Straight Talk About Braces

Straight Talk About Braces

An early trip to the orthodontist can spare you a fearsome dental bill

Dr. Tom Graber has been in the forefront of orthodontic research since he began practicing in 1945. He authored several textbooks on the subject and has edited The American Journal of Orthodontics and Dentofacial Orthopedics since 1985. Though he’s never worn braces himself, three of his children have.

What does an orthodontist do?

Just as an orthopedic surgeon guides the growth of an abnormally forming leg or arm, an orthodontist guides the growth of the jaw and face, particularly for children with underdeveloped jaws or when the upper and lower jaw don’t fit together.

What are the tip-offs that preventative measures like an appliance might be needed?

The most obvious problems are the inherited ones, such as when a child inherits a small jaw from one parent and large teeth from another, leading to jaw disorders. Also, the upper jaw can be deformed by finger sucking or, more likely, compensatory tongue-swallowing habits. This happens when kids continue natural back and forth tongue-thrusting when they stop nursing, which pushes the front teeth out. Kids whose front teeth stick out tend to get their lower lip under them every time they swallow, which pushes the teeth even further out. Mouth-breathing or enlarged adenoids and tonsils can also cause compensatory problems.

Starbucks. Photo by Elena

What can be done to prevent such problems?

Children should be seen by a qualified orthodontist by the time they are six. A pediatric dentist may not have the training to recognize the early developmental problems that can be solved with simple interceptive orthodontics, and recognizing these problems can save a lot of trouble down the road. By the time your girl hits 11 or 12 or your boy hits 13 or 14, all you can really do is shove teeth around. Better to start with simple appliance procedures than to go in there later with an expensive long-term procedure.

A simple appliance, for instance, can be used to expand a narrow jaw or to prevent the deleterious effects of bad habits. You probably will want to use a simple fixed appliance which is cemented to the child’s upper teeth. A removable appliance relies too much on patient cooperation, which is hard to come by with very young children.

What about braces? What are some of the reasons one would get them?

Mostly for cosmetic reasons, but braces also help to correct abnormal jaw growth and function. The cause of real dental health problems is not necessarily crooked teeth but the way the teeth fit together, so you use braces to get a handle on the jaw. When the jaws are not in the right relationship, it places abnormal stress on the jaw joint, and that may cause pain and improper functions.

Are there any new technologies that can make wearing braces a less traumatic experience for a self-conscious young person?

Lingual braces, which are hidden behind the teeth, are fine for purely cosmetic reasons, but they are much harder to adjust and make eating and talking difficult. And they aren’t as effective because you can’t get the same kind of control over them.

The alternative is ceramic braces. The brackets are made out of the same sort of material as coffee cups and are nearly invisible against the teeth. Ceramic brackets are bonded to the tooth instead of being glued around it like the old metal bands were. They make very cosmetically acceptable brackets for the wires, which have also come a long way. The new thin nickel titanium wires are light and they need less adjustment. They work so well that you don’t need them as long.

In some specialized cases, small magnets can be used to speed up and simplify treatment, for example with growth guidance appliances and the eruption of teeth embedded in the jaw, but this is very unusual.

How can a parent know if a price quoted by an orthodontist is reasonable?

Early interceptive work with appliances may run you hundreds of dollars, but if it’s a difficult case that requires braces and a lot of treatment, it may be thousands and thousands of dollars. Of course, prices vary geographically, but in most cases, braces will run from around $2,000 up for involved programs.

In a lot of cases you have to rely on the integrity of your orthodontist. Make sure he is board certified, which only about 30 percent of orthodontists are. You can also call one of the dental schools in your town to get an idea of what the going rate for a specific procedure is. And, of course, you should always get a second opinion.

When does is make sense for adults to undergo an orthodontic procedure?

About 25% of the orthodontic work done today is on adults, mostly for cosmetic reasons. There is also a relationship between some gum problems and jaw problems that braces can help. You put up to 350 pounds of pressure on your jaw when you chew, and that can really affect your gums. A lot of adults tend to grind or clench their teeth at night, which, if your bite is wrong, can lead to a popped disc in the jaw joint. Orthodontists can make a splint that will help relieve that pressure.