What is orthodontics ?
Orthodontics is the branch dentistry specialising in the diagnosis, prevention and treatment of dental and facial irregularities in children and adults in order to achieve improved appearance and better function. The technical term for orthodontic problems is malocclusion, which simply means bad bite. The science of orthodontics is concerned with genetic variation, development and growth of the facial tissues, and the manner in which these factors influence the bite and alignment of the teeth, as well as the health of their associated organs.

The practice of orthodontics requires professional skill in the diagnosis and identification of facial disharmony and dental abnormality; as well as the design, application and control of a wide range of corrective appliances or braces that can bring teeth, lips and jaws into proper alignment and achieve facial balance for a lifetime of beautiful healthy smiles.

It has been proven that improvements in personal appearance contribute to greater mental and physical well-being. Creating a beautiful smile through orthodontics is a reliable way of improving the health of your teeth as well as your self-esteem. In this way, orthodontic treatment can benefit social and career success, as well as improve one’s general attitude toward life.

If left untreated, crooked teeth could lead to an improper bite, tooth wear, tooth injury and even tooth decay and gum disease. Crooked teeth can also lead to a decrease in one’s personal self-confidence. Treatment by a specialist orthodontist to correct the original problem is often less costly than the additional dental care required to treat more serious problems that can develop in later years.

In many cases, your orthodontist will need an opportunity for a careful and meticulous study of the records he has taken in order to arrive at a considered decision regarding your treatment plan.

What is an orthodontist ?
A British-trained specialist orthodontist is a highly trained professional who has completed a five-year university dentistry degree course to obtain a dental qualification; then worked in various branches of dentistry to gain a broad working knowledge and experience of its different fields; and then completed an approved three-year full-time university or hospital postgraduate orthodontic training programme to achieve higher qualifications.

This advanced training includes subjects such as growth and development, genetics, biomechanics and anatomy; as well as clinical skills in the design, application and control of corrective appliances or braces.

Orthodontics has long been a specialised discipline, though general dentists are also legally entitled to perform procedures in any branch of dentistry. However, specialist orthodontists are the most highly trained experts in the field of orthodontics.

Our specialist orthodontist Dr Sunil Hirani treats orthodontic problems only. He is on the Specialist Register of the General Dental Council; as well as being a member of the British, European and American Associations of Orthodontics, the British Lingual Orthodontic Society and a Fellow of the World Federation of Orthodontists.

What types of braces are there?

FIXED BRACES:
These are the most common type of orthodontic brace. Most patients require the use of fixed orthodontic appliances (‘train tracks’) to have really straight teeth, and achieve the best possible improvement of their smile. Small precisely designed buttons called brackets are stuck/bonded to each tooth. Sometimes rings called bands are also fitted around the back/molar teeth. The brackets are then connected to each other using a thin wire, called an archwire. The wire is held in place with small elastic rings called modules, or with very thin wires called ligatures. The wires are adjusted at regular intervals to straighten the teeth and correct the bite.

With fixed braces, there is no plastic in the roof of the mouth. This means speech is unaffected and the flavour of food can be enjoyed fully. As the appliance cannot be removed, it acts full-time, and so it is very effective.

Fixed braces are very good at achieving fine detail, and making the smile look really perfect!

Fixed appliances, by definition, cannot be removed by the patient. The simplest way to think of each bracket is as a handle with which it is possible to control each tooth individually and precisely. The brackets are highly sophisticated as every tooth has its own bracket design engineered to achieve correct position and angle of axis.

As we have already mentioned, in the early part of treatment, a thin archwire is fitted to link up all the brackets. Because the teeth are irregular, the wire has to bend up and down or in and out between the teeth.

This is the clever bit: the wire, a bi-product of NASA research, has perfect shape memory and will gradually return to its original shape, bringing the teeth with it. As treatment progresses, stiffer wires are fitted and these act as a

monorail. At this time, tiny springs and elastics guide the teeth.

There are different types of fixed brace, and subject to the right clinical indications Dr Sunil Hirani is pleased to offer them all in our practice.

STAINLESS STEEL FIXED BRACES:
The brackets in these fixed braces are made of metal. Modern brackets are quite small, and they cover a relatively smaller area of each tooth, making braces more attractive than they used to be. These conventional braces are very practical, reliable and relatively fast-acting.

COLOURED BRACES:
These are basically the normal metal brace, but the modules used to hold the archwire in place come in a multitude of colours to make the wearing of braces more fun. These colours can be changed at every appointment.

TOOTH-COLOURED, CLEAR OR CERAMIC BRACES:
The brackets are made of ceramic or plastic; they are translucent or the same colour as the teeth, making them much less noticeable than metal brackets.

REMOVABLE BRACES:
Sometimes fixed braces are not the ideal appliances to bring about the required changes to the bite, and a removable brace has to be used. A removable brace consists of a plastic base and custom-made metal wire components. Some of these wires are designed to keep the brace secured to the teeth.

A removable brace simply clips onto the teeth, and can be easily fitted or removed. Its insertion or removal does not cause any pain.

