Dental Braces

Dental braces are appliances used to align teeth and jaws to produce an even bite and to correct misaligned or rotated teeth and gaps between teeth. Although usually worn during early adolescence, adults whose teeth have not been corrected can still benefit from dental braces, but results may take longer to achieve.

Modern materials and technological developments have paved the way for a variety of dental braces, including wire-free invisible ones as well as the more familiar wire based variety.

Reasons for choosing to have braces

The desire to improve their smile is a key motivator for those seeking braces. A recent survey by the American Academy of Cosmetic Dentistry found that virtually all the Americans responding (99.7%) believed that a smile is an important social asset. An overwhelming majority of adults (96%) said they believe that an attractive smile makes a person more appealing to the opposite sex, and 74% of adults felt that an unattractive smile could hurt their chances for career success. When asked what they notice first in a person’s smile, the most common response was straightness of teeth, followed by whiteness and colour of teeth, cleanliness, and missing teeth. Discoloured, yellow, or stained teeth, missing, crooked or decaying teeth and gaps and spaces as well as dirty teeth made it to the list of things that make a smile unattractive.

Aesthetics are just one reason for wearing braces. Many people are referred to an orthodontist by their primary dentist because of various functional problems. Aesthetics aside, proper functioning of the mouth, teeth and jaw is important.

You can benefit from braces if you have

• A problematic bite, including overbite, underbite or cross bite.
• Protruding teeth that prevent you from comfortably closing your lips.
• Teeth that do not meet properly or meet in an abnormal way.
• Misaligned or rotated teeth that distort your smile.
• Crowded teeth.
• A desire to improve the overall appearance of your smile, to make it wider and more youthful.

Although it may not be a primary motivator, orthodontic treatments can also improve facial contours, providing support for the lips, cheeks and general facial balance.

Adults usually wear braces to correct features that were not corrected with orthodontics when they were younger. Ageing can change the structure of the mouth and jaw, as can overcrowding. Adults can use braces to correct these problems and give the teeth proper support.

Braces can also be used to reduce the need for major dental restorations in later life. Some people are asked by their cosmetic dentists to consider braces before undergoing restorative work, as part of a program to correct the foundations. Braces can help ensure the long-term stability of the restorations, saving money in the long run and avoiding costly short-term solutions.

Because overlapping or crooked teeth can make it difficult to clean the teeth properly, braces can also improve oral health.

Braces can’t correct all orthodontic problems. If the jaw is too narrow or too wide, too large or too small, braces will not be effective because the teeth can’t be moved sufficiently to correct the problem. Functional jaw orthopaedics (FJO) or jaw surgery—also referred to as orthognathic surgery—may be necessary in such instances.

FJO orthodontics refers to the process that ensures that the jaw is the correct shape and size and in its correct position. FJO is also called no-braces orthodontics because it improves balance in the facial structure without using braces. Improving or restoring jaw function can improve breathing and sleeping, reduce jaw pain, headaches and neck pain as well as balancing facial features.

Your orthodontist can tell you if FJO is needed to improve the structure of your jaw. Usually these are elective procedures. Using braces alone to correct structural problems is not always the best choice. Your smile will improve, but you may end up with long-term functional issues.

Things to consider once you’ve decided to have braces

There is a wide variety of choice when it comes to selecting braces. Your first decision will be between braces and clear aligners. If you opt for wire braces, you must choose which type to use. In all cases, the most important choice is your orthodontist or cosmetic dentist.

Fixed wire braces or clear aligners?

At the most basic level, your choice will be between fixed wire braces and clear removable aligners. Both types have their benefits and disadvantages. You may need to become familiar with them before making this decision.

Clear braces are a series of clear plastic trays similar to mouth-guards worn a certain number of hours each day. They will be fabricated to move the teeth a little bit with each new tray. Obviously, this involves taking images and impressions of your teeth multiple times during the treatment period.

The greatest advantage of clear braces is that they are less visible than wire braces. They can also be easily removed for eating and for cleaning. This is extremely helpful in avoiding tooth decay, staining and gum disease inherent in wearing wire braces.

