Comprehensive Orthodontic Services for the Entire Family

The field of orthodontics is most commonly associated with treatment for pre-teens and teenagers, but an increasing amount of adults are choosing to correct jaw irregularities (malocclusions) and misaligned teeth with orthodontics. It is now estimated that approximately one third of all orthodontic patients are adults. The major advantage of treating irregularities at a young age is that orthodontic appliances are widely accepted in youth and ideal alignment can be achieved before adulthood. Most orthodontists agree, however, that it is never too late to get braces.

Orthodontic treatments are most commonly associated with pre-teens and teenagers. However, the American Association of Orthodontists (AAO) recommends children receive their first orthodontic check-up around the age of seven. In cases where obvious irregularities are noted, treatment may be sought at an earlier age.

Most orthodontists agree that there is an optimal time for treating malocclusions (bad bites) and irregularities in the face and jaw. While an early orthodontic check-up does not mean that treatment will begin immediately, or even that it will become necessary, some irregularities are more easily corrected before jaw growth is complete, making it imperative to have problems detected early.    

Adjusting to proper oral hygiene with a smile full of brackets, including cleaning around bands and wires, is incredibly important. Effectively cleaning orthodontic appliances ensures that plaque is not allowed to build up around the braces. Typically, if a proper oral hygiene routine is not strictly adhered to, gum inflammation and tooth decay can occur.

The key to brushing and flossing effectively with orthodontic braces is learning the best technique. Though everyone has different preferences, here are some excellent tips on how to get started:

Brushing

Regular, proper brushing is especially important when braces have been applied to the teeth. If possible, brush teeth after every snack to eliminate plaque buildup. If this isn’t practical, aim to brush four times daily, including:    

• After breakfast

• After lunch

• After dinner

• Right before bedtime
  

It is important to choose an appropriate toothbrush and to inspect the bristles routinely for signs of wear. The orthodontic braces will wear and fray the bristles, so replacement brushes will be needed more often than usual.

A soft bristled toothbrush is best because it will not damage the archwire or brackets. Apply a small strip of toothpaste, preferably a brand with fluoride, to the brush. Keep in mind that every tooth has several sides that need to be thoroughly cleaned: the outside, the sides facing each other and the chewing side.

When brushing front-facing sides of the teeth, create a 45 degree angle between the brush and the gum line. Brush in gentle circular motions from the top of the tooth to the bottom and then from bottom to top. Try not to exert too much force on either the wire or the brackets. When brushing the inside angles of teeth, work methodically creating the same 45 degree angle with the brush. The back surfaces of the teeth should pose no additional problems and should be brushed in the regular way.

Next, use a specially-designed proxabrush (Christmas tree brush) to brush between two brackets at a time. Insert the proxabrush and use downward and upward motion. Continue until all the spaces between the braces are plaque-free. As a last step, use mouthwash to flush out remaining bacteria.

Flossing

Flossing is also of paramount importance. Plaque and food particles can quickly provide fuel for the formation of bacteria colonies that cause gum disease and tooth loss. Though flossing between braces can be more time-consuming, it should still be completed several times per day.

Floss threaders can be used or the floss can be wrapped around fingers in the standard method. First, thread a piece of floss underneath the archwire of the braces. Slide the floss in an up-and-down motion against the large surface of the tooth. Exercise great care around the bracket and archwire, as they can easily be damaged by excess pressure.

Next, guide the floss to the interdental area (between the teeth) and use gentle sawing motions to move down from the gum line toward the bottom of the tooth. Repeat this motion several times. Then, using the same sawing motion, work the floss from the bottom of the tooth toward the gum line several times.

In some cases, flossing around orthodontic braces can cause mild bleeding, which should go away. If this bleeding persists for several days, be sure to inform your oral health professional.

One of the most commonly asked questions about dental braces is whether placing them causes any pain or discomfort.  The honest answer is that braces do not hurt at all when they are applied to the teeth, so there is no reason to be anxious.  In most cases, there is mild soreness or discomfort after the orthodontic wire is engaged into the brackets, which may last for a few days.

There are two common types of fixed dental braces used to realign the teeth: ceramic fixed braces and metal fixed braces.  Both types of fixed appliances include brackets which are affixed to each individual tooth and an archwire the orthodontist fits into the bracket slot to gently move the teeth into proper alignment.  Elastic or wire ties will be applied to hold the wire in place.  Some orthodontists may use self-ligating brackets which do not require a rubber or wire tie to secure the wire.

