By: Waleed K. O. Jaber
g. 34 , 3rd
Adults and children both seek orthodontic
◦ Malocclusion (incorrect bite)
◦ Tooth alignment (crooked teeth)
◦ Improvement of overall appearance, including gaps
Class I Class II Class III
Upper and Lower
properly, but teeth
are crooked. 72%
of ortho cases.
Upper molars are
positioned too far
compared to the
lower molars. 22%
of ortho cases.
The upper first
the lower first
molar. 6% of
Overbite – The upper front teeth cover too much
(more than 30%) of the lower front teeth. Also
called a deep bite. This may be seen in a Class I
or II malocclusion.
Overjet – causes “buckteeth”. The upper front teeth are
positioned too far forward (normal distance between
upper and lower front teeth is 1-3 mm). This is typical in
Class II maloclussion.
Underbite – causes a “bulldog” appearance. The
lower front teeth are positioned in front of the upper
front teeth. This is seen in Cass III malocclusions.
Crossbite – The upper teeth should overlap the
lower teeth slightly when the jaws are closed.
When this does not occur, it is called a crossbite.
May occur in any class of malocclusion.
Open bite – open space exists between upper and
lower teeth when jaws are closed. Often caused
by thumbsucking, seen in all classes of
Midline shift – the center of the upper front teeth is
not aligned with the center of the lower front teeth.
Can be seen in all classes of malocclusion.
Genetics - You may inherit a small mouth from
mom and large teeth from dad.
Tooth loss - If a tooth is lost from an injury,
cavities, or gum disease, the remaining teeth may
Bad habits such as thumbsucking can shift teeth
or cause them to erupt improperly.
Malnutrition – Nutritional deficits can restrict the
growth of jaws and teeth.
The jaws of pre-teens and teens are still growing.
Therefore, it is easier to shift teeth at this stage.
Sometime, two separate phases of braces are
necessary for treatment.
◦ Phase I – when patients are 6 to 7 years old, to make room for
the permanent teeth to erupt properly
◦ Phase II – at age 12 (or when permanent teeth have erupted) a
second round of braces are applied to straighten teeth and
•It is becoming more common for adults to seekIt is becoming more common for adults to seek
orthodontic treatment. Their treatment may take longer toorthodontic treatment. Their treatment may take longer to
When a primary, or deciduous, tooth (commonly
called “baby” tooth) is lost too early, the space
needs to be held open until the permanent tooth is
ready to erupt.
A space maintainer is an appliance made of metal
or plastic and may be removable or cemented
onto neighboring teeth.
Removable space maintainer Band and loop maintainer Lower lingual holding arch
An incorrect bite can have long-term effects
◦ Interference with normal growth and development of jaws
◦ Difficulty swallowing
◦ Impaired chewing
◦ Speech defects
◦ Susceptibility to cavities and gum disease
◦ Poor aesthetics
Teeth can be GRADUALLY moved into proper position by
applying pressure in certain directions using bands,
wires, and elastics. A series of clear trays, such as
Invisalign, may also be used.
Removeable appliances may also be used such as:
◦ Palatal expander to widen the arch
◦ Jaw repositioning appliance, or splint, to retrain the jaw
to close properly
◦ Headgear- involves a strap that wraps around the
head and attaches to a wire or face bow in the front.
used to slow the growth of the upper jaw and move
front teeth towards the back.
palatal expander Jaw repositioning
Treatment typically lasts 1 to 2 years. After
braces are removed, retainers are used to hold
the teeth in their new position.
Typically, retainers are worn 24 hours a day for
the first six months and then worn only at night
thereafter. Permanent retainers, bonded to the
back side of front teeth, may also be used.
Braces collect food and plaque very easily.
Often, ortho patients are children or teenagers
who do not have optimum brushing and flossing
If braces are not kept clean, tooth decay and gum
inflammation easily occur.
Orthodontists may decide to remove braces
prematurely if the patients hygiene is poor.
◦ Special orthodontic toothbrushes or battery
toothbrushes may be useful.
◦ Patients need to brush both above and below the
brackets, paying special attention to the space
between the gumline and the brackets.
◦ Flossing around braces is time consuming. Superfloss
(strands of floss with stiff ends) or floss threaders are
used to floss beneath the wires.
◦ Interdental brushes can be used between the wire and
the tooth, between brackets.
• A fluoride mouthwash, either over-the-counter or
prescription, is usually recommended to help
prevent tooth decay around the brackets and to
• A oral irrigator such as a Waterpik, may be used
to flush debris from the brackets.
An orthodontic patient needs to visit his or her
general dentist at least every 6 months for a
cleaning and check-up to monitor the health of the
teeth and gums, ensuring great results when
treatment is complete!