Glossary: Brace

Dental braces (also known as orthodontic braces or tooth braces) are a fixed appliance used in orthodontics to correct alignment of teeth and their position with regard to bite. Braces are often used to correct malocclusions such as underbites, overbites, cross bites and open bites, or crooked teeth, and various other flaws of teeth and jaws, whether cosmetic or structural. They can be used on either upper or lower sets of teeth, or both, depending on the problem they are being used to treat. Orthodontic braces are often used in conjunction with other orthodontic appliances to widen the palate or jaws, create spaces between teeth, or otherwise shape the teeth and jaws. Most orthodontic patients are children or teenagers; however, more and more adults are seeking out orthodontic treatment. Contents [hide] 1 The procedure 2 How braces work 3 History 4 Types of braces 5 Post-treatment 6 Complications and risks 7 Treatment time and cost 8 References in popular culture 9 External links [edit] The procedure

The service of orthodontics may be delivered by either an orthodontist or general dentist. An orthodontist is a dentist who specializes in diagnosing and treating malocclusions, which are mis-alignments of the teeth, jaws, or both. Following dental school, an orthodontist completes 2-3 years of additional training resulting in a specialty certificate in orthodontics. The first step is a consultation. During the consultation, the doctor will review the patient's teeth visually and speak with the patient. If treatment is recommended and the patient is willing, a records appointment will be set where X-rays, molds, and impressions of the teeth will be taken to determine the problem and proper course of action. Treatment time can vary from six months to six years depending on the type and intricacy of problem. Orthognathic surgery may be required in extreme cases. Teeth to be braced will have an etchant applied to the surface to help the cement stick to the surface of the tooth. A bracket will be applied with a dental grade cement, and then cured with a light until hardened completely. This process usually takes only a few seconds per tooth. If required, orthodontic spacers may be inserted between the molars to make room for molar bands to be placed at a later date. Molar bands are required to ensure brackets will stick. Bands are also utlized when dental fillings or other dental work make securing a bracket to a tooth unfeasible.

Dental braces, with a powerchain, removed after completion of treatment. An archwire will be threaded between the brackets and affixed with elastic ligatures. Archwires in the past had to be bent, shaped, and tightened frequently to achieve the desired results. Modern orthodontics makes use of nickel-titanium archwires and temperature-sensitive materials. When cold, the archwire is limp and flexible, easily threaded between brackets of any configuration. Once heated to body temperature, the archwire will stiffen and seek to retain its shape, creating constant light force on the teeth. Elastics are used to close open bites, shift the midline, or create a stronger force to pull teeth or jaws in the desired direction. Brackets with hooks built in can be placed, or hooks can be created and affixed to the archwire to affix the elastic to. The placement and configuration of the elastics will depend on the course of treatment and the individual patient. Elastics come in different diameters, sizes, and strengths. In many cases there is not enough space in the mouth for all the teeth to fit properly. There are two main procedures done to make room in these cases. One is extraction: teeth are removed to create more space. The second is expansion: the palate or arch is made larger by using an expander. Expanders can be used with both children and adults. However, since the bones of adults are already fused, expanding the palate is not possible without surgery to unfuse them. An expander can still be used on an adult without surgery, but to expand the arch, and not the palate. [edit] How braces work

Teeth move through the use of constant, light force. The constant force applied by the archwire pushes the tooth in a particular direction. Force on the bone in the jaw will cause the bone to break down in the direction the force is being applied. Osteoclasts will be produced by the body which break down bone and allow the tooth to slide into the space where the bone once was. Once the tooth is moved into the correct position, over time osteoblasts will be produced by the body to re-form bone behind the tooth, securing it in place. The process to break down bone takes about three days. The process to rebuild bone can take up to three months. Braces are required to be worn continually until new bone has formed to secure teeth after movement. [edit] History

