Why select an orthodontist?
Why straighten teeth?
What happens at my first visit?
What are diagnostic records?
How do I take care of my braces?
Want information about orthodontic treatment for children? (Through age 12)
Frequently asked questions about childhood orthodontic treatment.
Want information about orthodontic treatment for teenagers?
Frequently asked questions about teenage orthodontics.
Want information about adult orthodontic treatment?
Frequently asked questions about adult orthodontics.
Orthodontic Glossary

Why select an orthodontist?
Just as there are specialists in medicine (such as cardiologists, gastroenterologists, neurologists, etc.), there are specialists in dentistry. Orthodontists are dental specialists who dedicate their professional lives to correcting misaligned teeth and jaws.

Orthodontists are qualified dentists, who after graduating from dental school, go on to additional full-time university-based education in an accredited orthodontic residency program supervised by orthodontists. That training lasts at least two academic years—sometimes more. By learning about tooth movement (orthodontics) and guidance of facial development (dentofacial orthopedics), orthodontists are the uniquely trained experts in dentistry to straighten teeth and align jaws.

Orthodontists diagnose, prevent and treat dental and facial irregularities. The majority of members of the American Association of Orthodontists (AAO) limit their practices to orthodontics and dentofacial orthopedics. Orthodontists treat a wide variety of malocclusions (improperly aligned teeth and/or jaws). They regularly treat young children, teens and adults.

Selecting an orthodontist who is a member of the AAO is your assurance that you have chosen an orthodontist: the dental specialist with at least two years of post-doctoral, advanced specialty training in orthodontics in a university-based program accredited by the American Dental Association. Specialty education includes the study of subjects in biomedical, behavioral and basic sciences; oral biology; and biomechanics.

Only orthodontists may be members of the American Association of Orthodontists (AAO).
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Why straighten teeth?
Straight teeth help an individual to effectively bite, chew and speak.  Straight teeth contribute to healthy teeth and gums.  Properly aligned teeth and jaws may alleviate or prevent physical health problems.  Teeth that work better also tend to look better.  An attractive smile is a pleasant “side effect” of orthodontic treatment.

An attractive smile is a wonderful asset.  It contributes to self-esteem, self-confidence and self-image—important qualities at every age.  A pleasing appearance is a vital component of self-confidence. A person's self-esteem often improves as orthodontic treatment brings teeth, lips and face into proportion. In this way, orthodontic treatment can benefit social and career success, as well as improve a person’s general attitude toward life.

You may be surprised to learn that straight teeth are less prone to decay, gum disease and injury.  Straight teeth collect less plaque, a colorless, sticky film composed of bacteria, food and saliva.  Decay results when the bacteria in plaque feed on carbohydrates (sugar and starch) we eat or drink to produce acids that can cause cavities.  Plaque can also increase the risk for periodontal (gum) disease.  When teeth are properly aligned, and less plaque collects, these risks decline.  And when teeth are properly aligned it is easier to keep teeth clean.  As for injuries to teeth, protruding upper teeth are more likely to be broken in an accident.  When repositioned and aligned with other teeth, these teeth are most probably going to be at a decreased risk for fracture.

Untreated orthodontic problems may become worse.  They may lead to tooth decay, gum disease, destruction of the bone that holds teeth in place, and chewing and digestive difficulties. Orthodontic problems can cause 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, sometimes leading to chronic headaches or pain in the face or neck. Treatment by an orthodontist to correct a problem early may be less costly than the restorative dental care required to treat more serious problems that can develop in later years.
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What happens at my first visit?
This is a time for orthodontists to listen to patient concerns and to provide an orthodontic examination. The orthodontist will likely be able to indicate whether or not treatment is needed and if needed, when the best time to start treatment would be. Typical steps prior to beginning treatment include gathering orthodontic records to provide specific information to tailor a treatment plan for that patient (see orthodontic records below).
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What are diagnostic records?
Diagnostic records include x-rays, photographs, and impressions made of the teeth. These “molds” are used to develop models for closer examination of the teeth and how the upper and lower teeth relate to each other.  X-rays are taken to look at the root structure of the teeth and how the jaw bones and teeth relate to each other.  At times additional imaging of the temporomandibular joints is helpful.  Typically facial photographs and intra-oral photographs are taken to evaluate facial proportions, facial aesthetics and the health of the teeth and gums.  These diagnostic records collectively enable the orthodontist to develop an appropriate treatment plan for the patient.
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How do I take care of my braces?
Extra time is needed with toothbrushing to make sure that all areas around the braces have been cleaned properly. Specialized brush tips are available to help get in between the braces and under the wires. Floss-threaders are helpful in passing floss under archwires to facilitate flossing of the teeth. Oral irrigators are often helpful to dislodge food debris from around the teeth. Over-the-counter mouth rinses can be used in conjunction with oral irrigators to help reduce the level of bacteria around the teeth.

Extra time is needed with toothbrushing.		Specialized brush tips help get in between braces and under wires

The goal is to remove plaque from around the teeth and gums. It is the bacteria in plaque that is responsible for causing inflamed gum tissue (gingivitis) (see photo below), permanent scarring of enamel (decalcification) (see photo below), as well as tooth decay.  Remember, braces don’t cause these problems, they just make cleaning the teeth more difficult.

