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This
webpage is courtesy of ArchWired.com
at http://www.archwired.com
Other
Questions about Orthodontics
Can you be too
old for braces?
There is no
age limit for braces. As long as you have good periodontal
health, braces can be used to straighten your teeth and
correct your bite. More people over age 30 are getting
braces today than ever before. Most ArchWired readers are
between the ages of 30 and 55!
My kids just
got braces and now I'm thinking of getting them, too.
Many adults
"finally get their teeth done" when their kids go
in for orthodontic treatment. It's more common than you
think! Several ArchWired readers have an entire family in
braces!
Should I get
braces done by a dentist or by an orthodontist?
My personal
opinion leans toward orthodontists. It takes years of
special training to learn to do orthodontics; it's not
something that a dentist can generally just "pick
up" along the way. However, some dentists can do
orthodontics if they are well-versed in the subject and have
been doing it for years. Some dentists also confer with
their professional colleagues to ensure that they're doing
things optimally. If you're considering getting braces, you
should probably get at least one opinion by an orthodontist.
What is a malocclusion?
Occlusion
is another word for your bite -- how the teeth in
your top and bottom jaw meet with each other. So, a malocclusion
means a bad bite -- a bite with problems.
What are the
"classes" of malocclusion?
Malocclusion is most often
caused by hereditary factors such as an abnormal
relationship between the size of the teeth and the size of
the jaws. Malocclusion may also result from missing teeth or
habits such as thumb sucking or tongue thrusting.
Malocclusions are
classified based on the relationship of the maxillary (upper
jaw) and mandibular (lower jaw) first permanent
molars.
There are three basic
classes of malocclusion, Class I, Class II, and Class III:
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Class I malocclusion
involves crowding, spacing, or overlapping of the teeth. In this
classification the upper jaw is in a normal relationship
to the lower jaw; that is, neither jaw protrudes.
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Class II malocclusion
occurs when the bottom jaw is in a more posterior (backward)
position than normal. The top teeth appear to protrude
out over the lower teeth. One example of this type of
malocclusion is often referred to as "buck"
teeth.
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Class III malocclusion
occurs when the lower jaw is in a more anterior (forward)
position than normal. The lower teeth protrude out
beyond the upper teeth. This is often the most difficult
type of malocclusion to correct.
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photos
and illustrations from http://www.dentallearningsystem.com
and http://www.bracesnfaces.com.au/disorders/
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What are the "types
of bite" and what do they mean?
The most common types of
bite problems are:
images
from http://www.colgate.com
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Overbite.
Patients with overbites appear "bucktoothed"
and have a receding chin. The lower front teeth are
positioned too far behind the upper front teeth. This
condition can result from a horizontal overdevelopment
of the upper jaw or an underdevelopment of the lower jaw
or a combination of both.
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Underbite.
Patients with underbites have a strong jaw with a chin
that juts straight out. The lower front teeth are
positioned in front of the upper front teeth. This
condition is caused by the horizontal underdevelopment
of the upper jaw, the horizontal overdevelopment of the
lower jaw, or most frequently a combination of both.
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Crossbite.
This occurs when the upper teeth are biting inside the
lower teeth. This is frequently the result of a narrow
upper jaw. Crossbites also occur because of a mismatch
in jaw size and position between the upper and lower
jaw. Some crossbites also lead to asymmetry of the lower
jaw by causing the jaw to be abnormally deflected to one
side when closing the teeth together. Proper diagnosis
determines how and when a crossbite needs correction.
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Open
bite. This occurs when the upper front teeth cannot
meet or overlap the lower front teeth even though the
back teeth have closed together. Sometimes this this
makes eating difficult. Open bites are caused by the
overdevelopment of the back portion of the upper jaw in
a vertical direction. As the back portion of the upper
jaw grows vertically downward, the lower jaw will open
in a clockwise direction. This explains why open bite
patients have a long facial appearance.
How
much do braces cost?
The average
cost for a full set of braces in a typical two-year treatment is
about $5,000 US. The cost varies depending on where you
live. Major metropolitan areas tend to be slightly higher in
cost than rural areas. Generally, metal braces cost less than ceramic.
Invisalign treatment can be just as costly as traditional
braces, and sometimes is even slightly more expensive.
Can I get
braces just on the top or bottom?
