Braces, an essential element of modern dental care

Many youngsters approaching adolescence have one thing on their minds at a semi-annual dental check up: "will I need braces?" Braces (as well as headgear, bionators, maxillary expansion appliances, etc.) are corrective dental and orthopedic appliances that straighten teeth and can help bring the lips and jaws into proper alignment during growth and development. An orthodontist is a dental specialist who generally performs this type of treatment for what is called dental "malocclusion" or literally a "bad bite". An orthodontist is dentist that has completed an additional two or three year program after college and four years of dental school.

Crooked teeth, those with wide gaps or overlapping, and uneven lengths of the upper and lower jaws, can make a person more susceptible to other dental problems. Crooked teeth can make the cleaning of destructive dental plaque and food debris difficult, leading to a possible increase in both cavities and gum disease. An upper jaw that juts forward can make the front teeth (central and lateral incisors) more susceptible to damage from trauma (an elbow in the mouth during basketball, slipping on an icy walkway, etc.). Both crooked teeth and uneven jaw lengths may contribute to TMJ (jaw-joint) problems, and may also be cosmetically unappealing.


Treatment with braces is accomplished by a series of complex biomechanical mechanisms. Brackets are fastened to the fronts and outer sides of the teeth, and a wire is connected through the brackets. The wire exerts slow but deliberate forces on the teeth, safely moving them through the jawbone. Over a typical course of treatment, eighteen to twenty-four months, thicker wires are used to continue moving the teeth, and prevent them from drifting back to their prior positions. Although braces are less noticeable then they were in the past, teenagers are often self-conscious about sporting that "tin grin". Special braces are available that have clear, rather than metal brackets, and braces can be made to fit on the inside (lingual) surface of the teeth. These lingual braces usually are more uncomfortable than traditional braces, and may take more time to get the required results. After treatment, a retainer is often made to insure that the teeth stay as straight as they were when the braces were removed.

What most parents want to know is, "when should I take my child to the orthodontist?" and "does my child need braces?" Your family dentist should be able to help you answer both of those questions when you bring your child for a dental visit. Although most children are advised to have braces when they are between the ages of eleven and thirteen (when most or all of their baby teeth have been lost), the American Association of Orthodontists suggests that an orthodontist evaluate all children no later than age seven. Treatment initiated in young children, six or seven years of age, for instance, will often be geared towards using orthopedic appliances to aid in the proper development the jaws.

Although any dentist can technically treat patients with braces, I strongly recommend seeing an orthodontist. As a resident at Mount Sinai Medical Center in New York, I treated patients with braces once a week. Working closely with the orthodontist on staff, I got an appreciation for the complexity of the field of orthodontics. I routinely refer all patients requiring braces to an orthodontist.

Always remember to have your child keep his or her teeth as clean as possible while wearing braces. Braces can trap food and plaque, increasing the risk of cavities, unsightly white-spots, and gingivitis. Your child should also avoid hard and sticky food, as they can damage their braces. Follow the orthodontist’s instructions (wear the elastics as directed, etc.) and remember to also see you family dentist for regular cleanings and check-ups twice a year.