Note the reddened areas of gum where the gum meets the teeth.  This is gingivitis.		Note the white decalcification spots on these teeth.

Avoiding hard, sticky, crunchy and chewy foods will also keep your braces intact and help to make your treatment flow smoothly.
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Want information about orthodontic treatment for children? (Through age 12)
Some children as early as 5 or 6 years of age may benefit from an orthodontic evaluation.   Although treatment is unusual at this early age, some preventative treatment may be indicated.

By age 7, most children have a mix of baby (primary) and adult (permanent) teeth.  Some common orthodontic problems seen in children can be traced to genetics, that is they may be inherited from their parents.  Children may experience dental crowding, too much space between teeth, protruding teeth, and extra or missing teeth and sometimes jaw growth problems. 

Other malocclusions (literally, “bad bite”) are acquired.  In other words, they develop over time.  They can be caused by thumb or finger-sucking, mouth breathing, dental disease, abnormal swallowing, poor dental hygiene, the early or late loss of baby teeth, accidents or poor nutrition.   Trauma and other medical conditions such as birth defects may contribute to orthodontic problems as well. Sometimes an inherited malocclusion is complicated by an acquired problem.  Whatever the cause, the orthodontist is usually able to treat most conditions successfully.

Orthodontists are trained to spot subtle problems with jaw growth and emerging teeth while some baby teeth are still present.  The advantage for patients of early detection of orthodontic problems is that some problems may be easier to correct if they are found and 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.  For these reasons, the AAO recommends that all children get a check-up with an orthodontist no later than age 7.  While your child’s teeth may appear straight to you, there could be a problem that only an orthodontist can detect.  Of course, the check-up may reveal that your child’s bite is fine, and that is comforting news.

Even if a problem is detected, chances are your orthodontist will take a “wait-and-see” approach, checking your child from time to time as the permanent teeth come in and the jaws and face continue to grow.  For each patient who needs treatment, there is an ideal time for it to begin in order to achieve the best results.  The orthodontist has the expertise to determine when the treatment time is right.  The orthodontist’s goal is to provide each patient with the most appropriate treatment at the most appropriate time.

In some cases, your orthodontist might find a problem that can benefit from early treatment.  Early treatment may prevent more serious problems from developing and may make treatment at a later age shorter and less complicated.  For those patients who have clear indications for early orthodontic intervention, early treatment gives your orthodontist the chance to:

• Guide jaw growth
• Lower the risk of trauma to protruded front teeth
• Correct harmful oral habits
• Improve appearance and self-esteem
• Guide permanent teeth into a more favorable position
• Improve the way lips meet

It’s not always easy for parents to tell if their child has an orthodontic problem.  Here are some signs or habits that may indicate the need for an orthodontic examination:

• Early or late loss of baby teeth
• Difficulty in chewing or biting
• Mouth breathing
• Thumb sucking
• Finger sucking
• Crowding, misplaced or blocked out teeth
• Jaws that shift or make sounds
• Biting the cheek or roof of the mouth
• Teeth that meet abnormally or not at all
• Jaws and teeth that are out of proportion to the rest of the face

If any of these problems are noted by parents, regardless of age, it is advisable to consult an orthodontist.  It is not necessary to wait until age 7 for an orthodontic check-up.
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Frequently asked questions about childhood orthodontic treatment:

What is preventive orthodontic treatment?
Preventive orthodontic treatment is intended to keep a malocclusion (“bad bite” or crooked teeth) from developing in an otherwise normal mouth.  The goal is to provide adequate space for permanent teeth to come in.  Treatment may require a space maintainer to hold space for a primary (baby) tooth lost too early, or removal of primary teeth that do not come out on their own so to create room for permanent teeth.

What is interceptive orthodontic treatment?
Interceptive orthodontic treatment is performed for problems that, if left untreated, could lead to the development of more serious dental problems over time.  The goal is to reduce the severity of a developing problem and eliminate the cause.  The length of later comprehensive orthodontic treatment may be reduced. Examples of this kind of orthodontic treatment may include correction of thumb- and finger-sucking habits; guiding permanent teeth into desired positions through tooth removal or tooth size adjustment; or gaining or holding space for permanent teeth.  Interceptive orthodontic treatment can take place when patients have primary teeth or mixed dentition (baby and permanent teeth). A patient may require more than one phase of interceptive orthodontic treatment.

What is comprehensive orthodontic treatment?
Comprehensive orthodontic treatment is undertaken for problems that involve alignment of the teeth, how the jaws function and how the top and bottom teeth fit together. The goal of comprehensive orthodontic treatment is to correct the identified problem and restore the occlusion (the bite) to its optimum. Treatment can begin while patients have primary teeth, when they have a mix of primary and permanent teeth, or when all permanent teeth are in.  Treatment may consist of one or more phases, depending on the nature of the problem being corrected and the goals for treatment.

Orthodontic care may be coordinated with other types of dental treatment that may include oral surgery (tooth extractions or jaw surgery), periodontal (gum) care and restorative (fillings, crowns, bridges, tooth size enhancement, implants) dental care. When finished with comprehensive treatment, the patient must wear retainers to keep teeth in their new positions.