For some people, these advantages are outweighed by the disadvantages. Clear braces work more slowly than wire braces, require a high level of commitment from the wearer and can only produce minor tooth movements in a properly aligned jaw.

Clear braces typically cost more than fixed braces, although the costs will vary with the extent of correction needed and the length of treatment. Your dentist or orthodontist can help determine the complexity of your treatment and provide you with a better idea of cost after an initial consultation.

At present, Invisalign is the more popular brand of clear braces found in the Australian market. You can read more about Invisalign in our article on the topic.

More about wire braces

Wire braces have three primary components: brackets, a flexible archwire that connects all brackets and ring-like bands that goes around the molars and holds the archwire in place. Tiny elastic ties or ligatures are used to secure the archwire to the brackets. There are also self-legating braces, which enable the locking of the brackets to the archwire without the elastic bands.

The variety of wire braces available depends on the types of materials used in brackets and wires, the type of ligatures used as well as the placement of the braces in the mouth relative to the teeth (behind or in front).

Brackets can be made of titanium, stainless steel, ceramic, polycarbonate or by combining a polycarbonate base with a ceramic bracket. Ceramic brackets can be clear or tooth-coloured, making them less obvious than metal ones. Brackets can be made in a variety of sizes and colours to suit your preference.

The archwire, which controls the movement of the teeth, may be made of stainless steel, nickel or titanium. Titanium or nickel archwires are superelastic and have shape memory, which makes them more flexible than stainless steel. They are also more expensive than stainless steel, but will need fewer adjustments over the period you need to wear them. Bands are usually made of titanium or stainless steel.

There may be other accessories— elastic bands, buttons, power chains and mini-molds—that are used to help position the teeth or jaw properly, depending on the type of tooth movement or jaw correction required.

Wire braces are very effective for a wide range of corrections for both the teeth and jaw. Compared with clear braces, they can bring about movements of the teeth relatively quickly. Since they are fixed in the mouth, wire braces do not require the same level of commitment from the wearer as do clear braces. They are also relatively less costly, but costs vary because braces made with modern materials can be a lot more expensive than basic metal braces.

The inherent disadvantages of wire braces include difficulty in eating sticky foods, food particles getting caught between the teeth and brackets and the danger of hard foods damaging the braces. It is difficult to clean teeth while wearing braces. The bond between the brackets and teeth can weaken over time and loosen or pop off. Dental braces can be broken or damaged when playing sports or by other accidents.

Lingual braces

Most types of wire braces are fixed in front of the teeth and are visible. Another group of braces, called lingual or invisible braces, are fixed on the inside edge of the teeth so they are less visible when the wearer is smiling or speaking. Although adults in particular may wish to have lingual braces, the amount of correction and the scope of effectiveness with lingual braces is relatively limited. Your orthodontist or dentist will be able to tell you whether you can benefit from lingual braces.

Choice of practitioner

The skill of your orthodontist or dentist—in evaluating your needs, preparing a treatment plan and placing the braces in your mouth—may determine the success of your treatment to a larger degree; rather than the type of braces you choose. How the brackets are positioned on the teeth and how your braces are structured depends on the training, skill and experience of your practitioner.

Some types of braces require special training, and without such training, your treatment may not succeed fully.

What to expect

At an initial consultation, your orthodontist or dentist will evaluate many aspects of your mouth, focusing attention on the function and the aesthetics of both the teeth and jaw.

Expect a physical examination, X-rays, plaster models for bite impressions and use of photos and panoramic 3D imaging to help enable a proper analysis.

• A physical examination of your mouth, teeth and jaw is usually the first step.
• Your teeth will be checked to see whether they are straight, meet properly, have gaps and are not rotated, crowded or missing.
• The health of your teeth and gums will also be checked.
• Your bite—how well your top and bottom sets of teeth meet when you open and close your mouth—will be checked to see whether you have an overbite, underbite, cross bite or any other bite issues.
• Your jaw will be inspected and you will be asked whether your jaw hurts or makes clicking noises.
• You will also be asked whether you encounter problems with chewing, breathing or sleeping.

