Guide to Orthodontics

Prepared by the AMERICAN ASSOCIATION OF ORTHODONTISTS

Orthodontics is that specialty area of dentistry which involves the diagnosis, prevention, and treatment of dental and facial irregularities.

It has been estimated that as many as 60 percent of children in the United States either require or will require orthodontic care. There are also thousands of adults who, either with the advice of their family dentist, or on their own accord, seek orthodontic treatment. It is for these persons that this material has been prepared, with the hope that it will answer many of their questions concerning this important health service.

Causes

There are two general causes of malocclusion (irregular teeth) or facial disharmonies. Many orthodontic problems are inherited. These include crowding, spacing, protrusion, retrusion, extra teeth, and missing teeth. Acquired causes include thumb or finger sucking, lip habits, mouth breathing, abnormal swallowing, dental neglect resulting in loss of teeth, enlarged tonsils and adenoids, early loss or prolonged retention of deciduous (baby) teeth, loss of permanent teeth, accidents, and certain diseases and dietary deficiencies.

Frequently an inherited malocclusion may be complicated by acquired causes, and the actual cause may be difficult to define. Quite often, the cause is unknown, but even then, orthodontists are usually able to treat the condition in a satisfactory manner.

Age

The proper age to treat malocclusion varies with the type and severity of the problem. The proper age for orthodontic consultation, however, would be as early as the problem is detected. Whether or not an orthodontic problem is detected, though, a child should visit an orthodontists for a check up no later than age 7. This may surprise you because an orthodontic treatment is usually associated with adolescence. Though treatment does not necessarily begin at this early age, an examination is very important to ensure maximum dental health for your child.

Until recently, the orthodontists has been concerned primarily with the "straightening of crooked teeth". More recently he has learned to utilize orthopedic force and principles to actually alter the facial development of a growing child, thus achieving better dental and facial results. In adults, the potential for this type of treatment is limited and correction is primarily dental.

Prevention

The responsibility for the recognition and early prevention of malocclusion rests with the patient's family physician, pediatrician, family dentist, and pedodontist. After birth, the establishment of good dietary habits, normal facial functions including breathing, nursing, swallowing and speech is essential. Early detection and treatment of enlarged adenoids and tonsils may also prevent the development of dental and facial problems.

There are four essentials in early dental treatment: adequate oral hygiene, restoring all cavities, eliminating habits, and space maintenance if teeth must be lost.

Interceptive or minor orthodontic care at an early age may reduce the necessity for full scale orthodontic treatment. This may be particularly true where acquired factors are the principal contributing cause to the problem.

Even with the best preventive measures, many problems, especially those of a genetic or inherited nature, will require orthodontic treatment at a later age. Orthodontic problems vary in the degree of severity from the minor, often esthetic types, to the extreme deformity such as cleft palate where the patient may exist as a dentofacial cripple" for the rest of his life if untreated.

Untreated Problems

Untreated orthodontic problems may result in harmful effects on the general health of the patient, including: speech defects, psychological and emotional disorders and often undetermined personality influences which result in the failure of the individual to reach otherwise attainable social or vocational goals.

If left untreated malocclusion may cause tooth decay, loss of teeth, diseased gums, bone destruction, and joint problems. More adults lose their teeth because of periodontal problems than because of decay. The increased costs of dental care for the untreated malocclusion may far exceed the cost of orthodontic treatment.

Adult Treatment

Although early treatment has been stressed, more and more adult irregularities are being treated with highly satisfactory results. It usually is being done in cooperation with the family dentist in the preparation for bridgework for full mouth rehabilitation. There is no reason for an adult to forego consideration of orthodontic treatment in this day of advanced techniques and enlightened society.

Selection of Orthodontists

When it becomes apparent that orthodontic treatment is necessary, the selection of a competent orthodontists is important. Usually, a responsible family dentist will refer you to an orthodontist whom he considers to be capable and whose techniques are results he respects. Membership of the orthodontists in The American Association of Orthodontists assures you that he has met certain minimal standards of training, education, and experience.

Initial Appointment

At this appointment he will advise concerning the severity of the malocclusion, and the need for treatment. He will also determine whether it should be delayed pending further growth, development, or eruption of teeth, and answer other questions that you might have.

If the case is ready for treatment, additional diagnostic records will be required. They include x-ray films, photographs, and plaster models of the teeth. This may be a part of the initial appointment or it may be done at a second appointment specifically for that purpose. A separate fee for diagnosis, which includes the case presentation, is generally applicable.

Following a thorough study of the diagnostic data, the orthodontist will present his findings and recommendations to the patient and parents. His evaluation will include an assessment of the need for treatment, a description of the techniques to be used, and the need for cooperation in the oral hygiene, appointments, and in following instructions. Other areas that will be stressed are the importance of continuing dental care, the results that can be expected, and estimated treatment time, and finally a discussion of fees and methods of payment.

Fees

Factors that enter into fee consideration includes: the complexity of the problem, the estimated treatment time, the type of appliance to be used, the frequency of appliance changes, and finishing and retention procedures.

Like any other dental or medical service, orthodontic care does cost. Yet, orthodontic fees have risen at a much lower rate than medical or dental fees.

Orthodontic treatment usually results in permanent correction. It commonly involves several years of treatment and payment usually can be extended over the years required for care.

Treatment Time

The average full treatment case will vary considerably in length of treatment depending on the patient's growth, his response to orthodontic forces, the degree of cooperation of the patient, and the complexity of the problem. In general, treatment time will vary between 15 to 30 months. Difficult cases will require more time and the simpler procedures less time.

Extraction Possibilities

The removal of certain teeth may be recommended as part of the treatment. These may be necessary to assure sufficient space for the remaining teeth, to establish proper occlusion and function, or to permit desirable changes in facial appearance. Spaces created by these extractions are closed during treatment. When indicated they actually improve the function or health of the mouth.

Occasionally, the extraction procedure is begun at an early age. It starts with deciduous teeth in underdeveloped arches and ends with the removal of certain permanent teeth. Such a program is known as "serial extraction" and is designed to prevent a more serious type of malocclusion. However, seldom does it completely eliminate the need for appliances.

Surgical Orthodontics

In rare cases or extreme facial disharmony, it is sometimes necessary to combine surgery with orthodontics to produce and acceptable result. Usually the orthodontist will make the diagnostic recommendations and treatment plan working in conjunction with an oral or plastic surgeon at the proper time.

If all the circumstances and considerations are acceptable to the parents or patient, then definite arrangements should be made to start treatment. Finally, it should be stated that the ultimate result will not be attained without some sacrifice on the part of the patient as well as the parents. Although orthodontic treatment may seem long, the final result is always worth the effort. The beauty of a radiant smile, the fact of good dental health, and the self-confidence assured by this remarkable health service, will reward both the parents and the patient many times over for the rest of their lives.