Terry Pracht, DDS, past president of the American Association of Orthodontics says that both heredity and environmental factors can create crooked teeth and bite problems. Dr. Pracht mentions that hereditary factors include crowded teeth, teeth where there is too much space and malocclusions. He also mentions that crooked teeth can be caused by thumb sucking and tongue thrusting as well as accidents occurring to the jaw(1).

What are Treatment Options to Straighten Teeth or Malocclusions?
There are three stages of orthodontic treatment. The first is when appliances are used to gain space in the mouth. For example, palatal expanders are used to expand the width of the palate and lingual bars are used to expand the lower jaw. The active corrective stage is next when the braces are placed on the teeth. The teeth are then adjusted and then straightened and malocclusions are corrected over a period of time based upon the severity of the irregularity of the teeth and jaw issues. The third stage is the retention stage after braces are removed and when the teeth are monitored through the use of a retainer (removable or fixed) and semi-annual orthodontic visits are conducted to maintain the straightened smile.

Types of Braces
Braces from over 30 or so years ago included large metal bands that were enclosed and cemented around each tooth. Braces can be attached to the cheek side of the teeth as well as the tongue side of the teeth depending on what your orthodontist recommends to you for treatment. Braces, arch wires and bands can be colorful and a lot of fun for children, adolescents and teenagers to choose from.

Today, tiny brackets are placed onto the front surface of the tooth and are made of metal or ceramic. The brackets are bonded to the front tooth surface with a glue-like material and metal bands can be used on the back teeth. Arch wires are placed inside the brackets and are made of a heat-activated nickel-titanium source that can become warm due to the temperature in the mouth, which will allow it to apply constant pressure on the teeth as well as when the arch wires are adjusted at the orthodontist’s office.

Another newer alternative to braces is the Invisalign system which uses a series of clear removable aligners that are worn during the day and night to help in moving teeth into the correct alignment. When eating or brushing and flossing, the aligners may be removed.

Caring for Braces
Your orthodontist, dentist or dental hygienist will provide you with thorough instruction of how to properly clean your braces. There are many toothbrushes you can use both manual (specifically designed for orthodontic patients), power, electric or sonic. Ask your dental professional which is be best for you. Brushing should be conducted at least 2-3 times per day at a 45 degree angle in a back and forth motion. Be sure to remove plaque at the gum line to prevent gingivitis (inflammation of the gum tissue). Be sure to angle the toothbrush at the gum line and then gently brush around the brackets to remove plaque and food debris.

It is very important to clean in between your teeth with a floss threader and floss, a Stim-U-Dent^® (tooth pick cleaner) or a proxabrush (interproximal cleaning brush) may be used if there is space between the teeth. Oral irrigators may be recommended to remove food debris and irrigate the gum tissue to remove disease and odor-causing bacteria that may be there if you have gingivitis. An antibacterial toothpaste and over-the-counter antimicrobial mouth rinses could also be used with the oral irrigator or alone.