An orthodontist is a specialist dentist who prevents the occurrence of, or treats, inappropriately positioned teeth and jaws. As part of any comprehensive oral examination of a child or an adult, dentists perform an orthodontic assessment and may make a referral to an orthodontist based on their findings.
In children, orthodontic problems can usually be recognised by about age seven to eight, when the adult first molars and some adult front teeth have come through. It is at this age that a referral might be made to a specialist orthodontist so that a treatment plan can be determined. This treatment plan might involve early treatment initially, plus follow-up treatment during adolescence. Alternatively, it may be more beneficial to monitor the orthodontic problems and possibly perform a single course of treatment at a later age. Generally, more urgent problems (such as a traumatic bite that injures the teeth and gums) require earlier treatment.
For adults, orthodontic treatment follows the same principles as in children and adolescents. However, as adult jaw bones tend to be denser, treatment time can be longer. Additionally, because the bones in the face have stopped growing, some jaw problems may require jaw surgery as well as orthodontics. In some adults, existing gum disease can complicate treatment; this may first need to be stabilised, and the forces applied to the teeth may need to be lighter than usual.
What does orthodontics involve?
Orthodontics involves a thorough oral examination and the taking of records such as impressions, photos and X-rays. A treatment plan can then be proposed which details treatment options, duration, frequency, risks, benefits and costs.
Common options include braces, sequential clear aligners (e.g. Invisalign® or Invisalign Teen®), arch expanders, removable plates and headgear. Another option that is sometimes considered for crowding is the extraction of some teeth to provide space for alignment.
Braces offer a high degree of control and accuracy in moving teeth and are also available in a ceramic form to minimise the amount of visible metal. Full treatment generally requires wearing braces for two years, with adjustments every four to eight weeks.
Sequential aligners are clear and less visible than braces and may be a suitable alternative in some patients. Many of the other appliances used in orthodontics are suitable for growing children and can optimally influence jaw growth.
After completion of treatment, discreet retainers are worn to keep the teeth in their final position. Patients can usually be weaned off using them, but in some cases they are worn permanently.