Learn more about Orthodontics
The following are the most commonly used terms in orthodontics. If you have any questions about orthodontics or would like to schedule an appointment, please contact our office.
Anterior Teeth: The upper and lower six front teeth on each arch.
Appliance: Any orthodontic device which moves or retains teeth. Appliances may also alter the positioning of the jaw.
Arch: The entire upper or lower jaw.
Archwire: The metal wire that connects orthodontic brackets. This wire guides the teeth into their new alignment.
Band with bracket: Metal bands (rings) that are generally cemented around the back teeth.
Braces: Fixed orthodontic appliances designed to align teeth.
Brackets: The tiny metal, ceramic or clear brackets that are affixed to each individual tooth on the arch.
Brushing: This is a crucial part of home dental care. Orthodontists recommend those wearing braces to brush after every meal and snack to eliminate bacteria and plaque.
Buccal: The outer (cheek) side of posterior teeth in the lower and upper arches.
Cephalometric Radiograph: A side X-ray of the face and head used to show growth and development.
Chain: Elastics connected together and placed around the brackets to stabilize the archwire and gently close spaces.
Class I Malocclusion: Molars are correctly aligned, but there is an anterior/posterior crossbite, an openbite or overcrowding on the arches.
Class II Malocclusion: Also known as an overbite. The upper front teeth are positioned further forward than the lower teeth.
Class III Malocclusion: Also known as an underbite. The lower front teeth are positioned further forward than the upper front teeth.
Closed Bite: The upper front teeth completely overlap the bottom teeth causing a deep overbite.
Congenitally Missing Teeth: Some permanent teeth fail to develop and erupt due to genetic factors.
Crossbite: A malocclusion in which the upper back teeth bite inside or outside the lower back teeth, or the lower front teeth bite in front of the upper front teeth.
De-banding: The removal of orthodontic bands from the teeth.
De-bonding: The removal of affixed orthodontic brackets from the teeth.
Diagnostic Records: Records used to assess, plan and implement treatments. These records usually include medical and dental history, radiographs, panoramic radiographs, bite molds and intraoral/extraoral photographs.
Digital Radiograph: Digital X-rays of the teeth which can be viewed, stored, and transmitted via computer.
Elastics: Some braces may require that elastic rubber bands be attached to exert additional pressure to an individual tooth or a group of teeth.
Eruption: The way in which teeth surface through the gums inside the mouth.
Fixed Orthodontic Appliances: Orthodontic appliances which are affixed to the teeth by the orthodontist and cannot be removed by the patient.
Flossing: An essential part of home care that removes debris and plaque from above and below the gumline.
Functional Appliances: Orthodontic appliances that use the muscle movement created by swallowing, eating and speaking to gently move and align the teeth and jaws.
Gingiva: The gums and soft tissue around the teeth.
Headgear: A removable appliance comprised of a brace and external archwire. This device modifies growth and promotes tooth movement.
Impressions: Teeth impressions are taken to allow the orthodontist to see exactly how a patient’s teeth fit together.
Interceptive Treatment: Treatment performed on children who have a mixture of adult and baby teeth. Early treatment can help reduce the need for major orthodontic treatment in the future.
Invisalign®: A newer, removable type of dental aligner that is completely transparent and doesn’t interfere with eating because it’s removable. Not all patients are candidates for Invisalign®.
Ligating Modules: An elastic donut-shaped ring which helps secure the archwire to the bracket.
Ligation: Securing the archwire to the brackets.
Lingual Side: The side of the teeth (in both arches) that is closest to the tongue.
Malocclusion: Literally means “bad bite” in Latin, and refers to teeth that do not fit together correctly.
Mandible: The lower jaw.
Maxilla: The upper jaw.
Mouthguard: A removable plastic or rubber device that protects teeth and braces from sporting injuries.
Open Bite: Upper and lower teeth fail to make contact with each other. This malocclusion is generally classified as anterior or posterior.
Orthodontics: The unique branch of dentistry concerned with diagnosing, preventing and correcting malocclusions and jaw irregularities.
Orthodontist: A dental specialist who prevents, diagnoses and treats jaw irregularities and malocclusions. Orthodontists must complete two or three additional years of college after dental school and complete a residency program.
Palatal Expander: A removable or fixed device designed to expand the palate in order create room on either the upper or lower arch.
Panoramic Radiograph: An extraoral (external) X-ray that shows the teeth and jaws.
Plaque: The sticky film of saliva, food particles and bacteria that contributes to gum disease and tooth decay.
Posterior Teeth: Back teeth.
Removable Appliance: An orthodontic brace or device that can be removed at will by the patient. It must be worn for the designated amount of time each day to be effective.
Separators: A wire loop or elastic ring placed between the teeth to create room for the subsequent placement of bands or orthodontic appliance.
