Common Orthodontic Issues

Introduction

What are orthodontics?

Orthodontics are a branch of dentistry that deals with irregularities of teeth like malocclusion and their correction by braces.

Common orthodontic issues

Good oral is not just a means to keep your teeth clean and cavity-free. Make sure your teeth should be properly aligned, if misaligned teeth are present that are not treated, it can lead to a variety of mouth problems like jaw problems, pain, chewing and speaking. It may even be a risk of disease and infection.

Malocclusions

A disruption of this alignment and incorrect relation between the upper and lower teeth is called malocclusion. Malocclusion has been separated 3 classes:

Class 1: in this malocclusion, the teeth are overcrowded or unevenly spaced, but both the upper and lower teeth properly overlap. This is the most common and least severe type of malocclusion.

Class 2: this malocclusion is classified as severe overbite— the upper jaw and teeth significantly overlap the lower. This class of malocclusion is called retrognathism.

Class 3: in this malocclusion, the lower jaw and teeth significantly overlap the upper. It is classified as a severe underbite. It is known as prognathism.

After three classifications, it still has several subdivisions of malocclusion. They are given below:

Jaw issues

Overbite: it is known as overjet. The upper jaw overlaps the lower, causing the teeth to protrude. The gap between the upper and lower teeth is about 1—3 mm. Causes of overbite are thumb sucking, bottle feeding, constant grinding of the teeth, and excessive nail biting.

Orthodontic treatments like braces, clear aligners, or dental appliances used to align the teeth. Slight overbite doesn't require treatment. 

Underbite: the lower jaw extended outwards or overlaps the upper teeth is called underbite. Causes of underbite are mostly genetic and excessive growth of the lower jaw. It may affect biting, chewing, and the ability to properly break down food.

Braces, dental appliances, headgear or reverse pull facemask to gradually shift the position of your jaws and teeth.

Crossbite: the upper teeth sitting inside the lower teeth when the jaw is closed. This may cause misaligned jaw growth that leads to difficulties in biting and chewing. Caused by a combination of genetics and abnormal jaw growth, often it worsened by the habits of thumb sucking and excessive use of pacifiers.

Orthodontic treatment for crossbite braces, specialised expanders or dental appliances to align the both upper and lower jaw.

Open bite: when the upper incisor (front teeth) and lower incisor don't meet and the gap occurs when the mouth is shut called an open bite. It may cause tongue thrusting, and potential speech issues.

Orthodontic treatment for open bite involves braces, dental appliances and a clear aligner that helps to align both the upper and lower jaws.

Crowding

When the jaw lacks space and all the teeth are not placed properly or aligned in the jaw. It may occur because of disharmony, or teeth are larger than the available space.

Some signs indicate to dental crowding:

• Crooked teeth
• Bleeding gums
• Crossbite
• Jaw pain
• Teeth overlapping
• Discomfort while eating

Causes of crowding

• Genetics
• Cleft palate
• Jaw problems like tumours and dislocation
• Any kind of mouth fracture or maxillary fracture

Spacing Gaps between the teeth but not caused by the missing teeth, called spacing. In dental terms, it's known as ‘diastema’.

Reasons for spacing issues

• Genetics
• Thumb sucking
• If you have a thick band of gum tissue(between the lips and gum bone) called frenum that can cause gaps in frontal teeth
• Jaw enlargement
• If your teeth are smaller than the jaw

Misalignment

Crooked Teeth—it is known as a dental crowding or malocclusion. Crooked teeth is a medical name. Teeth do not fit in the jaw properly and the result is crooked teeth because lack of space. It comes under misalignment.

Here are some causes of misaligned teeth:

Genetics

• Abnormally shaped teeth
• Birth defects of the jaw
• Extra teeth
• Impacted teeth, like wisdom tooth

Losing teeth

• Baby loses teeth early
• Losing a permanent tooth that leads to shifting all the teeth

Dental treatment problems

• Ill-fitting dental crowns, and dental fillings
• Appliances like braces, retainers and mouthguards are not fitted properly

Genetics

Perhaps this is the most common cause of orthodontic issues. Modern human mouths are smaller than evolutionary forefathers, not everyone has enough space for his/her dental arch to fit all 32 teeth properly. So results are crowded teeth and misalignment.

Habits

• Thumb-sucking
• Mouth breathing
• Prolonged pacifier use
• Early Loss of Primary Teeth
• Tongue thrusting is the cause of orthodontic issues too

Orthodontic treatment options

If you have crooked teeth, malocclusion or misalignment jaw then you require orthodontic treatment. It is a way to straighten or move your teeth, to improve their appearance. It helps the long-term health of your gums and teeth.

Components 

Bracket adhesion: made of ceramic, plastic or stainless steel glued to teeth after dried and cleaned thoroughly. They are not painful.

Bands: When the brackets are fixed to the teeth, elastic bands known as O-rings or ligatures are attached.

Spacers: Helps to lift your jaw by expanding your oral cavity. If your mouth is too small, metal or rubber bands are used to create space. 

Archwires: Are available in stainless steel, nickel-titanium or copper titanium. It is used to join the tooth brackets together.

Buccal tubes: Brackets and wires of the braces are firmly held by buccal tubes at the back molar of the mouth.

Springs: Braces may be supplemented by a coil spring. It works like gentle pressure on the area between two teeth, which forces it to create a space.

