models of the teeth, photos of the patient’s face and teeth, a panoramic or other X-rays of all the teeth, a facial profile X-ray, and other appropriate X-rays. This information is used to plan the best course of treatment, help explain the problem, and propose treatment to the patient and/or parents.

The profile X-ray, or cephalometric film, shows the facial form, growth pattern, and inclination of the front teeth (if teeth are tipped or tilted), which are essential in planning comprehensive treatment. Panoramic or other dental X-rays are used to locate impacted teeth, missing teeth, and shortened or damaged tooth roots, to determine the amount of bone supporting teeth, and to evaluate position and development of permanent teeth that have not yet come in, among other things. From the necessary records, a custom treatment plan is created for each patient.

How is treatment accomplished ?

Custom-made appliances, or braces, are prescribed and designed by the orthodontist according to the problem being treated. They may be removable or fixed (cemented and/or bonded to the teeth). They may be made of metal, ceramic or plastic. By placing a constant, gentle force in a carefully controlled direction, braces can slowly move teeth through their supporting bone to a new desirable position.

Orthopedic appliances, such as headgear, bionator, Herbst and maxillary expansion appliances, use carefully directed forces to guide the growth and development of jaws in children and/or teenagers. For example, an upper jaw expansion appliance can dramatically widen a narrow upper jaw in a matter of months. Over the course of orthodontic treatment, a headgear or Herbst appliance can dramatically reduce the protrusion of upper incisor teeth (the top four front teeth) or retrusion of the lower jaw (a lower jaw that is too far behind the upper jaw), while making upper and lower jaw lengths more compatible.

Orthodontic treatment and a child's growth can complement each other. A common orthodontic problem to treat is protrusion of the upper front teeth ahead of the lower front teeth. Quite often this problem is due to the lower jaw being shorter than the upper jaw. While the upper and lower jaws are still growing, orthodontic appliances can be used to help the growth of the lower jaw catch up to the growth of the upper jaw. Abnormal swallowing may be eliminated. A severe jaw length discrepancy, which can be treated quite well in a growing child, might very well require corrective surgery if left untreated until a period of slow or no jaw growth.

What kinds of orthodontic appliances are typically used to correct jaw-growth problems ?

Correcting jaw-growth problems is done by the process of dento-facial orthopedics. Some of the more common orthopedic appliances used by orthodontists today that help the length of the upper and lower jaws become more compatible include:

Headgear

This appliance applies pressure to the upper teeth and upper jaw to guide the rate and direction of upper jaw growth and upper tooth eruption. The headgear may be removed by the patient and is usually worn 10 to 12 hours per day.

Herbst

The Herbst appliance is usually fixed to the upper and lower molar teeth and may not be removed by the patient. By holding the lower jaw forward and influencing jaw growth and tooth positions, the Herbst appliance can help correct severe protrusion of the upper teeth.

Bionator

This removable appliance holds the lower jaw forward and guides eruption of the teeth into a more desirable bite while helping the upper and lower jaws to grow in proportion with each other. Patient compliance in wearing this appliance is essential for successful improvement.

Palatal Expansion Appliance

A child's upper jaw may also be too narrow for the upper teeth to fit properly with the lower teeth (a cross-bite). When this occurs, a palatal expansion appliance can be fixed to the upper back teeth. This appliance can markedly expand the width of the upper jaw.

The decision about when and which of these or other appliances to use for orthopedic correction is based on each individual patient's problem. Usually one of several appliances can be used effectively to treat a given problem. Patient cooperation and the experience of the treating orthodontist are critical elements in success of dento-facial orthopedic treatment.

How can the Herbst appliance help a patient with an underdeveloped lower jaw? (I changed the question – see original quest)

For patients who have an underdeveloped lower jaw, it is important to begin orthodontic treatment several years before the lower jaw ceases to grow. One method of correcting an underdeveloped jaw uses an orthodontic appliance that repositions the lower jaw. These appliances influence the jaw muscles to work in a way that may improve forward development of the lower jaw. There are many appliances used by orthodontists today to treat underdeveloped lower jaws - such as the Frankel, headgears, Activator, Twin Block, bionator and Herbst appliances. Some are fixed (cemented to the teeth) and some are removable. You and your orthodontist can discuss which appliance is best for your child.

Why does orthodontic treatment time sometimes last longer than anticipated ?

