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Frequently Asked Questions - Braces

Home / FAQs - Braces
01. When would one need orthodontic treatment?

Teeth are important for chewing food properly, for good appearance and for proper speech. If any one or more of these functions of teeth are adversely affected due to irregular teeth and/or jaws, one would need orthodontic treatment.

When teeth of the upper and the lower jaws do not meet properly with each other grinding of food properly is impaired. This may cause indigestion and related health problems.

When teeth are projecting out, lips are not closing normally, or teeth are crowded and are spoiling the smile, one needs orthodontic treatment for aesthetic reasons.

One may need orthodontic treatment to correct discrepancies in jaw size and/or positions, which affect the facial appearance adversely. When the jaws and/or teeth do not meet properly with each other, excessive forces may be transmitted to some teeth leading to wearing out of the enamel of the teeth. Excessive forces may also cause damage to the tooth supporting structures like the gums and surrounding bone. This can cause weakening and early loss of these teeth.

Irregular teeth can also cause difficulty in brushing thereby leading to cavities and gum problems which may shorten the life of the affected teeth.

In rare cases irregularities like spacing in the front teeth can cause speech problems and orthodontic treatment can improve the speech as well.

02. How important is orthodontic treatment?

In today's world good appearance and a good smile go a long way in making a person feel confident and comfortable with one's self.

People with good looks and a pleasant smile are perceived well by others and are treated favourably by them.

Good-looking children are subconsciously liked more by parents, teachers and other adults.

Good-looking adults are more likely to get good jobs, more friends and better life partners.

So, the value of orthodontic treatment cannot be overemphasized. It is a question of a child's or an adult's future physical and psychological well-being.

03. When should a child go for an orthodontic consultation?

It is recommended that the first check up by an orthodontist should be done by 6 years of age. If a dental or jaw problem is developing it can be corrected as the child grows. If the teeth and the jaws are developing normally then a regular check up should be done every six months to monitor the development.

In case the lower jaw is growing excessively, it must be corrected at the earliest because this condition becomes more difficult to treat as the child grows. Some conditions can be treated later. Certain teeth irregularities can be corrected earlier thereby preventing them from becoming more severe and would need less time to treat later.

04. Up to what age can an adult be treated for orthodontic problems?

There is no upper age limit for treating an adult. Persons in their 40's and 50's and even 60's can also be treated for orthodontic problems. The deciding factors would be the condition of the teeth and the supporting structures like gums and bone.

05. How much time is required for orthodontic treatment?

The duration of orthodontic treatment varies according to the condition of the teeth and jaws at the beginning. On an average, treatment with the fixed braces takes about 1 to 2 years in cases where all the permanent teeth have erupted and there is minimal jaw discrepancy. The treatment time has reduced now with the use of "Friction-Free Ties" developed by us. We are able to complete treatment in a few months in some cases.

In growing children where jaw discrepancies have to be corrected it may take 3 to 4 years. The treatment may be split into two phases. Jaw correction is done in the first phase with one of the various growth modification appliances at the orthodontist's disposal. In the second phase, fixed braces are given to set the teeth in their proper positions.

06. How much would orthodontic treatment cost?

Different orthodontic problems need different treatment modalities and different duration of treatment time. So the fees are decided according to the conditions to be treated and the appliance/s to be used. As the mal-alignments differ, the treatment fees also differ from patient to patient. The fees may vary from Rs.10,000/- for minor corrections to Rs.2,00,000/- or more for the correction of severe irregularities.

07. Is orthodontic treatment not very expensive?

It is a relative term. Orthodontic treatment costs so much because the treatment goes on for a long duration. There are certain expenses incurred to maintain a high level of sterilization of equipment and asepsis of the clinic. The appliances used are expensive. Thus some amount is spent for the patient himself/herself.

The fees are professional charges for the knowledge, experience and skill of the orthodontist. Considering the long term, positive, physical and psychological benefits of orthodontic treatment whatever spent on orthodontic treatment should be considered as a sound investment.

