Every summer and winter, the number of people coming to consult orthodontics is increasing, we will find that our knowledge of oral health is still too far from the developed countries than the degree of popularity. Even the imperial capital is like this, let alone the second and third-tier cities. Some time ago, I was fortunate to be invited to do a popular science lecture, and I organized the content into a text version for your reference. The content is very long, with all the pictures of the slides, the mobile party is recommended to read in wifi.
At first glance my title starts with the big words, orthodontic is teeth, change is life. This is not my words, but as an orthodontist I do not think it is an exaggeration, and I hope this content will make a difference. I will talk about the following 5 areas.
Basic general knowledge of orthodontics
Orthodontics, professionally we call it orthodontics, is the straightening of uneven teeth. Looking at this concept alone, it seems that the disease we correspond to is called malocclusion. In fact, it is not exactly. The disease we treat is called malocclusion, and malocclusion is only one of the clinical manifestations, other than that, it also includes abnormalities in jaw morphology, size and position, irregularities in inter-arch and inter-jaw relationships, and facial deformities. However, for the convenience of communication with patients, doctors usually use the term “malocclusion” to refer to all problems.
So why do these problems occur?
First one is genetic. One is human genetics, that is, racial evolution. Humans change their center of gravity from crawling to upright, their jaws become smaller, the food they eat changes from raw to cooked, from hard to soft, and their chewing organs degenerate. But this degradation is not balanced, the slowest degradation is the number of teeth, so modern people generally appear crowded teeth misalignment.
The second is individual development, this means inherited from the parents, more intuitive is the facial shape, such as geodesic, small jaws are usually inherited. The presence of genetic factors is usually more difficult to correct the misalignment, so the timing of the correction is important.
The second is environmental factors, and contains two cases, one is congenital, mainly refers to the prenatal occurrence, but not genetic congenital factors, such as the mother’s nutritional metabolism abnormalities during pregnancy, fetal endocrine disorders or fetal position abnormalities, trauma during pregnancy and birth injuries. This prompts the need for proper perinatal examination and care. Acquired factors include childhood diseases, early or late loss of milk teeth, early eruption of permanent teeth, wrong order of tooth replacement, bad habits such as finger biting, lip biting, eating with one side, open mouth breathing, etc. In addition, trauma, tooth decay and periodontal disease are also important causes of tooth misalignment. So parents should not think that the milk teeth are not important, small habits may seem harmless, but these can have a negative impact on the teeth.
The point is to know that the causes of malocclusion are complex and often a combination of factors, so it is important to pay attention to all kinds of dental problems from an early age.
On the performance of uneven teeth online there are some pictures for your reference, common are crowded teeth misalignment, the opposite is the gap is too large; upper teeth too protruding we commonly called buck teeth, lower teeth wrapped around the upper teeth commonly known as the ground, and the front teeth do not bite on we called open. Missing teeth for too long not to set, it will be like the picture on the two sides of the teeth are down, the opposite tooth elongation, especially affect the eating.
The previous is the problem of teeth, but in the face, there will be convex, concave, skewed face and gingival smile. These deformities can be classified as dental, bony, or functional depending on the cause. The treatment varies from one cause to another, so the doctor usually does not tell us how to treat them in the first place, but has to do a detailed clinical examination combined with x-rays and models to measure and analyze them.
What are the dangers of misaligned teeth? I guess the first thought is that they are unattractive. Indeed, like this photo, a girl who covers her mouth and smiles looks pretty, but taking her hand off will reveal that it is so horrible that it doesn’t even look like the same person. That’s why teeth have such a big impact on aesthetics. But are the dangers of misaligned teeth really just an aesthetic issue? Let’s take a look.
First of all, it will affect the normal development of the jaw and hard and soft tissues, more commonly because of the ground is not enough to cause the development of the upper jaw.
Secondly, it affects the oral health, the misaligned teeth are not easy to clean, and are prone to dental caries, gingivitis and periodontitis. For example, in this patient, the upper teeth completely encapsulate the lower teeth when biting, and the gums of the lower teeth are so severely damaged that the roots can be seen. The teeth are also prone to trauma, especially in children with anterior incisors, who often bump or even knock out their upper incisors.
Third, it affects oral functions, such as abnormal swallowing, abnormal pronunciation, and abnormal chewing. For example, this child’s pronunciation and chewing are greatly affected because of his finger-sucking habit of opening and closing his front teeth.