What is a space maintainer?
Baby molar teeth, also known as primary molar teeth, hold needed space for permanent teeth that will come in later. When a baby molar tooth is lost, an orthodontic device with a fixed wire is usually put between teeth to hold the space for the permanent tooth.

Why do baby teeth sometimes need to be removed?
Removing baby teeth may be necessary to allow severely crowded permanent teeth to come in at a normal time in a reasonably normal location. If the teeth are severely crowded, it may be that some unerupted permanent teeth (usually the canine teeth) will either remain impacted (teeth that should come in, but do not), or come in to a highly undesirable position. To allow severely crowded teeth to move on their own into much more desirable positions, sequential removal of baby teeth and permanent teeth (usually first premolars) can dramatically improve a severe crowding problem. This sequential extraction of teeth, called serial extraction, is typically followed by comprehensive orthodontic treatment after eruption of permanent teeth has brought about as much improvement as it can on its own.

After all the permanent teeth have come in, the extraction of selected permanent teeth may be necessary to correct crowding or to make space for necessary tooth movement to correct a bite problem. Proper extraction of teeth during orthodontic treatment should leave the patient with both excellent function and a pleasing look.

How can a child's growth affect orthodontic treatment?
Orthodontic treatment and a child’s growth can complement each other. A common orthodontic problem to treat is protrusion of the upper front teeth. Quite often this problem is due in part to the lower jaw being shorter than the upper jaw. Upper teeth may also be the primary cause of the protrusion if they stick out too far.  While the upper and lower jaws are growing, orthodontic appliances can be beneficial in reducing these discrepancies.  A severe jaw growth discrepancy may require orthodontics and corrective surgery after jaw growth has been completed, although this is rare.

The AAO recommends that all children have a check-up with an orthodontist no later than age 7 so that growth-related problems may be identified and so that treatment can be commenced at the appropriate time for each patient. 

What kinds of orthodontic appliances are typically used to reduce the severity of jaw-growth problems?
A process of dentofacial orthopedics (guiding the growth of the face and jaws) with orthodontic appliances may be used to correct jaw-growth problems. The decision about when and which appliances to use for this type of correction is based on each individual patient's problem. Some of the more common orthopedic appliances include:

• Fixed functional appliance: The appliance is usually fixed (glued) to the upper and lower molar teeth and may not be removed by the patient. By holding the lower jaw forward, it reduces the protrusion of the teeth while the patient is growing and helps bring the teeth together.  The appliance can help correct severe protrusion of the upper teeth.
  
  
• Headgear: This appliance applies pressure to the upper teeth and upper jaw to guide the direction of upper jaw growth and tooth eruption. The headgear may be removed by the patient and is usually worn 10 to 12 hours per day.
  
  
• Palatal Expansion Appliance: A child’s upper jaw may be too narrow for the upper teeth to fit properly with the lower teeth (a crossbite). When this occurs, a palatal expansion appliance can be fixed to the upper back teeth. This appliance can markedly expand the width of the upper jaw.  For some patients, a wider jaw may prevent the need for extraction of permanent teeth.

Can my child play sports while wearing braces?
Yes. But wearing a protective mouth guard is advised while riding a bike, skating, or playing any contact sports, whether organized sports or a neighborhood game. Your orthodontist can recommend a specific mouth guard.

Will braces interfere with playing musical instruments?
Playing wind or brass instruments, such as the trumpet, will clearly require some adaptation to braces. With practice and a period of adjustment, braces typically do not interfere with the playing of musical instruments.

Why does orthodontic treatment time sometimes last longer than anticipated?
Estimates of treatment time can only be that - estimates. Patients grow at different rates and will respond in their own ways to orthodontic treatment. The orthodontist has specific treatment goals in mind, and will usually continue treatment until these goals are achieved. Patient cooperation, however, is the single best predictor of staying on time with treatment. Patients who cooperate by wearing rubber bands, headgear or other needed appliances as directed, while taking care not to damage appliances, will most often lead to on-time and excellent treatment results.

What is patient cooperation and how important is it during orthodontic treatment?
Good “patient cooperation” means that the patient not only follows the orthodontist’s instructions on wearing appliances as prescribed and tending to oral hygiene and diet, but is also an active partner in orthodontic treatment.

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 prescribed by the orthodontist, avoid foods that might damage braces 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.

What is two-phase treatment?
Two-phase treatment simply means that the treatment is carried out in two stages.  The first is the interceptive orthodontic phase (see above) and the second is the comprehensive orthodontic phase (see above). 

Some of my children’s friends have already started treatment, but our orthodontist says my child should wait a while.  Why is there a difference in treatment?
Each treatment plan is specific for that child and his/her specific problem.  In some cases, children mature early (e.g.: get their permanent teeth early) and in some cases early treatment is indicated to prevent a more severe problem from occurring.  Your orthodontist is the best person to decide the most optimum treatment plan.  If you have questions, you should discuss them with your orthodontist.

What do the initials mean after an orthodontist’s name?
The initials after an orthodontist’s name indicate the academic education of the orthodontist.  For instance, DMD and DDS indicate that the individual is a graduate dentist.

