Orthodontics

Orthodontic treatment can improve the appearance, health and function of the teeth and jaws.

Orthodontic treatment is not restricted to children and teenagers. Orthodontic treatment can be successful at any age. Treatment may take longer for adults because their jaw bones are dense than in children.

As an adult’s facial bones are no longer growing. Some severe malocclusions cannot be corrected with braces alone. In such cases, orthodontic treatment is combined with jaw surgery (orthodontic surgery) to achieve an acceptable outcome. 

Benefits of orthodontic treatment

  • Appearance: an attractive smile can play an important role in enhancing self-confidence.
  • Cleaning of teeth: Teeth with good alignment are much easier to floss and brush.
  • Chewing: your ability to chew food is best when your occlusion (“bite”) is correct. 
  • Speech problem: some people have difficulty pronouncing certain words properly because of alignment problems with their teeth and jaws.
  • Gum damage: in cases of incorrect bite (malocclusion), teeth may damage gum tissue
  • Tooth wear: crooked teeth often show abnormal, and sometimes damaging, patterns of wear.

Appliances

Orthodontic treatment uses corrective appliances including braces, plates and headgear. These appliances move teeth by exerting gentle force on them. These appliances need to be adjusted on a regular basis. 

When to have an orthodontic assessment

Most problems are apparent by seven to nine years of age when the six year molars and most of the adult teeth have come through. The best age for a child to have a consultation is usually around seven to eight years of age.

Early treatment

Early examination of the teeth and jaws allows planning the best treatment and to prevent orthodontic problems from getting worse or may prevent damage to teeth and gum. It may also result in shorter and less complicated treatment at a later age.  These treatments include

  • Arch expansion appliance to correct cross bites
  • Functional appliances to correct jaw disharmony
  • Removable orthodontic plates to correct relatively simple problems
  • Elastic bands and headgear

Full treatment

Full treatment usually involves fixed appliances (braces) for about two years. 

Once the need for treatment is established, records are taken. These include:

  • Impression form which plaster models of the teeth are constructed 
  • Photographs of the teeth and face
  • X-ray films of the teeth and jaw.

Advice can then be given on:

  • Treatment options
  • When treatment should start
  • How long is should last
  • How much it is likely to cost.

If it is too early to start treatment, the patient is reviewed at regular intervals until the time is right to start.

Braces

Braces consist of bands, brackets and wires. They are usually made of stainless steel and selected metal alloys. Clear brackets (made of a tough ceramic) are used if the person wishes to display less metal; these braces usually cost more.

Extraction and other treatments

Sometimes, one or more teeth must be removed so enough space is available to align teeth and produce a balanced outcome. Cavities in teeth should be filled before orthodontic treatment. Teeth may need to be professionally cleaned. 

Continue to attend your general dentist for regular dental check-ups at least every six months during the course of treatment 

For most people, treatment will require changes to their daily routine and diet. .  Braces and appliances do not cause cavities. However, they can make cleaning difficult. Cleaning must be thorough so that food and plaque are removed from all tooth and appliances surfaces. For example, you may not eat sticky food such as toffees and hard food such as raw carrots.

Avoid soft drinks, or take them in moderation.  When playing contact sports, wear a mouth guard

Retention

At the completion of treatment, braces are removed and retaining appliances (“retainer”) are fitted to hold and support the teeth in their new position. These appliances may be removable plates or wires fitted behind the teeth. If they are not worn according to instructions, the teeth may move out of alignment.

During retention and the subsequent observation period, patients are expected to attend once or twice a year for several years following treatment

Possible complication of orthodontic treatment

All dental procedures are associated with some risk. While the dentist or orthodontist makes every attempt to minimise risks, complications can occur, and some may have permanent effects.

The following are possible complications. There may be other risks that are not listed.

Damage to tooth enamel

Weakening of the tooth enamel can occur. This is called “decalcification”. 

Inflammation of gums

An orthodontic appliance may cause gum inflammation. Usually it is not serious and clears up when the brace are removed. 

Damage to tooth roots

 As each tooth is moved, its root may shorten al little. This usually does not affect the tooth. 

Damage to pulp

 In the first days after adjustment of an appliance, the blood supply to the pulp and tooth nerve may be reduced, causing some discomfort or pain

Damage to tissue inside and around the mouth

If an appliance rubs on soft tissue (cheek, lip or gum), a mouth ulcer may develop. This type of ulcer heals quickly. In time, the tissue of the mouth “toughen up” and ulcer become less frequent. 

Dangers of loose appliances

Rarely, a loose appliance may be swallowed or aspirated into a lung. Urgent medical treatment is needed if the part has gone into a lung and is causing distress. Contact the nearest hospital with an accident and emergency department.

Allergies  

 Allergies to orthodontic materials can occur but are rare. 

Injury from headgear

Headgear can cause injury, especially during rough play. Follow the safety instructions

Growth 

If young patient’s jaws grow in an unfavourable or unpredictable way, treatment time may increase. 

Failure to treatment

Successful if the patient does not complete the full course, or maintain good oral hygiene, the orthodontic appliance may have to be removed to prevent further damage to teeth and gums. This interruption or premature ending of treatment will affect the outcome.

Relapse

Despite orthodontic treatment of a high standard and a good initial outcome, it is possible that some teeth may move away from their corrected position. This is called relapse. Front teeth are the most prone to such movement. If worn according to instructions, retainers should restrict this movement. If the relapse is severe, another course of orthodontic treatment may be needed.

Teeth continue to move during one’s lifetime. This movement may not be related to the orthodontic treatment and can be restricted by occasional wearing of the orthodontic retainer.

Cost of treatment

The cost of treatment will depend on the severity of the problem and the dentists or orthodontics fee scale.

In Australia, the fee for full orthodontic treatment involving upper and lower braces varies from about $3,500 to $7,500 and sometimes more

The orthodontics fee usually covers the entire treatment including fitting of braces, periodic adjustment, removal of the braces, fitting of retainers, and visits to assess the result of treatment. The fee does not cover the initial consultation, records or other preparatory steps for the fitting of braces. You should discuss cost fully before proceeding with treatment. 

Dental benefit fund

If you have private health insurance, your rebate depends on your level of health cover. You should discuss the rebate with your health fund before starting orthodontic treatment as there may be a mandatory waiting period involved.