COMMON TREATMENT

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Crowding of teeth is one of the most common orthodontic problem. Crowding of teeth occurs when the bone surrounding the teeth is smaller compared to the teeth size. Crowded or overlapped teeth look weird, cause oral hygiene problems leading to dental cavities and gum inflammation and may lead to abnormal wear of teeth due to faulty contacts of teeth. Unattended crowded dentition can lead to multiple teeth loss in future and painful internal injuries to jaw joints.

Crowded teeth are easily treated by Orthodontic treatment with braces. In young age, small jaw bone can be expanded to grow to a larger size so that the crowded teeth can be aligned properly in the extra space created. These cases can be treated without any teeth removal.

In some children and adults, one premolar tooth in each quadrant is removed so that other teeth can be aligned in that space. Decision to extract of teeth for braces treatment is taken after careful evaluation of patient’s teeth, face and facial bones and the effect it may have on facial balance and teeth position. Extraction of recommended teeth for braces treatment does not have any untoward effect on future health of the teeth. The space created after the removal of teeth is entirely closed during the braces treatment and is less likely to open again in future.

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Protruded teeth or buck teeth is another common orthodontic problem. It may be genetic or acquired. Teeth jutt out due to lack of space in the jaws to accommodate them or a persistant thumb / finger sucking habit has pulled them forward or a large / forwardly placed tongue continuously pushed the teeth out.

Protruded teeth not only look ugly but also cause difficulty in normal mouth closure. The mouth remains open and lip musculature becomes lax. Mouth breathing causes dryness of mouth, gum enlargement, bad mouth odor etc.

This problem can easily be treated with braces. If done at the right age, the untoward effect of protruded teeth on development of face and lip musculature can be avoided. If spaces are present in between teeth then these spaces are utilized to move the teeth to their normal position. If there are no spaces in teeth, then one premolar tooth in each quadrant may be required to be removed to create space to move the protruded teeth into normal position. Even though healthy teeth may be required to be removed, it does not cause any harmful effect on the dentition.

As the teeth are moved behind to their normal position, the facial profile improves and the smile as well as the face will have more pleasing appearance.

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Spaces between teeth may be seen if teeth size is small and bone that surrounds the teeth is larger. Spaces may also develop due to thumb / finger sucking / tongue thrust or improper swallowing pattern. A large frenum tissue, specially between upper front teeth or an extra tooth which is unerupted may lead to unesthetic spaces between teeth.

Once the causative factor for the spaces in teeth is identified, steps are taken to eliminate it. Thumb / finger sucking habits are controlled, tongue posture or bad swallowing pattern is improved or the large frenum tissue or the unerupted extra tooth is surgically removed. Braces are then put on the teeth to gradually bring the teeth to their natural position.

Eliminating the unesthetic spaces between teeth not only improves the appearance of teeth but also makes the gums healthy and easier to maintain.

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In ideal dentition, the upper teeth overlap the lower teeth by about 1 – 2 mm. This allows normal cutting and chewing function of teeth. This ideal ovelap which is called as overbite also helps to prevent abnormal wear of teeth or jaw joint problems and mutually protects the teeth in function by the way of “incisal” and “cuspid” guidance.

In open bite, the teeth do not overlap at all or there may be a space of few mm between upper and lower front or even back teeth. This interferes with normal function of teeth as they do not meet at all.

An Open bite may be caused due to a persistent sucking habit or a bad tongue posture. It may also be a result of a complex facial growth problem and swallowing patterns.

A mild to moderate open bite can easily be treated with habit breaking appliances and / or braces treatment, when diagnosed at the right time during growing age. Complex skeletal open bite problems due to growth abnormality or improper swallowing patterns are difficult to treat, specially when diagnosed at a later stage and may require surgical jaw procedures to improve / correct them.

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Deep overbite is another common orthodontic problem which may be genetic or developmental in nature. In deep bite, the upper teeth overlap the lower teeth more than 2-3 mm. In severe cases, this overlap may exceed 10 mm.

Due to deep overbite, there may be a compromise in the function of the teeth. In certain severe deep bites, upper teeth completely overlap lower teeth and cause abnormal wear of lower front teeth causing tooth sensitivity, pain or loss of teeth. Also Upper teeth gums may be traumatized by continuous chafing of lower teeth during function.

Most Deep bites are successfully corrected with braces treatment, particularly when done at the right age.

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In a normal dentition, upper teeth are placed outside the lower teeth by about 1 – 2 mms.

Sometimes, due to tooth eruption problem or due to lack of space an upper tooth erupts behind the lower teeth. This condition is called crossbite. There may be a single tooth crossbite or multiple teeth may be involved.

Uncorrected crossbites may lead to improper function and development of face. Gross jaw disproportions, asymmetry of face or an abnormal TMJ function are many a times attributed to uncorrected crossbites.

Crossbites should be corrected as soon as they are diagnosed. Sometimes orthodontic treatment may be advocated for a child of 4 years old with a developing anterior / posterior crossbite of primary (baby) teeth. Early Correction of crossbites helps to reestablish development of normal function and facial bones.

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Congenitally missing teeth cause drifting of other teeth, development of spaces in dentition and improper relations between upper and lower teeth. Sometimes a decayed natural tooth is extracted and is not replaced immediately which causes drifting and tilting of adjacent and opposing teeth in extraction spaces, hampering the entire occlusion.

Orthodontically, a missing tooth space may be opened up with braces treatment to accommodate ideal size artificial tooth for replacement . Alternatively, the space may be closed orthodontically and normal contact relationships are achieved between the remaining teeth in the mouth. A careful analysis of dentition is undertaken to device ideal treatment plan for a patient.

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The bones of the jaws and the face are in a certain ideal proportion to each other. This gives a pleasing appearance to the face. Proportionate jaw bones help in having good teeth relations, normal jaw muscle patterns and ideal jaw function. Sometimes due to genetic predisposition or aberrant development, the jaw bones develop disproportionately to one another. Most common of these is small lower jaw.

If a developing disproportion in the jaw bones is diagnosed during growing age ie before the age of 11 years , a GROWTH MODIFICATION or Growth modulation treatment can be undertaken to correct this disproportion. For this Myofunctional appliances are custom fabricated for the child. These are removable appliances which a child has to wear on teeth for specified number of hours per day. Good compliance in appliance wearing mostly ensures positive result. There are certain conditions which respond favorably and certain conditions may not respond favorably even after prolonged treatment.

If a child is diagnosed with jaw disproportion after his growth spurt, still some attempts can be made to modulate jaw growth with a fixed growth modification appliance. This appliance is generally worn in tandem with the braces and can not be removed by the child. This ensures continuous growth stimulation to maximize the use of remaining growth potential of the child.

Untreated jaw disproportions , can be improved with surgical procedure in adulthood. This is called Orthognathic Surgery. In this procedure the defective jaw bones are either lengthened or shortened surgically depending on the requirement. Before and after the surgery, treatment with fixed braces is mandatory to optimize the treatment results.

In a few cases, in developing teeth, if a developing crossbite or crowding of a small magnitude is diagnosed early, then few measures could be taken which doesn’t involve putting braces to correct this crossbite or even crowding of teeth. Therefore, early evaluation of the dentition by an orthodontist is always recommended. A child’s first consultation with an orthodontist should be at the age of 7- 8 years. Few of the developing teeth alignment problems can be diagnosed then and measures taken to correct them or prevent them from worsening.