Q There has been a lot of media attention recently about extreme makeovers. How can orthodontic treatment help achieve an ideal smile makeover?

A Orthodontic treatment can be extremely helpful to achieve a smile makeover. For example, orthodontic treatment can place the teeth in better positions to correct the bite and eliminate crowding so that it is easier for the restorative dentist to improve the appearance of the teeth. A smile makeover without orthodontic correction may require reshaping and removal of tooth structure to adjust for crowding or faulty positions of the teeth. Often, an extensive makeover can be eliminated with orthodontic treatment and patients may only desire whitening or relatively small corrections of blemished or worn teeth.

Q I know orthodontic treatment provides cosmetic benefit, but what are some of the other reasons for having braces?

A Adults and children benefit from orthodontic treatment to correct the bite, alleviate crowding and improve alignment, thus improving function, facilitating proper oral hygiene, and preventing possible future dental problems such as increased wear of teeth. For children, orthodontics is not only important for alignment of teeth, but treatment may help correct jaw discrepancies through some modification of jaw growth in combination with tooth movement and bite correction. Children also benefit through correction of problems when teeth do not erupt normally and reduction of overjet (“buck teeth”) to minimize trauma and fracture of front teeth.

Q My dentist has recommended my daughter see an orthodontist because her canine teeth are not coming in correctly. How will this be corrected?

A Depending on the exact position of the canines and if the patient is seen early enough, the orthodontist may be able to help redirect the eruption path of the canines so that they will erupt normally. However, if the patient is already past the age of the normal canine ruption time or the positions of the teeth are significantly abnormal, the orthodontist may need to assist in the eruption of the teeth by employing surgical uncovering of the tooth and orthodontic tooth movement.

Q What is Invisalign?

A Invisalign is a form of orthodontic treatment that utilizes a series of custom made clear retainers to move teeth. Each retainer moves select teeth a tiny amount and then the patient progresses to the next retainer. It is usually more expensive than fixed orthodontics and is more limited in the scope of what can be accomplished compared to traditional fixed braces. It is not recommended for children and is designed for the adult who does not want to wear traditional braces.

Q Do I still need to see my dentist while I am in braces?

A Absolutely yes! I recommend that all of my patients see their dentist at least every 6 months or as recommend by their dentist; in some situations, a patient may need to have professional exams and cleanings more frequently.

Q Is it necessary to have teeth removed for braces?

A Your orthodontist may or may not recommend removal of teeth as part of your treatment. The most obvious reason is for severe crowding or protrusion of teeth. However, there may be many other reasons for the removal of teeth. For example, in young patients, extraction of baby teeth may be necessary to help the eruption of the permanent teeth and to prevent a tooth from being “impacted” or unerupted. In adult and adolescent patients, extraction of teeth may be necessary to correct a bite problem.

Q What is an underbite and what problem does it cause?

A The word “underbite” is used to describe a bite characterized by the lower front teeth biting ahead of the upper front teeth. This situation can be seen in all ages. It may be a sign of an abnormality in the position of the jaws but it can also be caused by just a few teeth that are poorly positioned. In the latter case, the patient may have excellent jaw positions but actually has to position his jaw forward in order to bite because of the faulty tooth positions. Early detection and correction of this situation can help a child greatly.

Q What is meant by a jaw discrepancy?

A I use the term “jaw discrepancy” to describe, in general, situations where jaws do not line up properly in one or more dimensions. For example, most people recognize when someone has a lower jaw that is too far back. Many other scenarios exist such as a lower jaw that is too far to one side, or too far forward causing an “underbite”, or an upper jaw that is too far forward. These situations are skeletal in their cause and are not just due to faulty tooth positions. They result from unfavorable patterns of facial growth.

Q What is surgical orthodontics?

A Surgical orthodontics involves a course of treatment during which a patient who has a major discrepancy between the positions of the jaws has orthodontics in combination with a surgical repositioning of one or both jaws. The surgery is often called orthognathic surgery. Typically, the patient undergoes orthodontic treatment first to carefully position the teeth in each jaw so that when the jaw positions are corrected, the teeth fit nicely together. The patient’s braces stay on during the surgery, and after the surgery, the orthodontist then “fine-tunes” the position of the teeth and bite prior to removal of the braces.

Q At what age is a patient too old for orthodontics?

A Fortunately, age does not disqualify someone from orthodontic treatment. As long as a person has healthy teeth and healthy supporting bone and gum tissues, they may be a candidate for orthodontics. Even if someone has had some bone loss around the teeth, they may be able to have orthodontics with careful treatment and monitoring of the gum tissues. One factor that may prevent someone from having orthodontic treatment is the chronic use of a bone density medication called a bisphosphonate; Boniva, Fosamax, and Actonel are examples of such drugs. A specific consultation with an orthodontist is recommended in such situations.

Q At what age do most children begin orthodontic treatment?

A Most children do not need to start treatment until preadolescence when they are starting to loose the last few baby teeth. A relatively small percentage of children will have specific conditions that warrant early intervention including problems such as correction of anterior or posterior cross bites which cause a child to “shift their jaw”, guidance of eruption when there are problems with teeth erupting in the wrong position, and a few very specific jaw position problems. In these cases, the early limited treatment is intended to prevent or minimize future problems and to facilitate comprehensive treatment when all of the permanent teeth are erupted.

Q At what age should I have my children seen by an orthodontist?

A Depending on the recommendation of your child’s general dentist or paediatric dentist, every child should have an initial examination by an orthodontist no later than age 8 or 9. However, your child’s dentist may recommend an earlier or later evaluation based on specific situations. The initial evaluation usually involves a screening radiograph to check for missing teeth or teeth that are erupting in an unfavorable position and a clinical exam to check the bite, jaw positions, and amount of crowding. Then the orthodontist can advise you if there are immediate needs or establish a time for a future follow-up examination.