Dental Braces: What You Need to Know About Dental Braces
Tooth loss at an early age or protruding tooth growth can cause asymmetry in the alignment of your teeth. This unbalanced growth can change the appearance of your smile; affect your ability to eat and loosen your teeth by putting extra pressure on them. Because of the abnormal growth, it is often harder to clean these teeth, and small pieces of food may get trapped around their empty spaces. Hence, these teeth are more prone to infection and inflammation.
Orthodontics is a procedure which lets your dentist straighten your teeth and give you that radiant smile. Orthodontics involves the use of braces that fix on the surface of teeth. Your teeth then grow and arrange in harmony based on the position of the braces. Orthodontics is a common dental procedure in the UK, and more than 220,000 people received orthodontic treatment in 2017 (1).
Orthodontist Initial Evaluation
The first examination of your mouth allows the orthodontist to check the condition of your gum and teeth as well as their arrangement. If there is any dental problem present, your orthodontist may suggest that you first receive treatment for that problem. Your orthodontics will also check if you have an allergy to the components of dental prostheses. In the presence of an allergy, your doctor will discuss the alternative options with you. Based on this information your orthodontist gives you the relevant available options.
Orthodontic Procedure and Aftercare
At the end of the initial assessment, your dentist schedules a suitable day for the procedure. Your dentist also gives you the information regarding the preparation and what to do after the prostheses assembly. On the procedure day, your orthodontist cleans your teeth and apply a special adhesive on their outer enamel facing your lips (or inward enamel in the case of lingual braces). Once in place, brackets can attach to the tooth and illumination of LED light secures the bonding between them. The specialist then inserts a wire into the clips on the surface of brackets and extends it across the entire arch. Your teeth ultimately align based on the position and gradual pressure from the archwire.
Alternatively, you may wish to use invisible aligners known as ‘Invisalign’. Here, your orthodontist will first capture a 3D impression of your teeth. The orthodontist then orders a removable fabricated plastic aligner that sits on top of your teeth and straightens them based on the shape of the plastic.
It is essential that you have a routine daily oral care after receiving your orthodontic treatment. You ideally should purchase orthodontics brushes to clean your teeth. The location of your braces may make it difficult to remove excess food and reach regions blocked by their wires. By having regular dental clean-ups with your dentist, you can ensure that these areas are cleaned to avoid any permeant plaque formation and tooth decay. In contrast to fixed braces, Invisalign aligners are removable, and you can remove them when you are having food or want to brush your teeth.
Types of Orthodontics Prostheses
Since the introduction of the orthodontics, several materials have been used to make the brackets. Stainless steel containing nickel and chromium is the primary metal constituent of braces and wires. People who have an allergy to the nickel component of the stainless steel may opt for other options such as titanium (Ti) coated brackets. Braces coated with Ti have high anti-bacterial qualities. However, they have less durability in terms of corrosion and may not last as long as the other materials (2,3). Your orthodontist will give you guidance on how to choose the right metal for the Orthodontic brackets.
If you dislike the appearance of metal brackets, then you may choose clear brackets which resemble the colour of your enamel. Ceramics and plastics are two of these materials. Bracket made of ceramic offer more durability to physical stress than those made of plastics (4). However, both of these materials are subject to undergo colour changes over time and may lose their invisible characteristics (5).
All of the mentioned brackets connect via metallic or non-metallic archwires. If the colour appearance of the wire is important to you, then you can select coated wires with a similar colour to your enamel. Alternatively, you can choose non-metallic transparent wires such as fibre reinforced composites (FRC). Both of the mentioned archwire categories have similar mechanical qualities (6,7) but vary according to their cost.
Invisalign Aligners and Lingual Braces
In comparison to the fixed brackets set up in front of the teeth, lingual brackets attach to the back of the teeth thereby making them invisible. Lingual braces use the same material but are harder to assemble and cost significantly more than other orthodontic methods. Other options include thermoplastic aligners such as Invisalign that do not require permanent fixation to your teeth, and you can remove them at any time(8). However, their accuracy is slightly lower than lingual orthodontics (9).