08. What is the procedure followed for starting orthodontic treatment in your clinic?

In the first consultation the patient is examined and the condition of the teeth, jaws, face and the function is assessed. History is taken to know the patient's health condition. Then the patient and the parents are explained about the treatment procedures with the help of computer animations, photographs of treated cases, models etc. The patient is then sent for special x-rays needed for diagnosis and treatment planning.

In the next appointment impressions are taken and the x-rays are collected to study them.

The final treatment plan, expected duration of treatment, and fees etc. are discussed in the next appointment. Once the patient or parents decide for the treatment, appointments are fixed for starting the treatment.

09. When are permanent teeth extracted for orthodontic treatment?

One or more permanent teeth may have to be extracted in some cases to create spaces in the upper and/or the lower arches. Extractions of permanent teeth are not necessary in all the cases.

When the jaw and teeth sizes are normal the teeth can be set in their proper positions without extractions.

When the jaws are small and the teeth are large the teeth get crowded or proclined or both. In such cases extracting teeth creates the necessary spaces to move the remaining teeth in the extraction spaces. This helps in aligning and retracting teeth to more aesthetic positions.

When the jaws are large and teeth small, the teeth get spaced out. These teeth can be aligned and spaces can be closed by orthodontic treatment without any extractions.

10. Which permanent teeth are removed for orthodontic treatment?

The decision to extract or not to extract teeth and which teeth to extract depends on a number of factors like the severity of the malocclusion, amount of space required, the area of crowding, presence of any decayed tooth/teeth or missing tooth/teeth, presence or absence of milk teeth, jaw discrepancies, presence of impacted teeth, presence of extra (supernumerary) teeth, amount of changes required in the facial appearance etc.

The orthodontist studies all the factors and charts out alternate treatment plans and decides on the most favourable treatment plan and then decides about extractions. Usually the first premolars are extracted but depending on the case requirements second premolars, second molars, upper or lower incisors and sometimes even canines may be extracted. The idea is to get the best possible result aesthetically and functionally with a long-term stability of the result.

11. Are extractions painful?

Extraction of teeth is not painful as the teeth are removed under local anesthesia. The healing also is very quick because there is no infection in the teeth and the jaws.

12. Does extracting teeth cause damage to the eyes or other parts of the body?

There is no evidence in scientific literature that extracting teeth weakens or damages eyes or any other parts of the body.

In almost 6/7 out of 10 orthodontic cases teeth have to be extracted. If there actually was any damage to any part of the body it would be known and nobody would take orthodontic treatment.

13. Is orthodontic treatment very painful?

No. With better understanding of physiology of tooth movement and latest Technology, pain during orthodontic treatment is kept to the minimum.

Initially when an appliance is given there is pressure on the teeth that can cause some discomfort and pain. This can be minimized by timely medication as prescribed by the orthodontist. There is NO constant pain or discomfort during the entire duration of orthodontic treatment. When the appliance is activated to exert pressure on the teeth the patient may experience pain for a couple of days. This subsides on its own and is usually bearable. If it is more, then the prescribed medicine can be taken to relieve the pain.

14. What are the different kinds of appliances used for orthodontic treatment?

Depending on the condition of the patient the appliance or appliances are selected. When there is a need for modifying growth one of the growth modification appliances is given. This may be removable i.e. it can be removed by the patient or fixed.

When the lower jaw is deficient or placed behind in relation to the upper jaw either a bionator, activator, twin block may be given.

When the lower jaw is more prominent or growing excessively a chin cap may be used.

Foe a deficient upper jaw a reverse pull head gear may be used. In case of an excessively growing upper jaw a high pull, cervical pull or a combi pull headgear may be given to the patient.

For setting the teeth properly usually fixed appliances are used which are commonly known as "braces". These comprise of brackets, bands, tubes, arch wires, elastics, power chains, pins, ligature wires, elastic modules etc. etc.

