How Braces Work to Straighten Your Teeth

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(Updated July 8, 2020)
Braces aren’t just a brute force solution to crooked teeth. They work by using the anatomy of the jaw to realign teeth in a healthy and natural way. The teeth in your mouth are attached to your jaw bone by something called a periodontal ligament. This ligament is made up of collagen, which is the same protein found between your bones, and is used for shock absorption between bones all over your body including your jaw. Your periodontal ligaments allow some small, natural movement of your teeth (when chewing, for example) while anchoring and suspending the teeth in place. These ligaments join to the root surfaces of your teeth via a connective substance created by your body called cementum.

 

Key Sections:

 

How Do Braces Really Work?

Braces work by compressing one side of the ligaments on your teeth, while at the same time stretching the ligaments on the other side of your teeth. As the ligaments become compressed, the bone on that side loses blood support and becomes necrotic. The body starts an inflammation process to send in bone-eating cells called osteoclasts to remove the bone; this clears the path and allows the tooth to move in that direction. The inflammation is what causes the soreness and discomfort to the teeth; it is the most intense in the first few days, then the teeth will start moving and the discomfort will subside. On the other side of the tooth where the ligament is being stretched, bone-creating cells called osteoblasts show up to  add new bone.around the tooth. This process is called deposition and it cements the tooth into its new position.  This process takes much longer to complete, which is why it is very important to wear a retainer full time during the process to make sure that teeth do not shift. 

This whole process is how your teeth move over time. It’s easy to see how  light but consistent  forces such as thumb sucking habits can have big impacts  on your bite over the long run!

Why Do We Need a Cast of My Teeth When Getting Braces?

The reason your orthodontist makes a cast, or a digital scan nowadays, of your teeth is  for us to have a copy of your teeth so we can spend time to study and analyze them to come up with the proper diagnosis.  After we have identified all the problems, we can then devise the best plan to carefully manipulate forces against your teeth to guide them into new, healthy alignment and bite. 

Do Teeth Move Back After Taking Off braces? Do Effects of Braces Get Reversed?

Once braces are removed, your teeth are no longer  held by the  braces. Instead, they are held securely in place by the bone under your gums. In fact, the reason why most braces take such a long time is that your orthodontist is slowly guiding the teeth to move at a pace as fast as bone turnover can occur. 

Once your braces are off, bone starts healing around the tooth to secure them in their new position. This process takes 3-6 months to complete, during which the teeth are still mobile and can shift. For this reason, patients are given a set of removable or fixed retainers to be worn full time until the bone heals completely. Afterwards, teeth will still have some natural movements. Even patients who never had orthodontic treatment will experience shifting in their teeth as they age. Therefore, we encourage our patients to still wear their retainers at least 1 or 2 nights per week. 

Why Do I Need to Wear a Retainer After Getting Braces?

Oftentimes, your orthodontist may recommend you wear a retainer after getting braces to keep your teeth in the same place. 

Most shifting in alignment of teeth (called relapse) will take place immediately after the braces are removed, making the following weeks a time when a retainer should be worn throughout the day to prevent any undesirable shifting. After several months, your orthodontist can evaluate the potential for further movement of the teeth. Should this not be of concern, the retainer may then be worn in the evenings only. 

Do Braces and Invisalign Work Differently?

Traditional braces use wires, elastics, and brackets to move your teeth into the desired position. Lingual braces are similar to traditional braces, except the brackets are on the back of your teeth facing your tongue. (So other people cannot see them.) Invisalign involves wearing transparent aligners on your teeth to create minor movements in your teeth. 

Although the application is different, all three methods apply constant and gradual force to move your teeth in the desired position gently.

Invisalign moves teeth the same way as braces, by applying force to the teeth in the direction we want the teeth to move towards. However the application and design of the force is different. Because Invisalign aligners are removable, they rely on friction between the aligner and the tooth surface in its force application. Braces are glued to the tooth, so the brackets become a handle by which we can grab on to and apply the force. The force to move the tooth is applied by the wires we use. When a wire is engaged into brackets on teeth that are crooked but adjacent to each other, the displacement of the wire creates tension through the flexing of the wire, and because the wire wants to return to its natural straighter form, it drags the teeth into a straight position.

How teeth are straightened by braces depend on the orthodontist’s skill in placing the brackets in the precise location on the tooth, and the adjustments that are done by the orthodontist to the brackets and wires during each appointment when the patients are in the office. The movements can be very precise because the brackets and wires are FIXED to the tooth, there is no slippage between the braces and the teeth. This is why the system is called Fixed appliance, and the technique is called Straight wire technique.