That depends
on your case. Orthodontics isn't just about making your
teeth straight or making them look better. Most dentists and
orthodontists take a lot of things into consideration when
recommending treatment, such as:
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how
the top and bottom teeth meet with each other (i.e.,
your bite)
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how
well you can chew your food
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whether
you have a tongue thrust problem
-
whether
extraction or surgery will be necessary to correct your
problems
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whether
you will need any appliances in your treatment, such as
a palate expander or headgear (yes, some adults do wear
headgear)
So you see, it
isn't just a matter of making your teeth look pretty. There
are lot of other factors to take into consideration. This is
why you sometimes need a full set of braces, even if you
think that you only need them on top or bottom. Of course,
some people are lucky. Their bites are good and perhaps they
only need a bit of straightening. People in this position
often can get braces only on top or bottom
When will I
begin to see changes in my teeth after the braces are put on?
According to a
recent ArchWired poll, most people begin see changes in their
teeth in the first 2 to 6 weeks of treatment.
Are people
going to think I look geeky or weird with braces on my teeth?
Of course
you're self-conscious because it is YOUR mouth, but frankly
most people don't give a hoot. Your braces are a
conversation piece for about 3 minutes; after that, nobody
pays much attention. Really. And most people don't think you
look geeky. In fact, they probably think you look cute, or
applaud that you are doing something positive to improve
your appearance and your dental health. Whenever you become
self-conscious about your braces, think about how great
you'll look after they come off!
FYI, here are
the results of a poll of ArchWired readers on this very
subject, conducted in January, 2004: 
Do
dental plans cover the cost of braces?
Most U.S.
dental plans cover children up to age 18, but do not cover
adult orthodontics. If your plan covers adult braces,
consider yourself in the lucky minority. I can't speak for
dental plans offered overseas, as I know very little about
them, and some are government-run. Remember,
most dental plans do not cover treatment that is already in
progress. So, if you are going to sign up for a dental plan,
do it before any treatment begins. Also, beware of
any waiting periods your dental plan may enforce. And by the
way, jaw surgery or extraction is sometimes covered under
your medical plan, so be sure to look into this, too.
Can
you recommend any dental plans or orthodontists?
ArchWired does
not make specific recommendations -- we just don't have the
resources for that.
Plans come and go; some
are better than others. Please read the fine print
carefully before you sign up for anything and check with the
Better Business Bureau. You can search for dental plans on
Google. There are plenty of them out there. Or, ask a
trusted insurance agent. To
help find an orthodontist near you, it's best to get
personal recommendations. Ask friends who have braces (or
whose kids have braces). If your insurance covers
orthodontics, see if it is limited to specific
dentists/orthodontists. Or, post a query on ArchWired's Metal
Mouth Forum; our readers are all over the US and around
the world, and are very helpful!
What if I
move away and change orthodontists or dentists once my
orthodontic treatment has begun? What happens?
Changing
orthodontists mid-treatment can be tricky. Most
orthodontists work on a "pay as you go" plan. In
other words, you pay a certain amount of money at the outset
of treatment (for the molds, consultations, and having the
braces installed). Then, each month, you pay a percentage of
the rest of your balance. So, if you move away from your
orthodontist, be sure to tell him/her ASAP so that you will
not be charged extra. You orthodontist will probably
"pro-rate" your balance or refund some of your
money. You should also request your dental records, or ask
your orthodontist to forward them to your new doc. However,
you may wind up paying a few hundred dollars more to your
new orthodontist. After all, this new doc has never seen you
before, and you are a new patient to him. Hopefully,
changing orthodontists mid-treatment won't raise your costs
too much. In
any event, this is a good argument for NOT PAYING THE ENTIRE
BALANCE UP FRONT. Personally, I think that paying it all
up-front is a really bad idea. For example, there was a
story in the news recently about an unscrupulous dentist who
took full payment from his patients -- and then closed his
practice! Some of them had to pay the full amount (in excess
of $5,000) again to the new orthodontist, and some
just couldn't afford the unexpected expense and had to stop
their treatment. Don't let this happen to you! For
more details on this subject, read Braces
and Moving.
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Should I
get teeth extracted as part of my orthodontic treatment?
It depends on
your specific case. When we are young and our jaws are still
growing, dentists/orthodontists can work with our growth to
straighten the teeth without extraction. But
once we are adults, dentists are limited to what is already
in place. If your orthodontist recommends extraction, it may
be wise to get at least one more (if not two more) opinions
before going through with the procedure -- once the teeth
are gone, they're gone! Sometimes,
depending on your unique case, extraction may be the only
way to successfully straighten your teeth and correct your
bite.
