Frequently asked questions in Orthodontic treatment?

Major Dr Pravin
23.03.18 03:12 PM Comment(s)

Can Crooked teeth correct on its own?

Crooked teeth are caused due to an imbalance between the jaw size and the tooth size. Let's say , for example if your jaw sizes are smaller and your teeth size are bigger then the teeth and the jaw have to accommodate itself in the jaw somehow, so it causes crookedness.

It is merely like three people who are bigger traveling in a small car , then each one has to adjust by either sitting front and back or one above the other to go comfortably. This is the same situation with the mouth also , either the teeth has to accomodate or it has to overlap each other or get arranged either front and back.

The correction for this problem could be one person has to leave the car so that others to sit comfortably. Vice versa  few teeth also have to be removed to get accommodated to each other. That is why your dentist will ask you to remove your few good teeth to correct the malocclusion or the crookedness.

Will there be a gap if my tooth extracted for orthodontic treatment?

It is the most common question asked by almost all the patients when they are told to remove the teeth for orthodontic corrections. Once your premolar teeth are removed which are the most commonly removed teeth for orthodontic corrections, the front tooth is brought into position into that extracted space, so you don't have to worry that there won't be any space after the treatment completion. 

The orthodontic goal for treatment would be proper alignment, leveling, retraction, and space closure. With this goal in mind, there won't be any space between the teeth once when the procedure is completed. However, after some period of Treatment completion, there are chances of relapse which means the tooth goes back to its original position causing a gap between the teeth. This is one of the most common drawbacks of orthodontic treatment. This can be avoided by doing the orthodontic treatment very slowly allowing the bone to form on one side and allowing the bone loss on the other side to cause tooth movements. 

The stability of the orthodontic treatment can be achieved by giving light forces on the teeth movements and giving permanent retention in most of the cases. The most common cases where there is permanent retention would be generalized spacing, midline diastema, and severely rotated teeth.

The permanent retention is achieved by giving a fixed permanent lingual
retainer behind the back side of the teeth with the help of composite cement
and retainer bands. This is done and kept for the life time.Many patients are however uncomfortable to know that the retainers are kept for a life time.This can't be avoided as we are dealing with nature.

Do braces hurt or pains? 

The answer for this question could be explained from an example whenever we buy new shoes it hurts our legs for a moment because there will be some elasticity of the shoe over a period for a couple of weeks. Later the shoe gets adopted to our leg causing no pain afterward.

Vice versa your new braces could hurt you due to the friction of your mouth tissues over the brackets causing pain and ulcerations during the initial stage of your treatment. 

Hurting braces happen on the day or next two to three days of the treatment. However, it subsides on its own if it is due to friction.

 If the pain is due to a poking wire, this can be corrected by going back to your dentist or orthodontist and adjust the wire accordingly

What should you do when your braces hurt or pains? 

1. Report the problem to your dentist over the phone or report to him personally. 

2. Identify the reason for the pain. 

3. If you are not able to reach your orthodontist or dentist immediately, you can do the following home remedies. 

     a. Apply the little bit of butter coconut oil or Vaseline on the tissue surface where it is getting ulcerations or pain. 

     b. If you are dentist are prescribed, or mucosal ointment much pain which is an anesthetic jelly topically applied can relieve your pain. 

   c. If the pain is very severe, you can take Paracetamol or acetaminophen which are used every day for a headache or any body pain.

     d. Please don't try to adjust the wire on your own because this could damage the brackets and get it dislodged from the tooth causing more problems for you. 

At what age should one schedule an orthodontic treatment? 

This is a fundamental question. Orthodontic treatment falls under four category. 

Preventive orthodontics, 
Interceptive orthodontics, 
corrective orthodontics
surgical orthodontics. 

An orthodontic problem doesn't start in one day it takes years and years of time for the issue to set in since we don't see the problem with our eyes till it becomes worse we don't understand the concept.Based on the age group of people the problems are approached accordingly. Lets see in detail how orthodontic treatment is planned and diagnosed as per age groups.

1. Preventive Orthodontics

Dental caries management in young children at the age of 1 to 5 years is very very important for orthodontics.

