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Dental braces (also known as orthodontic braces or brackets) are a fixed appliance used in orthodontics to correct alignment of teeth and their position with regard to bite. Braces are often used to correct malocclusions such as underbites, overbites, cross bites and open bites, or crooked teeth, or goofy teeth and various other flaws of teeth and jaws, whether cosmetic or structural. They can be used on either upper or lower sets of teeth, or both, depending on the problem they are being used to treat. Orthodontic braces are often used in conjunction with other orthodontic appliances to widen the palate or jaws, create spaces between teeth, or otherwise shape the teeth and jaws. Most orthodontic patients are children or teenagers; however, more and more adults are seeking out orthodontic treatment.
History Historians believe that two different men deserve the title of being called "the Father of Orthodontics." One man was Norman W. Kingsley, a dentist, writer, artist, and sculptor, who wrote his "Treatise on Oral Deformities" in 1880. What Kingsley wrote influenced the new dental science greatly. The second man who deserves credit was a dentist named J. N. Farrar, who wrote two volumes entitled "A treatise on the Irregularities of the teeth and their corrections". Farrar was very good at designing brace appliances, and he was the first to suggest the use of mild force at timed intervals to move teeth. How braces work Teeth move through the use of force. The force applied by the archwire pushes the tooth in a particular direction and a stress is created within the periodontal ligament. The modification of the periodontal blood supply determines a biological response which leads to bone remodelling, where bone is created on one side by osteoblast cells and resorbed on the other side by osteoclasts. Two different kinds of bone resorption are possible: direct resorption, starting from the lining cells of the alveolar bone, and indirect or retrograde resorption, where osteoclasts start their activity in the neighbour bone marrow. Indirect resorption takes place when the periodontal ligament has become acellular (necrosis or hyalinization), for an excessive amount and duration of compressive stress. In this case the quantity of bone resorbed is larger than the quantity of newly formed bone (negative balance). Bone resorption only occurs in the compressed periodontal ligament. The other important phenomenon that is intricately associated with tooth movement is bone deposition. Bone deposition occurs in the distracted periodontal ligament. Without bone deposition, the tooth will loosen and voids will occur distal to the direction of tooth movement. A tooth will usually move about a millimeter per month during orthodontic movement, but there is high individual variability. Furthermore, orthodontic mechanics can be more or less efficient, thus explaining a wide range of responsiveness to orthodontic treatment. Procedure
Post-treatment Retainers are required to be worn once treatment with braces has been finalized. The orthodontist will recommend a retainer based on the patient's needs. If a patient does not wear the retainer as recommended, the teeth might move towards their original position (relapse). A hawley retainer is made of metal hooks that surround the teeth and are enclosed by an acrylic plate that is shaped to fit the patient's palate. An Essix retainer is similar to Invisalign trays; it is a clear plastic tray that is form-fitted to the shape of the teeth and stays in place by suction. A bonded retainer is a wire that is permanently bonded to the lingual side of the teeth (usually the lower teeth only). Sometimes, if a person's teeth are not ready for a proper retainer, the orthodontist may prescribe the use of a pre-finisher. This rubber appliance similar to a mouthguard fixes gaps between the teeth, small spaces between the upper and lower jaw, and other minor problems that could worsen later on. These problems are small things that a set of dental braces cannot fix. The pre-finisher is first molded to the user's teeth by use of severe pressure to the appliance by the person's jaw. The pre-finisher is then for as long as prescribed, with the user applying force to the pre-finisher in their mouth for ten to fifteen seconds at a time, with the goal of increasing the "exercise" time, time spent applying force to the appliance. Like the retainer, the pre-finisher is not a permanent addition to one's mouth; it can be moved in and out of the mouth. Complications and risks Plaque gets easily caught in the fine metalwork of braces. For this reason, it is important to maintain proper oral hygiene by brushing and flossing thoroughly when wearing braces to prevent tooth decay, decalcification or unpleasant color changes to the teeth. There is