How
long does it take to close gaps between teeth after an
extraction?
That depends
on your unique physiology. Gaps in teeth on the lower jaw
tend to close slower than on the upper jaw. It can take
anywhere from a few months to a year to close extraction
gaps.
Can
I get those invisible braces (Invisalign) instead of
traditional ones?
That depends
on your specific case. Invisalign braces are usually not
recommended for very complicated cases, or cases that
involve extractions. Only a qualified dental professional
who has examined your mouth can decide whether Invisalign is
right for you.
Do
you have to change your diet when you wear braces?
Yes, you do,
to some extent. At first your teeth will hurt and you won't
be able to bite into hard foods, big sandwiches, or anything
too chewy or crunchy. It is best to stick to soft foods until
your teeth begin to feel better -- usually in a few weeks.
Read Soft Food Suggestions to
help you cope.
I
wore my retainer when I was younger, but my teeth shifted
years later. Is
this common?
Yes, it is
more common than you think. The teeth are actually more
dynamic than you'd expect. Often, when wisdom teeth erupt,
your bite can change in adulthood. A large percentage of adults in
braces are in them for a second time!
Why
do I need to have spacers put in before braces?
Sometimes
there isn't enough space between certain teeth to insert a
metal band or other appliance. Spacers help move the teeth
slightly to create space that is needed for your treatment.
For more information, read What are
Orthodontic Spacers?
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What is an
arch wire?
The arch wire
is the metal wire that goes across your braces, from one end
of your mouth to the other. You have two arch wires; one on
top and one on bottom. The pressure from the arch wire is
what helps to move your teeth.
What is a
ligature?
A ligature
(also called an "o-ring") is a tiny elastic that
holds the arch wire onto each bracket of your braces.
Ligatures come in a variety of colors. Some brackets are
"self-ligating," which means that they do not need
the little elastics to hold the arch wire onto the brackets.
How do braces
work?
In a nutshell,
the ligament surrounding the teeth is loosened, allowing the
teeth to move. For a more detailed explanation, and
illustrations of the parts of braces, read How
Do Braces Work?
Is there a
big difference between metal and ceramic braces?
All the pros
and cons are outlined in What
Type of Braces are Best? Also, visit ArchWired's Links
page.
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Do braces hurt?
Yes, at first
they do. For me, it felt like I had been hit in the teeth
with a baseball. Your teeth hurt and your gums get sore in specific
places. This is because
your teeth are not used to the pressure, and your cheeks are
not used to the metal or ceramic rubbing against them. After
wearing braces for a few weeks, the pain and discomfort
begin to diminish. You can use dental wax and topical
anesthetic to help create a barrier between the braces and
any sores that develop on your gums (the sores usually heal
within a few weeks). In
a few months, pain is less of an issue, and it goes away.
You sometimes
even forget that you're wearing braces! Your teeth may also hurt
again for several days after your monthly adjustment, but by
then you're used to it and it doesn't bother you as much.
How long will
braces cause pain and discomfort?
When you first
get braces on, your teeth will hurt for several weeks, as
though you have been hit in the teeth with a baseball. After
about a month, it is better. In 3 months you can eat almost
anything you like. In six months, you might even be biting
into hard cookies, chips, and crusty bread once again. Eat
these things in moderation and always be careful.
I just got my
braces recently and my teeth feel loose. Why? Is it OK?
The
periodontal ligament, which helps to hold your teeth in
place, is loosening up. Yes, this is perfectly normal,
although it is very disconcerting. The teeth should stop
feeling loose after a few weeks. If you're very concerned
about it, or if the teeth feel loose for months on end, talk
to your dentist about it.
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Do I need
to use a special toothbrush or other gadgets when I have
braces?
Yes and no.
You can use a regular soft toothbrush, but most
orthodontists recommend an orthodontic-cut toothbrush, where
the bristles in the middle are lower than the bristles on
the edges. You can also use any electric toothbrush, such as
a Sonicare or Oral-B Braun. These do an especially good job
of cleaning your teeth. To
floss your teeth, you don't need special floss, but you do
need a plastic threader needle to help you get the floss
between each bracket (or floss with a stiff end). You
might also want to get a small spiral dental brush or a
rubber-tipped stimulator to help clean food debris out from
between the brackets before you brush. And
finally, you will need some dental wax, because inevitably,
the brackets will irritate the insides of your cheeks at
first.
