Ask the Orthodontist
Q: I am a 38 year old executive. I am not satisfied with my smile but cannot conduct business with braces on my teeth.
A: According to the American Association of Orthodontics, there are a million adults in the United States and Canada who have braces on their teeth to align them and effect a pleasing smile. This means you probably know an adult who is wearing braces -- but does not necessarily mean you know it. By using a series of clear, removable aligners, Invisalign® straightens your teeth with results you'll notice sooner than you think. The course of treatment involves changing aligners approximately every two weeks, moving your teeth into straighter position step by step, until you have a beautiful smile. And unlike braces, these clear aligners can be removed while you eat and brush your teeth. Invisalign is virtually invisible, so there's no reason you cannot have your teeth straightened without unwarranted attention to your mouth. In fact, very few people will notice at all - unless you tell them. They're comfortable to wear and remove easily when you eat, brush, and floss.
Q: My 6-year-old has been going to the dentist regularly. What should I watch for that would indicate an orthodontic problem?
A: Every orthodontic problem determines its own best starting time, which will be coordinated with the child's growth pattern. An early examination by the orthodontist enables evaluation of the problem and early determination of the appropriate time to treat the child for maximum improvement. The American Association of Orthodontists recommends that every child should be examined by the orthodontist by the age of 7.
Early Warning Signs:
- Difficulty in chewing or biting
- Early or late loss of primary (baby) teeth
- Thumb or finger sucking
- Open mouth breathing or snoring
- Overlapping or crowding
- Clicking or popping of the jaws
- A developing underbite, overbite, protruding front teeth or other abnormal bite development
Q: What can happen if orthodontic problems are left untreated?
A: Crooked and crowded teeth are harder to clean and maintain than straight teeth, which bite properly with their counterparts in the opposite jaw. This may lead directly to tooth decay, staining, gum disease, movement of other teeth in the opposing arch, and even tooth loss. Other orthodontic problems (incorrect tooth position or malocclusion) can cause abnormal wear of the teeth, excessive stress on the supporting bone and gum tissues, or misalignment of the jaw joints. Tooth position, in its extreme, can affect speech and digestion.
An investment in orthodontic treatment now may offset more costly treatment in the future. In addition, an untreated malocclusion may result in harmful effects, not only to the oral health of the individual, but also to his or her self-esteem. A person's self-consciousness often disappears as orthodontic treatment brings teeth, lips and face into the proper position.
Q: My dentist told me I have periodontal disease and that as part of my entire treatment I must see an orthodontist to reposition my teeth. Why do I need braces for gum disease?
A: First let us explain the term "gum disease." This is really a misnomer and should be "disease of the supporting structures of the teeth." These structures include the bone and soft tissue surrounding the teeth. The importance of these structures is obvious. The teeth will not survive over the long haul if the support of foundation is poor or diseased. Just as a house with a faulty foundation will eventually fail, so will the supporting structures of the teeth.
Sometimes this disease process is due to the position of the teeth (e.g., the occlusion). Therefore if the teeth come together or bite in a way that produces or enhances the disease process, there can be periodontal or gum disease. Here it is necessary to resolve or fix the bite problem through treatment. Braces put the teeth in a better position. As in the example of the house, first you must fix the foundation, then you can fix the house.
Q: Why should I replace missing back teeth? They don't show.
A: As with the previous question, one would liken back teeth to the foundation of a house. The foundation of a house usually does not show either BUT if it is not intact and whole, then the house may shift and even fall in. The back teeth are the foundation of a healthy bite. These are the teeth that "hold up the bite." When one or more is missing, it puts excessive stress on the remaining teeth. The stress may cause periodontal disease and/or movement of teeth. This could result in a bad bite. The terminology is "posterior bite collapse."
When one tooth is lost, the teeth on either side lean into the space. These teeth are now out of position and biting forces may move them even more. If the teeth have moved a lot, it may be necessary to see an orthodontist to move them back into position. Sometimes orthodontics can be done to close the spaces and still have a healthy bite. In order to support the bite properly and to maintain healthy back teeth, bridges, implants or braces may be used.
Q: My children are young. One child uses a pacifier and the other sucks his fingers. Do these habits make teeth stick out and cause the need for braces?
A: Sucking on fingers and pacifiers are habits that may cause teeth malalignment and/or developmental problems of the jaws. This happens to some degree depending on force and duration of the sucking habit. Finger sucking usually causes more of a problem than the pacifier due to the distribution of forces. The fact is that digits are sucked for a longer period of time. Therefore it is recommended that pacifiers be used if one or the other is deemed necessary by the parent.
Behavior modification is well documented as a means of breaking the habit in those children past the age of 4 who have a real interest in stopping. This can be done by positive encouragement daily. In some cases, this is insufficient and an orthodontic appliance must be placed to stop the habit. This is done as intervention since continued use can cause "buck teeth," narrowing of the upper jaw, crowding and backward movement of lower teeth.
Many times merely stopping the habit will spontaneously return the teeth and jaws to their proper position. It will certainly stop any additional movement. It still may be necessary to move the teeth orthodontically, even though the habit has been stopped. Therefore, it is very beneficial for you as the parent to attempt to reward behavior modification training to stop the habit. If this is unsuccessful or teeth remain out of alignment after 6 months, it is best to see an orthodontist regarding possible orthodontic intervention.
What About My Wisdom Teeth?
Q. What's the problem with wisdom teeth?
A. For most people there are quite a few problems with wisdom teeth. These include:
- Difficulty in accessibility for cleaning
- A high susceptibility to decay
- Chronic or recurring gum infections
- Biting against the gum tissue of partially erupted wisdom teeth
- Damage to the second molars by wisdom teeth
- Interference with normal bite or jaw movements
Q. Will wisdom teeth cause other teeth to become crowded after braces are removed?
A. While there is some disagreement in this regard within the dental profession, according to the American Dental Association impacted teeth can crowd adjacent teeth out of alignment, causing an incorrect bite or crooked teeth. By far, the greatest cause of relapse after teeth are straight is failure to wear retainers as instructed.
Q. Do all wisdom teeth need to be removed?
A. No. We believe that wisdom teeth that are not causing problems and are not likely to be a future problem can and should be retained. Nevertheless, most people are well-served by having wisdom teeth removed.
Q. What should be done in my case?
A. Be sure to have regular check-ups by your family dentist. He or she will evaluate the wisdom teeth and recommend removal if necessary. If the wisdom teeth should be removed, your family dentist may, in some cases, recommend an oral surgeon.
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