Space Maintainer: A fixed appliance used to hold space for permanent (adult) tooth. This is usually used when a baby tooth has been lost earlier than anticipated.
Wax: Orthodontic relief wax is a home care remedy used to alleviate irritations caused by braces.
Wires: Attached to the brackets to gently move the teeth into proper alignment.
Orthodontic treatment is primarily used to prevent and correct “bite” irregularities. Several factors may contribute to such irregularities, including genetic factors, the early loss of primary (baby) teeth, and damaging oral habits (such as thumb sucking and developmental problems).
Orthodontic irregularities may be present at birth or develop during toddlerhood or early childhood. Crooked teeth hamper self-esteem and make good oral homecare difficult, whereas straight teeth help minimize the risk of tooth decay and childhood periodontal disease.
During biannual preventative visits, your pediatric dentist is able to utilize many diagnostic tools to monitor orthodontic irregularities and, if necessary, implement early intervention strategies. Children should have an initial orthodontic evaluation before the age of eight.
Why does early orthodontic treatment make sense?
Some children display early signs of minor orthodontic irregularities. In such cases, your pediatric dentist might choose to monitor the situation over time without providing intervention. However, for children who display severe orthodontic irregularities, early orthodontic treatment can provide many benefits, including:
Enhanced self-confidence and aesthetic appearance.
Increased likelihood of proper jaw growth.
Increased likelihood of properly aligned and spaced adult teeth.
Reduced risk of bruxing (grinding of teeth).
Reduced risk of childhood cavities, periodontal disease, and tooth decay.
Reduced risk of impacted adult teeth.
Reduced risk of protracted orthodontic treatments in later years.
Reduced risk of speech problems.
Reduced risk of tooth, gum, and jawbone injury.
When can my child begin early orthodontic treatment?
Pediatric dentists recognize three age-related stages of orthodontic treatment. These stages are described in detail below.
Stage 1: Early treatment (2-6 years old)
Early orthodontic treatment aims to guide and regulate the width of both dental arches. The main goal of early treatment is to provide enough space for the permanent teeth to erupt correctly. Good candidates for early treatment include: children who have difficulty biting properly, children who lose baby teeth early, children whose jaws click or grind during movement, bruxers, and children who use the mouth (as opposed to the nose AND mouth) to breathe.
During the early treatment phase, your pediatric dentist works with parents and children to eliminate orthodontically harmful habits, like excessive pacifier use and thumb sucking. The dentist may also provide one of a variety of dental appliances to promote jaw growth, hold space for adult teeth (space maintainers), or to prevent the teeth from “shifting” into undesired areas.
Stage 2: Middle dentition (6-12 years old)
The goals of middle dentition treatments are to realign wayward jaws, to start to correct crossbites, and to begin the process of gently straightening misaligned permanent teeth. Middle dentition marks a developmental period when the soft and hard tissues are extremely pliable. In some ways therefore, it marks an optimal time to begin to correct a severe malocclusion.
Again, the dentist may provide the child with a dental appliance. Some appliances (like braces) are fixed and others are removable. Regardless of the appliance, the child will still be able to speak, eat, and chew in a normal fashion. However, children who are fitted with fixed dentalappliances should take extra care to clean the entire oral region each day in order to reduce the risk of staining, decay, and later cosmetic damage.
Stage 3: Adolescent dentition (13+ years old)
Adolescent dentition is what springs to most parents’ minds when they think of orthodontic treatment. Some of the main goals of adolescent dentition include straightening the permanent teeth and improving the aesthetic appearance of the smile.
Most commonly during this period, the dentist will provide fixed or removable “braces” to gradually straighten the teeth. Upon completion of the orthodontic treatment, the adolescent may be required to wear a retainer in order to prevent the regression of the teeth to their original alignment.
Brushing and flossing are of paramount importance to oral hygiene. Though bi-annual professional dental cleanings remove plaque, tartar, and debris, excellent homecare methods are equally valuable. Proper brushing and flossing can enhance the health of the mouth, make the smile sparkle, and prevent serious diseases.
Reasons why proper brushing and flossing are essential:
Prevention of tooth decay – Tooth decay is one of the leading causes of tooth loss, and its treatment often requires complex dental procedures. Tooth decay occurs when the acids found in plaque erode the natural enamel found on the teeth. This phenomenon can easily be prevented by using proper home hygiene methods.
Prevention of periodontal disease – Periodontal disease is a serious, progressive condition which can cause tooth loss, gum recession, and jawbone recession. Periodontal disease is caused by the toxins found in plaque and can lead to serious health problems in other parts of the body. Removing plaque and calculus (tartar) from the surface of the tooth using a toothbrush and from the interdental areas using dental floss, is an excellent way to stave off periodontal problems.