Complications and Problems with Orthodontics
Root Loss (Resorption)
The process of teeth alignment using the orthodontic approach puts a gradual force on the teeth. This force then guides the movement of the teeth to create a uniform arrangement. This movement triggers an inflammatory response whereby the dentin (the root of our teeth) becomes destroyed, and the eventual tooth loss follows (10). Thankfully your dentist can use X-ray to detect root resorption easily. He/she can then make the required adjustment to your prostheses to prevent it from progressing further.
White Spots of Enamel
Often orthodontic treatment causes a degree of plaque build-up on the outer layer of our teeth. If the daily care is inadequate, then this plaque build can wash off the calcium minerals from the enamel in a process called decalcification. This causes the white spots to appear on the surface of enamel and affect the expected aesthetic outcome. The use of special mouthwash and toothpaste that include amine fluoride/stannous fluoride as well as products containing topical fluorides can help reduce the incidence of white spots after orthodontics treatment (11,12).
This inflammatory condition affects the soft tissue around our teeth known as gingiva. Gingivitis arises from plaque accumulation as a result of poor dental hygiene. Plaque accretion follows bacterial growth which ultimately causes pocket formation and tooth decay. In the absence of optimal dental hygiene after orthodontics treatment, plaque can grow around our teeth and lead to gingivitis (13). Brushing and flossing your teeth as well as regular check-ups with your dentist can help you stop the progress of such disease.
Sometimes the presence of a low level of adhesive weakens the bonding between the bracket and the tooth. This can increase the chance of bracket falling out of its place. If this happens, you need to consult your orthodontics to re-attach the bracket to your tooth.
Cost of Orthodontic Treatments
The cost of orthodontics often is based on the nature of the procedure and the type of materials used. Fixed metal braces can range between £2000 to £4000 whereas clear brackets can shift the price to a slightly higher range. Invisalign can cost around £1500 to £2500 for a single arch treatment. Lingual braces are the most expensive orthodontics treatment with a starting price of £3000 for a single arch. In the UK you may be eligible to receive an orthodontic therapy for free. Approximately 203,000 individuals received NHS funding to undergo orthodontic treatment in 2017 (1).
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- Salehi P, Babanouri N, Roein-Peikar M, Zare F. Long-term antimicrobial assessment of orthodontic brackets coated with nitrogen-doped titanium dioxide against Streptococcus mutans. Prog Orthod [Internet]. 2018 Sep 17;19(1):35. Available from: http://www.ncbi.nlm.nih.gov/pubmed/30221309
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- Guignone BC, Silva LK, Soares RV, Akaki E, Goiato MC, Pithon MM, et al. Color stability of ceramic brackets immersed in potentially staining solutions. Dental Press J Orthod [Internet]. 2015;20(4):32–8. Available from: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S2176-94512015000400032&lng=en&tlng=en
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- Invisalgin. No Title [Internet]. Available from: https://www.invisalign.ca/frequently-asked-questions
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- Krishnan V, Davidovitch Z. Biological mechanisms of tooth movement [Internet]. Krishnan V, Davidovitch Z, editors. Chichester, UK: John Wiley & Sons, Ltd; 2015. Available from: http://doi.wiley.com/10.1002/9781118916148
- Srivastava K, Tikku T, Khanna R, Sachan K. Risk factors and management of white spot lesions in orthodontics. J Orthod Sci [Internet]. 2013 Apr;2(2):43–9. Available from: http://www.ncbi.nlm.nih.gov/pubmed/24987641
- Øgaard B, Alm AA, Larsson E, Adolfsson U. A prospective, randomized clinical study on the effects of an amine fluoride/stannous fluoride toothpaste/mouthrinse on plaque, gingivitis and initial caries lesion development in orthodontic patients. Eur J Orthod [Internet]. 2006 Feb 1;28(1):8–12. Available from: http://dx.doi.org/10.1093/ejo/cji075
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