The fourth point is to affect the appearance, such as open lips and teeth, facial obliquity, and double jaw protrusion. This is also the reason why most patients come to the hospital for consultation.
Problems with chewing function will affect digestion and thus health. In addition, many children with misaligned teeth, missing teeth, and encircled teeth will have negative character formation such as shyness and low self-esteem, which affects mental health if not corrected in time.
Therefore, the goals of orthodontic treatment are fourfold.
Aesthetics – to straighten the teeth, improve the side appearance and have a beautiful smile.
Health – orthodontics makes it easy to clear the teeth and keep the teeth and gums and other periodontal tissues healthy; at the same time enhance self-confidence and maintain psychological health.
Function – It is mainly to improve the chewing function by adjusting the bite.
Stability – it is to maintain the results of orthodontic treatment and avoid relapse.
The importance of orthodontic treatment at each age
Papillary stage (3-5 years old)
The main thing that needs to be treated in this period is mastoid diastema and bad habits. Many children easily form diastema because of incorrect feeding posture, using comfort pacifiers, biting fingers or upper lips, and sticking out their jaws to play. Treatment at this time is beneficial in establishing the correct anterior-posterior relationship of the front teeth, promoting maxillary growth, and preventing permanent tooth retrusion. At the same time, we can correct the bad habits and prevent the occurrence of malocclusion. There are also a number of diseases that can cause diastema, and early detection can lead to early treatment. Therefore, parents should not miss the opportunity to correct this problem because they think that baby teeth are not important and will fall out anyway.
The teething stage (girls: 8-10 years old, boys: 9-12 years old)
At this stage, if you find that your child has bad habits (such as biting the lower lip, biting fingers, sticking out the tongue, stretching the jaw forward, etc.), abnormal facial shape and abnormal tooth alignment, you should promptly take your child to the orthodontist for examination and consultation. Here is a list of some common cases where early intervention is needed, not to wait until the teeth are replaced.
most cases of diastema in this period are dental or caused by underdevelopment of the upper jaw, and good results can be obtained through early orthodontic treatment.
Severe big buck teeth, a slight protrusion of incisors during tooth replacement is normal, but children with too severe buck teeth will be very unconfident and prone to low self-esteem, affecting learning and socialization, and should also be corrected in time. And protruding incisors can be very easily knocked out by sports or falls.
Lateral chewing, due to one side of the teeth decay or missing, etc., long-term use of the other side to eat or other reasons, resulting in bilateral facial asymmetry, which seriously affects the child’s mental health and self-esteem.
receding lower jaw and underdeveloped chin, which affects facial aesthetics; doctors can use growth and development to promote forward growth of the lower jaw during this period.
severe tooth crowding, generally mild to moderate crowding can wait until the replacement of teeth; but particularly severe, individual or multiple overlapping teeth will prevent the cleaning of local teeth and good decay, gingivitis, etc., need early treatment
Multiple teeth, especially extra teeth between the upper incisors, will occupy the position of normal teeth, resulting in misalignment or eruption disorders of normal teeth.
premature loss of baby teeth before it is time to replace them, which can cause local jawbone underdevelopment and the position of the missing teeth can be partially or even completely occupied due to the displacement of neighboring teeth, resulting in misaligned eruption or complete failure of permanent teeth to grow out.
Premature loss of permanent teeth, the most common is that the six-year-old teeth are not protected and decayed because of the earliest eruption, then we need to make a gap to maintain its space.
Because this stage is the pre-puberty and peak period of child’s growth and development, we can make full use of the growth potential of jaw bone and achieve the treatment purpose by promoting the growth of jaw bone, which is more beneficial to improve the facial shape and function of children.
Both of the above two treatment stages are early treatment, both of which mainly target the maxilla, while the growth trend of the patient, especially the lower jaw growth trend, cannot be changed. In some patients, the anterior retrusion may reappear after early treatment, and this “recurrence” is very unpredictable. However, we believe that it is important to correct the retrognathism as early as possible. Although recurrence cannot be completely avoided, early orthodontic treatment can promote the growth of the upper jaw and reduce the developmental imbalance of the upper and lower jaws, which can reduce the difficulty of subsequent treatment or even avoid later treatment. In addition, the orthodontic treatment not only affects the aesthetics and function of the face, but also has a certain impact on the child’s psychology.