Why
do you use wax when you have braces?
Wax helps to
create a barrier between the bracket and the inside of your
cheek. This is helpful if the bracket is irritating your
cheek or gums.
How do you use
orthodontic dental wax?
To
use dental wax, break off a tiny bit of wax from the
container, smoosh it with your fingers a bit to mold it,
then place it directly on the bracket that is causing the
irritation. Dental wax
is non-toxic, so it's ok if you swallow it. Wax tends to
break down over time, so you'll probably have to apply more
after eating a meal. Take off the wax before you brush your
teeth, or it will gunk up your toothbrush.
Usually your
dentist/orthodontist gives you some dental wax after you get
your braces put on. Most pharmacies carry dental wax. DentaKit.com
also sells silicone dental wax, which tends to last longer
than traditional wax.
How
do you floss your teeth with braces on?
It's a little
tricky at first. You must thread the floss under the arch
wire between each tooth, floss, then remove it. Repeat for
each tooth. You can use any type of floss that is
comfortable. Most people attach the floss to a plastic
needle called a Floss Threader, or use floss that has a
stiff end, such as Glide Threader Floss, Oral-B Super Floss,
or Thornton Floss for Braces and Bridgework.
Can
you use whitening toothpaste when you wear braces?
It's probably
best not to use a whitening toothpaste until after your
braces come off. If you use a whitening toothpaste on a
daily basis, the teeth underneath the brackets may not be as
white as the rest of your teeth when your braces come off!
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I seem to be
drooling more, now that I have braces. Why?
Excess saliva
(drool) is actually very common. Apparently your mouth
mistakes the feeling of the brackets on the inside of your
cheeks for food, and sometimes produces extra saliva to help
digest it.
Suddenly I've
developed gaps between teeth which never had gaps before.
Should I be worried? It
is very common for your teeth shift and develop gaps while
treatment is underway. Your bite will change many times during
your treatment. Remember than any strange gaps or bite
problems will be resolved by the time your treatment is
finished. If you are really concerned, mention it to your
orthodontist.
Do I really
need to brush my teeth after every meal when I'm wearing
braces? What a pain!
Yes and no.
Yes, you should, because depending on what you eat, food
gets stuck in and around the brackets. Besides looking
gross, it causes tooth decay and bad breath. It also feels
yucky. Some people can't stand the feeling of food stuck in
their brackets. You wouldn't believe how much food can get
stuck -- often more than you'd imagine! However,
if you let the brushing slide every so often, it's not the
end of the world. Just try to be as diligent as possible on
a regular basis. At the very least, swish your mouth with
water and try to pick out any food that is stuck in your
brackets. It's also a good idea to floss each night, or at
least a few times per week. Sometimes food gets stuck
between teeth and you don't realize it until you floss it
out. Some
dentists also recommend a fluoride mouth rinse, such as
Colgate ACT (which I use -- it leaves my mouth feeling very
clean and fresh, with the benefits of fluoride).
I don't want
to wear my headgear during the day. Why
can't I wear my it only at night?
Nobody likes
to wear headgear, but it serves a specific purpose in your
treatment. If you don't wear it as many hours as your
dentist recommends, your treatment won't progress as fast,
and you might wind up wearing the headgear additional
months. It's best to just go along with what your dentist
recommends and get it over with sooner. Read A
Few Words About Headgear for more information.
Why
do I need to wear elastics?
Elastics help
fine-tune the alignment of your teeth and your bite. There
are many different ways that you can wear elastics for
specific reasons. You should wear the elastics the
number of hours that your dentist recommends to help your
treatment progress properly. (Wearing them "double
time" or "double strength" to make up for
time you spent without them is NOT advisable -- that could
harm your teeth). Most people take elastics out
before a meal, brush, then replace them after a meal.
What
is an adjustment and how is it done?
In a nutshell,
the elastic ligatures are changed, and sometimes the arch
wire is also changed. For a detailed description of the
procedure, read About Tightening/
Adjustment.
How
can I cope with canker sores when I have braces?
There are many
ways to cope with canker sores. If the sore is near a
bracket, you can put some dental wax or dental
silicone on the bracket to create a barrier, then apply some
canker sore medication to the sore area. For more detailed
information, read Ouch! I Have a
Canker Sore!
Do
ceramic (non-metal) braces stain?
The brackets
themselves usually do not stain. It's the elastic ligatures
that hold the arch wire to the bracket that stains. These
are changed at each adjustment, when you get fresh clean
ones. So, if your ligatures or power chains stain, you'll
only have to live with it for a short time.
