Braces

When people have teeth that are out of alignment, it can have a number of implications for their dental health. Those with misaligned teeth, a condition known as malocclusion, often have uneven pressures exerted on their teeth due to the misalignment and can experience any number of uncomfortable and costly problems from a loose tooth (where the tooth starts to be unstable, i.e. it has some wiggle room in its socket) to a fractured tooth (where the tooth begins to break apart). Those with malocclusion may also experience difficulty in chewing or talking. The less-threatening but dismaying aesthetic implications can be an uneven and unsightly smile. So what is to be done? Most commonly, braces are the most viable solution. There are about four million people in the United States wearing them right now. Simply put, they are an appliance placed in the mouth—affixed to and exerting pressure on the teeth—for one and a half to two and a half years. They help teeth to move back into alignment in a natural, healthy way. They can both prevent the dental complications ensuing from misaligned teeth and cosmetically render a more perfect, sightly smile.

 

Essentially, this orthodontic appliance consists of solid “brackets” that are held against the teeth with a bonding material and connected into a whole or system by a metal wire called an arch-wire. They complete their function by putting pressure on the teeth collectively and individually, helping direct each one in the direction the tooth needs to move in order to become aligned. Since each tooth may have a slightly different angle of alignment, a number of implements help the system of braces to bring the whole smile into alignment. Elastics, springs, colligations, and elastomeric chains are some of these implements. Elastics are placed over hooks or ties connected to a bracket and help to exert a downward pressure to help realign the teeth they are connected to. Springs can be open coiled or closed coiled: an open coiled spring between two braces helps to open or widen the space between two teeth, while a closed coiled spring helps to merely maintain the space between the teeth. Colligations are wires that reinforce the pressure between two brackets, keeping the space between two teeth closed. Elastomeric chains or “e-chains” are rubber along the wire, connecting two brackets that both keep the wire firmly in place and pull two teeth closer together.

 

The foundational principle for the effectiveness of braces is that of pressure—as they exert pressure on the teeth, the teeth shift in position. To put it in more precise language, each tooth sits in a socket called the “alveolus.” The tooth is connected into the socket directly with a connective tissue called the “periodontal membrane.” As constant pressure is exerted on a tooth, its periodontal membrane is stretched on one side and compacted on the other, and the tooth is effectively realigned. Rather than becoming loose after being shifted, the realigned tooth is actually braced as new bone growth occurs with the shifting. Because the mouth is adapting and essentially being reformed to fit the new arrayal of the teeth, the process must be done slowly—braces are only adjusted to add to the pressure every three to four weeks, as trying to shift the teeth around too quickly would result in their becoming loose and possibly being lost.

 

Most any age group that needs braces is eligible to get them, but most users are pre-teens to early adolescents; of the four million Americans wearing them, it is estimated that roughly a fourth of them are adults. Modern dental/orthodontic science has worked to make braces adaptive and appealing to a broader and broader range of people as well. While most systems have stainless steel brackets, there are gold-plated and titanium alternatives for those with nickel allergies. There are cosmetically appealing alternatives in clear and lingual brace systems—clear or white brackets and wires are less visible, and lingual systems are actually installed on the interior of the teeth to reduce visibility to virtually nothing. There are options for just about everyone.