Orthodontic Braces: Perfect Smile Replaces Tin Grin

by Food and Drug Administration (FDA)

When her four children, ages 9 to 16, all had braces at the same time several years ago, Wanda Brown of Knoxville, Tenn., always knew what she'd be doing on her days off work.

"I knew it was Tuesday because we were at the orthodontist," she says with a laugh.

Today her children smile at the results of all those appointments: The three oldest have straight, perfect teeth, while the youngest has had some treatment but still awaits full braces.

"I really wanted braces," says daughter Diana, 17. "I'm glad I had them because I feel a whole lot better about myself. I'm always smiling now."

Years ago, few teens had such a positive attitude about braces. Orthodontic appliances triggered taunts like "metal mouth" and "tin grin." But today, braces are almost a status symbol among middle-class American teenagers. About 3 million teenagers in the United States and Canada have braces, an increase of about 30 percent in the last 10 years, according to the American Association of Orthodontists.

Teeth aren't any more crooked than in the past. It's just that more teenagers want the perfect smiles that braces can give them, and more parents are willing to foot the bills. Today there are more orthodontic devices than ever before, allowing more choices in how braces look and how long the patient must wear them.

"In general, people get braces for aesthetic reasons," says D. Gregory Singleton, D.D.S., a senior dental officer with FDA's Center for Devices and Radiological Health and an orthodontist in private practice.

"But that doesn't mean they won't get a functional benefit in the process," he adds. A better bite and fewer jaw problems are often the byproducts of what begins as a cosmetic procedure.

The Crooked Smile

Anyone who's spent time in an orthodontist's chair has seen pictures and plaster molds of the "ideal" mouth. The top front teeth extend over the lower front teeth slightly, while the molars line up and meet on both sides of the mouth, top and bottom. The teeth are straight and not crowded, spaced close together like a string of pearls.

But in most mouths, variations on this theme are more common. Some problems affect chewing or speaking, but most are simply cosmetic issues.

Improper tooth alignment is called malocclusion. Malocclusion is not a disease, but crooked teeth can decay faster than straight ones because people have more trouble keeping them clean. Severe misalignments may require extra flossing and brushing. But malocclusion doesn't always cause jaw problems or pain, and many people have lived long and healthy lives with misaligned teeth.

Nevertheless, malocclusions can be embarrassing. There are three types of malocclusions, plus a number of other bite problems. The malocclusion types are:

Class I: Teeth line up correctly top to bottom, but they are spaced too far apart or are crooked, crowded or turned.

Class II: Upper teeth protrude and the lower teeth are too far back. This is also called an "overbite."

Class III: Lower teeth are too far in front and the upper teeth are too far back. This is also called an "underbite." This is the most difficult problem to correct, says Singleton, and may require surgery.

Other orthodontic problems include:

Open bite: Front teeth stay open even when biting down with back teeth. This can make chewing food difficult or impossible.

Closed bite: When biting down, upper teeth cover the lower teeth completely. This is also called a "deep bite."

Cross bite: When biting down, some upper teeth close inside or outside lower teeth.

Causes

Bite problems stem from a number of causes. Most are inherited, but others are behavioral.

Habits such as a reverse swallow, tongue thrust, or sucking the thumb, fingers or the lower lip can apply pressure to teeth. Over time, teeth spread. If these habits aren't corrected before treatment, the teeth may spread even after the braces are removed.

Babies who suck their thumbs or pacifiers aren't generally at risk, says Singleton. As long as they break those habits by age 5 or 6, they usually don't cause malocclusion in their permanent teeth.

Baby teeth can greatly affect the look and health of permanent teeth. If a baby tooth falls out too early or decays, the other teeth may move to fill in the space, blocking permanent teeth from coming in when they are ready. Similarly, if a baby tooth does not fall out soon enough, the bigger tooth behind it may come in crooked. And if a permanent tooth is lost to decay or trauma and is not replaced, the other teeth will drift to fill up the space, sending them out of alignment.

The size of teeth can affect their alignment as well. Teeth that are too small can drift, and teeth that are too large will crowd. Mouth size can also cause drifting or crowding.

Bands and Brackets

Braces and other orthodontic appliances can solve most bite problems. Braces apply gentle pressure to teeth, moving them slowly over a period of 12 to 36 months. As teeth move, the jaw bones around them grow to fill in spaces left by the tooth roots. The main advancement for braces in the last 15 years has been the elimination of metal bands around front teeth. Today, small brackets are bonded onto the front teeth instead, greatly reducing the "metal mouth" look.

The brackets are tiny devices that attach each tooth to an archwire. The wire acts as a track to guide teeth along. Metal bands are now used only around the back teeth, which are stronger and more difficult to move.

Today's brackets can also be made of more aesthetically pleasing materials. Clear or tooth-colored materials can be used to create almost invisible braces, although they tend to be more expensive and difficult to work with. Some braces can even be hidden on the insides of teeth, although these are much more difficult for the orthodontist to place and adjust. They can also irritate the patient's tongue, which may hit them repeatedly. Most teens and children get stainless steel brackets because they're durable and less expensive than other kinds.

About the Author

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