Orthodontic Braces : Part 2

by Food and Drug Administration (FDA)

(Page 2 of 2)

Another development has been "space age" wires. These wires, made of nickel titanium alloys developed through the NASA space program, hold their shape better than stainless steel wires. As a result, they require fewer replacements and trips to the orthodontist, often shortening treatment time.

Other appliances include "elastics," small rubber bands that apply extra pressure between the jaws. "Headgear," which fits around the head or neck, helps move jaws into a new position, and "functional appliances," worn sort of like a football player's mouth guard, help align jaws and chewing muscles. "Retainers" help keep teeth straight after treatment. Special-purpose appliances can correct specific problems, such as the roof of the mouth being too small. Most patients wear a combination of two or more appliances over the course of treatment.

Some patients can even make a fashion statement with their braces, getting multi-colored ligatures — the small wires or elastics that hold the arch wires to the brackets. Elastics and retainers also come in an array of colors. It's even possible to put a logo or mascot on a retainer.

The latest development, although not widely used, is magnets attached along the archwire to the upper or lower molars. Encased in stainless steel and placed with opposing or attracting forces, the magnets can help create or close spaces between teeth. In some cases, they can replace headgear, one of the most conspicuous orthodontic appliances.

FDA reviews all new materials and orthodontic devices before they go on the market. Manufacturers must file a pre-market notification, showing through laboratory or clinical tests that their device is substantially equivalent to others already in use. Most older orthodontic devices were already on the market in 1976, the year device regulations went into effect. Unless FDA receives evidence to the contrary, those devices are assumed to be safe and effective.

Keeping Braces Clean

Perhaps the biggest challenge of living with braces is keeping them clean. The nooks and crannies formed by braces create ideal hiding spots for bacteria that lead to cavities and gum problems.

Patients who don't take care of their teeth risk even more dental decay than they would have without the braces.

"This is a problem especially for patients around 11 and 12 years old," says Singleton. Flossing and brushing for them is often not a priority, he explains.

Orthodontic patients should brush thoroughly after every meal and before bed. Flossing is more of a challenge because the wires make maneuvering difficult. A floss threader, available from an orthodontist or pharmacy, helps the floss slip behind the archwire and get to the gums.

Certain foods can damage braces. Sticky food, hard food, crunchy food, and sweets are the four troublemakers for those who wear braces.

Sticky foods like gum, taffy and caramels can loosen cement and damage the brackets. Hard food like apples and carrots must be cut into bite-sized pieces so they won't break appliances. Crunchy foods like corn chips, popcorn and nuts should be avoided for the same reason. And sweets, because they feed bacteria when caught between braces, should be avoided as much as possible. Teeth should be brushed soon after eating sweets to prevent decay.

In fact, many orthodontists say that much of the success of braces depends on the willingness of the patient to stay away from harmful foods, keep teeth clean, and wear appliances faithfully.

What Cost Beauty?

The cost of braces varies with the patient, but typically treatment runs from $1,800 to $4,500. Some insurance plans cover a portion of the cost.

"It wasn't as high as I'd expected," Wanda Brown remembers. "I guess I thought we'd have to sell the house to pay for it. The cost was absolutely worth it — without question."

Aside from cost, braces can be physically uncomfortable. A day or two of soreness is not unusual after every visit to the orthodontist because of adjustments to the archwire. Also, some patients must have teeth extracted to make room for others.

Fifteen-year-old Michael Brown, for example, had to have 11 teeth extracted before getting braces. Most of them were baby teeth that hadn't come out on their own.

"That was pretty painful," he remembers. "Compared to that, the braces weren't bad."

In addition to pain and expense, orthodontic patients must keep track of extra equipment daily. Elastics, retainers, headgear — school lockers are full of orthodontic devices. More than a few teens make the mistake of wrapping their retainers in paper napkins while they eat and then accidentally tossing them out.

"We've been through a few restaurant trash bins," Brown remembers.

Did they find the missing retainer?

"Oh yes!" she says. "I'm sure some people thought we were crazy, but we always searched till we found it."

Braces: Not Just for Kids

Just because braces weren't fashionable or affordable when you were a kid doesn't mean you have to go through life with a major malocclusion.

In 1979, 17 percent of orthodontic patients were adults. By 1992, that number had risen to 23 percent. Of those, 70 percent are women.

Orthodontists have made adult braces more palatable by fashioning them out of plastic and ceramic, which are clear or tooth-colored. Some appliances can fit on the inside of teeth, completely out of sight. Called "lingual braces," these devices may not be appropriate for everyone. They are not as strong as traditional braces so they usually have to be worn longer. They are also more difficult to adjust, and they can be uncomfortable because the patient's tongue hits them.

FDA has found new appliances to be substantially equivalent to older stainless steel brackets. Many of them, however, are more expensive.

Nevertheless, braces are increasingly popular among adults. They have even gotten good press from famous patients: Cher, Diana Ross, and Phyllis Diller have all sported "tin grins" and beautiful smiles later.

About the Author

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FDA is A United States government body that oversees medical devices, including contact lenses, intraocular lenses, excimer lasers and eyedrops. In the US, these products must be approved by the FDA before they can be marketed.