Preventive measures start from 5 years of age.This includes learning
 the right brushing techniques, understanding the eruption pattern of the milk tooth and also taking measures like caries control using pit and fissure sealants, fluoride applicants and educating the child and even the parents for brushing two times daily. 

All these things will come under a preventive category.  When a child is monitored from the time it is born until five years of age many of the orthodontic problems for children in future could be avoided easily. 

2. Interceptive Orthodontics:

What is the interceptive Orthodontic treatment method?  Why is Interceptive orthodontic treatment procedures are important?

Interceptive orthodontics treatments start right from the age group of 6 years till the child reaches an age group of 11 to 12 years.

 Some common problems we could solve is mainly habits of children. Children have the lot of bad habits like nail biting, lip biting, thumb sucking, tongue thrusting, and also mouth breathing. These are some of the interceptive orthodontic problems, which mean this problem if we don't intercept this could lead to significant problems for the child, so any habit correction measures should be taken into consideration as an orthodontic treatment for the child. 

The child orthodontic issues can be classified by age and also by sex groups of both male and female.Both the male and female child will have different problems in their mouth .since the girl children they grow very faster compared to the boy's upcoming orthodontic issues for girls will be much earlier than the boys and treatment also should be planned accordingly. 

What are the common interceptive treatment methods in orthodontics? 

1. As discussed earlier any habit- breaking appliance has to break the habit of the child comes under an interceptive category. This includes tongue crib an appliance for preventing the patient to protrude the tongue by giving a device called tongue crib. This tongue crib is permanently fix torn to the permanent molars of the child where there will be a small wire which goes towards the front tooth where the tongue pushes the front seat of the tooth causing it to open up and other face profile changes because of that. 

2. The second most common solution to the interceptive problem would be correcting the mouth breathing.Children tend to have mouth breathing because of three main reasons when there is some blockage in the nose this obstructs the nasal airflow of the child causing the child to open the mouth and breath. This mouth breathing habit then becomes the typical pattern for the child. So when the child starts breathing through the mouth, there is an excess pressure from the cheek onto the tooth surface causing the face to become long and narrow because the pressure could cause the excess vertical growth of the face. 

3. Mouth breathing could cause dryness of the mouth during night time causing gum infections in the front tooth which has signs of bleeding gums bad breath and also decay starts in the front tooth first. 

The correction for this starts by referring the child to an ENT surgeon who specializes in the ear nose and throat. 

The ENT surgeon will do the following tests :

1. He will refer to take  a PA view of sinus x-ray 

2. He will ask for nasal endoscopy if the problem is severe to assess the intranasal polyps and any lesion and conditions causing nasal obstruction. 

3. He might ask for an MRI test also for determining the Nasal pathway and oral pathway and even the pharyngeal path. 

4. When there are conditions of nasal polyps and tonsils, the ENT surgeon might ask the patient to go for tonsillectomy or polypectomy using lasers or conventional surgical methods to clear the obstruction of the nose.
5. Once the nasal obstruction is clear the child will be referred back to the suffering dental surgeon or the orthodontist. 

6. Then the orthodontist or the dental surgeon will give an appliance called oral screen. 


7. An oral screen is a custom-made device which looks like a thick plate of acrylic which is kept on the buccal surface of the tooth or of the outer surface of the tooth. 

8. There will be four holes in the Oral screen which helps the child to breathe through the mouth itself during the initial phase of treatment. 

9. Every two months the patient has to be evaluated, and the holes will be closed one by one week by the doctor generally and slowly improving the patient to breathe through the nose and to solve the patient's problem by interceptive orthodontics measures. 

10. The oral screen has to be worn throughout the night and 2 to 3 hours of conscious wearing during the daytime once the child comes back from the school. 

11. The child has to do an active exercise called oral screen exercise where the 'O'ring or the handle of the oral screen will be pulled manually by the child, and the child has to suck the oral screen with the lips. This causes lip elongation or lip growth for the child. This will help the child to have a proper lip when there is a problem of very small lips, and also it helps the child to close the mouth passively. 

