Orthodonty

Orthodonty

Who is an Orthodontist?

An orthodontist is a specialist dentist who deals with the diagnosis and treatment of tooth alignment and jaw relation disorders. In order to become an orthodontist, it is necessary to receive 4 years of specialization training after 5 years of dental education.

What is malocclusion?

Malocclusion is defined as a “bad closing” of the teeth. Sometimes in childhood, the jaws do not develop properly and the teeth are not aligned properly. This causes the teeth in the lower and upper jaws to be curved, crowded, or to a disorder in the jaw structures. Malocclusion is not a disease, it simply means that the jaws or teeth are not in their normal position. Severe malocclusions may affect functions such as eating and speaking and may make it difficult to clean the teeth. Individuals may have different malocclusions. Some of them are:

  • Overdevelopment in the upper jaw
  • Underdevelopment in the upper jaw
  • Overdevelopment in the lower jaw
  • Underdevelopment in the lower jaw
  • Forward positioned anterior teeth
  • Crowding
  • Impacted tooth
  • Missing teeth
  • Deep closing
  • Open closing
  • Cross closing
  • Diastema

What causes malocclusion?

Early loss of deciduous teeth: Loss of deciduous teeth due to caries at a young age and failure to preserve the position of the deciduous teeth with retention causes the closure of the developing permanent teeth.

Genetic factors: Jaw disorders, hereditary tooth deficiencies, impacted teeth, narrow upper jaw, crowding problems can also be inherited to the child.

Ear-nose-throat problems: Tonsillitis, presence of nose and adenoids or continuous mouth breathing can cause malformation of the jawbones, deep and narrow palate, and cause problems with the space necessary for the proper placement of the teeth.

Bad habits: Bad habits such as tongue pushing, thumb sucking, using a pacifier or bottle for a long time, tongue sucking, lip sucking, pen biting, nail biting can also cause orthodontic disorders in teeth and jaw structures.

Congenital anomalies: Some congenital anomalies involving the head and face region (such as cleft lip and palate, hemifacial microsomia, Apert syndrome, Cruzon syndrome) may cause problems in the development of the jaws, alignment of the teeth, and sometimes an asymmetrical appearance on the face.

Permanent tooth loss: If permanent tooth cavities that are removed due to caries in adulthood are not treated prosthetically, it can cause tipping in the neighboring teeth, narrowing of the space in the extraction space, changes in chewing habits and difficulties in implant or bridge construction.

What kind of problems do tooth and jaw disorders cause if orthodontic treatment is not performed?

It is difficult to clean the teeth if crowding is present. Poor closing (malocclusion) due to jaw disorder or tooth alignment problems can cause abrasions on tooth surfaces, difficulties in chewing and function, and excessive load accumulation in the bone and gingival structures that support the teeth. If left untreated, various problems may become more serious over time, thus requiring more complicated treatment.

When should the first orthodontic examination be done for children?

For children, it is recommended that they undergo orthodontic checks before the age of 7. At this age, the orthodontist can detect problems in jaw and tooth development while the child has deciduous teeth. Early diagnosis is important because certain orthodontic problems are easier to treat when diagnosed early. Some of the disorders in the jaw relations can be resolved before the child’s growth period ends. Most patients’ orthodontic treatment begins between the ages of 9-14, when children are growing fast.

Who can receive orthodontic treatment?

Orthodontic treatment can be performed at any age. In the past, there was a misconception that orthodontic treatment was only applied to children. Today, the number of adult patients who want to receive orthodontic treatment is quite high. Age is not a negative criterion for orthodontic treatment. Healthy teeth can be moved at any age.

What is required for orthodontic examination and planning?

Before orthodontic treatment, clinical examination should be performed for diagnosis and treatment planning. Smile, side profile, the degree of disorder in the jaws and teeth are determined by examination. Orthodontic x-rays are necessary to determine the treatment plan and course. By evaluating the x-ray(s) taken, clinical findings and x-ray findings are combined and a clear treatment plan is revealed.

What dental preparations are necessary before starting orthodontic treatment?

Before starting orthodontic treatment, it is absolutely necessary to clean the tartar and treat the caries. The person must have regular teeth brushing habits before starting orthodontic treatment.

What are the appliances used in orthodontics?

  1. Fixed orthodontic appliances (Brackets)

The most commonly used method in orthodontic treatment is to insert brackets on the teeth. Brackets are adhered to the teeth with a special material and the teeth are moved by applying force with the braces. Today, there are various types of brackets made of metal or transparent materials. Brackets are placed on the front surfaces of the teeth. There are also bracket types placed on the back surfaces of the teeth.