If you have sleep apnea, recurring head, jaw and neck pain or have bruxism (teeth grinding) or other habits that may affect your teeth or jaw, it is best that you mention them at your initial consultation.

The next step will be deciding on your choice of braces to suit both your lifestyle and your budget. Your orthodontist will help you make the correct decision by explaining the pros and cons of each type as well as the estimated costs.

Once you make the choice, a treatment plan will be customised for your treatment needs. Your orthodontist may recommend extraction of one or more permanent teeth prior to fitting braces if your mouth is very overcrowded.

Beyond the initial consultation, you will need to visit your orthodontist’s office on multiple occasions; to fit the braces, to make periodic adjustments and to fit the retainers, once braces are to be removed.

The process explained below for fitting braces relates to wire braces. The details for clear braces can be found in our article on Invisalign.

To fit braces, the teeth are prepared by cleaning them, applying a preparation solution and washing it off to clear the surface for bonding brackets. Because the exact location of the brackets on your teeth will determine the final outcome, your orthodontist will carefully place the braces on your teeth. His or her skill in positioning braces depends on experience as well as the knowledge and ability to visualise and predict tooth movements. This is a good reason why you should take extreme care in choosing your practitioner.

The braces may be glued into position faster and more solidly with blue light exposure, reducing your waiting time. When the braces are set, the wire is placed and tied with ligatures or clipped in if braces are of the self-legating variety.

Once this procedure is complete, you will be given a braces care pack and instructions on how to make and care for your braces.

You will also be given a schedule with dates for future visits to make adjustments to your braces to help complete the treatment plan. You should follow this schedule and visit your orthodontist as required to ensure the corrections are going proceeding to plan.

Before and after braces

There is little preparation needed to have braces. However, it is important to remember that the hardware (braces), the treatment plan and skill of your orthodontist or dentist will come to nothing if you are not committed to the success of your treatment. You need to stick to the adjustment schedules, take proper care of your braces and oral health on a daily basis and follow instructions carefully. This is especially important in the period after the braces are removed and you are required to wear a retainer to maintain the good results gained from wearing braces.

Taking care of your braces and oral health

Here’s what you can do to avoid damage to your braces and your teeth and oral health while wearing braces:

• Try to reduce your intake of starchy and sugary foods.
• Brush and floss your teeth carefully at least twice a day. If you are brushing after meals, do not do it immediately after eating because that can damage teeth. Use fluoride toothpaste with a soft-bristled brush.
• When you floss, make sure to floss between braces and under wires as well, using a floss tape.
• If you cannot brush after every meal, rinsing your mouth with water is a good substitute. Swirl the water in your mouth to help remove any food particles lodged between the teeth and rinse thoroughly.
• Rinsing your mouth with water after drinking acidic and sugary beverages is also a good way to reduce tooth erosion.
• Use a fluoride mouthwash recommended by your dentist or your orthodontist.
• Make periodic professional dental cleaning sessions. Your dentist or orthodontist may be able to guide you on the frequency, which depends on your risk of tooth decay and gum disease.
• Be careful of what you eat, avoiding sticky foods like gum, sticky candy, caramel and hard foods such as nuts, popcorn and hard candies. Eating sticky foods puts you at risk of pulling the brackets off your teeth while hard foods can lead to breaking of the braces.

Possible risks and complications

As with any treatment there are risks and potential complications that may arise while wearing braces. However, wearing braces is a very safe treatment and most people wear them without any problems.

There could be both short term and long term risks involved with braces.

Short-term risks and complications include:

• Discomfort or pain

  – You may encounter this a few days after you begin wearing braces for the first time, and after each subsequent adjustment to the braces. The pain may even affect appetite, especially in young children.
  You can ask your orthodontist for a prescription for a pain reliever in case you encounter discomfort. Eating soft foods for a few days may also help because it puts less strain on the teeth.