Estimates of treatment time can only be that - estimates. Patients grow at different rates and will respond in their own ways to orthodontic treatment. The orthodontist has specific treatment goals in mind, and will usually continue treatment until these goals are achieved. Patient cooperation, however, is the single best predictor of staying on time with treatment. Patients who cooperate by wearing rubber bands, headgear or other needed appliances as directed, while taking care not to damage appliances, will most often lead to on-time and excellent treatment results.

Why are retainers needed after orthodontic treatment ?

After braces are removed, the teeth can shift out of position if they are not stabilized. Retainers provide that stabilization. They are designed to hold teeth in their corrected, ideal positions until the bones and gums adapt to the treatment changes. Wearing retainers exactly as instructed is the best insurance that the treatment improvements last for a lifetime.

Will a child's tooth alignment change later ?

Studies have shown that as people age, their teeth may shift. This variable pattern of gradual shifting, called maturational change, probably slows down after the early 20s, but still continues to a degree throughout life for most people. Even children whose teeth developed into ideal alignment and bite without treatment may develop orthodontic problems as adults. The most common maturational change is crowding of the lower incisor (front) teeth. Wearing retainers as instructed after orthodontic treatment will stabilize the correction. Beyond the period of full-time retainer wear, nighttime retainer wear can prevent maturational shifting of the teeth.

What about the wisdom teeth (third molars) should they be removed ?

In about three out of four cases where teeth have not been removed during orthodontic treatment, there are good reasons to have the wisdom teeth removed, usually when a person reaches his or her mid- to late-teen years. Careful studies have shown, however, that wisdom teeth do not cause or contribute to the progressive crowding of lower incisor teeth that can develop in the late teen years and beyond. Your orthodontist, in consultation with your family dentist, can determine what is right for you.

Do you need to put braces in all teeth ?

In most cases, the answer is yes. Even if the teeth in one of the jaws is well aligned it is necessary to coordinate the teeth in both the jaws so as to obtain a good bite. It is important to understand that orthodontic treatment not only improves the way the teeth look but also improves function and balance of the jaws and the face.
My child’s baby teeth were straight but the new teeth are crooked. Why?
In case your child has perfectly aligned baby teeth with no spaces, then it is almost certain that he/she will have crooked teeth when the permanent teeth erupt. Nature has meant to provide large gaps between baby teeth to compensate for the larger size of the permanent teeth. So spaces in the baby teeth is natural and essential for alignment of the larger permanent teeth.

What are invisible aligners /  braces ?

The advent of invisible braces has considerably helped increase patient acceptance to orthodontic treatment, especially adults.

Invisalign® is one such system that uses advanced 3D computer imaging technology to transform your bite impressions into a custom-made series of clear and removable aligners. The course of treatment involves changing aligners approximately every two weeks, moving your teeth into straighter position step by step, until you have a more beautiful smile. And unlike braces, these clear aligners can be removed while you eat and brush your teeth as usual. However this system has its limitations and are capable of treating only minor problems. This system requires specialized laboratory back up, not available in India yet, and may cost $4000-$6000.

Invisible braces or lingual orthodontics refers to correction of malaligned teeth by fixed braces bonded to the inner side (lingual surfaces) of teeth. Therefore correction of malocclusion is possible without the braces being seen at all! While removable systems like, Invisalign® can correct only minor alignment problems, lingual orthodontics can correct even extreme maloccusions. The newer generation of lingual appliances require special laboratory back-up which makes it an expensive treatment option.

Do braces damage teeth ? Will my teeth be discolored after treatment ?

Not at all. The orthodontic braces are stuck to teeth using a special adhesive which can be easily chipped off while removing your braces. The tooth damage, if any, that appears to be caused after orthodontic treatment is due to the lack of oral hygiene during the treatment process. If adequate oral hygiene in not maintained during treatment there will not be any damage/ discoloration. The orthodontist will generally reinforce oral hygiene methods by proving special toothbrushes and recommending fluoride mouthrinses to help protect teeth during treatment.

PAIN / DISCOMFORT

What is having braces like ?

Generally, the mouth is usually sore for the first week after you get braces. Also, your mouth will be sore when the braces are tightened. However, with modern braces, you should get so used to the braces that you should not notice the braces, except when the braces are being tightened or if you get hit in the mouth.
If you start orthodontic treatment when you are 18 or older, it generally is more uncomfortable; your teeth feel like they are loose in your mouth. Still, the pain is worth the gain.