Adult Orthodontics
Theoretically, there is no strict age limit for orthodontics, but for adults, there are many complications that are different from those of teenagers, most notably
Adults are more aesthetically conscious
adult dental bone is less reactive, so the treatment process is generally longer
Adult patients have more oral diseases than teenage patients, such as caries, periodontal disease and even missing teeth problems. These problems will lead to complications in orthodontic treatment for adult patients. It is important to note that periodontal inflammation is prevalent in adults and cannot be corrected if it is active or uncontrolled.
Adults have no growth potential, and more severe skeletal deformities generally require surgery.
In addition, gingival recession may occur in adult patients after orthodontic treatment, especially in patients with crowded teeth and a large difference between the width of the cervical and incisal margins, and a “black triangle” may appear in the anterior region, which affects the aesthetics to a certain extent.
With the improvement of the standard of living and the change of concept, the number of adult orthodontic cases has been on the rise, orthodontics and age are not necessarily related to each other, not with the growth of age can no longer be orthodontic treatment. The periodontal condition is closely related to the orthodontic treatment, and one of the more helpless phenomena is that due to the lack of attention to oral hygiene in our population, the periodontal condition tends to get worse as we grow older, thus depriving many patients of the opportunity for orthodontic treatment. The oldest patient I have treated so far is 67 years old, who has been treated for six months and has moved his teeth very smoothly. So for those adult patients who have missed the prime age for orthodontic treatment, the best time to get orthodontic treatment is now. It’s not too late if you’re thinking about orthodontics.
Orthodontic treatment methods
Early orthodontic treatment refers to the correction of malocclusion during the period of milk or replacement of teeth before the replacement of milk teeth is completed. Successful early orthodontic treatment can make follow-up easier and more effective, with some shorter treatment sessions and some cases that would otherwise require tooth extraction. In some cases, early orthodontic treatment can even avoid secondary orthodontic treatment. If you are still unsure, it is recommended that you take your child to an orthodontist for a consultation and examination.
Labial orthodontics is an orthodontic technique where aligner components such as brackets and wires are glued to the labial and buccal surfaces of the teeth. It has the widest range of indications and the most mature technology, and is the treatment of choice for the majority of patients. Metal brackets are the most widely used because of their smooth surface, compact size, durability and low cost. Ceramic brackets are made of nearly transparent ceramic material, which is more concealing than metal ones and has good aesthetics, so adults mostly choose these for work reasons, but they are more expensive than metal ones, slightly larger and more frictional, and cannot be repeatedly bonded once they fall out. Self-ligating brackets are available in metal or ceramic and have been used more and more in recent years. It is less painful initially, more comfortable than traditional brackets, and easier to maintain oral hygiene. However, it is more expensive.
In contrast, lingual invisalign is a treatment in which the aligners are all mounted on the lingual side of the teeth, making any orthodontic treatment device invisible and aesthetically pleasing. Not all orthodontists can perform lingual orthodontic treatment, and lingual orthodontic treatment is far less comfortable and more expensive than labial orthodontic treatment.
Invisible braceless braces are braces made of clear material that patients can take off and wear without affecting their appearance. Patients achieve their orthodontic goals by wearing them on a regular basis and replacing them regularly, and for some simple cases good results can be achieved. However, it is not suitable for all misalignments and is expensive.
It is important to mention here that orthodontic appliances are just tools and no one is the best, as long as the orthodontist’s treatment plan and individual aesthetic needs are coordinated.
Surgical treatment: This treatment process is usually divided into three steps: first wearing braces to straighten the teeth, then surgery to correct the jaw, and a period of braces to adjust the bite after the surgery. It is mainly for those who have obvious bony deformities or have high demands on their aesthetics.
Precautions for orthodontic treatment
Before treatment, have an objective understanding of orthodontic treatment. Orthodontic forces act on the teeth to move them, and there are limits to this movement of teeth.
Generally speaking, crowding, protrusion, gap, etc. are indications for orthodontic treatment; minor bony deformities can also be improved by orthodontic movement of teeth, which is called “masking treatment”. The more serious bony deformities need combined orthodontic-orthognathic treatment to solve.