• Discoloration, tooth decay and gum disease

  – Wearing braces can make it difficult to clean teeth properly, and often food particles can get trapped within the braces, under arch wires and brackets. In the short term, this may result in damaging the tooth surface, demineralising the enamel and leading to permanent whitish stains on the tooth. Sometimes this may even lead to cavities. Properly cleaning teeth, brushing more carefully and using floss, can help avert this risk.
  After removing braces discolouration can be treated with tooth whitening. If the problems are severe you may need to consider tooth bonding or dental veneers.

• Allergic reactions

  – Sometimes people are allergic to the metals such as nickel used in the braces in the wires and brackets. Others may be allergic to the plastic or rubber components of the braces, or even to the latex gloves used by the orthodontist. More recently there are reports of cases of allergies to plastic in the removable aligners and aligner trays. If you have known allergies, you need to inform your orthodontist about them so that they can use safer alternatives.
  If you encounter allergic reactions, including but not limited to mouth sores, problems with your upper respiratory system, swelling or hives, immediately talk to your orthodontist about them. Allergies should not be taken lightly because some reactions can end your life within a matter of minutes.

• Injury to soft tissues and canker sores

  – When you wear braces for the first time, your lips, gums and the inner cheeks may begin feeling sore due to the contact with the metal parts. When such irritation continues, canker sores may develop where the sensitive inner parts of the mouth keep rubbing against the metal. If this occurs, talk to your orthodontist who will prescribe medication to reduce irritation, pain and to heal the sores. Sometimes applying dental wax on brackets that cause irritation may help prevent further problems.

• Relapse

  – the corrected teeth may become misaligned again, after the braces are removed. This is more usual in case of bad oral habits such as pen biting, adult thumb sucking or pushing the tongue against the teeth. The changes in the mouth due to the eruption of wisdom teeth may also affect the results of an orthodontic treatment.

The long-term risks involved with wearing braces include:

• Unstable teeth resulting from shorter root lengths

  – When teeth move, some of the bone that is in the path of the moving tooth dissolves away while new bone is created behind it to fill the gap created. This process could result in unstable teeth, especially until new jawbone around the tooth root becomes fully formed; and in some cases the teeth can remain unstable for the long term. This is usually not a problem for most people who wear braces.

• Relapse or loss of correction

  – This usually occurs when people fail to follow instructions given by their orthodontist after the braces have been removed. Usually it is necessary to wear a retainer that helps keep the correction intact. Failure to do so may result in loss of correction. The changes that take place in the mouth with the eruption of wisdom teeth or the changes that occur in the jawbone and mouth structure as people age can affect orthodontic corrections.

The best way to reduce risk is to find a practitioner who is fully qualified, has received formal training in addition to their dental qualifications and who has experience and training in fitting the type of braces you need.

However, even the best orthodontist cannot completely remove your chances of risk and complication because as with any procedure, the outcome also depends on how each person’s body—in this case, your mouth, teeth and jaw—responds.

Just as you would discuss potential benefits before a medical or dental procedure it is always advisable to ask your orthodontist to address the potential risks as they apply to you. Your orthodontist can also advise you and guide you on how to avoid or minimise some types of risk.

Rough costs involved

You can expect the fee for orthodontic treatment involving upper and lower braces to range between $4,500 to $7,000 (AUD), depending on the severity of correction and your orthodontist’s or cosmetic dentist’s fee scale. In some cases it could be more, but, if your treatment involves braces for just one arch or the problems require only a simple treatment, your costs could be significantly lower.

It is difficult to predict the cost of treatment with braces without a complete evaluation because each person requires a unique treatment plan. Your practitioner will be able to give you an exact figure before treatment begins.

Some dental health funds may give a limited rebate on fees paid for orthodontic treatments. You should discuss the details with your health fund before beginning orthodontic treatments.

You should expect the costs to be higher if you are having combined orthodontic treatments at the same time.

This information is correct as of 2019.