Usually the brackets used are of metal but aesthetic tooth-coloured (or clear) brackets are also available which are not very visible in the mouth.

Certain conditions like cross bites, mild to moderate spacing can be treated with removable appliances. Fixed appliances provide total control over tooth movements so they are routinely used. Removable plates have a limited use. Lingual or invisible braces are becoming more popular as more adults are seeking orthodontic corrections to improve their smiles.

15. What care should be taken during orthodontic treatment?

Since the brackets of fixed appliance are glued to the teeth they can get detached if anything hard hits them. So one has to avoid eating hard things like toast, "chikki", "chakli", cookies, banana chips, corn cab and such hard things. One must also avoid eating sticky things like "eclairs".

If the brackets keep coming out, wires keep breaking due to negligence on the part of the patient the treatment takes longer time and the desired result may not be achieved.

There are more chances of food collection around the brackets and under the wires. This can cause cavities, bleeding gums and bad breath. It can also cause permanent discoloration of teeth that would spoil the smile.

One must brush teeth with toothpaste after every meal to keep the teeth clean and to avoid problems mentioned earlier.

16. What should one do if a part of the braces hurts?

If there is any sharp, projecting part of braces, cover it with orthodontic relief wax or wet cotton pellet.

Call the doctors at the earliest and it would be taken care of at the earliest. In case of pain, medication is prescribed to relieve it.

17. How stable are the treatment results?

The orthodontic treatment is planned and executed keeping optimal results and long term stability of the results in mind.

Once the appliances are removed or discontinued retainers are given to keep the teeth in their new positions.

Normally some settlement of teeth takes place in a few months. In some cases long term retention is recommended to prevent teeth from relapse.

18. What are retainers?

Retainers are plates or wires given to prevent teeth from moving after the orthodontic treatment is completed. The teeth have a tendency to shift from their new positions as the bone supporting them is softer when the braces are removed. Even after the bone gets back to normal there are a number of forces acting on the teeth. A retainer supports the teeth and keeps them in their desired positions.

There are two types of retainers, removable and fixed.

Removable retainers are plates which can be removed by the patient. They have to be worn all the time except while brushing and eating.

The fixed retainers are thin wires bonded to the teeth on the inner surfaces so that they are not visible at all. These can be kept in the mouth as long as necessary, without any problems.

19. How long does one need retainers?

The recent studies in the orthodontic literature suggest that it is better to keep retainers for a long time. It is not possible to predict whose teeth are likely to move after the retainers are discontinued. The orthodontist would decide about the duration of the retainers for an individual based on her/his condition of teeth and jaw structures. In some cases life-long retention may be necessary for the stability of the teeth.

20. What is the role of the patient in successful outcome of the treatment?

The success or failure of orthodontic treatment very much depends upon the patient's motivation and cooperation.

Once the appliance is given to the patient it is her/his responsibility to take care of it and to follow the instructions given by the doctors.

If the patient does not take care and does not follow the instructions the treatment result cannot be what is desired and planned for.

21. Can aesthetic treatment substitute for orthodontic treatment?

With orthodontic treatment one can shift the position of teeth in the jawbones. The teeth can be moved from one place to another along with their roots that are in the jawbones. This helps in taking protruded teeth inside, aligning or straightening irregular teeth, opening or closing the bite etc. Once the teeth are set correctly in the jaws they look better and function better for a long time.

Cosmetic or aesthetic dentistry is a recently developed branch of dentistry that deals with the shape, size and the colour of the teeth. It may be useful in minor corrections of irregular teeth but it cannot substitute for orthodontic treatment. And it does not give a long-term solution for orthodontic problems.

The aesthetic procedures may have to be repeated periodically. Some times these procedures may be harmful to the teeth and gums.

In some cases, both orthodontic treatment and aesthetic procedures combined would give the best possible results.

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