Do Braces Hurt ?

It matters what kind of braces you use. Old fashioned braces will hurt often. However, if you get modern braces, they will not hurt except when they are first put in or when your braces are tightened.

Are all braces designed to minimize pain ?

Unfortunately, no. Some orthodontists may still use old fashioned braces however newer braces are available that are comfortable enough.

Will braces cause sores in the mouth ?

Initially, when you first get braces, there may be some sores on your lipsthe sores usually heal in the first few days. Warm salt water rinses and/or topical anaethetic gels help in reducing the discomfort.Thereafter, there will be an occasional sore when, for example if you get into a fight. However, the sores should heal rather quickly.
If your lips get too sore during the first week, you can put wax on the braces to prevent the braces from rubbing and irritating the sore.

Are there other things that can be done to reduce the pain ?

Several over-the-counter medicines have been found to reduce the pain. Dologel, Dentogel Oraguard-B to name a few.
Can one talk easily wearing braces?
Yes. Standard braces should not affect how you talk or the sound of your voice. You can talk, sing, yell and act just as you do now. Braces will not stop you from having fun. Occasionally the orthodontist needs to put in a gadget which gets in the way of your tongue. If so, you may have trouble talking clearly for a day or two, but then you will be able to talk fine

Can the patient play outdoor games with braces ?

Yes, while playing games like football, hockey, cricket or etc., it is advisable to wear a mouth guard so that you do not get hit in the mouth.it is recommended to avoid sports where you will get hit in the face. Fighting, boxing, wrestling, karate, can be very painful when you have braces.

Will blowing musical instruments like trumpet or flute etc., affect braces ?

The orthodontist will give you lip protectors for your braces. This protects your lips and will make it possible for you to still play musical instruments.

Is there any chance that the sharp ends of the braces will hurt the insides of the cheeks ?

In the beginning part of orthodontic treatment, your teeth will move a lot. Sometimes the end of the wire will stick out past the end of the tube, and create a sharp edge. We recommend that you if you notice a sharp wire you go back to the orthodontist and ask the orthodontist's assistant to trim the sharp edge before the wire cuts your cheeks

Why do braces need to be tightened ?

During orthodontic treatment, the orthodontist stretches your jaw and moves around your teeth so that everything fits. If the orthodontist would try to move your teeth all at once, it would hurt too much, and it might damage the roots of your teeth. Generally, the orthodontist moves your teeth slowly to avoid hurting you too badly.
Still, the orthodontist does have to move your teeth. Every time the orthodontist tightens your braces, the orthodontist moves your teeth a little bit. Then the orthodontist waits for your teeth, jaw and gums to shift, before trying to move your teeth again.

Will it hurt while removing braces ?

It should not hurt generally. The brackets are easy to remove. They just twist off. Sometimes, removing the bands at the back of your mouth is painful. If so, please tell the orthodontist. He can cut the bands so it does not hurt.

EATING WITH BRACES

Can a person eat after getting braces ?

Yes! You can eat most of the good things that you can eat now.
The one big limitation is that your mouth will get sore after you first get braces, so it is recommended that you only eat softer foods for the first week. However, after that you should be able to eat normally.

What about having chewing-gum and other sweets with braces ?

Gum is usually not recommended. The gum can get caught on the braces and pull the braces off. Also the sugar in the gum can get trapped behind the braces and cause cavities.

What happens if the braces come off ?

The orthodontist will attach them again. Usually, this is no big deal, although if it happens lots of times, your orthodontic treatment will take longer.

Why cannot the orthodontist attach the braces strongly enough that the braces cannot come off during eating ?

The orthodontist needs to take off your braces at the end of the orthodontic treatment. If the orthodontist attaches your braces too firmly, the braces will not come off again at the end of your orthodontic treatment.

What happens if a piece of braces come off and gets swallowed ?

All braces are tested so they are completely safe. The parts just pass through your digestive system. Inhaling a part from your braces is a problem however. If you inhale a part of your braces, and the part gets into your lungs, it could cause a problem.

BRUSHING WITH BRACES

How often should teeth be brushed with braces ?

