Successful orthodontic treatment is a “two-way street” that requires a consistent, cooperative effort by both the orthodontist and patient. To successfully complete the treatment plan, the patient must carefully clean his or her teeth, wear rubber bands, headgear or other appliances as prescibed, 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. Patients who do their part consistently make themselves look good and their orthodontist look smart.

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.

Today’s 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. A type of clear orthodontic wire is currently in an experimental stage.

Custom-made appliances, or braces, are prescribed and designed 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.

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.

In general, active treatment time with orthodontic appliances (braces) ranges from one to three years. Interceptive, or early treatment procedures, may take only a few months. The actual time depends on the growth of the patient’s mouth and face, the cooperation of the patient and the severity of the problem. Mild problems usually require less time, and some individuals respond faster to treatment than others. Use of rubber bands and/or headgear, if prescribed by the orthodontist, contributes to completing treatment as scheduled.

While orthodontic treatment requires a time commitment, patients are rewarded with healthy teeth, proper jaw alignment and a beautiful smile. Teeth and jaws in proper alignment look better, work better, contribute to general physical health and can improve self-confidence.

The actual cost of treatment depends on several factors, including the severity of the patient’s problem and the treatment approach selected. You will be able to thoroughly discuss fees and payment options before any treatment begins.

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.

Most malocclusions are inherited, but some are acquired. 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 trauma (accidents), thumb, finger or dummy (pacifier) sucking, airway obstruction by tonsils and adenoids, dental disease or premature loss of primary (baby) or permanent teeth. Whether inherited or acquired, many of these problems affect not only alignment of the teeth but also facial development and appearance as well.

Children and adults can both benefit from orthodontics, because healthy teeth can be moved at almost any age. Because monitoring growth and development is crucial to managing some orthodontic problems well, the American Association of Orthodontists recommends that all children have a check-up with an orthodontic specialist no later than age 7. Some orthodontic problems may be easier to correct if treated early. Waiting until all the permanent teeth have come in, or until facial growth is nearly complete, may make correction of some problems more difficult.

An orthodontic evaluation at any age is advisable if a parent, family dentist or the patient’s physician has noted a problem.

All orthodontists are dentists, but only about 6 percent of dentists are orthodontists. An orthodontist is a specialist in the diagnosis, prevention and treatment of dental and facial irregularities. Orthodontists must first attend college, and then complete a three to five year dental graduate program at a dental school accredited by the Commission on Dental Accreditation of the American Dental Association (ADA). They must then successfully complete an additional two- to three-year ADA-accredited residency program of advanced education in orthodontics.