  1. Removable appliances

Removable appliances are appliances that are used to solve simple problems and can be easily put on and removed by the patient. It is preferred in slight crookedness and slight narrowness of space.

  1. Extraoral appliances

These are orthodontic appliances that correct both jaw and tooth disorders and receive support from the outside of the mouth.

  1. Functional appliances

Functional appliances utilize the forces created by the jaw muscles of the person and transmit these forces to the teeth and jaws, helping to ensure a proper closure. There are fixed types as well as removable types.

  1. Transparent plaques

It can be used in mild orthodontic disorders or to preserve the condition obtained after active orthodontic treatment. These are transparent plaques that can be put on and removed by the patient. These plaques are made by your doctor in accordance with the personalized plan. There are no brackets or braces in the mouth. However, this system is not suitable for every orthodontic disorder.

What foods can be eaten during fixed orthodontic treatment?

Eating may be more difficult than before for the first few days of treatment. Pain may be experienced while chewing. During this period, soft foods are recommended when there is sensitivity in the teeth. Foods such as ice cream, yoghurt, pudding, soup, boiled potatoes, bananas, soft foods, milk are recommended for comfortable chewing. As long as the brackets are in the mouth, patients undergoing orthodontic treatment must be careful about what they eat and drink. Otherwise, the bracket(s) may break off from the tooth, which will prolong the treatment period.

Foods that should not be consumed during treatment:

  • Crispy foods: Popcorn, chips, etc.
  • Sticky foods: Caramel, chewing gum, Turkish delight, jelly beans, etc.
  • Hard foods: Nuts, almonds, sugar, etc.
  • Foods to be bitten: Apples, plums, carrots, sandwiches, boiled corn, etc.
  • Acidic beverages: Sodas, carbonated juices, etc.

How to ensure good oral care during orthodontic treatment?

Teeth require special care during orthodontic treatment. Food residues accumulate on brackets, braces, bands, and other appliances, therefore cleaning of teeth with brackets is more difficult than regular dental cleaning. During this period, the only way to prevent dental caries and gingival diseases is to brush teeth after every main meal and snack.

The procedures that can be performed for good oral care during orthodontic treatment are as follows:

  • Teeth should be brushed after every meal and snack
  • An interface brush should be used to remove stuck food residues
  • Mouthwash should be used after brushing in order to reduce bacteria in the mouth
  • Fluoride toothpaste and soft-bristled toothbrush should be preferred
  • Regular checks with the general dentist should be continued throughout the treatment

What kind of problems are encountered if the teeth are not brushed well during orthodontic treatment?

Preserving dental and gingival health requires more care during orthodontic treatment because orthodontic treatment creates environmental changes in the oral environment. It is easier for food to be stuck on the extensions of the appliances and brackets. Food accumulation accelerates the accumulation of dental dirt, which we call plaque. In the presence of plaque, the number of acid-producing bacteria on the tooth increases. If the plaque is not cleaned, staining on the tooth surface, deterioration of the enamel layer of the tooth and caries occur.

What are the responsibilities of the patient during orthodontic treatment?

The patient is primarily responsible for the preservation of dental and gingival health. For this reason, the patient must perform oral care in the most perfect way. Orthodontic appliances are attached to the teeth with a certain durability; excessive and sudden load can cause the appliances to break or break, therefore the patient must comply with the eating and drinking rules. In order to ensure the rapid progress of the treatment and to achieve the targeted result, recommendations of the physician should be fully complied with throughout the treatment. Appointments should not be postponed. Reinforcement appliances applied at the end of the treatment should be used for the period recommended by the physician.

How often should orthodontic treatment appointments be made?

Appointments in orthodontic treatment are planned according to the patient’s condition. Appointments in patients undergoing fixed orthodontic treatment vary between 4-6 weeks. In special cases that require more frequent control, appointments are planned accordingly.

How long does orthodontic treatment take?

Orthodontic treatment continues until the targeted result is achieved. Individual differences affect the treatment process. In addition, the severity of the problem, differences in the structures of the teeth and jaws, teeth and gingival health, the individual’s interest in treatment and oral care also create differences in the treatment period. Orthodontic treatment may be required for different periods ranging between 6 months and 3 years. The treatment takes 1,5 to 2 years for most people.

What are the risks of orthodontic treatment?

No pain is experienced during the placement of the brackets. During the first 3-4 days of treatment, tenderness may occur during biting movement. There may be injury to the lips, cheeks and tongue for a few weeks until you get used to the appliances. Some appliances may cause speech difficulties for the first day or two. Food residues around orthodontic appliances can lead to plaque formation on the teeth, which can lead to enamel damage, staining, caries or irreversible damage to the teeth. There is also a risk that the teeth will return to their former positions despite the treatment. In order to minimize this risk, the person should not interrupt the reinforcement treatment phase.