12. When the patient is having problems with jaw growth, there are many appliances which are given in this age group of 7 to 11 or 12 years. These are all called activators bionator and frankels appliances. These appliances are provided when the patient has got the problem which is mostly muscle oriented.

13. But when the tooth is being affected by the jaw growth, then it becomes an Orthopaedic problem. Orthopedic problems are corrected by using headgears, chin cups, face masks. 

Corrective Orthodontics :

When a child reaches an age group of 12 to 13 if it is a girl child, then we can start orthodontic treatment which are the regular and conventional treatment methods like using stainless steel brackets, ceramic brackets and all the bracket based treatment therapies for orthodontics. 

There are many types of braces colors which come. Braces colors come from the modules which we are applying to hold the wire into the brackets. But these days kids are very conscious, and they never prefer to go for color braces they prefer to go for braces which are normal in color.

 There are many many types of braces available based on the material we can classify it as standard Steel brackets and ceramic orthodontic brackets. Based on the ligation methodology brackets are classified as self-ligating brackets or regular modular brackets. 

self ligating braces in chennai  
The difference between self-ligating brackets and modular brackets would be self-ligating brackets use an automated door Technology where the wire is retained with the bracket with the help of a small sliding stainless steel door. In the conventional Technology, the wires and the braces are connected using wire module or elastic modules. 

Based on the visibility of the braces there are aligners which are called clear aligners. Clear aligners are those acrylic aligners which are made up of clear acrylic sheets printed using 3D printing Technology. These are the most sought-after treatment for orthodontics over the last 2 to 3 years for correcting orthodontic problems.

Adult braces are not very appealing to adults because of social concerns. People who are very conscious about their treatment appearance seek clear aligners. These are little expensive by way of its cost of aligners. But the number of advantages are very vast. 

The benefits of clear aligners would be 

1. They are very very clear and not visible, so it is very convenient to wear during office time and also patients till functions like wedding and any other ceremonies. 

2. Clear braces are very comfortable to remove and place it back there is no restriction on any food. 

3. In regular braces chances of dislodgement of brackets are more causing more time to fix it back and tooth movements etc., 

4. In clear aligners, this kind of problems never happens, so treatment time is considerable shorter with clear aligners. 

5. Chances of relapse are very less because of light forces applied. 

6. Very predictable treatment outcome can be seen before the treatment is completed using software for 3D aligner Technology. 

7. The chances of tooth damage in conventional orthodontic treatment caused by using adhesives, sealants and acid etching in traditional braces are not there in clear aligners.Clear aligners keeps  the tooth to be as virgin as possible without altering the nature of the tooth in the mouth. 

8. Clear aligners don't cause any secondary caries because of no damage to the tooth structure. 

These are some of the preventive interceptive and corrective methodologies of orthodontic treatment. 

Surgical Orthodontics :

Any adult patient after 18 years of age has to undergo only surgical orthodontics the most commonly solved using surgical orthodontics are 

1. Prognathic maxilla where the upper jaw is proclined forward. 

2. The retrognathic mandible was causing jaw deficiency. 

3. Prognathic mandible and retrognathic maxilla. 

4. Chin corrections, malar bone corrections can be done using surgical orthodontics. 

The advantage of surgical orthodontics are 

1. Very very quick correction of orthodontic problems, suitable for people who are seeking orthodontic treatment for the wedding and marital problems in a short span of time.

2. People who are traveling abroad and wants to get their problems corrected in their native town with the help of a specialist. 

3. The complete transformation of the person happens during surgical orthodontics where the whole face changed in 3 hours or 4 hours.
4. Surgical orthodontics is highly predictable these days using 3D Technology where we can visualize the face appearance before it is getting done. 

5. Surgical orthodontics is performed by the team of oral and maxillofacial surgeons and orthodontist under general anesthesia in hospital setup, not in clinics. 

6. Surgical orthodontics cost in Chennai would be roughly from 100000 to 1.5lakhs. 

Finally, in this blog, I have explained you very openly about all the four modalities of orthodontic treatment preventive interceptive surgical and corrective. I have also explicitly explained about the treatment timings the appliances used; the problems addressed and the cost.

if you would like to consult personally with me kindly