How can I fit the orthodontist’s fee into my family budget?
Orthodontic costs and payment options can be discussed with your treating orthodontist. Your orthodontist will be able to provide you with information about insurance and other possible funding options.
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Want information about orthodontic treatment for teenagers?
Most patients begin orthodontic treatment between ages 9 and 16, but this varies depending on each individual.  Because teenagers are still growing, the teen years are often the optimal time to correct orthodontic problems and achieve excellent results.

Most orthodontic problems are inherited.  Examples of these genetic problems are crowding, too much space between teeth, protruding upper teeth, extra or missing teeth and some jaw growth problems.

Other malocclusions (crooked teeth) are acquired.  In other words, they develop over time.  They can be caused by thumb-sucking or finger-sucking as a child, mouth breathing, dental disease, abnormal swallowing, poor dental hygiene, the early or late loss of baby (primary) teeth, accidents, poor nutrition or some medical problems. 

Sometimes an inherited malocclusion is complicated by an acquired problem.  But whatever the cause, the orthodontist is usually able to treat most conditions successfully.

Treatment is important because crooked or crowded teeth are hard to clean, and that may contribute to tooth decay, gum disease, and tooth loss.  A bad bite can also cause abnormal wear of tooth surfaces, difficulty in chewing and/or speaking, excess stress on supporting bone and gum tissue, and possible jaw joint problems. Without treatment, problems may become worse.  Orthodontic treatment to correct a problem may prove less costly than the additional dental care required to treat the problems that can develop in later years.

Then there’s the emotional side of an unattractive smile.  When you are not confident in the way you look, your self-esteem suffers.  Teen-agers whose malocclusions are left untreated may go through life feeling self-conscious, hiding their smiles with tight lips or a protective hand.
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Frequently asked questions about teenage orthodontics:

How do braces feel?
Most people have some discomfort after their braces are first put on or when adjusted during treatment. After the braces are on, teeth may become sore and may be tender to biting pressures for three to five days. Patients can usually manage this discomfort well with whatever pain medication they might commonly take for a headache. The orthodontist will advise patients and/or their parents what, if any, pain relievers to take. The lips, cheeks and tongue may also become irritated for one to two weeks as they toughen and become accustomed to the surface of the braces.  Orthodontic wax applied to an offending bracket will help relieve discomfort. Overall, orthodontic discomfort is short-lived and easily managed.  Once patients have become accustomed to their braces, they may even forget they have them on.

Do teeth with braces need special care?
Yes.  Patients with braces must be careful to avoid hard, sticky, chewy and crunchy foods. They must not chew on pens, pencils or fingernails because chewing on hard things can damage the braces. Damaged braces will almost always cause treatment to take longer, and will require extra trips to the orthodontist’s office.

Keeping the teeth and braces clean requires more precision and time, and must be done every day if the teeth and gums are to be healthy during and after orthodontic treatment. Patients who do not keep their teeth clean may require more frequent visits to the dentist for a professional cleaning.  The orthodontist and staff will teach patients how to care for their teeth, gums and braces during treatment. The orthodontist will tell patients (and/or their parents) how often to brush, how often to floss, and, if necessary, suggest other cleaning aids that might help the patient maintain good dental health. 

A good reason to keep teeth, gums and braces clean during orthodontic treatment is that clean, healthy teeth move more quickly!  This will help keep treatment time as short as possible.

Patients who are active in contact sports, whether in organized programs or just games in the neighborhood, should wear a mouth guard.  Talk with your orthodontist about the kind of mouth guard to use while braces are on.

What is patient cooperation and how important is it during orthodontic treatment?
Good “patient cooperation” means that the patient not only follows the orthodontist’s instructions on oral hygiene and diet, but is also an active partner in orthodontic treatment.

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 prescribed by the orthodontist, avoid foods that might damage braces 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.

How long does treatment take?
Although every case is different, generally speaking, patients wear braces from one to three years.  Treatment times vary with factors that include the severity of the problem, patient growth, gum and bone response to tooth moving forces and how well the patient follows the orthodontists’ instructions on dental hygiene, diet and appliance wear (patient cooperation).  Patients who brush and floss thoroughly and regularly; avoid hard, sticky, crunchy and sticky foods; wear their rubber bands and/or headgear as instructed; and keep their appointments usually finish treatment on time with good results.  After the braces are removed, most patients wear a retainer for some time to keep or “retain” the teeth in their new positions.  The orthodontist will determine how long the retainer needs to be worn.  Most patients remain under the orthodontist’s supervision during the retention phase to ensure that the teeth stay properly aligned.

Why are retainers needed after orthodontic treatment?
After braces are removed, the teeth can shift out of position if they are not stabilized. Retainers are designed to hold teeth in their corrected, ideal positions until the bones and gums adapt to the treatment changes. Wearing retainers exactly as instructed is the best insurance that the treatment improvements last longer. It is normal for teeth to change with increasing age.

Will tooth alignment change later?
Studies have shown that as people age, their teeth may shift. This variable pattern of gradual shifting, called maturational change, probably slows down after the early 20s, but still continues to a degree throughout a lifetime for most people. Even children whose teeth developed into ideal alignment and bite without treatment may develop orthodontic problems as adults. The most common maturational change is crowding of the lower incisor (front) teeth. Wearing retainers as instructed after orthodontic treatment will stabilize the correction and can prevent most of this change.