Brushing and flossing is really important when you have braces because food can get caught in the braces and cause cavities. Also you will have terribly bad breath so no one will want to talk to you.
You should brush and floss your teeth after every meal and before you go to bed.

Will it hurt to brush teeth with braces ?

Brushing might hurt the first week after you get braces but then everything might hurt your first week in braces. Fortunately, you can get through it.
After the first week, brushing should be fine. Flossing is a little harder. Ask your orthodontist for special brushes and floss designed to clean around your braces. Also, please ask your orthodontist's assistant for help flossing every time you get your braces tightened. The orthodontist's assistant can do a great job cleaning your teeth.

What happens if there is a cavity with braces ?

If it is a normal cavity, your regular dentist will just fill it. If the cavity is underneath your braces, your orthodontist will have to remove your braces first.

RUBBER BANDS / ELASTICS

What do the rubber bands in the braces do?

The rubber bands are used to move teeth forward or back in your mouth. For example, they could be used to move your lower teeth forward or back, to move a tooth that is in the wrong place, or to close a gap between your teeth.

How often should rubber bands be changed?

Orthodontic rubber bands break after they have been chewed a few times. Usually, the rubber bands will snap suddenly when you open your mouth wide. The rubber bands will hurt your jaw. The only way to avoid the pain is to change your rubber bands frequently.

What happens if I leave off my rubber bands?
Your braces will need to stay on for up to a year longer and your teeth will hurt more.
Changing rubber bands is not hard, so there is no reason not to change them. Old fashioned rubber bands used to taste awful, but people now make flavored rubber bands which taste like candy breath mints. With flavored rubber bands, changing your rubber bands after every meal is like eating a piece of candy after every meal, but using a flavored rubber band does not cause cavities.

What happens if accidentally I swallow a rubber band?
Nothing; the rubber band is safe unless you are allergic to it. The rubber band just passes through your digestive system and out.

What different types of braces are available?
Metal braces are the most popular with kids and teenagers. These braces are much smaller than ever before.
• "Gold" braces are a new addition as well. They are stainless steel braces coated with gold colored plating. They have the strength of metal, but blend in with the color of the teeth much better. That is because most teeth have a natural yellow tint. Quite often, ceramic braces are put on the top teeth and gold braces on the bottom.
• Translucent ceramic braces are the most popular with adults. You have to be very close to someone to be able to see them. Yet, because they are a ceramic material, they are more fragile. Treatment time is often slightly longer with ceramic braces.
• Lingual braces are placed on the back of the teeth. Lingual braces are considerably more expensive than conventional braces, and treatment often takes longer with lingual braces.
• Invisalign™ is a new system that uses a series of clear polymer overlays to straighten teeth.

• Are there less noticeable braces?
Today, braces are generally less noticeable than those of the past when a metal band with a bracket (the part of the braces that hold the wire) was placed around each tooth. Now the front teeth typically have only the bracket bonded directly to the tooth, minimizing the "tin grin." Brackets can be metal, clear or colored, depending on the patient’s preference. In some cases, brackets may be bonded behind the teeth (lingual braces). Modern wires are also less noticeable than earlier ones. Some of today’s wires are made of "space age" materials that exert a steady, gentle pressure on the teeth, so that the tooth-moving process may be faster and more comfortable for patients.

• How have new "high tech" wires changed orthodontics?
In recent years, many advances in orthodontic materials have taken place. Braces are smaller and more efficient. The wires now being used are no longer just stainless steel. They are made of alloys of nickel, titanium, copper and cobalt, and some of the wires are heat-activated. (The nickel-titanium alloy was originally engineered by NASA to automatically activate antennae or solar panels of spacecraft orbiting into the sun's rays.) These new kinds of wires cause the teeth to continue to move during certain phases of treatment, which may reduce the number of appointments, needed to make adjustments to the wires.

ADULT ORTHODONTICS
• Can orthodontic treatment do for adults what it does for children?
Healthy teeth can be moved at almost any age. Many orthodontic problems can be corrected as easily and as well for adults as children. Orthodontic forces move the teeth in the same way for both a 75-year-old adult and a 12-year-old child. Complicating factors, such as lack of jaw growth, may create special treatment planning needs for the adult.

One in five orthodontic patients is an adult.

