Having orthodontic treatment can massively improve your smile and self-confidence. It can also correct a lot of problems associated with the imperfect position of teeth. These problems can be aesthetic but can also affect how the teeth develop, how they meet on chewing, how easy they are to keep clean, risk of trauma to teeth or gums. Aesthetic considerations should not be underestimated. Certain orthodontic problems can have a profound impact on your quality of life.
Crowding
Crowding is due to a disproportion between the size of the teeth and the jaws. It is a very common orthodontic problem. Crowding can also make oral hygiene maintenance more challenging. It can be corrected by maintaining the space of baby teeth, regaining space that has been previously lost, by removal of some permanent teeth or reducing the width of certain teeth (enamel reduction). Your orthodontist will do a detailed orthodontic assessment taking into consideration the shape of your jaws, your facial profile or side view, growth potential, your smile, teeth present and the position of teeth and amount of crowding. They can then discuss the options with you and come up with a treatment plan to suit you or your child.
Overbite
Overbite is the vertical overlap of the top incisors over the lower incisors. An increased overbite (or deep bite) can sometimes lead to traumatic wear of the enamel of the incisors or the supporting gums. If the top teeth trap the lower teeth, this can restrict the growth of the lower jaw. Overbites are best corrected at a younger age and preferable during growth spurts (age 10-14, younger for girls, slightly older for boys). Overbites can be corrected in adults but involve more tricky orthodontic mechanics.
Overjet or protruding teeth
Overjet is the horizontal overlap of the top incisors relative to the lower incisors, sometimes known as buck teeth. Increased overjets are associated with an increased risk of trauma to the upper incisors. Often the top incisors are thought to be protruding, however, more often than not, the top incisors are in the correct position to the face and the lower jaw/teeth are set back in the face. Increased overjets may be associated with a narrow palate or thumb-sucking habit. Narrow upper jaws and relatively small lower jaws are best corrected again during growth spurts (age 10-14, younger for girls, slightly older for boys). Increased overjets can be corrected in adults but involve more tricky orthodontic mechanics or jaw surgery.
Spacing
Spacing or gaps between the teeth are either due to small teeth, large jaws, or missing teeth (hypodontia). Your orthodontist will do a full assessment to determine the cause of the gaps and then make a patient-specific plan for you. Options include the closure of spaces, replacement of missing teeth or composite build-ups or enamel bondings of small teeth. Each option has pros and cons and your orthodontist is best positioned to help you make the best decision for you.
Missing teeth/hypodontia
Missing teeth affects 5% of the population. The most common missing teeth are 2nd premolars and upper lateral incisors. Orthodontic treatment options for missing teeth are either to open the space for replacement teeth (bridges, implants or dentures) or close the space. Depending on the case, space closure can be a great option as you would not need long-term replacement teeth or implants.
The treatment plan will depend on several factors: crowding, remaining baby teeth, position and shape of the jaws, face, and smile aesthetics. Your orthodontist will help create a treatment plan for you taking into consideration all of the above and your personal preference of long-term maintenance of the spaces. Often, we need to involve your general dentist or specialist prosthodontist in the treatment plan as they would be involved with replacing the teeth or reshaping them as needed after the braces are removed.
Impacted canines
Impacted upper adult canines or canines that are developing in the incorrect position affect 2% of the population. Assessment for impacted canines should be done at age 10 by your dentist or orthodontist. If the canines cannot be felt under the gum at this age, an orthodontic referral is necessary to see where the canines are. Simple orthodontics can be done at this age to improve the position of the adult canine. This might involve extraction of the baby’s canines or widening of the top jaw to make more room for the developing canines. If the canines do not erupt by themselves, a small surgical procedure might be needed to expose the developing canine and then an orthodontic brace fitted to help move it into the correct position. Early intervention is best. If you are worried about impacted canines, book in with your orthodontist at age 10 for an assessment.
Crossbite
A crossbite most commonly involves the upper teeth biting inside the bottom teeth (normally the upper teeth bite outside of the bottom teeth). If left uncorrected, it can lead to traumatic wear of the enamel surfaces of the teeth. Crossbites can be due to crowding, a small upper jaw, a large lower jaw or asymmetric growth of the jaws. If this affects the incisors, it is one of the orthodontic problems that can be corrected early (interceptive treatment, age 7-10) to limit or reduce the need for orthodontic treatment later. This might be done with a short course of fixed braces, a removable brace or a fixed expander brace. Speak to your specialist orthodontist to discuss the options.
Open bite
Open bite is when the upper and lower incisors don’t overlap. It can be due to a habit, like thumb sucking, a prominent resting position of the tongue or vertical growth patterns of the jaws. Your orthodontist will do a full clinical examination to assess the underlying factors and then create a treatment plan for you.
