How Braces Move Teeth
The 3 main parts of an orthodontic appliance are the brackets, wires and modules. The brackets are the little ‘square’ pieces that are attached to the teeth (the “braces” itself). A wire of a certain shape is then flexed to fit into the brackets. To secure the wire in the brackets, tiny rubber bands called modules are used to tie them together. The modules are the colourful parts you see on the braces. They can be removed to make adjustments of the wire.
As the wire tries to return to its original form, a force is transmitted to teeth down the root to the surrounding bone. This creates a stimulus for the bone around the root to be remodelled and allow the teeth to “move through the bone”. To put it simply, bone is cleared away ‘in the front’ to make room for the teeth to move, and laid down ‘at the back’ to fill the void created after the teeth move.
An interesting point to note is that tooth movement is a biological process that involves a cascade of events at the cellular level. People sometimes ask their orthodontist to make the braces tighter to move the teeth faster so that treatment can be expedited. However this biological process requires some time, just like we can’t make a plant grow faster by watering it more often or put it under brighter light. In fact, we might end up harming the plant….and roots (of the teeth). Shorter treatment duration should instead be achieved by more efficient treatment mechanics whenever possible.
How aligners work
The biology of tooth movement is the same as using normal braces. However, instead of using a wire to deliver the force, a plastic appliance is used.
Treatment involves changing to a new aligner about every two weeks. Each aligner is of a slightly different shape from the previous one. When worn, the teeth move to adapt to the new aligner. This process is continued until the desired movement is achieved.
Because the aligners are not “glued” to the teeth like braces, the teeth sometimes do not follow the aligners completely. Additional steps might be needed to “recapture” the teeth.
If you ask your friends that have done braces before, you will probably get different answers about how long their treatment took. This is due to the individual differences between them. To state the obvious, complex cases usually takes longer to complete than simple cases.
But other factors also play a role. Just like any other biological response, one person’s response is different from another. Take weight lifting for example, two person can train at the same level of intensity, but one might see more muscle development. The same goes for tooth movement, some people’s teeth move faster. So a complex case can sometimes finish faster than a simple one.
How smoothly treatment progresses also affects the total duration. If a person has frequent appliance breakages, more repairs are needed and the treatment doesn’t progress as fast.
Treatment can be expedited by properly planning the treatment so that time is not wasted. It is possible to take “shortcuts” to shave off some time as well. However, the case needs to be monitored closely and any signs of unwanted effects should be picked up early and controlled.
There are times when, as the saying goes, “less is more”. Some well-intentioned practitioners will always try to put brackets on every single tooth, right from the start of treatment. Although it seems counter-intuitive, the progress can actually be more efficient if some teeth are excluded when there is severe crowding. Placing every bracket creates a “locking” effect, like in a traffic congestion where every driver tries to force their way into limited lanes. Engaging only selected teeth with braces is like the traffic warden directing vehicles to clear the congestion smoothly.
Common problems with braces
The human bite force has been recorded to be as high as 275 pounds. Those are some strong jaw muscles! Now glue some braces on the teeth so they get bitten on. It’s a surprise they don’t all drop out. Appliance breakages are a very common occurrence during orthodontic treatment. These can be minimized by choosing softer foods and being mindful when chewing. Some dental cement can also be placed on the teeth to “prop” the teeth up, away from the braces.
With wires in the mouth…you’re bound to experience some discomfort or even pain. Things break, wires stick out… most people will get some ulcers while having braces. Even if nothing breaks, people commonly get ulcers at the initial stages of treatment, just like getting blisters when you wear a new pair of shoes. But don’t worry, the skin on the lips and cheek gets accustomed to the braces over time and life is good again. Putting dental wax to cover the braces will help to minimize getting ulcers. Dry lips are also more prone to abrasions so keeping yourself hydrated will help too.
Braces trap food every time you eat. If the oral hygiene is not good, this will lead to dental decay and gum disease fairly quickly. The harm is irreversible, so prevention is key! You don’t have to brush all your teeth, just the ones you want to keep 😉
Braces will usually get in the way of your normal bite so your teeth will not be able to contact the way it used to. This might cause difficulties in pronouncing certain words at the initial stages. So scheduling your braces to be put on in the same week as your oral exam is not a good idea.