a small chance of an allergic reaction to the latex rubber in elastics or the type of metal in braces. However, there are latex-free elastics and other types of metal that can be used instead. If a person with braces believes he is allergic to his braces, it is important that an orthodontist or dentist be notified immediately Mouth sores are usually triggered due to the oral obstructions from certain components of the braces. There are many products that can make a patient more comfortable, such as oral rinses, dental wax or dental silicone, and products that help heal the sores. Braces can also be damaged if not careful. It is important to wear a mouthguard to prevent breakage when playing sports. Certain sticky or hard foods and confectionaries, gum and toffee for example, should be avoided because they can damage braces. Constantly breaking braces can prolong orthodontic treatment. In the course of treatment, orthodontic brackets may occasionally pop off due to the force involved, or due to the adhesive cement weakening over time. The orthodontist should be contacted immediately for advice if this occurs. In most cases, the bracket must be replaced and re-applied to the tooth. When teeth move, the arch wire may become displaced, causing it to painfully poke into the back of the patient's cheek. If this happens, it is recommended to apply a glob of dental wax to cushion it. The orthodontist must be called immediately to have it clipped, or a painful mouth ulcer is likely to form. If the wire is poking to an extent that severe pain is present, it may be necessary to carefully bend the edge of the wire in with a spoon until the wire can be clipped by an orthodontist. Patients with periodontal disease usually must obtain periodontal treatment before getting braces. A deep cleaning is performed, and further treatment may be required before beginning orthodontic treatment. Excessive bone loss due to periodontal disease may lead to loss of teeth during treatment. The dental displacement obtained with the orthodontic appliance, determines in most cases some degree of root resorption. Only in a few cases this side effect is large enough to be considered a real clinical damage for the tooth. ** It also generally hurts after an adjustment, possibly causing the person wearing them to have difficulty eating for a period of time. This time varies from case to case. It is reccomended that, during this period, the patient eats soft foods that will not cause pressure on or otherwise irritate the teeth. Treatment time and cost Typical treatment time is anywhere from six months to six years, depending on the severity of the case, location, age, etc., although two years is average. Treatment can be accelerated using novel planning and positioning techniques. Typical cost of braces is about $5,000 in the United States, although in other countries the price can be much lower. In CIS countries for example, the price is anywhere from $200 to $500 per jaw. In some European countries, orthodontic treatment is available without charge to patients under 16 (or for treatment to start at 16, such as Ireland), as benefits for orthodontic treatment is provided under the government-run health care systems. Types of braces Modern orthodontists can offer many types and varieties of braces: Braces in popular culture Like eyeglasses, braces can be seen as "geeky". That stigma, however, is fading. For many Americans, even those without severe bite problems, braces are simply a part of growing up. Additionally, there are a growing number of adults (roughly 25% of brace patients are over 21) wearing braces to correct orthodontic issues. Celebrities who have been spotted wearing functional braces in adulthood include Tom Cruise, Gwen Stefani, Lil Bow Wow, Ashley Judd, Lee Ann Womack, Lila McCann, Linda Gray, Cher, Nancy Kissinger (wife of former Secretary of State Henry Kissinger), Brett Favre, Randy Moss, Marquis Daniels, Josh Howard, Kelly Clarkson, Alyssa Milano and Svetlana Kuznetsova. Paula Jones, who gained fame during the late 1990's for filing a sexual harassment lawsuit against then-President Bill Clinton wore braces during the months when she was going through other physical and wardrobe changes. Wearing braces as a fashion statement, rather than from medical necessity, appears to catch on among the young in some parts of the world. In 2006, the media reported that wearing fake braces had become a teen fad in Thailand, to the extent that authorities felt it necessary to consider punishing sellers of fake braces with six months in prison or a $1,300 fine. Dental braces carry the connotation of youth, and as such have become a sexual fetish for some people (see dental braces fetishism). Notable appearances of braces in popular culture include: See also | ||||||||||
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