All orthodontists are dentists, but only few percentage of dentists pursue further studies to become an orthodontist. After attaining graduation- Bachelor of Dental Surgery (BDS), an additional 2-3 year residency program of advanced education in orthodontics is done to attain a master degree of MDS [Master of Dental Surgery (in Orthodontics & Dentofacial Orthopedics)]. Through this extensive training, the orthodontist learns the skills required to manage overall care of the orthodontic patient.

Most orthodontic problems (malocclusions) are inherited and some are acquired. Inherited problems include crowding of teeth, spacing, extra or missing teeth and/or upper and lower jaw excess or deficient growth. Acquired problems occur due to finger/thumb sucking habits, airway obstruction by enlarged tonsils and adenoids, allergies, asthma, premature loss of milk and/or permanent teeth, and dental disease .

Each orthodontic problem determines its best starting time. However, the American Association of Orthodontics recommends that all children be evaluated by an Orthodontist by the age of 7 years. “Prevention is better than cure”- certain irregularities of the teeth can be prevented if early examination of the child is arranged; also, certain orthodontic problems when recognized at an early stage can be of immense advantage because they can be addressed with interceptive form of orthodontic treatment & henceforth, future elaborate & expensive procedures can be avoided in carefully selected cases.

Orthodontic treatment, for any age (even 40 or 45 years of age also), is appropriate as long as there is healthy bone, teeth and gum tissue. Adult orthodontics is an upcoming & ever increasing treatment modality in the field of orthodontics with more & more awareness & readiness of adults to undergo the orthodontic treatment. With the advent of clear aligners, adult patient’s orthodontic treatment is further made comfortable & absolutely esthetic as well during the course of treatment.

The following signs may indicate that you or your child needs to be examined by an Orthodontic Specialist:

• Spaces between the teeth.
• Forwardly placed upper front teeth.
• Thumb or finger sucking.
• Overlapping or crowding of erupting/erupted permanent teeth
• Broken or missing teeth.
• Difficulty chewing food.
• Mouth breathing due to allergies, enlarged tonsils and/or adenoids.
• Jaw joints that click, pop or experience discomfort.
• Developing underbite, overbite, crossbite or abnormal bite development.
• Teeth wearing unevenly or excessively.
• Lower jaw shifts from one side to the other when biting together.

• Crowded and uneven teeth are difficult to clean and maintain. This condition may cause tooth decay, gum disease and/or tooth loss.
• Orthodontic treatment reduces or eliminates abnormal tooth wear.
• Orthodontic treatment improves chewing. Inefficient chewing causes more stress on gums and bones that supports the teeth. This inefficiency may result in TMJ dysfunction of the jaw joints that may also cause headaches and joint discomfort.
• Many orthodontic problems become worse, if not treated. In this circumstances orthodontic treatment proves less costly than the additional dental care which may arise in future.
• A beautiful, healthy smile is a personal asset that will follow the young and remain with the old, throughout life. A great smile is vital to one’s self-confidence and improves one’s general attitude towards life.

To summarize, with the aid of orthodontic treatment one can achieve good facial (Structural) balance, create a beautiful smile (Esthetic harmony) & achieve optimal functional efficiency (also called as ‘Jackson Triad’ in scientific literature). .

Treatment time typically ranges from one to two years, depending on age, the growth status and the severity of the problem. The patient’s diligent use of any prescribed rubber bands, proper oral hygiene, following the recommended diet to avoid emergencies and keeping scheduled appointments are important factors in achieving beautiful smile in a timely manner. Interceptive, or early treatment procedures, may take as few as six months, depending upon the problem.

Right from the moment braces are put on the teeth, life is as normal as it was except for following instructions. These should be followed religiously through out the duration of the treatment:

• Don’t pull wire or clip & don’t try to adjust the braces on your own. If you have any problem, consult the doctor immediately.
• Brush the teeth in the morning & before going to bed (Brush has to be used on the braces as well). Specialized brush will be prescribed which is able to clean more effectively around the braces.
• Gargle with water after eating anything.
• Don’t eat very hard & sticky food (Chocolates, Cadbury, Coconut, etc.) during the course of the orthodontic treatment. Also, avoid drinking soft drinks during the orthodontic treatment.

