Why does everyone seem to need braces?

Modern jaws

Anthropologists have long noted the significant differences between the jaws and teeth in modern skulls compared to skulls of pre-agricultural, hunter-gatherer humans from thousands of years ago.

The differences are a stark contrast to humans who lived as recently as a century-and-a-half ago during the pre-industrial times.

These bygone humans showed minimal tooth crowding, rare impaction of their wisdom teeth and had almost no malocclusion (bad bites).

In a new study, Stanford researchers argue that all these problems afflicting modern humans are relatively new and can be traced to the shrinking in the size of our jaws.

They maintain that this “jaw epidemic” is not only genetic in origin, as previously thought, but also a lifestyle disease. Our ancestors certainly did not enjoy the sustentative luxury of slurping down protein shakes and other refined foods.

Aesthetics have become particularly important in recent years, and everyone is chasing perfection.Even when aesthetics was becoming a consideration, in the recent past, it was much more likely that the offending teeth would have been extracted and a quick-fix denture (with a set of perfectly straight teeth) was opted for instead of going through a lengthy process of orthodontic treatments.

What are braces and why do we need them?

Braces are appliances that move teeth by transferring the forces of a wire onto the teeth for extended periods of time.

The shape of your jaw gradually adapts to conform to this pressure. Between the teeth and the bone and under your gums is a membrane that connects the roots of your teeth to your jaw bone.

This membrane controls the position of your teeth, and it responds to the pressure being placed on your teeth by braces.

Aesthetics is not the only consideration for braces. Sometimes, even a person with fairly straight-looking teeth might need braces because of the mal-relations of groups of teeth or individual teeth to each other that affect the functioning of your bite.

Plus, one must also consider the relationship of the upper jaw to the lower jaw might not be the way it should. This mal-relationship might necessitate surgery as well as braces for correction.

Malocclusion (bad bite) can affect not only facial aesthetics but also cause difficulty in biting, chewing, speaking and the ability to clean well. The goal with braces is to restore function as well as improve aesthetics.

When should I take my child to the orthodontist?

Always consult with your dentist and get a professional opinion. The earlier the child sees a dentist, the better. Start taking your toddler to the dentist and/or hygienist when they’re about 3 years old or when your child is comfortable enough to sit in the dental chair.

At around 7 years old, the dentist will be able to assess the possible need for future orthodontic treatments and if necessary, will refer you to the orthodontist. In certain cases, early referral might result in starting an initial first interceptive phase of orthodontics at an earlier age than normal.

Generally speaking, comprehensive orthodontics is done around 12 years of age when all the permanent teeth have erupted, however specific problems may require earlier intervention.

Luckily, almost all children get to a stage where they feel braces are fashionable, “socially acceptable” and where most of their peers seem to want them and so teasing is less common.

There’s an advantage to completing orthodontic treatment before events like the matric dance and other important milestones.

Braces are not only for children

Lots of adults have braces too. You’re never too old to correct your bite or align your teeth, but treatment may take a little longer when you are older. The advantage of having braces as an adult, is that adults take better responsibility for their dental hygiene as compared to children. (Probably because adults are paying for the treatment and understand consequences better!)

One or more of the following might indicate that your child (or you) needs braces:

1. Crooked/overcrowding of teeth or evidence of mal-relations of teeth
2. Stubborn baby teeth that don’t fall out or that obstruct a new tooth that is trying to erupt
3. Finger sucking and other habits like lip biting and persistent use of a dummy
4. Jaw noises and clicks when opening and closing the jaws and during chewing
5. Cheek and tongue biting
6. Mouth breathing/sleep apnoea/snoring
7. Speech issues
8. Grinding or clenching of teeth

Classification of mal-relations of teeth include:

• Excessive spacing-:Gaps, or spaces, between the teeth as a result of missing teeth or teeth that do not “fill up” the mouth
• Crowding: When there are too many teeth for the dental ridge to accommodate the teeth or the jaws are too small to accommodate the teeth
• Open bite: When the teeth don’t meet over in the bite (in the front or on the sides) and the bite is “open.
• Overbite: The upper front teeth lie too far forward over the lower teeth
• Cross bite: When the upper back teeth bite slightly narrower than the lower back teeth one has a crossbite.
• Underbite: The lower front teeth are too far forward or the upper front teeth are too far back when the teeth bite together.
• Overjet (Flared teeth):Top front teeth stick out forward past the bottom teeth, leaving a big gap between the top and bottom rows of front teeth. This makes them vulnerable to accidental trauma and injury if the child falls.
• Abnormal eruption: A tooth erupts through the gum out of its proper expected position.
• Edge-to-edge bite:The tips of the upper and lower front teeth meet each other upon biting.

Classification of malocclusion (bad bite) include:

• Class I: The upper and lower arches (dental and/or bone) are correctly aligned, but crowding or spacing might be present.
• Class II: Upper and lower arches are not aligned: the upper dental arch (teeth and/or bone) is forward of the lower dental arch.
• Class III: Upper and lower arches are not aligned: the lower dental arch (teeth and/or bone) are forward of the upper dental arch often causing an underbite. Either or even both of the two jaws may be responsible for this mal-alignment.

What are my options for braces?

Fixed braces

Brackets(braces) are glued to the teeth and a wire is joined to the brace with a “tie” to apply the force onto the braces to make the teeth move. The “tie” keeps the wire in place. Pressure is applied to gradually align the teeth. Elastic bands are sometimes used to help adjust the position of the jaw and the bite between the upper and lower teeth.  You get different kinds of fixed braces: metal (conventional braces), ceramic (clear) and lingual braces (glued on the tongue-side).

Metal braces

Pro’s
Most affordable
Very noticeable
Durable
Can treat severe cases
Can add fun colourful bands

Con’s
Very noticeable
Can’t remove them
Require regular visits to orthodontist
Gum irritation and discomfort

Ceramic braces

Pro’s
Affordable
Treat severe cases
May be slightly more comfortable than metal
Less noticeable

Con’s
Regular visits to orthodontist are required
More brittle

Lingual braces (hidden/incognito)

Pro’s
Hidden
Better for those who play musical instruments with their mouth
Less prone to de-calcification on the visible side of the tooth

Con’s
Treatment may take longer
More expensive
Regular trips to orthodontist
Longer appointments at orthodontist
Can cause irritation to the tongue
Might affect speech

Clear aligners

These are a series of custom-made clear aligners which are removable.

Pro’s
Comfortable
Almost invisible
Removable
Easy to clean and maintain your teeth                                                                                  

Con’s Can’t treat severe cases
More expensive

How long do I need to wear braces?

The duration of treatment depends on many factors such as severity of the problem, compliance with treatment (e.g. wearing elastics according to the instructions of the orthodontist.) This can range from 1 to 2 years or even longer.

Minor corrections might take shorter time, and more complicated cases might take longer than 2 years, especially if treatment is done in different phases. Although it is possible that some braces systems might be quicker than others, always listen to the recommendation of your orthodontist.

What do I need to do in preparation for braces?

Firstly, it’s important we need to understand how important it is to have healthy teeth and gums before we can even consider braces.

1. Complete any dental procedures prior to starting orthodontic treatment (fix cavities or restore broken teeth).
2. Have a professional cleaning.
3. Prepare yourself mentally for the commitment of spending more time caring for your teeth and the initial discomfort of the braces.
4. Take pre-braces selfies.
5. Do not whiten your teeth before you get braces (this is the cherry on the top after braces are removed).
6. Understand that you’ll need to wear fixed and/or removable retainers after the treatment, often for extended periods (as determined by your orthodontist). Retainers are used to keep the moved teeth in their new position and to prevent the teeth from relapsing as there is an immediate tendency for the teeth to move back to their previous position once the braces are removed.
7. Know that you will need to use a mouth guard when playing sport.