Invisalign moves teeth by using REMOVABLE aligners. Each aligner differs slightly from the last one. The changes are incremental, and are designed on the computer by the orthodontist. All the movements are designed into the system at one time, at the beginning of treatment. The teeth move due to the slight difference between each stage of the aligner; the slight difference in the aligner and the teeth create tension, or force, on the teeth, pushing them toward the final form we want them to be. The aligners are forced on to the teeth and are held in place by friction. Because the aligners are not glued to the teeth, there may be some slippage, causing slight loss of precision in this system. The imperfection in fit needs to be compensated by over-correcting a particular movement. Therefore, at the end of a series of aligners we may see that a particular goal is not reached with the first set of aligners, we will need to create another set of aligners to compensate for that discrepancy between what is designed and the actual result.

Risks and Considerations

When considering braces, it is important to discuss any potential risks that could be encountered as well as any special considerations worth noting. Here are some of the most commonly asked questions about braces:

Can braces ruin my teeth?

In short: no, if done properly by a dental professional. By consulting with an orthodontist and practicing proper hygiene, it is very unlikely that braces will ruin your teeth. Everyone’s situation is unique – our orthodontists at PacificWest will assess your oral health to ensure braces are suitable for you.

1 – The most common issue with wearing braces is tooth decay and gum disease due to poor hygiene. This happens when patients do not spend enough time to thoroughly clean their teeth around the appliance and under the gum. This is why we spent a significant amount of time teaching and coaching patients how to identify dirty teeth and inflamed gums, and how to properly clean them. 

2 – The second most risk is improper treatment planning, resulting in pushing teeth into the wrong position. Even though the teeth may look straight, the wrong position may cause traumatic bite, or teeth sitting outside of the bone, resulting in poor bone and gum support. This is a potential  risk with DIY orthodontics programs that are not supervised by a certified orthodontist.

This is why many patients choose to go to orthodontists for braces, as orthodontics are specialists who focus their practice solely on teeth alignment, bite issues, and the creation of a beautiful and healthy smile. Orthodontists are dentists who received 2-3 years of additional training and education  and have passed the rigorous examination to become certified in the speciality.

Do teeth become weak after braces?

No, with proper treatment planning and maintenance of oral hygiene, your teeth should not be weakened after your braces treatment is complete. In fact, braces will fix your teeth’s alignment. This will correct any bite issues, make it easier to clean your teeth, and improve your overall oral health!

While wearing braces, your teeth will shift, resulting in what it feels like looseness of the teeth. The shifting is gradual and the teeth are never in any danger of falling out. 

Why Do Wearing Braces Cause Pain and Discomfort?

Unfortunately, the process of correcting teeth through the use of braces does come with some discomfort. 

Minor Soreness: Feelings of soreness are a common occurrence reported amongst those who wear braces. Braces exert consistent but gentle force to slowly move teeth into the correct position. As the ligaments around the tooth become compressed, the bone around the tooth loses blood support and becomes necrotic. The body starts an inflammation process to send in bone-eating cells called osteoclasts to remove the bone; this clears the path and allows the tooth to move in that direction. The inflammation is what causes the soreness and discomfort to the teeth; it is the most intense in the first few days, then the teeth will start moving and the discomfort will subside Typically the pain is mild and can be dealt with painkillers such as Tylenol or even an ice pack.

Poking From Wires: When braces are newly applied, irritation often occurs as the mouth adjusts to the presence of the metal wires and brackets. Our orthodontist will provide orthodontic wax to form a protective shield over the delicate skin inside the mouth. Patients choosing Invisalign would not have this problem.

Difficulty in Chewing: Many patients do report some challenges with both chewing and eating food initially when they first get braces or after each adjustment. This is again due to the inflammation process occuring to the bone around the teeth. However, after a few days, the soreness will go away and chewing will get easier. When your teeth are sore, soft or liquid food is recommended to minimize the need to chew.

Are Braces and Orthodontic Treatments Safe?

Orthodontic treatments are considered to be one of the safest dental treatments that a patient can go through. There are no injections, drilling, cutting, or open wounds involved, so there are not really many true contraindications in the sense that it would put patients in grave danger if they still receive orthodontic treatment. 

There are certain health conditions (such as the ones listed below) that would either make orthodontic treatment more complicated and have less predictable outcome, or make the teeth or supporting tissue (bones and gum) less healthy during orthodontic treatment. 

