Frequently Asked Questions of Orthodontics

There are several reasons for orthodontic treatment - aesthetic, functional or a combination of both.

Aesthetic reasons include crowded teeth, gaps between teeth, teeth that are protruding or otherwise not lined up properly.

Functional reasons include the inability to chew properly, discomfort caused by biting of gums, lips or cheeks, speech difficulties, impacted teeth that affect cleaning and predispose teeth to decay and gum disease, and jaw length problems such as shorter or longer lower/upper jaws.

If you experience any of the above symptoms, do consult an orthodontist.

For most patients, the best time to start orthodontic treatment is after all their milk teeth have been replaced by permanent teeth. This is usually between the ages of 12 to 14. In some situations, your orthodontist may advise you to start treatment earlier due to functional, traumatic or jaw growth problems.

Fixed braces can be made of stainless steel brackets and wires. There are also fixed braces with brackets made of tooth-coloured ceramic.

Removable braces are made from acrylic plastic and can be removed from the mouth when required. There are various designs depending on the indication for use. Some are used for some minor tooth movements, and others for correction of jaw growth problems in younger patients.

Invisalign® braces use a series of slim, clear plastic appliances fitted to the teeth to move teeth gradually into alignment. Invisalign® braces are removable and the main advantage is that they are barely visible.

Braces need a series of appointments to complete. For predictable results, you have to make sure you keep to your scheduled appointments and brush your teeth well. Regular professional dental cleaning every three to six months is also essential for a good overall treatment outcome. Caring for your braces and preventing breakages helps to ensure that you complete your treatment within the expected duration. Do contact your orthodontist for an earlier appointment if you have appliance breakages.

The traditional view was that misalignment of teeth was hereditary, i.e., it tends to run in the family. Certain hereditary traits such as small/big teeth, missing teeth, jaw size and jaw growth problems have strong genetic links.

The current view of crowding and misalignment of teeth is that there are also other factors involved: e.g., thumb-sucking or pacifier sucking past a certain age, or mouth breathing. There are also specific causes not linked genetically such as early loss of primary (milk) teeth and trauma.

Not necessarily. We try not to extract teeth unless we see a clear indication. Sometimes, teeth can be aligned without the need for extractions. On the other hand, in some situations, extraction is one of the means to get space required to align crooked teeth properly and achieving a pleasant facial profile.

It is never too late!

Scientific literature shows that orthodontic treatment in adults is feasible and predictable. As long as your gums are in good condition, braces treatment is predictable. There are times that your dental team may need to clear up some existing dental concerns (e.g. cavities) before orthodontic treatment is started.

Orthodontic treatment typically requires 12 to 24 months to complete. Those individuals who travel frequently or with a busy schedule may not be able to cope with this.

Alternatively, veneers may be suitable for such situations as described above. Veneers treatment may require minor adjustment to the natural teeth. In a few days, the completed new teeth may be bonded onto to the natural teeth. The overall process typically takes only a few days to complete. In addition, veneers can dramatically enhance the color of the teeth to any color shade one desires.

The overall treatment cost for veneers will be higher than that of braces. However, it may suit people with a busy life style who may not be able to work with the longer orthodontic treatment schedule.

After your orthodontic treatment is completed, your braces are removed. You will need retainers to maintain your teeth in their corrected positions and prevent relapse (teeth moving back out of alignment). These retainers are a lot less visible than the fixed braces.

Some retainers are removable and can be taken out of the mouth for eating, brushing and contact sports. There are also retainers that are fixed onto the back of your front teeth. Your orthodontist will prescribe the best design for you.

It is important that you wear your retainers faithfully. The removable retainers have to be worn full time daily for the first six months, followed by night time wear and this is reduced over time. They can be easily kept clean with simple brushing using a toothbrush and toothpaste and rinsed with tap water.

In addition, a six-monthly ongoing dental follow-up helps to maintain optimal treatment results and overall dental health. Also, any issues (e.g. change of alignment) arising after completion of your braces treatment could be addressed promptly. Follow-ups can be done at the same time during your regular professional dental cleaning.

What are the common problems during orthodontic treatment?

Maintenance of adequate oral hygiene is crucial. Issues such as oral hygiene problems are not uncommon but it can be addressed with adequate hygiene instruction, proper home care and professional oral hygiene maintenance.

Our team of dental specialists are well-trained and experienced in resolving these problems for our patients.

Before any treatments can be recommended, the cause of these exceptionally long teeth must be determined. A thorough clinical and X-ray examination needs to be done to asses the dental condition and rule out any underlying problems. Gum disease is seldom symptomatic but can shou up as excessively long teeth, i.e. the bone and the gums that support those teeth are destroyed, resulting in more root surfaces being exposed, and longer-looking teeth.