What about the wisdom teeth (third molars) - should they be removed?
Research suggests that wisdom teeth do not necessarily cause teeth to shift.  In most cases, removal of wisdom teeth is done for general dental health reasons rather than for orthodontic health.  Your orthodontist, in consultation with your family dentist, can provide guidance regarding removal of wisdom teeth.

What happens to teeth and gums if they are not kept clean during orthodontic treatment?
Teeth can develop white spots, called “decalcification,” when an individual’s teeth are susceptible or when oral hygiene has been poor.  If plaque is not regularly removed, the patient can develop gum disease.  This is why the orthodontist, orthodontic staff, the dentist and dental hygienist stress dental hygiene—for the good of the patient’s dental health.

What can I do to get my braces off sooner?
Follow the instructions your orthodontist gives you with regards to oral hygiene (keeping your teeth and gums clean) and wearing your appliances (e.g.: elastics, headgear, etc.)  Your cooperation may help speed up your treatment.

What will I look like with braces on?
Much will depend on the kind of braces used for your treatment.  Many patients have silver-colored brackets and wires while others may have tooth-colored brackets or clear plastic aligners.  Braces are much less noticeable today than they were  when each tooth had a metal band around it.

Do you have any suggestions on what foods I CAN eat?
Choose foods that are softer.  Right after you get braces or whenever they are adjusted, you may want foods that require little or no chewing such as soup and macaroni and cheese.  Cut or tear sandwiches and pizza rather than biting into them.

What happens if something breaks?
If a portion of the appliance breaks, let your orthodontist know so that arrangements can be made for repairs.

My child wants to get his/her tongue pierced.  Will this interfere with orthodontic treatment?
Tongue-piercing jewelry may contribute to breakage of appliances and to tooth and gum damage from contact with the stud.
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Want information about adult orthodontic treatment?
Today, orthodontic treatment is a viable option for almost any adult.  It is well recognized that when left untreated, many orthodontic problems may become worse.  When you have a malocclusion (“bad bite”), your teeth may be crowded, excessively spaced or may not fit together correctly.  Such conditions may lead to dental health problems.  Crowded teeth are hard to clean and, given time, may contribute to tooth decay, gum disease and even tooth loss.  Bad bites can also result in abnormal wearing of tooth surfaces, difficulty chewing and damage to supporting bone and gum tissue.  Poorly aligned teeth can contribute to pain in the jaw joints.

You’ll be pleased to learn that orthodontic treatment will fit in with your current lifestyle – you can sing, play a musical instrument, dine out, kiss, and even have your picture taken. One in five orthodontic patients is an adult. The AAO estimates that more than 1,000,000 adults in the United States and Canada are receiving treatment from orthodontists who are members of the AAO.

The rate of toothlessness has declined over recent decades.  Our great-grandparents, for the most part, lost their teeth around age 40.  Today’s 25-year-old has the potential of another 75 years of keeping and using their teeth.  This is a major change in dental health care (and life expectancy).  Teeth that do not fit well often wear down more quickly—another reason to make sure that your teeth are in good alignment and well maintained in your adult years.
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Frequently asked questions about adult orthodontics:

Can orthodontic treatment do for me what it does for children?
Yes.  Healthy teeth can be moved at any age. Many orthodontic problems can be corrected as easily for adults as for children. Orthodontic forces move the teeth in the same way for both adults and children, but adult treatment may take longer due to the maturity of the bone. Complicating factors, such as lack of jaw growth, may create different treatment planning needs for the adult.  This is why a consultation with an orthodontist, the dental specialist who aligns teeth and jaws of patients of all ages, is essential.

How does adult treatment differ from that of children and adolescents?
Adults are not growing and may have experienced some breakdown or loss of their teeth and the bone that supports the teeth. Orthodontic treatment may then be only a part of the patient's overall treatment plan. Close coordination may be required among the orthodontist, oral surgeon, periodontist, endodontist and family dentist to assure that the treatment plan is managed well. Below are the most common characteristics that can cause adult treatment to differ from that of children.

No jaw growth: Jaw discrepancy problems, including both width and length, in the adult patient may require jaw surgery.  For example, if an adult’s lower jaw is too short to match properly with the upper jaw, a severe bite problem results. The amount that the teeth can be moved in some cases, with braces alone, may not correct this problem. Establishing a proper bite relationship could require jaw surgery, which would lengthen the lower jaw and bring the lower teeth forward into the proper bite.

Gum or bone loss (periodontal breakdown): Adults are more likely to have experienced damage or loss of the gum and bone supporting their teeth (periodontal disease).  Periodontal disease is a chronic bacterial infection that affects the gums and bone supporting the teeth.  The word periodontal literally means “around the tooth.”  Many people are unaware that they have gum disease because there is usually little or no pain.

Periodontal disease can affect one tooth or many teeth. It begins when the bacteria in plaque (the sticky, colorless film that constantly forms on your teeth) causes inflammation in the gums.

The mildest form of the disease is called gingivitis.  The gums redden, swell and bleed easily. Gingivitis is often linked to inadequate oral hygiene. Gingivitis is often reversible with professional treatment and good oral home care.

