Many treatment options are available for malocclusion (poor bite), and expert opinions differ about timing. Your dentist or orthodontist may give you a choice between early or later treatment or may prefer one particular approach. Adults have effective treatment options as well. The general categories of orthodontic devices (appliances) are functional and fixed.
Functional appliances use the movements of the muscles and jaw to create gradual bone movement.
Some functional appliances are removable, while others are bonded to the teeth.
A functional appliance may fit between the upper and lower teeth (a splint) or may span across the mouth between the molars, pressing the bone outward.
Headgear can attach to bands on the teeth to speed up treatment time.
Fixed orthodontic appliances are sets of wires and brackets that are cemented to the teeth. These are commonly called braces. Over a period of months, the wires are tightened and adjusted, gradually applying enough force to move the teeth (bone remodeling).
Retainers are removable appliances made of molded plastic and wire. They hold the teeth in place after braces are taken off. If the teeth start to move back out of position, the orthodontist may bond a short retaining wire to the back of some teeth. This will hold the teeth in place until the wire is removed.
Child and adolescent treatment
During the childhood and teen years, the orthodontist will time the treatments to match with your child's natural growth spurts to move permanent teeth into place.
Treatment for crowding, the most common malocclusion problem, may mean removing (extracting) some permanent teeth, but orthodontists avoid removing permanent teeth when they can.
The malocclusion treatments for children and adolescents are:
Growth modification. This involves wearing fixed or functional appliances during the day and night to move the jaw into a better position.
Extraction (serial removal). Removing some baby teeth may ease severe crowding.
Fixed appliances (braces). For children and teens, this treatment phase usually lasts about 24 months; for adults, about 28 months.
Retainers. Retainers hold the teeth in place after orthodontic treatment. Some orthodontists recommend that retainers be worn for many years, because teeth have a natural tendency to drift out of place.
Space maintainers, made of metal or plastic. Spacers keep the surrounding teeth from moving (drifting) into open spaces created when teeth are pulled or lost in an accident.
Most adults have little or no jaw growth. This means that surgery is the only way to correct jaw-related bite problems. Some adults may benefit from simply camouflaging, or hiding, a jaw-related problem. Using braces, the orthodontist can move the teeth so that they fit together, despite the jaw discrepancy. However, surgery is the best way to treat more severe jaw problems.
Orthodontic treatment for malocclusion is a popular option for adults, due in part to better technology. In the past, wide silver bands held braces in place. Today they are less obvious. Instead of the wide bands, a small metal or ceramic fastener is bonded to each tooth, and a narrow wire passes through the fasteners.
New options include:
Clear plastic instead of silver wires.
Lingual braces. These braces attach to the back of the front teeth.
Removable clear plastic aligners (Invisalign). These are molded specifically for you.
Lingual braces and aligners don't work for everyone. They aren't options for children. Your orthodontist can tell you the best choices for your situation.
Orthodontic treatment for adults may also involve:
Removal (extraction) of teeth to create more space.
Orthognathic surgery of the jaw.
A retainer, after braces are removed.
Adjustments, such as grinding of high tips of teeth, to prevent continued or increased malocclusion for adults.
What To Think About
Some cases of malocclusion clearly require orthodontic treatment. In many cases, however, the decision is a matter of personal choice.
The timing of treatment is ultimately up to you and your child or teen. Talk to your orthodontist about the pros and cons of treatment options.
Orthodontic treatment doesn't pose risks to adults who have healthy teeth and gums. Adults who have gum (periodontal) disease, however, must first get treatment from a periodontist to avoid possible gum damage or tooth loss. Orthodontic treatment sometimes can worsen preexisting conditions.
Orthodontic treatment isn't an exact science. Treatment is sometimes unpredictable, taking longer than planned. If teeth are likely to move after braces are removed, you may need a retainer for an indefinite period of years.
Orthodontic treatment is costly. Most medical and dental insurance plans don't pay for orthodontics. Before deciding on treatment, ask about the projected cost, terms of payment, and terms of the treatment contract.
Once treatment is over, teeth often begin to shift. Molded plastic retainers, usually worn at night, help prevent this tooth movement. Your orthodontist may suggest using a retainer for months or even years.