Orthodontics: What you need to know about braces

World Orthodontic Health Day on May 15th brings to the forefront the issues of bad bite and its consequences, many of which remain largely unknown to the general public.

“Many people have the impression that orthodontic treatments are done for aesthetic reasons, but in reality, the main reason is not cosmetic but developmental and functional,” says Dr. Katerina Douma-Michelaki, DDS, PhD, specialist in Orthodontics for Children & Adults. “If orthodontic problems are corrected in time, injuries to protruding front teeth that can break can be avoided, correct positions can be ensured for the teeth, making it easier to clean with a reduction in cavities and gingivitis, and the bones of the face can develop properly to achieve skeletal harmony.”

Other benefits of early orthodontic treatment include reducing the need for future tooth extractions, improving chewing and speech problems due to incorrect tooth positioning, and enhancing facial aesthetics and a sense of well-being, as the patient will feel better about themselves.

Most orthodontic problems appear after the change of primary teeth and may be dental (teeth are crooked, protrude, or don’t close properly), skeletal (teeth are in relatively correct positions, but jaw bones are not in harmony), or dentoskeletal (problems are found both in the teeth and the bones).

“Most dental bite problems are genetically determined, but there are also external (environmental) factors that may play a role,” explains Dr. Michelaki. “Although one cannot avoid genetic causes, it is very important to diagnose them early in life when they are easier to correct. It is wrong to believe that orthodontic problems ‘will pass’ on their own, as this very rarely happens.”

Regarding environmental factors that may play a role in poor bite, they include thumb sucking, prolonged use of pacifiers (after the age of 3), or bottles (after the age of 2), mouth breathing (which is linked to problems in the development of the face and mouth), and pushing teeth with the tongue. Even poor oral hygiene can play a role when, for example, it leads to periodontal disease that causes gum recession. Premature loss of a baby tooth can also lead to lack of space for the proper eruption of the permanent tooth.

In Children

According to the American and World Orthodontic Federations, the first visit to an orthodontist should occur at the age of 7, to make an early diagnosis of any potential issues and decide when treatment should begin.

The preventive or interceptive orthodontic treatment that a child may need at this age aims to correct issues such as anterior or/and posterior crossbite, severe crowding of teeth, anterior open bite (gaps between the front teeth), severe skeletal issues, excessive or insufficient horizontal and vertical overbite, chewing difficulties or pain in the joint between the upper and lower jaw, dental problems caused by prolonged childhood habits like thumb sucking and pushing teeth with the tongue, and severe bruxism (teeth grinding), etc.

“Because jaw bones in younger ages respond much more easily to orthodontic interventions, early initiation of orthodontic treatment will contribute to the smooth development of the entire face and may avoid future tooth extractions,” emphasizes Dr. Douma-Michelaki.

In Adults

Approximately 20-30% of orthodontic patients are adults, who seek treatment not only for poor bite or crowded teeth but also for gaps that suddenly appear between their teeth. These often hide some periodontal problem that needs to be corrected before starting orthodontic treatment to prevent potential worsening and eventual premature tooth loss.

Another common reason for orthodontic treatment is when an adult discovers a baby tooth (usually a canine) in the place of a permanent one and needs special treatment to uncover the impacted tooth. In many cases, orthodontic treatment is also done in preparation for dental implants (for example, when there are gaps or misalignments in the teeth that need to be first corrected with braces) and when there are skeletal issues, in which case a combined treatment with maxillofacial surgery is performed.

“Although the basic principles for straightening teeth are more or less the same at all ages, adults may face special difficulties, with the most common being periodontal issues, including gingivitis, which is much rarer in children,” explains Dr. Douma-Michelaki. “Difficulties may also arise from decades of dental procedures (e.g., fillings, bridges) that have been performed, as well as the fact that teeth and jaw bones have long completed their development, so tissue changes occur at a slower rate, making the treatment duration slightly longer.”

The Mechanisms

The mechanisms used in orthodontic treatment may be removable (the patient can take them out by themselves) or fixed (they remain in place during treatment and can only be removed by the orthodontist).

Although most people are familiar with the classic metal “braces,” modern Orthodontics has a wide variety of advanced materials at its disposal, such as nickel wires, nearly invisible ceramic brackets, lingual brackets that are placed on the back of the teeth, mini-implants, etc. Of course, the right treatment with clear aligners, with no “braces” at all, now gives more people the opportunity to achieve a proper result without the worry of appearance.

The rapid advancement in technology, supported by solid and continuously expanding knowledge, are the powerful tools in the arsenal of the modern orthodontist to provide a “smile of life” to an ever-growing number of both children and adults. Because the smile is our first contact with the world, and as the message of today’s World Orthodontic Day says, “The world unites when people smile!”, concludes Dr. Douma-Michelaki.