Untreated gingivitis can advance to periodontitis, a more severe form of gum disease. With time, plaque can spread and grow below the gum line. Toxins produced by the bacteria in plaque irritate the gums. The toxins stimulate a chronic inflammatory response in which the body, in essence, turns on itself, and the tissues and bone that support the teeth are broken down and destroyed. Gums separate from the teeth, forming pockets (spaces between the teeth and gums) that become infected. As the disease progresses, the pockets deepen and more gum tissue and bone are destroyed. Eventually, teeth can become loose and may have to be removed.

The good news is that teeth that are properly aligned are less prone to gum disease.

Special treatment by the patient’s dentist or a periodontist may be necessary before, during and/or after orthodontic treatment. Bone loss can also limit the amount and direction of tooth movement that is advisable. Adults who have a history of or concerns about periodontal disease might also see a periodontist (a dental specialist who treats diseases of the gums and bone) on a regular basis throughout orthodontic treatment.

Worn, damaged or missing teeth: Worn, damaged or missing teeth can make orthodontic treatment more difficult. Teeth may gradually wear and move into positions where they can be restored only after precise orthodontic movement. Damaged or broken teeth may not look good or function well even after orthodontic treatment unless they are carefully restored by the patient's dentist. Extra space resulting from missing teeth that are not replaced may cause progressive tipping and drifting of other teeth, which worsens the bite, increases the potential for periodontal problems and makes any treatment more difficult.

I have painful jaw muscles and jaw joints - can an orthodontist help?
One of the problems commonly associated with jaw muscle and jaw joint discomfort is bruxing, that is, habitual grinding or clenching of the teeth, particularly at night.  Bruxism is a muscle habit pattern that can cause severe wearing of the teeth, and overloading and trauma to the jaw joint structures. Chronically or acutely sore and painful jaw muscles may accompany the bruxing habit. An orthodontist can help diagnose this problem. Your family dentist or orthodontist may place a bite splint or nightguard appliance that can protect the teeth and help jaw muscles relax, substantially reducing the original pain symptoms. Sometimes structural damage can require joint surgery and/or restoration of damaged teeth. Referral to a TMJ specialist may be suggested for some of these problems.

My family dentist said I need to have some missing teeth replaced, but I need orthodontic treatment first - why?
Your dentist is probably recommending orthodontics so that he or she might treat you in the best manner possible to bring you to optimal dental health. Many complicated tooth restorations, such as crowns, bridges and implants, can be best accomplished when the remaining teeth are properly aligned and the bite is correct.

When permanent teeth are lost, it is common for the remaining teeth to drift, tip or shift. This movement can create a poor bite and uneven spacing that cannot be restored properly unless the missing teeth are replaced. Tipped teeth usually need to be straightened so they can withstand normal biting pressures in the future.

My teeth have been crooked for many years - why should I have orthodontic treatment now?
It’s never too late! Orthodontic treatment, when indicated, is a positive step—especially for adults who have endured a long-standing problem. Orthodontic treatment can restore good function.  And teeth that work better usually look better, too. A healthy, beautiful smile can improve self-esteem, no matter the age.

Is orthodontic treatment affordable?
Patients are finding that braces are more affordable today than ever.  The cost of orthodontic treatment will depend on many factors, including the severity of the problem, its complexity and the length of treatment.  Your orthodontist will be glad to discuss the cost with you before treatment begins.  Most orthodontists have a variety of convenient payment plans.  Often there are combined plans available for parents and children who have treatment at the same time. In addition, many dental insurance plans now include orthodontic benefits.  Dollar for dollar, when you consider the lifetime benefits of orthodontics it is truly a great value.

I am pregnant and want to begin orthodontic treatment.  Is this OK?
Pregnancy brings on bodily changes that can affect the mouth.  Soft tissues such as gums become much more susceptible to infection. The possible need for x-rays during the pregnancy is not advised.   Discuss this question with your medical practitioner/physician and orthodontist before you start orthodontic treatment.

My orthodontist wants to do something called enamel stripping to make my teeth smaller.  I have never heard of this.  Is this something new?  Is it safe?
This procedure goes by many names: enamel stripping; interproximal reduction; slenderizing; reproximation and selective reduction.  The goal is to remove some of the outer tooth surface (enamel) to acquire more space for your teeth.  The procedure has been used in orthodontic treatment since the 1940s and has been shown to be safe and effective.  Some studies among patients who have had this procedure show that it neither makes teeth more susceptible to tooth decay nor does it predispose patients to gum disease.

I see ads for perfect teeth in only one or two visits to the dentist.  Will that give me straight teeth? 
Crooked teeth should be evaluated by an orthodontist so that the most appropriate treatment plan can be suggested.
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Orthodontics Glossary

Anterior
Front.

Appliances
Any device, attached to the teeth or removable, designed to move the teeth, change the position of the jaw, or hold the teeth in their finished positions after braces are removed.

Arch
Upper or lower jaw.

Arch Wire
The metal wire that is attached to the brackets and used to move the teeth.

Band
The metal ring that is cemented to a tooth for strength and anchorage.

Braces
A word commonly used to describe a fixed orthodontic appliance, usually comprised of brackets, bands and wires.