Soft drinks (Coke, Pepsi, Sprite, etc.), fruit drinks (Tropicana- orange juice, etc.), sports drinks (Gatorade, etc.) and energy drinks (Red Bull energy drink, etc.), weaken tooth enamel. Soft drinks contain acids. Acid pulls calcium out of the enamel, making the tooth soft to touch. Acid dissolves tooth enamel, a process called “decalcification,” and can lead to cavities. Tooth enamel begins to dissolve at 5.5 pH. Once enamel dissolves, it does not come back. The loss is permanent. When acid is present along with the sugar in the soft drinks, the damage to the enamel is doubled.

• Avoid soft drinks, especially during orthodontic treatment.
• Drink water and milk.
• Brush and floss as recommended.
• Fluoride strengthens teeth –use fluoride toothpaste.

If you must drink a Soft Drink, following care will help in reduction of tooth damages:

• Drink soft drinks through a straw.
• Have soft drinks with a meal.
• Brush right away after drinking a soft drink; if you can’t brush right away, at least rinse with water.
• Drink the soft drink quickly; avoid sipping over a long period of time – each sip renews the acid attack on teeth
• Immediately after the braces are put on the teeth, the patient can start eating normal food from the same day & same moment itself (i.e. patient doesn’t have to eat soft food or any special liquid diet on the day when braces are put on the teeth).

In some patients, there is space deficiency (Tooth size arch length discrepancy) to accommodate all the teeth or to take the teeth back. After detailed analysis of the case, a patient may need removal of four permanent teeth to achieve the desired result. This kind of removal of teeth is a scientific procedure which is backed by enormous amount of research. During the course of orthodontic treatment, the space from where the teeth were removed gets closed completely & no artificial teeth (prosthesis) is given.

In many orthodontic patients, treatment is divided into two phases: 1) Phase I: It is shorter phase of approximately 6-8months duration wherein limited orthodontic treatment (eg. expander or partial braces) is done before all the permanent teeth erupt- 7 to 10 years of age. This treatment may be recommended to make more space for developing teeth, to correct crossbites, overbites, underbites, or harmful oral habits. Phase II treatment is also called comprehensive treatment, because it involves full braces & is done when all the permanent teeth have erupted, usually between the ages of 11 to 13 years. Doing orthodontic treatment in two phases, gives more stable & better results; it also limits the teeth/jaw irregularity from worsening.

Orthodontic appliances can be made of metal, ceramic or plastic. They may be removable or they may be brackets bonded to the teeth. By placing a constant, gentle force in a carefully controlled direction, braces or clear aligners slowly move teeth to a corrected position. With lot of advancements in orthodontic material science, this is a great time to wear braces! Gone are the days when a metal band with a bracket was placed around each tooth. You can choose brackets that are clear or metallic color. You can choose the color of the ties that hold the wire into the brackets. Wires are also less noticeable than they used to be and the latest titanium heat reactive wires move teeth faster, with less discomfort to patients and with fewer appointments. Patients are normally seen for adjustments every 6-8 weeks. This helps us accommodate busy school and work schedules.• Standard metal brackets. Colored elastics are available • Ceramic brackets • Invisible Aligners for both teens and adults. The “braceless” alternative to straighten teeth.

The placement of bands and brackets or clear aligners on your teeth does not hurt. Once your braces are placed and connected with the archwires or your clear aligners are inserted, your teeth begin to move. You may feel some soreness of your teeth for one to four days. Tab. Combiflam or Tab. Ketorol DT works well to alleviate discomfort/pain during this time. The lips and cheeks may need one to two weeks to get used to the braces on the teeth.

No. However, patients need to protect their teeth by wearing a mouth guard when participating in any sporting activity. Nowadays, special orthodontic mouth guards that come in a variety of styles and colors are custom fabricated.

Upon completion of orthodontic treatment, all patients need to wear retainers full time, as instructed by Dr. Aakash Shah. Teeth have a very high tendency to return to their original place after orthodontic treatment; Retainers prevent this unwanted tooth movement (relapse) & are a very important part of orthodontic treatment. Retainers can be removable (patient can wear & remove on their own) or fixed (bonded) to the teeth.