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Braces - What it is

Orthodontics is the field of dentistry that specialise in the diagnosis and treatment of irregularities of the teeth and jaws. The treatment is instituted by means of removable or fixed appliances, possibly in conjunction with jaw surgery, if required. The treatment include improving oral health, function and appearance of the teeth and jaws.

Braces - Symptoms

Teeth may not bite so well if there is an underlying jaw discrepancy. Visible signs of these may include increased horizontal or vertical overlap of the upper and lower teeth. Overlapping of teeth may also be present in cases of dental crowding.

Braces - How to prevent?

An ideal bite is one where there is slight overlap of the upper teeth over the lower teeth in both hori-zontal and vertical dimensions. When there is deviation from this overlap, the resulting condition is described as a malocclusion- where teeth are not aligned and biting properly. 

Oftentimes, malocclusions are hereditary in nature, and little intervention is advised until the child has the full set of permanent teeth. However, they may also be acquired; environmental factors such as decay of primary teeth (and their consequent premature loss), thumb-sucking, prolonged pacifier use may also contribute to the development of dental issues such as spacing or crowding. Undesirable habits should ideally be discontinued to allow minimal disruption to growth and development of the jaw bones and teeth, while regular dental visits will go a long way in preventing premature loss of primary teeth and consequent crowding of the adult teeth.

Braces - Causes and Risk Factors

People have their teeth straightened for a variety of reasons. These include: 
  • Dental health – crooked teeth may be more difficult to keep clean, increasing susceptibility to gum disease or dental decay 
  • Aesthetics 
  • Chewing function 

For most people, orthodontic treatment is most often elective. It is rare that teeth will be lost if treatment is not started. There are often alternative solutions to orthodontic problems, but a decision on treatment modality should only be made after a consult with a dental specialist. 

Braces - Diagnosis

Orthodontic diagnosis must be performed prior to orthodontic treatment planning and dental consultation. 
1) First consultation- during this visit, clinical examination is performed and diagnostic records are obtained (impressions of the teeth, photographs and radiographs) 
2) Second consultation- discussion of risks and benefits of the various treatment options and confirmation of treatment plan.

Braces - Treatments

When is the Best Time to do Braces? 

This depends on the type of orthodontic problem. 

If the problem is related to the aberrant growth (or lack of growth) of either the upper or lower jaw, treatment should ideally be started while the child is still growing. Treatment can be instituted between the ages of 8 and 12, but this can vary on an individual basis. Appliances used may differ from case to case, but generally they are either worn in the mouth or are combined with components that may be out of the mouth. 

For dental issues, there are occasions for which early intervention is possible. One example would be for an anterior cross-bite with displacement of the jaws. 

Another problem that would benefit from early management would be if there are teeth that are impacted. Treatment varies depending on how the case present, but generally, teeth that are stuck have better odds of being ‘tracked’ out when patients are younger. This is usually done with braces and may occasionally require a minor surgical procedure. 

Regular dental visits are advisable, so that these issues may be identified early and appropriate management instituted. 

For treatment of milder issues (overlapping of teeth or crowding) that are unrelated to jaw problems, treatment can generally be delayed until all the primary teeth (milk teeth) have changed to permanent ones. 

There is no age limit for orthodontic treatment. Adults may also benefit from orthodontic treatment.

Braces - Preparing for surgery

Braces - Post-surgery care

Braces - Other Information

What Type of Braces are Available? 

There are many different types of braces, each suited to a particular type of problem. The best type of appliance for you will be advised by the Orthodontist. 

Removable appliances can be used for simple problems in younger patients (usually under age 11) or as part of a plan involving fixed braces. These are plastic plates with wires and clips and can be individualised for different patients. 

Fixed braces consist of small squares of metal or ceramic (brackets), bonded to teeth by dental adhesive. linked together by orthodontic wires. These wires are held in place by means of elastics (the ‘colours’ that you see on patients’ teeth when they have braces on) or mechanically by ‘doors’ on the brackets (as in self-ligating bracket systems such as the Damon system). 

Invisalign is a system utilising sequential clear removable aligners which gradually straighten teeth when worn 20-22 hours daily. They are less conspicuous than conventional braces, and it is easy to maintain good oral hygiene as the appliance can be removed to facilitate tooth brushing. Invisalign is a good alternative treatment modality for patients who are not keen to have fixed braces placed. 

Lingual braces are fixed braces which are attached to the back of the teeth (inner surface) and not the front. This means they are truly invisible so you can continue to smile with confidence throughout treatment. Because lingual braces are not visible they are ideal for adults or older teenagers who are concerned about the appearance of traditional fixed braces. Lingual braces are invisible when the patient smiles. 

Your Orthodontist will be the best person to recommend the appliance best suited to your lifestyle and mal-occlusion.

What are the Outcomes of Treatment?
Outcomes of braces/orthodontic treatment can be measured through objective assessment of the degree of improvement achieved using the Peer Assessment Rating (PAR). PAR is a widely accepted orthodontic index that is designed to evaluate improvement in alignment and positioning of teeth and jaws.

Scores are assigned to the pre- and post-treatment states, reflecting the deviation from an ideal alignment and bite for the patient. The difference in pre- and post-treatment scores will indicate the degree of improvement. A higher percentage difference reflects a higher degree of improvement in alignment and bite. As patient outcomes may be influenced by many factors, it has been recommended that 75% of completed cases should exhibit an improvement greater than 70%[1].

In NDCS, PAR is tracked on a yearly basis based on a sampling of cases. Results show that at least 90% improvement is achieved in 100% of completed cases evaluated. Year-on-year average is tabulated below.

[1] NHS England South Personal Dental Services Orthodontic Services Specification. Issued 19 February 2018.   

*Please visit our Appointments page for information on how to make an appointment at NDCS for Braces treatment. 

The information provided is not intended as medical advice. Terms of use. Information provided by SingHealth

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