Having orthodontic treatment can massively improve your smile and self-confidence. It can also correct a lot of problems associated with the imperfect position of teeth. These problems can be aesthetic but can also have an effect on how the teeth are developing, how they meet on chewing, how easy they are to keep clean, risk of trauma to teeth or gums. Aesthetic considerations should not be under-estimated. Certain orthodontic problems can have a profound impact on your quality of life.
Crowding is due to a disproportion between the size of the teeth and the jaws. It is a very common orthodontic problem. Crowding can also make oral hygiene maintenance more challenging. It can be corrected by maintaining space of baby teeth, regaining space that has been previously lost, by removal of some permanent teeth or reduction in the width of certain teeth (enamel reduction). Your orthodontist will do a detailed orthodontic assessment taking into consideration the shape of your jaws, your facial profile or side view, growth potential, your smile, teeth present and their position of teeth and amount of crowding. They can then discuss the options with you and come up with a treatment plan to suit you or your child.
Overbite is the vertical overlap of the top incisors over the lower incisors. An increased overbite (or deep bite) can sometimes lead to traumatic wear of the enamel of the incisors or the supporting gums. If the top teeth trap the lower teeth, this can restrict the growth of the lower jaw. Overbites are best corrected at a younger age and preferable during growth spurts (age 10-14, younger for girls, slightly older for boys). Overbites can be corrected in adults but involve more tricky orthodontic mechanics.
Overjet or protruding teeth
Overjet is the horizontal overlap of the top incisors relative to the lower incisors, sometimes known as buck teeth. Increased overjets are associated with an increased risk of trauma to the upper incisors. Often the top incisors are thought to be protruding, however more often than not, the top incisors are in the correct position to the face and the lower jaw/teeth are set back in the face. Increased overjets may be associated with a narrow palate or thumb sucking habit. Narrow upper jaws and relatively small lower jaws are best corrected again during growth spurts (age 10-14, younger for girls, slightly older for boys). Increased overjets can be corrected in adults but involve more tricky orthodontic mechanics or jaw surgery.
Spacing or gaps between the teeth are either due to small teeth, large jaws, or missing teeth (hypodontia). Your orthodontist will do a full assessment to determine the cause of the gaps and then make a patient specific plan for you. Options include the closure of spaces, replacement of missing teeth or composite build ups or enamel bondings of small teeth. Each option has pros and cons and your orthodontist is best positioned to help you make the best decision for you.
Missing teeth affects 5% of the population. The most common missing teeth are 2nd premolars and upper lateral incisors. Orthodontic treatment options for missing teeth are either to open the space for replacement teeth (bridges, implants or dentures) or close the space. Depending on the case, space closure can be a great option as you would not need long term replacement teeth or implants.
The treatment plan will depend on a number of factors: crowding, remaining baby teeth, position and shape of the jaws, face, smile aesthetics. Your orthodontist will help create a treatment plan for you taking into consideration all of the above and your personal preference of long term maintenance of the spaces. Often, we need to involve your general dentist or specialist prosthodontist in the treatment plan as they would be involved with replacing the teeth or reshaping them as needed after the braces are removed.
Impacted upper adult canines or canines that are developing in the incorrect position affect 2% of the population. Assessment for impacted canines should be done at age 10 by your dentist or orthodontist. If the canines cannot be felt under the gum at this age, an orthodontic referral is necessary to see where the canines are. Simple orthodontics can be done at this age to improve the position of the adult canine. This might involve extraction of the baby canines or widening of the top jaw to make more room for the developing canines. If the canines do not erupt by themselves, a small surgical procedure might be needed to expose the developing canine and then an orthodontic brace fitted to help move it into the correct position. Early intervention is best. If you are worried about impacted canines, book in with your orthodontist at age 10 for an assessment.
A crossbite most commonly involves the upper teeth biting inside the bottom teeth (normally the upper teeth bite outside of the bottom teeth). If left uncorrected, it can lead to traumatic wear of the enamel surfaces of the teeth. Crossbites can be due to crowding, a small upper jaw, large lower jaw or asymmetric growth of the jaws. If this affects the incisors, it is one of the orthodontic problems that can be corrected early (interceptive treatment, age 7-10) to limit or reduce the need for orthodontic treatment later. This might be done with a short course of fixed braces, a removable brace or a fixed expander brace. Speak to your specialist orthodontist to discuss the options.
Open bite is when the upper and lower incisors don’t overlap. It can be due to a habit, like thumb sucking, a prominent resting position of the tongue or vertical growth patterns of the jaws. Your orthodontist will do a full clinical examination to assess the underlying factors and then create a treatment plan for you.