POSSIBLE UNDESIRABLE EFFECTS OF TREATMENT
Orthodontic treatment is generally safe but like all treatment, there are risks. These include:
- Dental decay and gum disease if the oral hygiene is not good.
- Fracture of weakened teeth during treatment. For example, when there is a large dental filling in the tooth and the surrounding tooth structure is very thin.
- Braces rubbing against the opposing teeth and wearing them down. The effect is more with ceramic appliances as they are more abrasive compared to metal appliances.
- Injury to the nerves inside the teeth. Teeth might feel sensitive during treatment but permanent nerve damage to healthy teeth is uncommon. It is believed to be more common in teeth that have sustained previous trauma (for example when you fall and hit the teeth)
- Severe root shortening. Slight shortening of the teeth roots is sometimes seen after treatment. This usually doesn’t affect the health or longevity of the teeth. However some people might experience severe root shortening of certain teeth. The exact mechanism is unclear. However such outcomes are considered quite rare.
ENSURING A GOOD RESULT
Achieving a good result starts with accurately identifying the problem and prescribing an effective treatment plan. Just as extractions are needed to correct certain conditions, knowing when NOT to extract is also important. This requires assessing the condition as a whole, rather than overemphasizing one particular problem. Sometimes keeping all the teeth, even when it looks like there isn’t enough space, is crucial in achieving a more ideal outcome. Extractions in fact, is detrimental in such cases.
After proper planning comes proper execution of the plan. The nuances in treatment “mechanics” will differentiate one orthodontist from another, just as two artists will create different paintings even if they are presented with the exact same thing. Orthodontics is a science and an art after all.
One example is adequate attention to positioning of the braces. This is important to get the teeth to “line up” nicely. Another example is using the right wires at the right time. The wires help to control how the teeth move. Using a wire that is not appropriate for certain movements will lead to unwanted side effects. This is more pronounced when teeth are moved too fast. So, faster isn’t always better. The difference between a well treated case and one that has been “rushed through” might not be obvious to the untrained eye, but patients who are more discerning will realise that “not all smiles are created the same”.
CHOOSING YOUR DENTIST
If you’ve read this far, you’re probably still researching on treatment and looking for a dentist. There are a few factors you should consider:
- Price: This seems to be the most important factor in most people’s mind, and rightly so. It’s good to have a budget in mind so you don’t burn a hole in the pocket. However, pricing shouldn’t be the main deciding factor. There is nothing wrong with googling “cheap braces in Singapore” and moving on from there. Especially considering expensive treatment doesn’t always guarantee a good result either. However if you are not comfortable with any other things about the clinic, go to the other “cheap” clinic. What is more important is knowing if there are any additional costs that might make you go over your set budget. Ask if X-rays and retainers are included in the quoted price, or if there is any charge for repairs.
- Location: You will be seeing the dentist about once every month for the next two years. So you want to pick a clinic that is convenient to get to. If you live and work in Pasir Ris, the benefits of a clinic being “centrally located in the heart of the city” doesn’t apply to you. Then again, Singaporeans will travel from East to West, then to North for good food. So why not for a good orthodontist?
- Operating hours: Some clinics have a visiting orthodontist that comes in only once a week. If your working schedule changes constantly, this might make it harder to get an suitable appointment. You should choose a clinic that offers multiple sessions that coincides with your available timing. This might be early morning appointments before you go to work or late evening appointments after your work. Some clinics open Saturdays and Sundays, some open till 9 every night. See what suits you.
- The dentist: Dentists, like all groups of people, have varying personalities. Since orthodontics is a long term treatment, it is important to pick a dentist you are comfortable with. Some people prefer the dentist to just “get the work done” without too much talking, while others like the dentist to spend time explaining things in more detail. Do you prefer a specialist or a general dentist? A specialist practice is focused primarily on orthodontics while a general dentist offers many services all “under one roof” (like a jack of all trades).
- The support staff: Although the treatment outcome is dependent primarily on the dentist, the support staff play a role in your overall experience. They are also in a way, an extension of the dentist and the way they interact with patients reflects the clinic’s core values.