Getting braces sequence of events

1. At your first consultation appointment, a thorough examination is done, impressions of your teeth are taken, and a mould is made (or a 3D scan). Photographs, measurements, x-rays and other records are also taken. This is necessary information to define and understand the problems and to formulate a treatment plan
2. There may be a case discussion at the consultation appointment or at a follow-up appointment where a treatment plan will be presented and various options of treatment will be discussed.
3. If the contacts between the teeth are too tight, spacers may be inserted in preparation for braces.
4. Getting braces (normally a 1.5 – 2 hour appointment).
5. Follow up visits every 4-8 weeks to replace wires and elastics and even to tighten the wires (there is a little discomfort afterwards).
6. After treatment, when braces are taken off, impressions will be taken for the retainers.

How to take care of braces during treatment

1. Do not miss appointments as this might slow down your treatment progress.
2. Wear your elastics exactly as prescribed.
3. Make sure you understand the instructions given to you.
4. Let the orthodontist know as soon as a bracket or wire has broken or it may slow down the treatment.

When bacterial plaque stays on the teeth for long periods of time, it starts demineralising the surface of the enamel. The first sign of demineralising is the appearance of chalky white marks on the tooth. It’s not always easy to see these white marks when braces are still on the teeth. Unfortunately, once the braces come off, the marks can seem prominent and may be irreversible.

Not only is this aesthetically very unpleasing, but these lesions make the tooth more vulnerable to tooth decay. With less minerals on the surface of the tooth, the enamel becomes softer, and it becomes easier for acid from bacteria (plaque) to form a cavity.

How do I clean my mouth when I have braces?

1. Brush and floss after every meal.
2. Do not only brush your teeth, but also brush the brackets, the wires and the gums
3. Follow the advice of the orthodontist and the hygienist as to what toothbrush to use. Orthodontic treatment requires specially designed orthodontic toothbrushes. My personal favourite is an electric toothbrush. But, check with your orthodontist.
4. Flossing takes a lot longer when you have braces and you must use a special kind of floss, called superfloss especially designed for braces. Alternatively, you can use a floss threader. Ask your dental hygienist/orthodontist to show you how to use these aids.
5. Interdental brushes are also very handy and easier to use to clean between the teeth and underneath the braces.
6. Oral irrigators (aquafloss, waterpik, waterjet) are a good adjunct to brushing. Flossing/interdental brushes help remove food and debris that get stuck between the braces.
7. A fluoride mouthwash (without alcohol) will greatly assist in reducing the chances of getting cavities
8. Make sure to see your hygienist every 3 months for a professional cleaning. Braces makes it more difficult to clean well. They can also give customised instructions and motivation to take care of your mouth.

Eating with braces

Although your teeth may be tender after your braces have been adjusted, you should be able to eat a variety of foods throughout your orthodontic treatment. To prevent damage to your teeth and braces, consider the following:

1. Remove elastics before eating anything.
2. Braces will trap more food and will result in more bacterial plaque build-up.
3. Avoid sugar as this will promote plaque.
4. Hard foods like crunchy fruits and vegetables and crusty bread rolls can be eaten with care if you cut them first and chew carefully.
5. Drink lots of water to help dislodge food particles from your braces.
6. Cut meat into small pieces and do not eat it off the bone.
7. Avoid the following: Chewing gum, chewing on ice, hard chips or cookies, popcorn, caramel corn, nuts and seeds, wholewheat and grains or hard or sticky candy.

A word to parents…

Mom and Dad, be mindful of how you refer to braces (e.g. train tracks) and of how your child feels about having braces. Try not to tease your child or tolerate teasing by others (e.g. sibling) as it might have a negative impact on your child and their treatment.

Try to be sympathetic, supportive and understanding of how difficult it can be to eat and to clean thoroughly with braces. Try to encourage and motivate your child to be responsible for good oral hygiene and care of the braces. If you have a bad bite and skew teeth yourself and did not have the opportunity to have your teeth straightened, this might be a good time to go through it together.