Facebow headgear: It is a band used to provide additional force to the teeth to achieve the desired correction.

Mechanisms

The periodontal tissue is a connective tissue which helps to hold the jaw in the proper place and prevent tooth damage. Once your teeth are placed in the right position, the osteoclast will be dissolved by the continued pressure that is applied by the braces. 

Duration of treatment

It depends upon the tooth position or alignment of the jaw and the requirement of treatment. if you have large teeth gaps then your teeth need to move a lot, so the treatment process may be closer to the 3 yrs estimate.

In bite correction treatment then you add more time to wear the braces. Correcting jaw alignment takes too much time, completed by using rubber bands, jaw expanders and headgear braces.

Mostly we can say the treatment of orthodontics takes time between 6 months to 30 months, as there are common and complex cases.

Orthodontic appliances

Retainers

Custom-made device. It helps to keep your teeth in their position after braces treatment. You wear it in your mouth over your teeth.

They are commonly used after braces so that the bone that holds the teeth can rebuild after the teeth have moved. It helps to maintain the new position of the teeth after braces.

In some cases, a gap is present between the 2 teeth then they can be treated by retainers only. The tongue thrusting case has also been treated by retainers which are specially designed to train your tongue not to move forward while speaking. If your child has bruxism(grinding teeth) also corrected by retainers.

Expanders

Palatal expanders are an oral device. It fits in the roof of your mouth which helps to widen a narrow upper jaw.

• Crowded teeth
• Overlapping teeth
• Crooked teeth
• Impacted teeth
• Difficulty chewing

Palatal expanders 

Removable palate expanders

Look similar to retainers. Made from acrylic. This expander is used to widen your upper jaw a little bit.

Rapid palate expander

This fits in the roof of your mouth, attached to your back upper teeth for stability. There’s a tiny screw in the mid part of the retainer, that you turn a little bit every day with a special palate expander key. it can widen your jaw by 0.5 mm per day.

Surgically assisted rapid palate expander

It is often used for moderate to severe cases. When your facial bones are fully developed then an oral surgeon places this expander on mid-palatal suture (the line where the left or right side of the palate meet). It is similar to a rapid expander, placed on the roof of your mouth to attach with the back upper teeth for stability. Need to activate your expander a little bit every day to achieve the desired width.

How to prevent from long-term complications 

Avoid chronic oral habits

Chronic habits like thumb sucking, use of pacifiers, and bottle feeding, cause oral health complications. Active habits cause misalignment and affect the roof of your mouth. They may cause orthodontic problems like speech problems, malocclusion and facial development. It is good to speak to your orthodontist to prevent your child's oral health and which time is good to avoid all the habits.

Maintain good oral care

Daily brushing and flossing need to be done. If your child is not doing that then he will get tooth decay or gum problems. In early age, if a tooth is lost from decay, then space will be created because a permanent tooth won't erupt again. It causes orthodontic issues. To prevent your child's oral health from deteriorating, it is good to speak with a pediatric dentist.

Be aware of mouth breathing

Chronic grinding at night, mouth breathing and snoring are an indicator of breathing problems. These problems are typically caused by a narrow palate or malocclusion. Sometimes they are congenital and sometimes use a pacifier or thumb sucking. Early ortho treatment with a palate expander can help to open the airways, creating more space to erupt the teeth in the mouth for better sleeping.

Space maintenance is a key

Some children lose their teeth prematurely because of trauma or excessive tooth decay. This disrupts the natural timing of tooth loss and eruption. Results are teeth shifting and lots of space for future eruption.

Many space maintenance are available like transpalatal arch, nance appliance or lower lingual arch appliance. You can ask your dentist to avoid long-term orthodontic issues.

Orthodontic care and maintenance

Follow-up appointments

It is important because your dentist has a particular plan and he needs to see you to make sure everything is going right according to his plan.

Teeth move roughly 1 mm per month so your dentist should know about you and your teeth to handle the pressure. 

Number of different possibilities, during the visit to your orthodontist:

• Changing the archwire
• Adding or changing elastic 
• Replacing rubber bands
• Adjusting or tightening ligature wires

Oral hygiene practices

• Use soft bristle toothbrushes that don't harm the braces
• Self-threading floss
• Interproximal flossers help to remove debris
• Mouthwash
• Dental checkups 

Dietary considerations

• Avoid chewing gums (sticky thing)
• Avoid hard bites like apple, pear and carrot bite
• High food in sugar should be avoided
• Avoid nuts and seeds
• Avoid chips and hard-shell tacos
• Avoid eating hard cookies

Summary

A dentist only can see your mouth's diseases like tooth decay, gum problems, debris formation etc. but the orthodontist will focus on malpositioned teeth and jaw, planning on how to prevent and cure your teeth. 

Orthodontic treatment: Helps to correct your crowded or misaligned jaw, and give a normal bite and a new smile. any causes of orthodontics issues like thumb sucking, tongue thrusting, and use of pacifiers.

Which are corrected by orthodontic appliances. 

Metal braces, clear aligners and retainers come into the orthodontic appliances. During treatment, ensure the maintenance of your oral hygiene with the help of brushing, flossing, interdental brushing and mouthwash.

Follow-ups to your orthodontics are also very important during the treatment because movement in your jaw and teeth will be observed by your orthodontics. It is necessary, as it provides confidence and a nice smile.