Diagram of Braces
The diagram below illustrates and names each part of a typical set of braces.

A. Ligature
The archwire is held to each bracket with a ligature, which can be either a tiny elastic or a twisted wire.

B. Archwire
The archwire is tied to all of the brackets and creates force to move teeth into proper alignment.

C. Brackets
Brackets are connected to the bands, or directly bonded on the teeth, and hold the archwire in place.

D. Metal Band
The band is the cemented ring of metal which wraps around the tooth.

E. Bracket Hooks
The bracket or band extensions that are used for the attachment of rubber bands.

Bracket
The small metal, ceramic, or plastic attachment bonded to each tooth with a tooth-colored adhesive.  The bracket has a slot that the archwire fits into.

Brushing
Brushing the teeth is part of an individual’s daily home dental care.  Patients with braces should follow the orthodontist’s instruction on how often to brush.

Bruxism
Grinding the teeth, usually during sleeping.  Bruxism can cause abnormal tooth wear and may lead to pain in the jaw joints.

Buccal
The cheek side of the back teeth in both arches or jaws.

Buccal Tube
A small metal part of the bracket welded to the cheek side of the molar band. The tube may hold an archwire, lip bumper, headgear facebow or other appliances an orthodontist may use to move the teeth.

Cephalometric Radiograph
A lateral (side view) x-ray of the head.

Chain
A stretchable series of elastic o-rings connected together and placed around each bracket to hold the archwire in place and move the teeth.

Class I Malocclusion
A malocclusion with the proper molar relationship and teeth that are crowded together, spaced apart, an overbite, an openbite, a posterior crossbite or an anterior crossbite. 

Class II Malocclusion
A malocclusion with the upper front teeth protruding or due to the lower teeth and/or jaw positioned back relative to the upper teeth and/or jaw.  

Class III Malocclusion
A malocclusion with the lower front teeth protruding or due to the lower teeth and/or jaw positioned ahead relative to the upper teeth and/or jaw.

Closed Bite/Deep Bite
Also known as deep overbite, this occurs when the upper front teeth overlap the bottom front teeth an excessive amount.

Comprehensive Treatment
Complete orthodontic treatment performed to correct a malocclusion.

Congenitally Missing Teeth
A genetic occurrence in which the expected number of permanent teeth do not develop.

Crossbite
Upper posterior (back) teeth are in crossbite if they erupt and function inside or outside of the arch in the lower posterior teeth.  Lower anterior (front) teeth are I crossbite if they erupt and function in front of the upper anterior teeth.  A crossbite can be individual teeth or groups of teeth.

DDS or DMD
DDS (Doctor of Dental Surgery) and DMD (Doctor of Dental Medicine) are equivalent degrees, according to The American Dental Association.  All orthodontists educated in the U.S. or Canada will have either a DDS or DMD after their names.  Orthodontists have an additional two to three years of specialty education in an accredited orthodontic residency program after dental school to become orthodontists.

Diagnostic Records
The material and information that the orthodontist needs to properly diagnose and plan a patient’s treatment.  Diagnostic records may include a thorough patient health history, a visual examination of the teeth and supporting structures, plaster models of the teeth, a wax bite registration, extraoral and intraoral photographs, a panoramic and a cephalometric radiograph.

Ectopic Eruption
Term used to describe a tooth or teeth that erupt in an abnormal position.

Eruption
The process by which teeth enter into the mouth.

Extraction
The removal of a tooth.

Elastics
Rubber bands.  During certain stages of treatment, small elastics or rubber bands are worn to provide individual tooth movement or jaw alignment.

Facebow
A wire appliance used with a nightbrace, or headgear.  Primarily used to move the upper first molars back, creating room for crowded or protrusive front teeth.  The facebow has an internal wire bow and an external wire bow.  The internal bow attaches to the buccal tube on the upper molar bands inside the mouth and the outer bow attaches to the breakaway safety strap of the nightbrace.

Fiberotomy
A surgical procedure designed to sever fibers of attachment around the tooth, usually performed to reduce the potential for relapse or post-orthodontic treatment tooth movement.

Fixed Appliances
An orthodontic appliance that is bonded or cemented to the teeth and cannot be or should not be removed by the patient.

Flossing
An important part of daily home dental care.  Flossing removes plaque and food debris from between the teeth, brackets and wires.  Flossing keeps teeth and gums clean and healthy during orthodontic treatment.

Frenectomy
The surgical removal or repositioning of the frenum, the lip and tongue attachment located between the upper and lower front teeth.  A large frenum attachment can cause spacing between top front teeth or cause the tongue to be tied.

Functional Appliances
Appliances that utilize the muscle action produced when speaking, eating and swallowing to produce force to move the teeth and align the jaws.   They are also known as orthopedic appliances with names such as orthopedic corrector, activator, bionator, Frankel, Herbst or twin block appliances.

Gingiva
Soft tissue around the teeth, also known as the gums.

Gummy Smile
Showing an excessive amount of gingival (gum) tissue above the front teeth when smiling.

Headgear
An appliance worn outside of the mouth to provide traction for growth modification and tooth movement.

