orthodonic appliances

When teeth come through crooked or crowded, a dentist may recommend orthodontic treatment to straighten or move them. This is important not just for looks but also because having straight teeth enables you to clean them thoroughly, and to talk and chew food more easily. Most orthodontic work is done on children, but increasingly adults who are concerned about the look of their teeth are having orthodontic work done.

Your dentist will probably refer you to a specialist orthodontist, who will assess your mouth and decide on the type of appliance you need to improve the alignment of your teeth. If appropriate, some orthodontists may recommend the extraction of teeth where extra room is needed. It can sometimes be followed by cosmetic work to improve the appearance of the teeth.

Usually known as braces, these appliances slowly and gently move your teeth into line. There are many types and designs, but broadly they can be either:

• Removable - can be taken out for cleaning... or
• Fixed - can only be removed by the orthodontist at the end of the treatment.

Plastic or ceramic brackets are now available which look more attractive than metal ones, but these are subject to technical limitations. At the end of the treatment, retainers are usually worn for a considerable time to allow the teeth to stabilize.

Depending on the complexity of the case, and how much the teeth need to be moved, the appliance will be used for several months, maybe for as long as two years, using regular returns to the orthodontist for adjustment. It will probably feel slightly uncomfortable for a while but this should settle. If you continue to feel discomfort, ask your orthodontist's advice.

Oral hygiene is particularly important while you are wearing an orthodontic appliance, as it is easy for food and debris to get lodged and for plaque to build up, leading to decay and gum problems, so you need to keep your mouth and your appliance as clean as possible. Your orthodontist and hygienist will be able to demonstrate cleaning techniques and advise you on any special requirements.

This may take up to three times longer than normal. Clean after every meal, trying to cover all sides of your teeth and the fixed appliance if worn. Clean systematically around each tooth, using a fluoride toothpaste and soft to medium brush.

Disclosing tablets can be helpful from showing you where plaque is building up, for example from hard-to-reach areas.

Toothbrushes using shortened central tufts are good for cleaning fixed appliances, while your hygienist or orthodontist may recommend specialist interspace brushes or an interdental bottlebrush to get the debris and plaque out from under the wires.

A fluoride rinse is often recommended. It gives daily protection and strengthens tooth enamel. Electric brushes may be used while the orthodontic appliance is from place. Remember, however, that no matter what specialist cleaning tools you have, application and thorough cleaning are the most important factors.

This should be done thoroughly each day using a soft toothbrush and warm soapy water or specific denture cleaner if necessary. Do not use normal toothpaste as it is much too abrasive. Clean the appliance over a sink of water or a soft surface so that it will not be broken if dropped. Sonic cleaners are also available which can be very effective.

Cut up hard foods rather than crunching on them. Very hard foods, like certain sweets, may damage a delicate appliance. Sugary foods and drinks should be avoided as far as possible as, if sticky they will adhere to the appliance, encouraging decay and may even pull out the components. Carbonated drinks may also lead to erosion of the enamel covering the teeth. Try to snack on non-sugary foods and, if toothbrushing cannot be done during the day, rinse the mouth out well using water after meals to wash out any food lodged there.