Braces & Retainers
Why are braces used?
If you have crooked teeth and/or a misaligned bite (an underbite or overbite), braces and retainers can help straighten your teeth. Your dentist will refer you to another dentist – called an orthodontist – who specializes in fitting devices made for straightening teeth.
The orthodontist will ask you questions about your health, conduct a clinical exam, gather impressions (molds) of your teeth, take photos of your face and teeth, and order X-rays of your mouth and head. A treatment plan is then developed.
In some cases, a removable retainer will be all that's necessary. In other rare cases (especially when there is an extreme overbite or underbite), surgery may be needed. In most cases, however, braces will correct the bite and alignment of teeth.
What types of braces are available?
There are five types of braces:
- Brackets: Made of stainless steel or clear or tooth-colored ceramic or plastic, brackets are bonded to the front of each tooth. Ceramic or plastic brackets are often selected for cosmetic reasons. Plastic brackets, however, may become stained and discolored by the end of treatment. Another disadvantage of ceramic or plastic brackets is that they cause more friction between the wire and brackets, which can increase treatment time.
- Invisible aligners: These are a series of clear aligners. They may be a treatment option when only minor alignment adjustments are needed and are also often selected for cosmetic reasons.
- Lingual-type brackets: These are brackets that attach to the back of teeth, hiding the bracket from view.
- Traditional bands: These are the generally outdated "full metal-mouth" look. With this option, metal brackets are soldered to metal bands that wrap around each tooth.
- Mini-braces: These braces are much smaller than traditional braces and may be an option for some patients.
How do braces work?
Braces apply constant pressure to teeth over a period of time. This pressure slowly moves the teeth. As pressure is applied and the teeth move, the bony socket of each tooth is able to adapt to its new position. The bony socket is the area where each tooth attaches to the jaw bone.
What are the names of the parts of braces and what do they do?
- Brackets are the small squares that are bonded directly to each tooth. The brackets are held in place by a special dental bonding agent or are attached to orthodontic bands. Brackets act like handles. They hold the arch wires that move the teeth.
- Orthodontic bands are stainless steel, clear or tooth-colored materials that are cemented to teeth with either dental bonding agents or cement. They wrap around each tooth to provide an anchor for the brackets. The clear or tooth-colored bands are more attractive because they can't be seen. They blend in with the color of the teeth. However, they cost more than stainless steel. They are not used in all patients. Some people need only brackets and no bands.
- Spacers are small appliances that are placed between teeth. They create a small space and are positioned before the orthodontic bands are put in place.
- Arch wires attach to the brackets and act as tracks to guide the movement of the teeth. Arch wires can be clear, metal or tooth-colored.
- Ties are small rubber rings or fine wires that fasten the arch wire to the brackets. They can be clear, metal or tooth-colored.
- A buccal tube is a small metal part that is welded to a molar. The part has slots that keep the arch wires and other parts used to straighten teeth in place. Instead of welding the buccal tube to molar, mini-implants can also be used as anchors.
- Ligatures are tiny rubber bands that hold the arch wires to the brackets.
- Springs may be placed on the arch wires between brackets to push, pull, open or close the spaces between teeth.
- Two bands on the upper teeth may have headgear tubes on them to hold the facebow of the headgear in place. (Headgear is another tool used to aid in correcting the position of the teeth.)
- Elastics or rubber bands attach to hooks on brackets and are worn between the upper and lower teeth in various ways. They apply pressure to move the upper teeth against the lower teeth to achieve a perfect fit of individual teeth.
- Facebow headgear is the wire gadget that is used to move the upper molars back in the mouth to correct the alignment of the bite. It also creates room for teeth that are crowded in the front of the mouth. The facebow consists of an inner metal part shaped like a horseshoe that goes in the mouth, attaching to buccal tubes, and an outer part that goes around the outside of the face and is connected to a headgear strap. Mini implants can be used for anchorage.
How long will I have to wear braces?
The length of time varies from person to person, depending on:
- Severity of the problem.
- Amount of room available in the mouth.
- Distance the teeth must be moved.
- Health of the teeth, gums, and supporting bone.
- How closely instructions are followed.
On average, however, once the braces are put on, they usually remain in place for 1 to 3 years.
How often will I need to see the orthodontist during treatment?
Typically you will be seen every month or so. At these appointments, your orthodontist checks on the amount of pressure the braces are putting on your teeth. To create more tension and pressure on your teeth, your orthodontist will make adjustments in the wires, springs, or rubber bands of the braces. In some cases, braces alone aren't enough to straighten the teeth or shift the jaw. In these situations, an external appliance, such as a headgear, may need to be worn at home in the evening or through the night. In some cases, orthognathic surgery (jaw surgery) might be needed.
Will braces cause pain?
Some of the adjustments to your braces may make your mouth feel sore or uncomfortable. When needed, over-the-counter pain relievers like ibuprofen (Advil®, Motrin®) or Tylenol® can help relieve the pain. If you always experience a lot of pain after your braces are adjusted, talk to your orthodontist. He or she may be able to use a different approach to make the adjustments.
Does the age at which I get braces affect the success of treatment?
The mechanics used to move teeth is the same at any age. This means that orthodontic treatments are an option for both children and adults who wish to improve their appearance and bite. However, certain corrections in adults may require more than braces alone and the treatments may take longer because adult bones are no longer growing.
Can I continue to play sports while wearing braces?
You can continue to participate in any sport you choose. When playing sports where there is a possibility of getting hit in the mouth, a specially designed mouth guard will need to be worn. The mouth guard, made of a durable soft material, is designed to fit comfortably over your braces and will protect the soft tissues, teeth, and brackets/wires inside your mouth.
What care can I expect after the braces come off?
After your braces are taken off, your teeth will be thoroughly cleaned. Your orthodontist may want to take another set of X-rays and bite impressions to see how well the braces straightened your teeth and to check for wisdom teeth. If wisdom teeth are beginning to come in after your braces have been removed, your orthodontist may recommend that the wisdom teeth be removed. Removing wisdom teeth prevents your newly straightened teeth from shifting position in your mouth.
Retainer. Your orthodontist will also fit you with a retainer. A retainer is a custom-made, removable appliance that helps keep teeth in their new position after braces have been removed. Retainers can also be used to treat minor orthodontic problems. The use of a retainer is a very important part of post-braces care. Retainers are typically made of rubber or clear plastic and metal wires and cover the outside surface of the teeth. They need to be worn all the time for the first 6 months and then usually only during sleep. The time frame for wearing a retainer will vary from patient to patient. The reason why a retainer is needed is that even though braces may have successfully straightened your teeth, they are not completely settled in their new position until the bones, gums, and muscles adapt to the change. Also, after long periods of time, teeth tend to shift.
How much do braces cost?
The cost of braces varies, but you can expect the cost to be between $1,800 and $6,500. Some insurance carriers provide partial coverage for orthodontic treatment while others provide none at all. Check with your insurance provider for the specifics of what your policy covers.