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Orthodontic Treatment Questions
By Stephen Yang, DMD, MS
Board Certified Orthodontist
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Will I need to have teeth extracted?
Your orthodontist may decide to extract teeth for a variety of reasons. Common reasons for extracting teeth are to provide space to align crowded teeth and improve facial balance. If your orthodontist wants to extract teeth, he or she will usually plan to close the spaces by the end of treatment. When teeth are extracted for orthodontic treatment, the recovery period is typically about 2-3 days.

When can I start seeing changes?
Many patients will begin noticing changes within the first 4 to 8 weeks, with some patients reporting changes in as little as 2 weeks.

What is an orthodontic adjustment and how is it done?
When patients talk about getting their braces “tightened,” they are usually referring to having their braces adjusted. In the old days, archwires were very stiff. Every time the patient came in, the orthodontist would remove the wires and either adjust them before placing them back in the mouth, or change the wires completely. The stiff wires would put high amounts of pressure on the teeth and cause the patient to be very sore.

With the evolution of new materials and superelastic wires that deliver light, continuous forces, wires are changed less often, often with minimal patient discomfort. Sometimes, adjustments may only consist of changing the elastic ties around the brackets, or with self-ligating brackets just checking to make sure treatment is progressing properly.

What are elastics and what do they do?
Elastics are removable small rubber bands that are worn to move your teeth in ways braces alone cannot. Elastics are used most often to correct bite problems. If you need to wear elastics, your orthodontist will tell you how to put them on, and whether you have to wear them all the time or only at night. Make sure you wear the elastics as directed by your orthodontist or your treatment may not progress.  Read more about elastics and other braces parts.

Why are braces making me have spaces that I didn’t have before?
In order to straighten your teeth, your orthodontist will likely put in a small, flexible wire. This flexible wire is good at making space to unravel your teeth. However, sometimes, the wire works too well and ends up making too much space for the teeth. If this happens you may see spaces. Not to fear, if your orthodontist made those spaces, he/she will be able to close those spaces as your treatment progresses. If you start seeing spaces you don’t like, tell your orthodontist and he/she may be able to do something to minimize the spaces from getting larger.

Why do some patients have braces for four to five years?
Most likely, the patient’s treatment was planned for a shorter time period. Things that commonly lead to longer than anticipated treatment times are:  broken brackets or appliances, bad oral hygiene, slower than normal tooth movement / slower than normal tooth eruption, poor patient cooperation, multiple missed appointments, and switching orthodontists.

Please note that these variables are out of the orthodontists’ direct control. When the orthodontist gives you an estimated treatment length, he/she is assuming that you will take care of your braces, show up regularly to your appointments, and wear elastics as directed.

What is serial extraction and why is it done?
If there is not enough space for the permanent teeth to grow in properly, the orthodontist my recommend removing some baby teeth first, followed by permanent teeth later. This is usually done only for severely crowded cases. Serial extraction allows more space for the remaining permanent teeth to erupt and in most cases leads to easier treatment later.

Can I get my braces off sooner?
Unfortunately, orthodontic treatment time is limited in part to how quickly or slowly your bone can remodel, thus allowing your teeth to move. In younger patients with less-developed bone, teeth tend to move faster than in older patients with more-developed bone. Some patients think that if the orthodontist “tightens” the braces more, the teeth will move faster. Indeed, the teeth need force in order to move. However, there is an optimal force that moves teeth, and increasing the force level after the optimal level has been reached may actually cause damage to the bone and surrounding tissues, and may slow down tooth movement. The best way to ensure that your braces come off on time is to not break anything, wear your elastics and other appliances as prescribed, and keep your teeth and gums healthy.

Is orthodontic treatment for adults different than treatment for children and teens?
Yes and no. Orthodontic treatment is similar because the braces and appliances used to move the teeth are similar. However, due to adult bone being more mature, treatment may take longer. Adults may be missing teeth or have worn down teeth so involvement with the restorative dentist may be needed to plan the final positions of the teeth and spaces. Also, adults are more likely to have damage to their gums or surrounding bone structures and may need to see a gum specialist before orthodontic treatment can begin. In kids, modifying jaw growth will help correct bite problems. However, in adults, because there is no growth, jaw surgery may be needed to correct severe bite problems.

I need implants or a bridge to fill in spaces of my missing teeth, but my dentist says I need to have orthodontic treatment first.  Why?
When teeth are missing, it is common for the remaining teeth to drift or tip into the space. This often creates a problem for general dentists because the uneven spacing is not ideal to place a restoration. Orthodontics can improve the spacing, align the remaining teeth, and correct any bite problems so that an ideal final restoration can be placed.

My orthodontist wants to slenderize my teeth.  Is this safe?
Interproximal reduction (IPR) is the removal of small amounts of outer enamel tooth surface between two adjacent teeth. It is a means to acquire additional space to create ideal tooth alignment. Alternative names include: slenderizing, stripping, enamel reduction, and reproximation.

Generally, interproximal reduction will not lead to an increased risk of tooth decay or gum disease. Some patients may experience sensitivity to hot or cold. Overall, this procedure is a very safe and effective means of creating ideal tooth alignment.

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