Historians claim that two different men deserve the title of being called "the Father of Orthodontics." One man was Norman W. Kingsley, a dentist, writer, artist, and sculptor, who wrote his "Treatise on Oral Deformities" in 1880. What Kingsley wrote influenced the new dental science greatly. The second man who deserves credit was a dentist named J. N. Farrar, who wrote two volumes entitled "A treatise on the Irregularities of the teeth and their corrections". Farrar was very good at designing brace appliances, and he was the first to suggest the use of mild force at timed intervals to move teeth. ST. LOUIS-More than one hundred years ago, in 1900, Dr. Edward H. Angle and a dozen colleagues came together to establish dentistry's first specialty. The formation of Dr. Angle's select group marks the genesis of the organization known as the American Association of Orthodontists (AAO) and the specialty today known as orthodontics and dentofacial orthopedics. [edit] Types of braces

A man with Ceramic Braces Modern orthodontists can offer many types and varieties of braces: Traditional metal braces are the most common and widely used. Metal braces offer many different types of brackets, including speed (or self-ligating) and damon brackets. Ceramic braces offer a less visible alternative. They blend in more with the natural color of the tooth and are more visually appealing, however they are not as strong as metal and may cause treatment time to be lengthened. Ceramic brackets are also slightly larger than metal brackets and may be more difficult to get used to. Gold braces are an alternative to metal. They are similar in strength and offer a different visual effect than traditional metal. Lingual braces are fitted behind the teeth, and are not visible with casual interaction. Lingual braces can be more difficult to adjust to, since they can hinder the movement of the tongue. For some patients Invisalign might be a viable alternative to braces. The Invisalign system uses a series of clear plastic trays to move teeth into their position over a length of time. This system is not recommended for more difficult cases, or for people whose last molars have yet to erupt. [edit] Post-treatment

Retainers are required to be worn once treatment with braces has been finalized. The orthodontist will recommend a retainer based on the patient's needs. A hawley retainer is made of metal bands that surround the teeth enclosed by a plastic plate that rests on the palate. An Essix retainer is similar to the Invisalign trays; it is a clear plastic tray that is form-fitted to the shape of the teeth and stays in place by suction. A bonded retainer is a wire that is permanently bonded to the back of the teeth (usually the lower teeth only). [edit] Complications and risks

Plaque gets easily caught in the fine metalwork of braces. For this reason, it is important to maintain proper oral hygiene by brushing and flossing thoroughly when wearing braces to prevent tooth decay, decalcification or unpleasant colour changes to the teeth. There is a small chance of an allergic reaction to the rubber in elastics or the metal in braces. Braces can also be easily damaged. It is important to wear a mouthguard to prevent breakage when playing sports. Certain sticky or hard foods and confectionaries, gum and toffee for example, should be avoided because they can damage braces. Constantly breaking braces can prolong orthodontic treatment. [edit] Treatment time and cost

Typical cost of braces in the United States is about 5,000 USD, although in other countries, the price can be much lower. In CIS countries for example, the price is anywhere from 200 to 500 dollars per jaw. Typical treatment time is about two years, although it can vary from six months to six years, depending on the severity of the case, location, age, etc. In the United Kingdom orthodontic treatment is availible for free on the NHS to patients below 16. [edit] References in popular culture

Like eyeglasses, braces used to be seen as "geeky". However (and also like eyeglasses) that stigma is fading. For many Americans, even those without severe bite problems, braces are simply a part of growing up. Additionally, there are a growing number of adults (roughly 25% of braces patients are over 21) wearing braces to correct orthodontic issues. The Simpsons' episode "Last Exit to Springfield" featured the memorable mantra "Dental Plan... Lisa Needs Braces" as Homer considered the fact that losing his work-based dental plan would force him to pay for Lisa's orthodontic work. Braceface is a cartoon where the protagonist's braces prevent her from having a normal life. Celebrities who have been spotted wearing functional braces include Tom Cruise, Gwen Stefani, Lil Bow Wow, Ashley Judd and Emma Watson. Tootie Ramsey, a character on the long-running U.S. sitcom The Facts of Life, wore braces for six years. Braces have become the subject of fetish, and fake braces are available for those who do not require treatment but enjoy the look of braces: Recreational Brace Company

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