Fixed dental braces are used to treat a wide variety of malocclusions, including overbite, underbite, crossbite, and overcrowding.  If the orthodontist has determined that the malocclusion has been caused by overcrowding, it is possible that teeth may need to be extracted to increase the amount of available space to properly align the teeth.

What to expect when getting braces

Here is an overview of what you can expect when getting braces:

• Placement day – The placement of braces will not be painful in the slightest.  It may take longer to eat meals, but this is largely because it takes some time to adjust to wearing the braces.  In some cases, the teeth may feel more sensitive than usual.  Hard, difficult to chew foods should be avoided in favor of a softer, more liquid-based diet for the first few days after placement of braces.
• Two days after placement – The first several days after placement of braces can be slightly uncomfortable.  This is because the teeth are beginning the realignment process and are not used to the pressure of the archwire and orthodontic elastic bands.  The orthodontist will provide relief wax to apply over the braces as necessary.  Wax helps provide a smooth surface and alleviates irritation on the inner cheeks and lips.  Additionally, over-the-counter pain medication (e.g., Motrin^® and Advil^®) may be taken as directed to relieve mild soreness.
• Five days after placement – After five days, any initial discomfort associated with the braces should be completely gone.  The teeth will have gradually acclimated to the braces, and eating should be much easier.  Certain hard foods may still pose a challenge to the wearer, but normal eating may be resumed at this point.
• Orthodontic appointments – Regular orthodontic appointments are necessary to allow the orthodontist to change the archwire, change the rubber or metal ties, and make adjustments to the braces.  Fixed braces work by gradually moving the teeth into a new and proper alignment, so gentle pressure needs to be applied constantly.  The first several days after an orthodontic adjustment may be slightly uncomfortable, but remember that this discomfort will quickly fade.
• Dealing with discomfort – Over-the-counter pain medication and orthodontic relief wax will help alleviate any mild soreness and discomfort following placement of braces and orthodontic adjustments.  Another effective remedy is to chew sugar-free gum, as this increases blood flow which helps reduces discomfort and can also encourage the teeth to align quicker.

If there is obvious damage to the wires, bands and brackets of your braces, it’s important to see your orthodontist as soon as possible. If you are not in pain as a result of these problems, it’s possible to see a dental professional within the next day or two, but treatment should be prompt.

There are many causes of damage to braces, including:

• Eating hard foods

• Trauma to the facial area

• Chewing inedible objects

Here is an overview of some common types of orthodontic emergencies:

Loose Brackets

Brackets are the small metal or ceramic appliances that have been attached to the teeth using dental adhesive (resin). If both the bracket and the archwire are moving, it’s probable that the adhesive has not cured correctly. This is not a true orthodontic emergency, but your orthodontist should be called promptly.

If the bracket has fallen and rotated around the archwire, place it in its proper position and use orthodontic wax as a temporary adhesive until your orthodontist reaffixes the bracket.

Loose Bands

Bands are the metal rings which have been cemented around teeth. Loose bands pose no immediate threat, but if left untreated for several weeks, decalcification (a white spot) or tooth decay can occur. This is because the dental bonding agents normally seal the inner portion of the band from bacteria, saliva and plaque. If bacteria and saliva enter the crevice, an acidic byproduct is produced, which erodes tooth enamel.

It is important to call your orthodontist immediately for advice in the case of a loose band. Your orthodontist will reaffix the band to the tooth or replace it if it has come off the tooth entirely. If an orthodontic band has fallen out of the mouth, save the band and do not attempt to affix it yourself.

Broken or Bothersome Wires

Broken archwires are one of the most common orthodontic problems. When the archwire is broken, there is a possibility it will cause soreness or irritation to the inner cheek. In this case, use tweezers or a pencil eraser to bend the wire into a less irritating position. If the broken archwire cannot be bent out of the way, place a pea-sized piece of orthodontic relief wax over the protruding end to protect soft tissue.

These measures are only temporary solutions. Your orthodontist must be called for an appointment to replace the broken wire.

If a band, bracket or piece of wire has been swallowed, please contact your orthodontist for instructions. Fortunately, these orthodontic appliances are so small they can pass through the body without incident, but it is always preferable to seek advice.