Gum disease is a serious problem that must be addressed early, so that those teeth can be preserved and not weakened further. If the diagnosis is receding gums, one option is gingival (gum) grafting – where gum tissue is added to the receded area.

If the gums are otherwise healthy, full ceramic crowns may be prescribed to shorten those teeth. However, root canal treatment may be required if the teeth are to be shortened substantially.

Orthodontics (braces) may be another solution. Braces (metal or ceramic) can align your front teeth to the same level. Invisalign® braces, where a series of transparent aligners are used to straighten the teeth, is another option. The cost will depend on which type of braces is used.

There are various ways to address the problem but this depends on the existing condition of the teeth and gums. Ideally, you should consult a dentist that can discuss the various options and their pros and cons so that the most appropriate treatment can be prescribed.

It is a myth that too much or too little calcium in the diet causes crooked teeth. The fact is that diet does not play a significant part in crooked teeth. However, a high sugar diet in childhood can lead to dental decay and early loss of baby teeth. Premature loss of baby teeth can lead to irregularities in alignment of the adult teeth later on.

Another contributing factor for crooked teeth is thumb sucking or use of a pacifier for a prolonged period of time. Thus, it would be good preventive practice to wean a child off the pacifier or thumb sucking as early as possible.

As long as the medical problem is well under control, and the patient is very motivated about treatment, there is rarely a contraindication for braces. Radiographs are needed at the start and end of treatment and sometimes along the way. Braces are not harmful during pregnancy.

When there is a protruding lower jaw, the lower teeth bite in front of the upper teeth. This is called ‘reverse bite’ or ‘reverse overjet’. A protruding lower jaw can be caused by excessive lower jaw growth, or an under-developed and retruded upper jaw (making the lower jaw appear protruded), or a combination of both upper and lower jaw growth problems. In younger patients, treatment using dento-orthopaedic appliances to modify jaw growth is possible. These orthopaedic appliances aim to move the upper jaw forward and restrict or re-direct the lower jaw growth. The recommended age for this type of treatment is between the ages of nine to 12, before the jaw bones fuse. After that, these appliances have limited use and success. The appliance commonly used in these cases is removable and has to be worn at least 10 to 14 hours a day for it to be effective. It takes one visit for impressions of the teeth to be made, and another visit to fit the appliance. Treatment effects generally take between six to 12 months to achieve.

It is difficult to predict future eventual severity of jaw growth discrepancy at the age of 12 years. There are also limitations on how much growth modification appliances can do. If the jaw growth continues to be unfavourable into puberty and adolescence, and depending on the severity, other treatment measures such as jaw surgery in combination with braces may be required after growth has ceased. This is usually after the ages of 16 or 18 for girls and boys respectively. If the jaw discrepancy is not severe, orthodontic compensation with braces alone may achieve some camouflage of the jaw problem.

You should have an orthodontist (braces specialist) and an oral surgeon assess your child’s condition to recommend the appropriate treatment for him or her.

Braces are a good option to align crooked teeth. Straight teeth are easier to clean and maintain. If food gets trapped between your teeth, bacterial dental plaque will also accumulate in that area. As the crowding of the teeth makes removal of the bacterial plaque difficult, this has likely caused inflammation, leading to bleeding gums. If left untreated, gum disease will progress and eventually lead to loss of supporting bone, loose teeth and loss of one or more teeth.

Braces often involve the movement of several teeth to achieve the ideal aesthetic and functional outcome. You don’t just get straight teeth with braces; the teeth must also bite well together. Co-ordination between a periodontist (gum specialist) and an orthodontist (teeth alignment specialist) is recommended in your situation.

Gaps can be closed through various methods. The key is assessing the cause and nature of the spacing, the location, the size of the spacing neighboring teeth.

With composite resin bonding, a tooth-colured filling material is added to the teeth to make them bigger so as to close the spaces. Composite resin bonding only works when the spaces are small and quite symmetrical on both sides. Porcelain veneers may also be a solution if a more permanent solution is desired.

There are various ways to close gaps with orthodontic treatment – fixed braces (metal or tooh-coloured ceramic braces), removable appliances, or Invisalign® (series of removable clear aligners). Braces are a more versatile method to address gaps between teeth as braces can close spaces of various sizes and positions, and re-destribute the remaining spaces for an aesthetic filling. Braces can also be combined with composite resin bonding.

Ocassionally, spacing between teeth is a reflection of underlying gum disease, so this should be ruled out prior to further treatment.

There are multiple variables in treating spacing conditions so an accurate diagnosis is the most important part. Ideally, one should have a joint consultation with a prosthodontist, periodontist and an orthodontist so that a comprehensive treatment can be prescribed.