Orthodontics & Braces: What You Should Know

     Orthodontics is the dental specialty associated with straightening crooked, rotated or malpositioned teeth in children and adults with fixed or removable braces. An Orthodontist is the dental specialist who performs this procedure.
     Orthodontics physically moves teeth with braces into their proper position by pushing them through bone.  When the proper amount of pressure is exerted on teeth (with the use of wires and springs) bone will disappear (resorption) in the area where the tooth is being pushed and will reappear (deposition) in the area where the tooth was originally.
     It is usually healthier to treat crooked teeth with braces rather than cosmetically (without braces) because orthodontics actually corrects the problem while non-orthodontic methods cosmetically hides the problem.  The drawback to orthodontics is that treatment can typically involve six months to two years of annoying braces while non-orthodontic cosmetic treatment can frequently be completed in one to two weeks.
     One big benefit of premium orthodontics is the dramatic decrease in time necessary to complete many orthodontic cases.  High volume insurance practices will typically spend 10-15 minutes per patient per month while a premium orthodontic practice may spend 60 minutes per patient every two or three weeks.  Braces that might have taken two years might be completed in one year but at greater cost to the patient.  For many adult patients the timesavings is worth the cost.
     Traditional fixed (non-removable) braces have brackets that can be clear (white) or metal.  Premium cosmetic orthodontic practices typically only offer clear (white) brackets.  Fixed braces are typically used to treat more complex orthodontic problems.  They can be used to correct rotations and can cause bodily movement of teeth through bone.
     Removable braces (spring-loaded or Invisalign type) look much like a retainer or bite plate but they aren’t the same since they are used to actually move teeth.  Removable braces are typically used to treat less severe orthodontic problems where teeth may be crowded out of the dental arch, in either direction to the tongue or lip, but where the teeth are not rotated.  Though these braces are removable the patient must have the dedication to wear them close to 23 hours a day during active treatment to physically move the teeth.  This is in contrast to wearing a retainer only at night to hold teeth in position following active treatment.  Beware of dentists and orthodontists offering removable braces for anything other than simple tooth movement or you will probably waste your time and money.
     Crowding of lower front teeth is common and continuous throughout life regardless of the presence of wisdom teeth. This occurs because our lower teeth tend to move forward over time.  This crowding of teeth occurs slowly, yet progressively, over decades.
     The lower front teeth of most people bite against the inside of the upper front teeth. As one (or more) lower front teeth begin to be pushed out of the dental arch they typically hit harder against their opposing tooth in the upper arch.
     Over time this upper tooth (or teeth) will also begin to be pushed forward resulting in an unattractive smile that is more susceptible to gum disease. Notice this happening to many of your friends and family who are over the age of 50. Proper diagnosis and early careful treatment by an Orthodontist can help prevent this because these problems get increasingly difficult to treat as the years of damage increase.

--Dr. Jeffrey Dorfman, Director
The Center for Special Dentistry
NYC