What
foods stain the ligatures of your braces the worst?
Foods like
curry, mustard, black coffee, and red wine create the worst
stains. For more details, read Help!
Did I Stain My Braces?
What colors
of ligatures or power chains resist stains the best?
Clear or white
ligatures show yellow stains the worst. The best colors,
according to ArchWired readers (and my own personal
experience) are: smoke, pearlescent, glow-in-the-dark, and
any dark vibrant colors. I have also worn light blue, which
turn a pleasant teal color when stained by curry (i.e., blue
ligatures plus yellow curry make greenish blue ligatures).
Can
I smoke cigarettes, cigars, or pipes with braces on my teeth?
Yes, you can
smoke or chew tobacco, but both of these habits will stain
your ligatures and may possibly stain ceramic brackets.
Is
it OK to have braces if you are pregnant, or plan to become
pregnant?
Yes, many
pregnant women have had orthodontic treatment. Your teeth
may be a bit looser than average because of the hormonal
changes and the effect on your periodontal ligaments. But as long as you maintain good periodontal
health, it shouldn't be a problem to wear braces if you're
pregnant. For a reader's perspective on the subject, read Braces
and Pregnancy.
Can
you wear braces if you snorkel or scuba dive?
Yes, you can.
It's probably best to have the braces on for a few months
before snorkeling or scuba diving, so you can get used to
the extra hardware in your mouth. For a reader's perspective
on the subject, read Braces
and Snorkeling/Scuba.
Can
you wear braces if you play a wind instrument?
Yes, you can.
Several companies make mouth guards specifically for this
purpose. Ask your orthodontist for one that he/she
recommends.
How
can I keep my braces clean after eating at a restaurant or
traveling?
Most people
who have braces carry a little dental kit to help them in
such situations. A dental kit should contain a dental pick,
some floss and floss threaders, a toothbrush, and some
toothpaste. A travel cup is also a good idea. All these
items are compactly offered in a product called DentaKit,
which is offered on the web at a reasonable price.
A
wire at the end of my braces is poking my cheek. What should I
do?
This is always
an annoying and tricky situation. If possible, gob a bunch
of dental wax at the end of the wire to stop it from poking
you. You can also try a bit of cotton. Call your dentist or
orthodontist and ask to come in ASAP so they can clip the
wire. Some orthodontists let you come in "as
needed" for a clipping without an appointment. By
the way, the wire pokes you because your teeth have moved,
displacing the end of the arch wire. Although this is
annoying, it's a good sign that your treatment is
progressing!
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What are the
types of retainers?
To retain
means to keep in place; therefore, an orthodontic
retainer is used to keep your teeth in their new positions
after your braces come off. Most orthodontists use one of
these three types of retainers:
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A
clear plastic retainer (also called an Essix
Retainer)
is sometimes placed on the upper teeth one or two
days after the braces are removed. It resembles the
Invisalign appliance. It is normally worn only at night
and lasts an average of 24 months. After it wears out
the orthodontist may replace it with a traditional wire
retainer. Some people have commented that this type of
retainer can be uncomfortable.
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A
bonded retainer 
is normally placed behind the lower teeth after the
braces are removed. It is a wire "permanently"
bonded to the teeth with composite material. Sometimes
this type of retainer is used for the upper teeth, but
usually this is not possible because it would interfere
with your bite. A bonded retainer will remain in place
for several years.
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A
wire retainer (also called a Hawley Retainer)
is normally placed after discontinuing use of either
the clear retainer or bonded retainer. This type of
retainer has the added benefit of being adjustable so
that minor tooth movement is possible. Sometimes a wire
retainer can be worn full time instead of braces to
correct mild crowding. As you can see, the plastic part
of the retainer can be made in a variety of colors and
patterns.
photos
from http://www.smileofyourlife.com/retainers.htm
Why do I have
to wear a retainer after my braces come off?
It takes many
months for your periodontal ligaments and bone to
"remember" the new position of your teeth and keep
them in place. The retainer helps keep them in their proper
new positions. It's important to wear the retainer exactly
as your dentist/orthodontist recommends. Otherwise, your
teeth may shift.
How do I
keep my retainer clean?
You should
brush your retainer each night as directed by your
orthodontist. You can also use a retainer cleaner, or even
denture cleaner (on a Hawley retainer) to keep it extra
clean.
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