Herbst Appliance
This appliance is used to move the lower jaw forward.  It can be fixed or removable.  When it is fixed, it is cemented to teeth in one or both arches using stainless steel crowns.  An expansion screw may be used simultaneously to widen the upper jaw.

Impaction
A tooth that does not erupt into the mouth or only erupts partially is considered impacted.

Interceptive Treatment
Orthodontic treatment performed to intercept a developing problem.  Usually performed on younger patients that have a mixture of primary (baby) teeth and permanent teeth.

Interproximal Reduction
Removal of a small amount of enamel from between the teeth to reduce their width.  Also known as reproximation, slenderizing, stripping, enamel reduction or selective reduction.

Labial
The surface of the teeth in both arches that faces the lips.

Ligating Modules
A small elastic o-ring, shaped like a donut, used to hold the archwire in the bracket.

Lingual
The tongue side of the teeth in both arches.

Lip Bumper
A wire appliance used to move the lower molars back and the lower front teeth forward, creating room for crowded front teeth.  The lip bumper is an internal wire bow that attaches to the buccal tubes on the cheek side of the lower molar bands inside the mouth.  The front portion of the bow has an acrylic pad or bumper that rests against the inside of the lower lip.  The lower lip muscles apply pressure to the bumper creating a force that moves the molars back.

Lip Incompetence
The inability to close the lips together at rest, usually due to protrusive front teeth or excessively long faces.

Malocclusion
The term used in orthodontics to describe teeth that do not fit together properly.  From Latin, the term means “bad bite.”

Mandible
Lower jaw.

Maxilla
Upper jaw.

Mixed Dentition
The dental developmental stage in children (approximately ages 6-12) when they have a mix of primary (baby) and permanent teeth.

Mouthguard
A removable device used to protect the teeth and mouth from injury caused by sporting activities.  The use of a mouthguard is especially important for orthodontic patients.

Nightguard
A removable appliance worn at night to help an individual minimize the damage or wear while  clenching or grinding teeth during sleep.

Open Bite
A malocclusion in which teeth do not make contact with each other.   With an anterior open bite, the front teeth do not touch when the back teeth are closed together.  With a posterior open bite, the back teeth do not touch when the front teeth are closed together.

Orthodontics
The specialty area of dentistry concerned with the diagnosis, supervision, guidance and correction of malocclusions.  The formal name of the specialty is orthodontics and dentofacial orthopedics.

Orthodontist
A specialist in the diagnosis, prevention and treatment of dental and facial irregularities.  Orthodontists are required to complete college requirements, graduate from an accredited dental school and successfully complete a minimum of two academic years of full-time, university-based study at an accredited orthodontic residency program.  Only those who have completed this education may call themselves “orthodontists.”  Orthodontists limit their practice to orthodontic treatment only unless they have training in another dental specialty.  Only residency-certified orthodontists may be members of the American Association of Orthodontists.

Orthopedic Appliance
A removable functional appliance designed to guide the growth of the jaws and face.

Panoramic Radiograph
An x-ray that shows all the teeth and both jaws on one film.

Palatal Expander
A fixed or removable device used to make the upper jaw wider.

Periodontal
Refers to the hard and soft tissue, or supporting structures, around the teeth.

Plaque
Plaque is a colorless, sticky film of bacteria, food particles and saliva that constantly forms in the mouth.  Plaque combines with sugars to form an acid that endangers teeth and gums.  Plaque causes tooth decay and gum disease.

Posterior
Back.

Preventive Treatment
Orthodontic treatment to prevent or reduce the severity of a developing malocclusion (bad bite).

Removable Appliance
An orthodontic appliance that can be removed from the mouth by the patient.  Removable appliances are used to move teeth, align jaws and to keep teeth in their new positions when the braces are removed (retainers).

Retainer
A fixed or removable appliance worn after the braces are removed.  A removable retainer attaches to your upper and/or lower teeth and holds them in their finished positions.

Rubber Bands
During certain stages of treatment, small elastics or rubber bands are worn to provide individual tooth movement or jaw alignment.

Safety Strap
The safety strap prevents the facebow of the headgear from coming loose and causing injury.

Separators
An elastic o-ring or small wire loop placed between the teeth to create space for placement of bands.  Separators are usually placed between the teeth a week before bands are scheduled to be cemented to the teeth.

Serial Extraction
Selective or guided removal of certain primary (baby) teeth and/or permanent teeth over a period of time to create room for permanent teeth.

Space Maintainer
A fixed appliance used to hold space for an unerupted permanent tooth after a primary (baby) tooth has been lost prematurely, due to accident or decay.

Supernumerary Teeth
A genetic occurrence in which there are more teeth than the usual number.  These teeth can be malformed or erupt in abnormally.

Tongue Crib
A fixed appliance used to help a patient stop habits or undesirable tongue forces exerted on the teeth and bone that supports the teeth.

Tongue Thrust
An individual’s tongue pushes against the teeth when swallowing.  Forces generated by the tongue can move the teeth and bone and may lead to an anterior or posterior open bite.

Wax
Wax is placed on the brackets or archwires to prevent them from irritating the lips or cheeks. 

Wires
Also known as archwires, they are held in the brackets using small elastic o-rings or stainless steel wire ligatures.  Wires are used to move the teeth.