Adults are not growing and may have experienced some breakdown or loss of their teeth and bone that supports the teeth. Orthodontic treatment may then be only a part of the patient's overall treatment plan. Close coordination may be required between the orthodontist, oral surgeon, periodontist, endodontist and family dentist to assure that a complicated adult orthodontic problem is managed well and complements all other areas of the patient's treatment needs. Below are the most common characteristics that can cause adult treatment to differ from treatment for children.

No jaw growth:
Jaw problems can usually be managed well in a growing child with an orthopedic, growth-modifying appliance. However, the same problem for an adult may require jaw surgery. For example, if an adult's lower jaw is too short to match properly with the upper jaw, a severe bite problem may result. The limited amount that the teeth can be moved with braces alone may not correct this bite problem. Bringing the lower teeth forward into a proper bite relationship could require jaw surgery, which would lengthen the lower jaw and bring the lower teeth forward into the proper bite. Other jaw-width or jaw-length discrepancies between the upper and lower jaws might also require surgery for bite correction if tooth movement alone cannot correct the bite.

Gum or bone loss (periodontal breakdown):
Adults are more likely to have experienced damage or loss of the gum and bone supporting their teeth (periodontal disease). Special treatment by the patient's dentist or a periodontist may be necessary before, during and/or after orthodontic treatment. Bone loss can also limit the amount and direction of tooth movement that is advisable.

Worn, damaged or missing teeth:
Worn, damaged or missing teeth can make orthodontic treatment more difficult, but more important for the patient to have. Teeth may gradually wear and move into positions where they can be restored only after precise orthodontic movement. Damaged or broken teeth may not look good or function well even after orthodontic treatment unless they are carefully restored by the patient's dentist. Missing teeth that are not replaced often cause progressive tipping and drifting of other teeth, which worsens the bite, increases the potential for periodontal problems and makes any treatment more difficult.
• Can an orthodontist help a person having painful jaw muscles and jaw joints -?
Jaw muscle and jaw joint discomfort is commonly associated with bruxing, that is, habitual grinding or clenching of the teeth, particularly at night. Bruxism is a muscle habit pattern that can cause severe wearing of the teeth, and overloading and trauma to the jaw joint structures. Chronically or acutely sore and painful jaw muscles may accompany this bruxing habit. An orthodontist can help diagnose this problem. Your family dentist or orthodontist may also place a bite splint or night guard appliance that can protect the teeth and help jaw muscles relax, substantially reducing the original pain symptoms. Sometimes structural damage can require joint surgery and/or restoration of damaged teeth.
• Your dentist may tell you to have some missing teeth replaced, but need orthodontic treatment first - why?
Your dentist is probably recommending orthodontics so that he or she might treat you in the best manner possible to bring you to optimal dental health. Many complicated tooth restorations, such as crowns, bridges and implants, can be best accomplished when the remaining teeth are properly aligned and the bite is correct.

When permanent teeth are lost, it is common for the remaining teeth to drift, tip or shift. This movement can create a poor bite and uneven spacing that cannot be restored properly unless the missing teeth are replaced. Tipped teeth usually need to be straightened so they can stand up to normal biting pressures in the future.
if teeth have been crooked for more than 50 years - why have orthodontic treatment now?
Orthodontic treatment, when indicated, is a positive step - especially for adults who have endured a long-standing problem. Orthodontic treatment can restore good function. Teeth that work better usually look better, too. And a healthy, beautiful smile can improve self-esteem, no matter the age.

RETAINERS
What does a retainer do?
The retainer keeps your teeth in perfect alignment after braces are removed so you keep an excellent smile as your mouth grows. Usually, when braces are first removed, your teeth will all be in perfect alignment, and your smile is excellent. However, your gums, bones, etc will not have completely shifted into their new positions. The retainer holds your teeth in position until your gums, bones etc settle in to their new positions. At the end of your orthodontic treatment, your smile will be wonderful and your will look excellent. You need to wear your retainer to keep yourself looking excellent. Also, you are still growing after your braces are removed. Sometimes, your mouth will grow unevenly. If so a retainer can be used to make sure your teeth stay perfect as you grow.

What happens if the retainer is not used?
Your gums and bones will not settle into their new positions so your teeth will move part way back to their old positions. Your fabulous smile will dwindle. You may even need to get your braces put on again. Don't let that happen!