Before orthodontic treatment starts, dental health problems should be solved. Before orthodontic treatment starts, dental caries, gum inflammation and periodontitis should be treated according to individual conditions. Before orthodontic treatment, you should cultivate good oral hygiene habits and master the correct brushing method to minimize the appearance of tooth surface demineralization, gum recession, “black triangle” and other problems during future treatment.
The most important thing is to fully trust your orthodontist, which will greatly improve the treatment efficiency.
In the treatment is to cooperate with the doctor carefully, the specific content when the real start of treatment doctor will repeatedly and constantly stressed with you, here not to say more.
Retainers are made after orthodontic treatment to prevent relapse, and are part of the orthodontic treatment, which is significant in the whole orthodontic treatment process, because when the teeth are aligned, the teeth are not yet stable in their new position, if you don’t wear retainers, your teeth will move to its original position, which we call relapse. You must wear a retainer to stabilize the tooth in its new position and give it enough time to undergo biological modification before you can truly have a straight tooth.
Retainers generally take two years to wear, with the first six months or so requiring the patient to wear them around the clock, and after a year the retention time is greatly reduced, usually only at night, which is determined by the doctor at the follow-up appointment based on the retention results. The retention time for adult patients is extended accordingly, and even lifelong retention is required.
Myths about orthodontics
First of all, why do orthodontics need to pull teeth? I believe this is something that every orthodontist explains every day. As we said before, because of the evolution of the jawbone, the jawbone is getting smaller and smaller, and it is easy to lead to crowding and misalignment of teeth. In order to match the teeth with the jawbone, it is often necessary to extract teeth if there is not enough space. Let’s look at these two patients with extractions. The left one has very crowded teeth, and it is easy to understand why the teeth were extracted in order to reconcile the amount of teeth with the amount of bone. But this patient on the right has not crowded teeth, so why did we choose to extract them, mainly to harmonize the shape of the face.
We can see that she had a convex face before the treatment, so we extracted 4 teeth to improve the face shape and used the space to retract the front teeth to get a beautiful side profile. You can compare her face shape before and after the treatment. After the recovery, does the lip shape and jaw look better? Therefore, whether or not to extract teeth for orthodontics is a multifactorial decision, related to the patient’s own requirements, periodontal condition, lateral appearance, treatment compliance, the treatment philosophy of the physician, the level of treatment and the orthodontic approach taken, and many other factors. Not all orthodontic treatment requires tooth extraction, and it is not true that tooth extraction is bad.
Why does orthodontics take 2 years? Patients often ask if it can be faster. We generally expect the orthodontic treatment to take about 2 years. However, the degree of deformity varies from patient to patient and the time taken for treatment will vary. The more complex the treatment, the longer it will definitely take. But as long as you cooperate well with your orthodontist, keep regular follow-up appointments, maintain good oral hygiene, and protect your aligners from damage; then the orthodontic treatment time will be greatly reduced.
This last question is often asked: Are there any side effects or after-effects of orthodontics? Will there be gaps in your teeth when you get older, will your teeth be loose or even fall out?
First of all, let’s look at the principle of orthodontics: teeth are not glued to the bone, there is a layer of tissue called periodontal membrane before the teeth and bone, the characteristics of bone and periodontal membrane is to give it an appropriate force, the teeth will move slowly in the bone. The continuous application of force causes resorption of the bone in the direction the tooth is moving, and as the tooth drifts, the ligament it is wrapped around begins to be stretched. The stretched ligament prompts the body to fill the gap created by the tooth movement, and over time, new bone deposits are formed, thus maintaining the tooth in its position after movement. This time usually takes 4-8 weeks, which is our review cycle. With the right orthodontic force this movement is physiological and does not cause any damage. As for loose or lost teeth in old age, it is due to caries or periodontitis and has nothing to do with whether or not orthodontic treatment was done.
Here I also want to emphasize the point that an ideal orthodontic = orthodontist + aligner + patient’s cooperation, where the aligner is the tool, the orthodontist is the core, the patient’s cooperation is a necessary condition, one cannot be missing. Not everything can be DIY, please boycott these Taobao products without scientific basis, a waste of money is a small matter, long-term wear on the teeth will lead to serious health problems. And how do you dare to use the oil that is claimed to make the alveolar bone resorption on your face? Finally, I’d like to give you a few photos of celebrities before and after treatment, thank you very much for seeing the end, and may each one have a healthy and confident smile!