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Dental Specialties 8 - Orthodontics

This specialty is officially called Orthodontics and Dentofacial Orthopedics.  This specialty is concerned with the diagnosis, prevention, and treatment of dentofacial structures (according to the Canadian Dental Association). 

Most patients think of Orthodontists as people who move teeth—usually in young people.  Indeed this is the bulk of the work load for most orthodontists.  However, the field is much broader than that.  An orthodontist is a growth and development expert in the region of the lower and mid face.  As well, an orthodontist can work with an oral surgeon to change the shape of a fully formed (adult) face, or often can simply work with the adult teeth as would be done on a young person.  

As a specialist in growth and development of the lower face, an orthodontist can often predict how the face will grow and sometimes can place simple appliances in a young person and direct the growth to occur differently than nature would have proceeded to avoid much more expensive and time consuming work later on.  This is termed interceptive orthodontics.  As well, even when it is decided that braces are inevitable, the timing of when those braces are placed often is critical to the outcome of the case.  This is why sometimes it is suggested by the general dentist that certain young patients are sent for an orthodontic consult a year or even several years before it is thought that braces might be needed.  The orthodontist monitors the young person until the time is right for placement of appliances (usually braces)—meaning placement will be for the shortest time and will move the teeth in the simplest way.

From a general dentist’s point of view, short treatment time is very desirable because small cavities between the teeth cannot be detected with radiographs (x rays) when the orthodontic wire is in place.  As well, if the person in braces does not clean the teeth meticulously while the braces are in place, the tooth structure between the orthodontic bracket and the gum line can become decayed or possibly even worse, can become permanently discoloured due to long contact with dental plaque.  For these reasons, the general dentist is interested in having the patient in braces for the shortest period possible.  The orthodontist is also interested in short treatment time, and so is the patient of course.  However, if treatment time is too short, the roots of the teeth can be permanently damaged.  The time of movement varies with each individual patient.  The orthodontist is specially trained to estimate what the treatment time needs will be for each individual case and modify the treatment time midstream if the case requires it.  

Many people have retainers in place for several or many years after braces have been removed.  A retainer retains teeth in place.  It does not move teeth.  It keeps teeth from moving.  In the non dental world, most people term any appliance that is removable as a “retainer”.  Some of these appliances are moving teeth, and actually might have been placed instead of braces.  These appliances that move teeth are not retainers, but are active appliances as opposed to a retainer which is a passive appliance.  In the case of actual retainers (appliances that are placed after the teeth are moved in order to hold the teeth from moving somewhere else), the period of retention is generally longer than it would have been years ago.  If you have questions about how long you should keep wearing your retainer, you should ask your orthodontist or your general dentist.

The science and art of moving teeth and transforming the shape of the bones in the lower and middle face is not a new field.  In fact, some movie stars were getting orthodontics done in the 1930’s.  As with the other specialties in dentistry, it took many years for what seemed unusual or even impossible to do to become part of the main stream of dentistry.  That being said, technology is marching forward in orthodontics.  Wires are becoming more flexible making the force needed to move teeth lower and the time between changing the wire (tightening the braces) to be longer.  As well, moving teeth in adults for many people can be done with clear mouth guards (Invisalign) instead of braces.  Moving teeth is more comfortable and more effective than ever before and is becoming even more so.

- This article was written by Dr. Mike Christensen and published in the Daily Miner and News, and Enterprise. Local Kenora News Publicatons (1998-2006)

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