Malaligned / Crooked Teeth

When a person’s teeth are not aligned or are crooked and crowded, (in place of two teeth more than two to three teeth are present) or they protrude, affecting the appearance of the face and can also make the pronunciation of certain words different. It may lead to gum problems or cavities as those areas in the mouth cannot be maintained clean by oral hygiene measures. A number of procedures are available for correcting the irregularities of teeth and its relation to the surrounding structures. One of the procedures used for this correction is called orthodontics. Here different appliances are used to put a constant but a gentle pressure on the teeth to move them into the correct position.

What is orthodontic treatment?
It helps in correcting the alignment of the teeth and its straightens the teeth, which eventually does the function of chewing and it works better and definitely looks better. It too helps in keeping the teeth cleaner than before.
This treatment can also be termed as orthopaedics of the face and teeth as it treats the incorrect positions of the teeth and also change or modify the growth of face.

Why need orthodontic treatment?
The main indication for orthodontic treatment is aesthetics and function. Different causes can be treated by the orthodontist that is, excessive space between teeth, crooked teeth, crowded teeth, an open bite, an over bite or under bite. The importance of treating teeth that are misplaced affect the appearance of the person and also bring down the confidence level.

As teeth are not aligned correctly they will affect the way a person bites and makes chewing of certain foods difficult, resulting in wear and tear of the teeth.

Maintenance of oral hygiene is difficult in such cases and causes decay and gum problems. There are certain orthodontic problems that should be looked into even without aesthetics problem and its treatment can be started even before all the permanent teeth have erupted.

When should orthodontic treatment start?
The time of starting the treatment depends on the kind of problem. In the stage of early mixed dentition, when the permanent teeth that is, the first molars have erupted along with the front teeth, but milk teeth are also present, treatment of cross bite of the front and back teeth can be started. Certain appliances for treatment can also be initiated when pubertal age and mixed dentition period coincides.

In majority of cases, orthodontic treatment is started only when the permanent teeth have erupted. Reaching adulthood is not a prerequisite of initiation of orthodontic treatment, rather teen age that also early teens is preferable as there is a rapid response to the movements caused by orthodontic treatment and is well tolerated too. During this age skeletal and dental changes can be achieved at a faster pace than in adult age as tooth movements slow down and the growth is also limited to achieve optimal results.

Methods of orthodontic treatment
There are a number of methods employed for orthodontic treatment. The most commonly used are braces but a dentist or orthodontist should decide the most beneficial one.

Braces are mostly used for orthodontic treatment. They have brackets that are stuck to an individual tooth with cement or a resin. Orthodontic wires are then fitted into each one of them and elastics hold the wires in the brackets. Nowadays coloured brackets and elastics are also available.

Another method is the use of head gear. There are different types of head gears which are used to guide the direction of the tooth and jaw growth for someone who is still growing. It is usually worn during the evening and at night as instructed by the dentist.

Next are appliances which are not fixed like the braces. They are removable appliances. These are used to move a tooth or a group of teeth. They are worn before the braces are fixed or while the braces are on.

After the braces are removed, retainers are given to keep the teeth in the corrected positions. These retainers can be attached or may be removable. Initially, the retainers are to be worn all the time and later they are weaned off after achieving the purpose.

There are times when removal of a tooth or teeth are required. If there is not enough space in the jaws to correct the alignment of teeth or of a tooth is hopelessly misplaced. Certain surgeries (orthognathic surgery) are carried out where braces or other appliances cannot achieve the positions of the teeth and jaws required for achieving correct occlusion or bite.

Considerations before orthodontic treatment
The success of any treatment depends upon the case selection. The dentist should be able to assess the outcome of this treatment so that it lasts a lifetime. The acceptance and full co-operation of the patient should be there to achieve this. Following the advices, maintaining protocol and follow ups are equally important.

Initially, there would be pain due to the movement of teeth by the appliances used and the ulcers due to the brackets or braces placed. Immediately reporting, taking medication and precautions would prevent further recurrence of these episodes.

Definitely, orthodontic treatment takes up time. Depending upon the severity of the case and age the time is usually prolonged.

Follow up treatment every 4-7 weeks for over period of 6 months for 2-3 years is required. With braces and wires over the teeth, it is quite natural that keeping the teeth clean will be difficult. For this, special orthodontic brushes are available to achieve good oral hygiene. When braces are on, there are certain restrictions that are to be followed regarding eating habits to avoid its breakage and prevent food from getting stuck between the braces. Avoid sticky foods like chewing gum, candies and toffees. Do not bite on hard foods such as nuts, hard crust pizzas or roasted items as they would break the braces and result in the need for taking longer treatment with increased visits to the dentist. Parent’s supervision is required for treatment of children, so as to involve children in the treatment plan and to clear all their queries and doubts solved beforehand. This can help in achieving a smooth treatment.