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Fear of the Dentist: Adult Orthodontics (Don’t Have Crooked Teeth Your Whole Life
Article by Dr. Dennis W. Bressack
“It’s too late!” “I’m too old!” “It’s not natural!” “It’s okay to have crooked teeth!” “It takes too long!” “It’s only for kids!” These are common remarks that I hear whenever I talk to an adult about them having orthodontic treatment. It’s especially true for those who want to live a natural or holistic lifestyle. If we define the word “natural” as it appears in Webster’s New World Dictionary as “produced or existing in nature; not artificial”, then, orthodontic treatment (braces) is not natural.
However, the fact that orthodontics can correct non-alignment (crooked) and malocclusions (bad bite) of the teeth and dysfunctions of the jaws caused by a multitude of occlusal (bite) abnormalities, growth and hereditary disorders and trauma and correct esthetic deficiencies (the way our teeth look) provides positive reasons to compromise on this philosophy.
This orthodontic treatment can dramatically improve the esthetics (appearance) and the quality of a patient’s life morphologically (form), physiologically (function) and psychologically with very few possible side effects, especially in the conscientious patient. A healthy adult with orthodontic needs must always weigh the benefits compared to the possible negative effects of wearing either fixed or removable orthodontic appliances (braces).
Significant factors that determine the necessity and rationale for orthodontic treatment are as follows: 1) severity of occlusion (bite) and esthetic (appearance) problems; 2) possible need for extracting (removing) one or more teeth to create space; 3) irritation, pressure and pain caused by having foreign materials in your mouth that are moving your teeth; 4) decreased ability to maintain cleanliness around appliances which may lead to tooth decay and periodontal(gum and bone) disease; 5) age of the patient; 6) length of the treatment and 7) cost.
Even though question 1a appears on the surface to be the less severe condition, there could be more is going on than just two crooked teeth. Necessary X-rays coupled with a thorough examination, diagnosis and treatment plan are needed to determine the full scope of the orthodontic condition. Assuming that there are no other underlying factors, a couple of crooked teeth pose mainly an esthetic and maintenance problem.
It is not considered a severe malocclusion (bite problem) because it does not affect the ability or the efficiency of mastication (chewing). Nowadays a problem such as yours can be treated conservatively by slightly filing the two teeth and bonding (adhering) composites, glass ionomers or veneers (thin porcelain facings).
If necessary, removable plastic retainers and appliances can be used to treat this problem. In order to create the small amount of space necessary to move the two teeth into position, it might be necessary to slightly file and narrow the proximal teeth on either side. Although the movement of the appliance might rub and irritate the surrounding tissue, the fact that it can be taken out of the mouth and that the teeth and the appliance can be more easily cleaned will reduce the potential for damage. Up to six months or more (two years) will be necessary to move and anchor those two teeth into proper position.
The use of more conservative, though not necessarily less costly, “short-term” approaches offered by treatment such as Invisalign, are very common and successful. Invisalign treatment consists of a series of removable, thin clear plastic aligners that fit over your teeth (similar to a mouthguard) that you switch out about every two weeks. Each aligner is custom-made for your teeth and is individually manufactured with exact calculations to gradually shift your teeth into place.
If the problem is more severe, traditional bonded fixed metal or plastic bands and brackets and adjustable wires and rubber bands may have to be used. It may also be necessary to extract some teeth in order to create the room necessary to align the teeth properly.
An “overbite” of the upper jaw is definitely a more serious malocclusion. In addition to an obvious esthetic and mastication problem, the malposition (wrong position) of the jaws can cause stress on the masticatory (chewing) muscles and damage to the TMJ (temperomandibular (jaw) joint) resulting in more discomfort and an increased possibility of complications.
Some severe orthodontic cases might need adjunctive additional treatment such as TMJ therapy, tooth extraction (removal), periodontal (gum and bone) surgery, operative dentistry (fillings) and crown and bridge treatment.
It should be noted that an adult offers further complications because the teeth are fully erupted and the completely formed jaw bones are more dense than that of an adolescent. Most cases like this will require the use of some combination of fixed and removable appliances (braces) and can take up to two years or longer to complete the case.
I cannot over-emphasize the importance of excellent home care during and after treatment. The patient can use a combination of toothbrushes, dental floss, floss threaders (thin flexible plastic needles to help get the floss under the non-removable bands and brackets), water pics and any other dental hygiene aids that are recommended. Dentists and orthodontists always advocate the decrease or elimination of sticky, hard or sugary food to lessen the possibility of tooth decay or breakage of the braces.
The appliances are bulky plaque, calculus, food and bacteria traps that can irritate and damage the gingiva (gum). Home care and regularly scheduled dental exams, prophylaxis and scaling ( professional cleanings) of the teeth and gingiva (gum) will also lessen the possibility of swelling, bleeding and discomfort of the gingiva (gum). Your dentist and orthodontist are able to inform and educate you about the pros and cons of treatment. Finally, although orthodontics might be difficult, costly and take a long time, adults are routinely and successfully treated with minimal negative effects on the oral cavity.
About the Author
I graduated from University of Bridgeport in 1969, from Georgetown Dental School in 1973, served in the Indian Public Health Service in 1973-74, and practiced holistic dentistry in Middletown, NY from 1975-1996.For more than 35 years, I have been writing articles on natural and holistic dentistry and more recently, have been writing articles and producing videos on the use of EFT to reduce dental fears and phobias. http://www.freedomfromdentalfears.com
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