FUNCTIONAL/ORTHOPEDIC BRACES:
A functional appliance is a functional brace that is worn on the upper and lower teeth at the same time in order to correct the way upper and lower teeth fit over each other. For example a functional brace may be used to correct very protruding upper or lower front teeth, improve the way molar teeth bite together, or even improve your facial profile so that the jaws look more aligned with each other when you look at the face in profile.

Functional braces only work in growing children and adolescents. Research is still being carried out to evaluate exactly how functional braces work. It is thought that functional braces deliver their effects through a combination of ways. They may promote or modify growth of the jaws, adapt the soft tissues and muscles of the face to new positions, move whole groups of teeth at the same time or change the angulation of teeth.

Depending on the condition of the bite, functional brace treatment starts either at an early age when milk teeth are still present (age 7-10), or around the time of the pubertal growth spurt (age 11-14) when all or nearly all the milk teeth have been shed.

HEADGEAR:
Headgear is being used less and less by orthodontists these days; but its use is still necessary in a small minority of cases. Headgear is worn to move the back teeth further back in order to create extra space; or to stop the back teeth from moving forwards and keep them in their present position, whilst the front teeth are being straightened. Headgear also helps you achieve the best possible bite between your upper and lower teeth.

RETAINERS:
Retainers are appliances that maintain and hold the alignment of your teeth and the improvement of your bite after the completion of active orthodontic treatment. They are usually passive and are not designed to move teeth. Even after orthodontic treatment, your teeth can lose their alignment throughout growth and even in adulthood. For example, most people notice increasing irregularity of their lower front teeth with age. Retainers are designed to prevent such undesirable changes.

Retainers are either removable or fixed to your teeth. Removable retainers can be made either from wires and hard plastic (where you only see a thin horizontal wire on the front of your teeth), or from soft clear plastic (which fits over your teeth a little like a mouthguard).

Fixed or bonded retainers are made from a fine piece of special wire that is stuck to the back of the teeth so that it is not visible from the front. Having taken various factors into consideration, your orthodontist will determine which retainer or combination of retainers is suitable for your teeth.

How to survive orthodontics

TEAMWORK:
Orthodontic treatment is an ongoing process, and most of this happens when you are not in the surgery! Teamwork between you, your orthodontist and the staff is essential.

What can you do to help?

• Follow the dietary advice
• Broken brackets? This can lead to longer treatment time.
• Do as your orthodontist instructs. At various stages you may be asked to wear rubber bands. If you do not wear them as instructed they do not work. This leads to longer treatment time.
• It is vital that you attend all of your appointments, please be on time. If not properly supervised braces can adversely move your teeth which can result in, yes you guessed it – longer treatment time.

DENTAL HEALTH:

• Clean your teeth after every meal using a regular toothbrush and an inter-dental brush or TePe brushes.
• Use Oral B Superfloss. Your regular floss is not suitable whilst wearing braces.
• Use a fluoride mouthwash, for example, Colgate Fluoriguard.
• Continue to see your dentist for regular check-ups.
• See your dental hygienist on a regular 3-6 month basis.

STARTING YOUR ORTHODONTIC TREATMENT:

Your braces may cause some discomfort for the first few days after they are placed and after some of the subsequent adjustments. A softer diet for the first few days, such as: pasta, rice, mashed potatoes, scrambled eggs etc. will be easier to manage.

There are no emergencies with Orthodontic treatment.

What to do in case of:

• Sore teeth : Whatever pain relief medication you would usually take.
• Brackets that are scratching/poking : Use the dental wax provided. This is free from reception.
• Broken bracket : Brackets do not break if you follow the dietary advice. However, should this happen, please call the practice. If the bracket is hurting you one of the dentists will see you to make you comfortable, if it is not hurting it can be left as it is. The bracket will only be replaced at your next orthodontic appointment.

SPEECH PROBLEMS:

If the option you have chosen is the Incognito, lingual brace, your speech could be affected for the first couple of weeks. Speak slightly slower, but the more you speak the quicker you will retrain your tongue to accept this “invasion of the braces” and normal speech will be resumed!

DIETARY ADVICE:

• Eat a softer diet, what can be squashed between your fingers can be eaten!
• Absolutely no nuts, toffees, chewing gum.
• Avoid hard and sticky sweet foods.
• Hard fruit – apples etc. slice rather than bite into the whole fruit.
• Raw carrots – can be eaten if grated.
• Be careful with hard breads such as ciabatta rolls, French bread, pizza crusts, corners of toast etc.
• Avoid sparkling and acidic drinks.

Curries, red wine etc can stain the white elastics sometimes used with the white ceramic braces. We have found that using whitening toothpaste does help to minimize this. We can sometimes use an alternative to the white elastics – please speak to Dr Hirani if your staple diet includes curries on a regular basis.

We hope this information helps you adjust to life with braces.

It is the first step towards your ultimate goal of a healthy, stable and beautiful smile that will last for the rest of your life.

If there are any questions you may have during the course of your treatment the staff here will be happy to chat to you.