Does the retainer hurt?
It should not. If your retainer hurts after the first week, it means that the retainer was fitted wrong. Go back to your orthodontist and ask him to give you a new retainer.

How long should I use a retainer?
You need to wear your retainer 24 hours a day for at least a year after your braces are removed. Then continue to wear the retainer a few nights a week until you are 24 and stop growing.

What happens if I break the retainer?
Ask your orthodontist for a new one.

Won't the retainer wear out after a while?
A well made retainer should last for years. If your retainer breaks ask your orthodontist for a new one.

What happens if I swallow a part of the retainer?
Nothing. The part will just pass through your digestive system

What are fixed retainers?
Fixed retainers are an alternative that is sometimes used when you keep "forgetting" to wear your retainer. The orthodontist cements a retainer in your mouth and you cannot take the retainer off for a year.
If this happens, be sure to clean the retainer every night or else your breath will smell awful.

Of what use are the little colored rings around the brackets?
The colored rings are called ligating modules. They hold the wires into the brackets. Ligating modules can be fun. You can get them in several colors. Ligating modules allow you to make your braces match your personality and can be changed to suit your moods.

What happens if I swallow a ligating module?
Orthodontic ligating modules are safe. Orthodontic ligating modules are made of medical grade polyurethane which is similar to the grade of polyurethane used for medical implants. The polyurethane is safe to eat. If you swallow a ligating module, the ligating using just passes through your digestive system

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The actual cost of treatment depends on several factors, including the severity of the patient’s problem and the treatment approach selected. Most orthodontists offer convenient payment plans to patients. Generally, treatment fees may be paid over the course of active treatment. Arrangements commonly offered in orthodontic clinics may include an initial down payment with monthly installments, credit card payment, and other innovative ways to make treatment affordable. Insurance plans or other employer-sponsored payment programs, such as direct reimbursement plans are not available yet.

Do teeth with braces need special care?
Patients with braces must be careful to avoid hard and sticky foods and must not chew on pens, pencils or fingernails because chewing on hard things can damage the braces. Damaged braces will almost always cause treatment to take longer, and will require extra trips to the orthodontist’s office. Keeping the teeth and braces clean requires more precision and time, and must be done every day if the teeth and gums are to be healthy during and after orthodontic treatment. The orthodontist and staff will teach patients how to best care for their teeth, gums and braces during treatment. The orthodontist will tell patients (and/or their parents) how often to brush, how often to floss, and, if necessary, suggest other cleaning aids that might help the patient maintain good dental health.

How important is patient cooperation during orthodontic treatment?
To successfully complete the treatment plan, the patient must carefully clean his or her teeth, wear rubber bands, headgear or other appliances as prescribed by the orthodontist, and keep appointments as scheduled. Damaged appliances can lengthen the treatment time and may undesirably affect the outcome of treatment. The teeth and jaws can only move toward their desired positions if the patient consistently wears the forces to the teeth, such as rubber bands, as prescribed. To keep teeth and gums healthy, regular visits to the family dentist must continue during orthodontic treatment. Adults who have a history of or concerns about periodontal (gum) disease might also see a periodontist (specialist in treating diseases of the gums and bone) on a regular basis throughout orthodontic treatment.

What is a space maintainer?
Baby molar teeth, also known as primary molar teeth, hold needed space for permanent teeth that will come in later. When a baby molar tooth is lost, an orthodontic device with a fixed wire is usually put between teeth to hold the space for the permanent tooth, which will come in later.

Why do baby teeth sometimes need to be pulled?
Pulling baby teeth may be necessary to allow severely crowded permanent teeth to come in at a normal time in a reasonably normal location. If the teeth are severely crowded, it may be clear that some un-erupted permanent teeth (usually the canine teeth) will either remain impacted (teeth that should have come in, but have not), or come in to a highly undesirable position. To allow severely crowded teeth to move on their own into much more desirable positions, sequential removal of baby teeth and permanent teeth (usually first premolars) can dramatically improve a severe crowding problem. This sequential extraction of teeth, called serial extraction, is typically followed by comprehensive orthodontic treatment after tooth eruption has improved as much as it can on its own.

After all the permanent teeth have come in, the pulling of permanent teeth may be necessary to correct crowding or to make space for necessary tooth movement to correct a bite problem. Proper extraction of teeth during orthodontic treatment should leave the patient with both excellent function and a pleasing look.