What is tooth extraction treatment?

For treatment of some orthodontic disorders, it may be necessary to perform treatment by pulling teeth. Tooth extraction decision for orthodontic treatment should be made by a specialist who has received orthodontic training.

What is reinforcement treatment?

It is a passive treatment phase applied to prevent the teeth from returning to their previous condition after the end of active orthodontic treatment. ‘Reinforcement appliances’ are used in order to preserve the result achieved with the treatment. Removable or fixed reinforcement appliances are applied at this stage. Teeth also demonstrate a natural change over the years, just like the aging of the human body. Reinforcement treatment is necessary to keep the change process to a minimum. The importance you attach to this period ensures that your treatment is permanent. It is the person’s own responsibility to use the reinforcing appliances. Removable appliances should not be lost, if fixed appliances are applied, careful care is required to protect the health of the teeth and gingiva.

What is orthognathic surgery?

Orthognathic surgery is a surgical method that helps to correct deformities that occur in chewing functions and facial aesthetics as a result of the disorder in the relation of the lower and upper jaw. The Orthodontist and Surgeon work together for this type of treatment. Teeth are corrected orthodontically, afterwards the jaws are surgically repositioned. Thus, both facial aesthetics and chewing functions are improved.

Orthodontic disorders requiring orthognathic surgery:

  • Cases where the lower jaw is anterior than normal
  • Cases where the lower jaw is posterior than normal
  • Cases where the upper jaw is anterior than normal
  • Cases where the upper jaw is anterior than normal
  • Cases where the tip of the chin is anterior or posterior
  • Severe anterior opening-closing disorders
  • Excessively long or short face cases
  • Cases of asymmetric development of the face and jaws

Orthognathic treatment consists of two stages: orthodontic treatment and surgical procedure. Pre-operative preparation is done with orthodontic treatment. Necessary assessment are made before the operation and it is determined whether the operation will be applied to a single jaw or a double jaw. Jaws are brought to the appropriate position with orthognathic surgery. Single or double jaw operations are applied according to the determined treatment plan.

Orthodontic treatment continues for a while after the recovery period of 2-4 weeks following the surgery. Final detailed corrections are made at this stage. Duration of treatment varies according to the severity of the disorder and the recovery period after surgery.

What is cleft lip and palate (CLP) and how is it treated?

Cleft lip and palate occur due to the fusion of the structures in the baby’s facial region due to various causes. It occurs in one of every 1000 births.

The baby may have a cleft lip, cleft palate, or both. These can be unilateral or bilateral.

Treatment of babies with cleft lip and palate (CLP) is started immediately after birth. Appliances applied in infancy aim both to facilitate feeding and to shape cleft palate parts. When a significant correction is achieved on the slit parts, the nose shaping process begins, for which a nose piece is inserted to the existing appliance. Patients come for treatment once a week. The treatment of unilateral CLP patients takes 3-4 months, and the treatment of bilateral CLP patients takes 4-5 months. After the orthodontic treatment, nose and lip surgeries are performed when cleft parts are brought closer to each other.

Simple orthodontic treatments are started from the age of 7-8. In cases where the growth of the upper jaw is insufficient, treatment is started at an early age and the development of the upper jaw is stimulated. At the age of 10-11, additional operations for the dental arch may be required in order for the teeth adjacent to the cleft line to erupt. This condition is detected during orthodontic treatment and the patient is directed to the surgeon who performs operations for the bone tissue to be added to the dental arch. Necessary orthodontic preparation is ensured by applying fixed appliances until this stage.

In order to correct jaw disorders in adults, it may be necessary to move the upper jaw forward with orthodontic treatment. Taking the upper jaw forward and establishing occlusion with orthognathic surgery or distraction methods are among the treatment goals. Orthodontic treatment takes a long time in individuals with cleft lip and palate. Although all orthodontic treatments have been completed, the final aesthetic and functional treatment is ensured with prostheses in cases such as tooth deficiencies and deformities.

What is sleep apnea?

Sleep apnea is sudden respiratory pauses that occur frequently during sleep. As a result of pauses in breathing during sleep, the amount of oxygen in the blood decreases and the amount of carbon dioxide increases.

What is the role of the orthodontist in the treatment of sleep apnea?
In order to create a wider airway, appliances can be applied to those with mild and moderate sleep apnea by attaching them to the mouth and pulling the lower jaw forward. The patient should have a medical examination before deciding to use the appliance. For patients diagnosed with sleep apnea, the physician and orthodontist can determine whether the person will benefit from appliance therapy.

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