Prevention of halitosis – Bad breath or halitosis is usually caused by old food particles on or between the teeth. These food particles can be removed with regular brushing and flossing, leaving the mouth healthier, and breath smelling fresher.
Prevention of staining – Staining, or yellowing, of teeth can be caused by a wide variety of factors such as smoking, coffee, and tea. The more regularly these staining agents are removed from the teeth using brushing and flossing techniques, the less likely it is that the stains will become permanent.
The Proper Way to Brush
The teeth should be brushed at least twice a day, ideally in the morning and before bed. The perfect toothbrush is small in size with soft, rounded-end bristles, and is no more than three months old. The head of the brush needs to be small enough to access all areas of the mouth, and the bristles should be soft enough so as not to cause undue damage to the gum tissue. The American Dental Association (ADA) has given electric toothbrushes their seal of approval, stating that those with rotating or oscillating heads are more effective than other toothbrushes.
Here is a basic guide to proper brushing:
Place the toothbrush at a 45-degree angle where the gums and teeth meet.
Use small circular motions to gently brush the gumline and teeth.
Do not scrub or apply too much pressure to the teeth, as this can damage the gums and tooth enamel.
Brush every surface of every tooth, cheek-side, tongue-side, and chewing surfaces. Place special emphasis on the surfaces of the back teeth.
Use back and forth strokes to brush the chewing surfaces.
Brush the tongue to remove fungi, food, and debris.
The Proper Way to Floss
Flossing is a great way to remove plaque from the interdental regions (between the teeth). Flossing is an especially important tool for preventing periodontal disease and limiting the depth of the gum pockets. The interdental regions are difficult to reach with a toothbrush and should be cleansed with dental floss on a daily basis. The flavor and type of floss are unimportant; choose floss that will be easy and pleasant to use.
Here is a basic guide to proper flossing:
Cut a piece of floss to around 18 inches long.
Wrap one end of the floss around the middle finger of the left hand and the other end around the middle finger of the right hand until the hands are 2-3 inches apart.
Work the floss gently between the teeth toward the gum line.
Curve the floss in a U-shape around each individual tooth and carefully slide it beneath the gum line.
Carefully move the floss up and down several times to remove interdental plaque and debris.
Do not pop the floss in and out between the teeth as this will inflame and cut the gums.
When braces are finally removed, the “retention” phase begins for most individuals. The objective of this phase is to ensure the teeth do not regress back to their previous position. A retainer will be used to maintain the improved position of the teeth.
A retainer is a fixed or removable dental appliance which has been custom-made by the orthodontist to fit the teeth. Retainers are generally made from transparent plastic and thin wires to optimize the comfort of the patient.
Retainers are worn for varying amounts of time, depending on the type of orthodontic treatment and the age of the patient. Perseverance and commitment are required to make this final stage of treatment successful. If the retainer is not worn as directed, treatment can fail or take much longer than anticipated.
What types of retainer are available?
There are a variety of retainers available, each one geared towards treating a different kind of dental problem. The orthodontist will make a retainer recommendation depending on the nature of the original diagnosis and the orthodontic treatment plan.
The following are some of the most common types of retainers:
Hawley retainer – The Hawley retainer consists of a metal wire on an acrylic arch. The metal wire may be periodically adjusted by the orthodontist to ensure the teeth stay in the desired position. The acrylic arch is designed to fit comfortably on the lingual walls or palate of the mouth.
Essix – The Essix retainer is the most commonly used vacuum formed retainer (VFR). A mold is initially made of the teeth in their new alignment, and then clear PVC trays are created to fit over the arch in its entirety. VFR’s are much cheaper than many other types of retainers and also do not affect the aesthetic appearance of the smile in the same way as the Hawley retainer. The disadvantage of VFR’s is that they break and scratch more easily than other types of retainers.
Fixed retainers – A fixed retainer is somewhat similar to a lingual brace in that it is affixed to the tongue side of a few teeth. Usually, a fixed retainer is used in cases where there has been either rapid or substantial movement of the teeth. It usually consists of a single wire. The inclination of the teeth to move rapidly means they are also more likely to regress back to their previous position if a fixed retainer is not placed.
What do I need to consider when using a retainer?
There are a few basic things to consider for proper use and maintenance of your retainer.
Don’t lose the appliance – Removable retainers are very easy to lose. It is advisable to place your retainer in the case it came in while eating, drinking, and brushing. Leaving a retainer folded in a napkin at a restaurant or in a public restroom can be very costly if lost because a replacement must be created. A brightly colored case serves as a great reminder.
