ORTHODONTICS
Last Updated : 4/24/2010
Dr. Firdaus P Bativala
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Everyone wants a beautiful & of course a healthy smile. Orthodontics is the branch of dentistry, that achieves both by correcting irregular, crowded or improperly placed teeth. It is the science that aims at diagnosis, prevention and treatment of dental & facial irregularities for maintaining structural balance, for restoring functional efficiency and for achieving aesthetic harmony. The practice of orthodontics
requires professional skill to design & use braces (corrective appliances) to bring teeth, lips and jaw into proper alignment. The word orthodontics is derived from Greek words "Orthos" meaning correct, "dons" meaning tooth.

Need For Orthodontic Treatment
There are various reasons, why one needs to undergo orthodontic treatment. Most important being medical illness, which follow due to difficulty in cleaning & maintaining crooked and crowded teeth. This may contribute to conditions, which cause not only dental caries, but eventual gum disease & tooth loss at an early age.

Second most important aspect is that, the children who are having "malocclusions" (a technical term for irregular teeth) may be subjected to ridicule by other children, which may interfere with psychological development of the child.

Finally the importance of an attractive smile should no be underestimated in this new era, which emphasizes on the best looks & designer clothing, then why not have a "designer smile" - sounds great, isn't it? Anyway, the bottom line is pleasing appearance which is vital asset to one's self- confidence. A person's self-esteem often improves as treatment brings teeth, lips and face into harmony. In this way orthodontic treatment can be beneficial to social and career success as well improve one's general attitude towards life and the quality of life itself.

Irregularities in occlusion before treatment(fig 1)








Patient before treatment


Patient after treatment


Why do teeth become irregular?
Most Malocclusions are inherited i.e. they exist at birth and some are acquired i.e. due to bad habits of a child. Inherited malocclusions include crowding of teeth, small jaw, extra teeth, cleft palate, rabbit teeth, buckteeth & other bony deformities of jaw.

Acquired malocclusions are caused by thumb or finger sucking, tongue thrusting, bad lip and tongue habits, mouth breathing due to tonsils or adenoids, nail biting, premature loss of primary or permanent teeth.



Different types of malocclusion







Diagnostic Aids
Diagnosis in Orthodontics deals with recognition of dentofacial deformities by means of,

i] Essential diagnostic aids - which include clinical examination, case history, study models, Intra oral X-Rays, facial photography etc.

ii] Supplementary diagnostic aids-, which are used only in special cases and are not required in routine clinical examination. These are special Extra & Intra oral X - rays, Electromyography and wrist X - ray to find out bone age.

When should The Treatment Begin?
Best starting time for Orthodontic treatment depends upon type of deformity a child has. But recommendations are that every child should visit an Orthodontist at an age of 7 years. An early examination, allows the orthodontist to determine when a child's particular problem should be treated for maximum improvement with the least time and expense. In many patients early treatment achieves results that are not possible to attain once the face and jaw have finished growing.

Another advantage an early intervention is that, the completion of treatment is easier & less time consuming.

However, the orthodontic treatment is successful at any age. The biological process involved in tooth movement is the same in both adults and children. The health of an individual's teeth, gums and supporting bone is most important in determining the prospects for improving an adult's smile and dental health. But certain corrections cannot be accomplished with braces alone as an adult's facial bones are no longer growing. Nevertheless, very dramatic and exciting results can be achieved nowadays with latest technology combining surgery with Orthodontics for those who need this type of treatment (Orthognathic Surgery).

What does the treatment involve?
Orthodontic treatment involves fixing of braces i.e. custom-made appliances which are designed according to the problem being treated. They may be removable or fixed (cemented &/or bonded). They may be made of metal, plastic, ceramic or may be in combination. All corrective appliances have one aim to use gentle pressure to move teeth into proper position. In some cases a patient may need to get some teeth extracted in order to fix the braces. Teeth are removed only after serious consideration. However, if the patient is referred to a qualified orthodontist at an early age and the problem is not severe, then, entire treatment may be carried out without tooth removal.

People are generally most scared of dental chair, rather many have "phobias", due to the painful dental treatment. But in orthodontic treatment, the pain is very mild and only discomfort felt is of a foreign body sensation in mouth. This too disappears in due course of time, as within a few days the child gets used to it very well. Most children adjust to braces quickly and they become a part of patient, just like a pair of spectacles, and wear their "tin grins" with pride.

Next favorite question is - are there any dietary restrictions? The answer is- not really, as one can eat regular food except for peanuts, chikki, caramels, chewing gum and hard fruits, as these food can break or loosen one's braces making patient feel uncomfortable and can delay treatment. Also one has to take care of braces during contact sports like boxing, football, hockey, cricket etc. to prevent damage to brace and injury to the teeth and lips.

Different treatment techniques
1 Begg's Appliance


2 Straight wire appliance



How Long Does Treatment Take?

Orthodontic treatment takes a little more time as movement of teeth itself is a slow process. The active treatment time ranges from one to three years, on an average 18-20 months depending upon the severity and the type of problem, patient's age and of course the cooperation of the patient. After the braces are removed a patient may have to wear (if required) a retainer for some time to keep the teeth in their new positions.

Successful Orthodontic treatment requires a combined effort of the Orthodontist and patient. Those patient who brush thoroughly, avoid sticky, hard foods; wear their rubber bands and headgears as instructed and keep their appointments usually finish treatment on time along with the achievement of treatment goals- a healthy mouth and a beautiful smile.

Thus, Orthodontic treatment promises you more then just a beautiful smile.

All that glitters is not gold,

but all those sparkle in your smile are diamonds.

Diamonds are forever & so is your smile.




Contributor Information and Disclosures

Dr. Firdaus P Bativala
Consultant Dentist, Bombay Hospital, Mumbai, India.


References

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