A softer diet is recommended when you have braces are on your teeth (soups, scrambled eggs, minced meat, chicken, pasta, rice, noodles, salads, softer fruits). You can generally eat most foods, you may just need to cut them up smaller, take your time and eat gently on your back teeth (eg apples, carrots). Opt for softer breads rather than hard baguettes. Avoid chewing gums, hard sweets, sucky sweets.
A softer diet is recommended when you have braces on your teeth (soups, scrambled eggs, minced meat, chicken, pasta, rice, noodles, salads, softer fruits). You can generally eat most foods, you may just need to cut them up smaller, take your time and eat gently on your back teeth (eg apples, carrots). Opt for softer breads rather than hard baguettes. Avoid chewing gums, hard sweets, sucky sweets.
You will need to brush your teeth more when you have braces fitted. I would advise brushing for 2 minutes 3 times a day. You will also need to use inter proximal brushes and a fluoride mouthwash to keep your teeth and gums healthy.
When the braces are in place, you are more at risk of dental decay, especially on the front teeth. To reduce the risk, you need to limit your intake of sugary foods and drinks and brush your teeth more.
You should also brush your teeth for 2 minutes 3 times per day with a Fluoride toothpaste (containing 1450ppm Flouride). You should rinse with a high strength Fluoride mouthwash for 1 minute once a day (Flourigard, made by Colgate) at a different time to when you are brushing your teeth.
You also need to actively cut down on sugary food and drinks in the diet. My advice is to drink water, milk or tea with no sugar routinely. Do not drink fizzy drinks, fruit juices, mix cordials with water (even the no added sugar ones) or sports drinks regularly. One fruit juice or smoothie is allowed with breakfast. Special occasions are ok as a treat.
Dr Sinead and Dr Christine will keep a close eye on your oral health at every visit and will let you know how you are doing or if you needed to tweek your brushing techniques or dietary habits. We also recommend that you see your general dentist every 6 months for a dental check up and clean.
Braces tend to be sore after they are initially fitted. This can be managed with pain killers such as paracetamol and ibuprofen. It is normally a pressure pain rather than a toothache pain. The braces may rub on the cheeks or lips and cause ulcers. Ulcers tend to heal within 7-10 days as the skin in the mouth hardens up and gets used to the braces. Much like wearing in a new pair of shoes. We will provide you with special orthodontic wax to cover the brace for when you do get some ulcers. Ulcers occur more at the start and less so throughout the treatment. Teenager take about 2 weeks to adjust fully to the brace and adults take a little longer.
Braces are stuck to the teeth with a small amount of dental glue or composite. They are tough but can become loose if you bite too hard on them. The wires we use can bend or break if put under too much pressure. Removable braces break if they are constantly clicked in and out. They should be kept in their retainer box when out of the mouth.
You need to be careful with your brace. This means eating gently and taking your time. Avoid hard, chewy foods and biting pens or nails. Broken braces slow down your treatment and ultimately lead to you being in braces for longer. If you are worried about your brace being broken, just give us a call and we will guide you through what best to do. If it is a loose bracket, and it is not causing any pain, it can sometimes be left until your next appointment. If a wire is long and hurting the gum, then you might need to pop in the practice where we can fix this for you. Because we are a specialist orthodontic practice, there is an orthodontist here every day to help you and are staff are trained to manage orthodontic emergencies. You are generally seen on the same day as you have a problem. There is no waiting around if you are in trouble!
Below is a really helpful link from our colleagues at the American Association of Orthodontists on how to manage orthodontic emergencies if you can’t get to see us. https://www.aaoinfo.org/system/files/media/documents/OrthoEmergency-FLYER-13-hl.pdf
When taking part in contact sports, your teeth and jaws are at a greater risk of trauma. Mouthguards reduce the risk of trauma to the teeth and act as a cushion to reduce the risk of concussion if you get a bang to the jaws. A good fitting mouthgard is very important. When you have braces on, your teeth are constantly moving so getting a perfectly fitting mothgaurd is difficult. At Navan Orthodontics, we sell special orthodontic mouthguards that fit over the braces. If you play lots of contact sports, it may be an option to get a custom made mouthgaurd a few months into your treatment after the larger tooth movements have taken place. After your braces have been removed, we recommend getting a custom made mouthguard fitted specifically for your mouth. These will protect your new teeth and smile but also has the huge benefit of fitting better so they are more comfortable to wear and easier to breath and communicate with them in.