Don’t drink while wearing a retainer – It is tempting to drink while wearing a retainer because of the unobtrusive nature of the device. However, excess liquid trapped under the trays can vastly intensify acid exposure to teeth, increasing the probability of tooth decay.
Don’t eat while wearing a retainer – It can be difficult and awkward to eat while wearing a removable retainer and it can also damage the device. Food can get trapped around a Hawley retainer wire or underneath the palate, causing bad breath. When worn on the upper and lower arches simultaneously, VFR retainers do not allow the teeth to meet. This means that chewing is almost impossible.
Clean the retainer properly – Removable retainers can become breeding grounds for calculus and bacteria. It is essential to clean the inside and outside thoroughly as often as possible. Hawley retainers can be cleaned with a toothbrush. Because harsh bristles can damage the PVC surface of a VFR, denture cleaner or a specialized retainer cleaner is recommended for this type of device.
Wear the retainer as directed – This phase of treatment is critical. The hard work has been done; the braces are off, and now it is tempting not to wear the retainer as often as the orthodontist recommends. Retainers are needed to give the muscles, tissues, and bones time to stabilize the teeth in their new alignment. Failure to wear the retainer as directed can have regrettable consequences, such as teeth returning to their original position, added expense, and lost time.
Regular dental check ups are essential for maintaining excellent oral hygiene and diagnosing potential problems, but they are not a “fix-all” solution. Thorough oral homecare routines should be practiced on a daily basis to avoid future dental problems.
Periodontal disease (also called gum disease and periodontitis) is the leading cause of tooth loss in the developed world, and is completely preventable in the vast majority of cases. Professional cleanings twice a year combined with daily self-cleaning can remove a high percentage of disease-causing bacteria and plaque. In addition, teeth that are well cared for make for a sparkling white smile.
There are numerous types of oral hygiene aids on the supermarket shelves, and it can be difficult to determine which will provide the best benefit to your teeth.
Here are some of the most common oral hygiene aids for homecare:
Dental floss is the most common interdental and subgingival (below the gum) cleaner and comes in a variety of types and flavors. The floss itself is made from either thin nylon filaments or polyethylene ribbons, and can help remove food particles and plaque from between the teeth. Vigorous flossing with a floss holder can cause soft tissue damage and bleeding, so great care should be taken. Floss should normally be used twice daily after brushing.
Many hygienists and periodontists recommend interdental brushes in addition to dental floss. These tiny brushes are gentle on the gums and very effective in cleaning the contours of teeth in between the gums. Interdental brushes come in various shapes and sizes.
There are two basic types of mouth rinse available: cosmetic rinses which are sold over the counter and temporarily suppress bad breath, and therapeutic rinses which may or may not require a prescription. Most dentists are skeptical about the benefits of cosmetic rinses because several studies have shown that their effectiveness against plaque is minimal. Therapeutic rinses however, are regulated by the FDA and contain active ingredients that can help reduce bad breath, plaque, and cavities. Mouth rinses should generally be used after brushing.
Oral irrigators, like Water Jets and Waterpiks have been created to clean debris from below the gum line. Water is continuously sprayed from tiny jets into the gum pockets which can help remove harmful bacteria and food particles. Overall, oral irrigators have proven effective in lowering the risk of gum disease and should not be used instead of brushing and flossing. Professional cleanings are recommended at least twice annually to remove deeper debris.
Rubber Tip Stimulators
The rubber tip stimulator is an excellent tool for removing plaque from around the gum line and also for stimulating blood flow to the gums. The rubber tip stimulator should be traced gently along the outer and inner gum line at least once each day. Any plaque on the tip can be rinsed off with tap water. It is important to replace the tip as soon as it starts to appear worn, and to store the stimulator in a cool, dry place.
Tongue cleaners are special devices which have been designed to remove the buildup of bacteria, fungi and food debris from the tongue surface. The fungi and bacteria that colonize on the tongue have been related to halitosis (bad breath) and a great many systemic diseases like diabetes, heart disease, respiratory disease and stroke. Tongue cleaners can be made from metal, wood or plastic and shaped in accordance with the contours of the tongue. Tongue cleaning should be done prior to brushing to prevent the ingestion of fungi and bacteria.
There are a great many toothbrush types available. Electric toothbrushes are generally recommended by dentists because electric brushes are much more effective than manual brushes. The vibrating or rotary motion helps to easily dislodge plaque and remove food particles from around the gums and teeth. The same results can be obtained using a manual brush, but much more effort is needed to do so.
Manual toothbrushes should be replaced every three months because worn bristles become ineffective over time. Soft bristle toothbrushes are far less damaging to gum tissue than the medium and hard bristle varieties. In addition, an appropriate sized ADA approved toothbrush should be chosen to allow proper cleaning to all the teeth. Teeth should ideally be brushed after each meal, or minimally twice each day.