Braces : Crooked Teeth - Part 2, Straightening Options

by Food and Drug Administration (FDA)

(Page 2 of 3)

For complete invisibility, braces can be fitted onto the inside of the teeth. These "lingual braces" have limitations, says Joondeph. "They can be tougher on a patient. They affect speech more and may irritate the tongue." Treatment times may also be longer than with standard braces, he says, adding that patients should talk with their orthodontists to find out if lingual braces or other options are appropriate for them.

Innovations in materials and designs have brought braces a long way since the "tin-grin" look of the past, but one thing that hasn't changed significantly is the length of time they are worn. "It's important to move the teeth gradually," says Runner. "If you move the teeth too fast, it can result in severe loosening of the teeth or tooth loss."

Braces, on average, are left on between 20 and 24 months, says Joondeph.

To keep teeth straight after braces are removed, people must wear retainers. These appliances hold the teeth in their corrected position until the bones grow around the teeth to stabilize them. Since teeth tend to shift as a person ages, wearing retainers periodically may be a life-long requirement.

Retainers can be all plastic, or plastic with some metal wire. They are either fixed permanently in the mouth or are removable. Like braces, retainers come in different colors and designs. They can be roof-of-the-mouth pink or personalized with such items as sports team logos, pictures of pets, or a person's or orthodontist's phone number in case of loss.

The FDA's Role

Braces, retainers, and other orthodontic appliances are classified as medical devices, which are regulated by the FDA. "Any innovative orthodontic devices or materials require FDA review before being allowed on the market," says Runner. In this way, the FDA can assure that any new devices or materials, including bonding agents and color dyes, are safe and effective.

Some older orthodontic appliances are exempt from review because they were already on the market in 1976, the year medical device regulations went into effect. "But medical device manufacturers are still required to register with the FDA and are subject to inspections," says Runner.

As with all medical devices, braces are not risk-free. The FDA has received reports of adverse events ranging from teeth broken during bracket removal to allergic reactions involving archwire and bracket materials.

"If you're going to have an allergic reaction, it will usually be to the nickel in the wires," says Pracht. Orthodontists can fit patients with titanium wires and brackets that don't contain nickel, he says.

And as for the risk of locking braces when kissing, Pracht says it only happens in the movies. "In my 33 years of practice, I've never seen it."

A Commitment

Having braces or any other orthodontic appliance requires more frequent brushing, flossing, and general care. "Orthodontics is a serious treatment commitment," says Janie Fuller, D.D.S., M.P.H., a regulatory review officer in the FDA's Office of Surveillance and Biometrics.

"If you have poor oral hygiene, you are trading one problem for another," adds Joondeph. "Your bite may be better and your teeth straighter, but there will be significant decay."

People with braces must avoid "hard, sticky, or gooey foods," says Joondeph, such as jawbreakers, peanuts, ice cubes, caramel, and taffy. These foods can break brackets, bend wires, or get caught in the braces, causing cavities.

Fuller advises parents to clean the teeth of young children. "Children shouldn't be expected to have the dexterity to clean their teeth properly until at least 8 or 9 years old, and parents need to help even without braces," she says.

And older children must want the braces and be willing to make the commitment to their care. "The work you have to do to take care of your mouth is too hard if you don't really want braces," says Fuller. "It's not just something that you have done to you — it takes a partnership with your orthodontist for it to work."

Joondeph uses a "combination of education and prodding" with children who are reluctant to get braces. "One option is to try to convince the child it's in their best interest in the long-term. We can also try to come up with a treatment plan that would expedite treatment." There's always the option of treatment later as an adult, but by then the jaw has stopped growing and some bite problems can be corrected only with surgery, he says.

Another Straightening Option

An alternative to braces, Invisalign, was cleared by the FDA to straighten crooked teeth in people who have all of their second molars, permanent teeth that usually come in by the late teens. Invisalign uses a series of clear removable aligners instead of wires and brackets. An orthodontist takes impressions of the teeth and sends these models to the maker of Invisalign, Align Technology Inc., of Santa Clara, Calif. The company uses a computer-generated simulation of the desired movement of the teeth to custom-make the aligners for each patient. Each aligner is worn for about two weeks.

The aligners are removable for eating, brushing, and flossing, so unlike people who wear braces, Invisalign-wearers aren't restricted from eating hard or chewy foods. But they still must visit their orthodontist every six weeks during treatment to ensure proper progress.

The total treatment time with Invisalign averages between nine and 15 months and the average number of aligners worn during treatment is between 18 and 30, according to Align Technology. For some people, a combination of braces and Invisalign is successful, requiring less time in traditional braces.

"Invisalign is intended to have the same function as braces in terms of gradual tooth movement," says Runner. But the device is not for everybody. "It depends on the extent of the orthodontic problem, and it is not intended for younger children," she says.

"They have a place in the spectrum of orthodontic treatments for mild to moderate cases," Joondeph adds. "But they can't give us the sophisticated tooth movement and control of braces."

About the Author

www.fda.gov
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.