Dra. Carina de Brito

Dentist

Frequently asked questions in the orthodontics consultation

HPA Magazine 18

Orthodontics is the area of dentistry dedicated to the prevention and correction of the positioning of the teeth and and/or jaws. Orthodontic intervention is extremely important to improve facial aesthetics, muscle and joint function as well as chewing. My clinical practice is exclusively dedicated to this area and in my daily routine I come across doubts and questions from patients, parents and even colleagues. Given this reality, I tried to gather the most frequently asked questions in my consultation, with the purpose of clarifying and encouraging an Orthodontic evaluation and a possible intervention when necessary.

What is the ideal age for a first Orthodontic consultation?
From the age of 6 to7 years, after the first permanent teeth have erupted so that the need for treatment can be evaluated. During this consultation, a clinical examination is carried out, the position of the teeth, intermaxillary relationship, the state of the joints and tissues, as well as the diction and phonetics of the patient are observed. Parents should be especially aware of some situations that can compromise the correct positioning of teeth and/or jaws:
• using a pacifier after the age of 4/5 years;
• sucking the thumb or tongue after the age 
of 4/5 years;
• early loss of a baby tooth;
• children with breathing problems 
(mouth breathing)
• cross bite situations
• phonetic problems; difficulty in pronouncing some words, namely the “ss” sounds.
Are braces advised when there are still milk teeth?
Yes, there are situations where braces are indicated in the first phase of treatment, which we call “interceptive treatment”.
The aim is to: correct skeletal problems (ex: anterior and posterior crossbites), that can condition the correct development of the jaws and, consequently, the position of the teeth, correct bad dental positioning which can prevent the eruption of permanent  teeth or to create the necessary space for the eruption of permanent teeth.
This interceptive phase can minimize the duration and complexity of subsequent orthodontic treatment (permanent teeth) or even avoid it.

Will it be possible to use braces in adulthood?
Yes, any adult can undergo orthodontic treatment. However, many times, due to several conditions (early loss of permanent teeth, gum and periodontal problems, teeth with extensive restorations) orthodontic treatment in adulthood requires multidisciplinary planning and treatment to achieve the best aesthetic and functional results.

How long does the treatment last?
On average, orthodontic treatment in permanent teeth will last for 24 months, but it varies depending on each case’s degree of difficulty and also on the patient’s availability and cooperation. Interceptive treatments are usually shorter.
Are extractions necessary for teeth alignment?
The lack of space and the presence of misaligned teeth does not in itself determine the necessity of tooth extraction. The need to extract teeth is evaluated according to the severity of dental crowding and the patient's facial and bone type. Currently, more and more conservative solutions are sought that allow us to achieve facial and functional harmony.

Is it possible for a patient with periodontal disease to have orthodontic treatment?
The number of adult patients with periodontal disease who wish to undergo orthodontic treatment is increasing. Respecting some limitations, it is possible to improve the level of bone insertion, smile aesthetics, chewing and oral hygiene of these patients. These cases always require a multidisciplinary approach of the various dental specialties.
 What precautions should I take during orthodontic treatment?
The use of braces, whether removable or fixed, requires some care, namely specific oral hygiene and also some dietary care.
Fixed braces retain bacterial plaque, so teeth should be brushed after each meal, using dental floss, interdental brushes, toothbrush and fluoride toothpaste.
All patients are explained on how to perform oral hygiene during orthodontic treatment and, as a rule, they are also provided with an oral hygiene kit containing everything they need.
In the case of removable braces, cleaning brushes and cleaning products are easily available. Correct oral hygiene is extremely important during orthodontic treatment to prevent caries and/or demineralization stains.
As far as food is concerned, it is not necessary to change eating habits, but it is important to be careful.
Particularly when eating some food (raw fruit, nuts, very hard cookies, toast and bread crusts) or food that is difficult to chew, such as toffees and chewing gum, as they can damage the braces.  Unless correct hygiene is carried out, food that can alter teeth enamel such as soft drinks, should be avoided. 

Is it difficult to adapt to braces?
After the placement of braces (fixed or removable) there is an adaptation period of the lips, tongue and diction, which varies a lot depending on the patient, being on average 5 to 7 days.

How do invisible /clear braces   work?
Over time, the techniques and materials used have been improved, in order to meet aesthetic requirements so valued today. In order to promote greater comfort and a better adaptation to patients’ routine, transparent braces emerged.
Treatment with “invisible braces” consists of a set of fully custom-made transparent braces called aligners. The aligners are removable, which facilitates cleaning as well as eating and are tailormade for each patient.
Each aligner should be worn approximately 22 hours a day for a minimum of 7 days. Tooth movement occurs gradually, as each aligner is slightly different from the previous one. In the treatment with aligners, rigorous digital planning is carried out using specific software. There are currently several brands on the market, the best known and most credited being Invisalign® and Spark®.
Transparent aligners have some advantages compared to conventional braces: they are more comfortable, more aesthetic, allow for better hygiene, both dentist and patient are able to foresee and visualize the final result throughout the treatment on the available software. This advanced technology allows for more predictable tooth movement and can help obtain the expected results quicker when  compared conventional orthodontics.

What is the function of retention  devices?
Retention devices are used at the end of orthodontic treatment to maintain the final position of the teeth. As a rule, these appliances do not stimulate teeth movement, but prevent teeth from moving. The fibers that support the teeth are elastic and have memory, and even after using the braces for several months, teeth tend to return to their original position. These devices can be fixed or removable and their use is extremely important in the long term to maintain the results obtained.
Throughout life, teeth undergo small movements, which can be influenced by numerous factors, such as the position of the tongue, the position of the lips, the way we breath and the aging process. Thus, failure to use the retention device correctly will be detrimental to the purpose of the entire result achieved. It is possible that aesthetic and functional changes may occur and the only solution to this problem is to carry out another new orthodontic treatment.

Are there devices indicated for sleep apnoea?
Sleep apnoea is classified as a sleep disorder. Treatment and diagnosis are multidisciplinary. In cases of mild to moderate obstructive sleep apnoea, the use of a jaw repositioning device may be considered, which aims to promote the protrusion of the jaw and consequent opening of the upper airways, that will in turn contribute to an improvement of the clinical symptoms. These devices are also an effective solution to treat snoring.