  1. Medical conditions that compromise healing, especially bone healing. An example would be patients with significant osteoporosis conditions receiving bisphosphonate treatment. The treatment stops bone turnover by inhibiting osteoclast activity. Without the ability for bone to turnover, tooth movement is limited.
  2. Patients with active disease in their mouth. This would include caries lesions, periodontal disease, or any other pathology (such as cancer). We need to take care of all infections and pathology inside the mouth and make sure we have a healthy foundation before starting orthodontic treatment. 

Braces and Your Age

Though most people typically associate braces with the teenage years,  many adults  also want to correct their teeth later in life. Among the most commonly asked questions concerning braces and age are:

Can teeth be straightened at any age?  

Yes! When it comes to teeth straightening, there is no such thing as an age limit. 

The process of your body being able to tolerate the movement of your teeth is the same process of your body being able to heal; such as  from a cut or broken bone. As long as there is no underlying medical issues that cause someone to have impairment to their healing process, there is no reason why we would not be able to straighten their teeth with orthodontics. 

Many adults make the decision to finally address tooth problems that have been nagging them through the bulk of their lives by seeking orthodontic treatment.

Orthodontic treatment will improve both the appearance of the  smile as well as the future dental health.  Problems such as overcrowding or a traumatic bite can lead to tooth decay, gum disease, excess tooth wear, and possible tooth loss.  Even if you have lots of fillings or are missing many teeth, it is still beneficial to receive orthodontic treatment to build a strong foundation to extend the lifespan of the rest of the teeth.

What is the age limit for teeth braces? Am I too old or too young for braces?

Thankfully, there is no real age limit for braces. To get braces, a patient must meet two criteria: (1) the person must have a healthy jaw and (2) be in possession of a set of adult teeth. This means that people with advanced cases of periodontal disease and those with loose teeth (or milk teeth) are not candidates for teeth braces. 

For children in need of tooth straightening or correction, braces can be considered only after getting a full set of adult teeth. When it comes to being too old for braces, there is no such thing. In cases of advanced age, the health of the teeth and gums is the determining criteria on whether to get braces or not.

5 Things You Did Not Know About Lingual Braces

Lingual braces, or inside braces are a type of orthodontic treatment appliance that are placed behind the teeth (by the tongue and palate), rather than in front, and therefore offer a great cosmetic alternative for those who want their teeth straightened, without the braces showing. They were the original “invisible braces”, and are still arguably the least noticeable orthodontic appliance available today.

Today, I’m going to share with you 5 facts that few people, even dentists, know about lingual braces!

1. Lingual braces were invented in the 70’s!

Developed in the 1970’s, lingual braces pre-dates Invisalign by 20 years! Its development was motivated by the increase in demand of a more aesthetic option from adults seeking orthodontic treatment. At the time, clear braces were still in its infancy and had a significant problem of staining. Dr. Kinya Fujita from Japan was the first guy to submit the concept of lingual braces in 1967, but it was Dr. Craven Kurz from Beverly Hill who first came up with a whole bracket system. The patent for Kurz Lingual Appliance was filed on November 15, 1976. With the help of Omrco, a company in California that makes orthodontic appliances, and Dr. Kurz’ lingual braces went on production in 1979 and it was the first commercialized lingual braces.

Lingual Braces 1

2. They were once so popular that they were featured in all major media

In just 2 years after Ormco and Dr. Kurz start production of the lingual braces, the new “invisible braces” was already featured in major magazines and broadcasted on both television and radio. It was called the “lingual fever”, and it spread even to the European and Asian markets. It reached the peak of its success in 1986 and Ormco had sold more than 18,000 cases by then! The development team was forced to provide an appliance for wide-scale use as quickly as possible.  The beta-testing was never completed and the product was rushed into the market prematurely.

3. They were almost completely abandoned by the orthodontic community in North America.

Following the initial excitement and euphoria was a period of disappointment and frustration. Orthodontists were not happy with the lingual braces as they were not able to obtain the same level of finish they expect from regular braces. Furthermore, truly stain-free clear braces were introduced around the same time and they provided a viable alternative to metal braces. This was the last nail in the coffin for lingual braces. The original task force of Omrco that once had over 1000 orthodontists involved was reduced to just three members in 1988.

4. Lingual brackets and wires need to be customized for each patient

The outside surfaces of our teeth are smooth and generally have little variation between individuals. Therefore, orthodontists may use pre-made, stock appliances for the outside braces. The inside surface, however, has a lot of irregularities. It is so unique that customized brackets and wires are needed for each patient in order to obtain the best results.

 

This was a huge challenge in the early days of the lingual braces and required intensive laboratory service to set up the cases. The invention of digital CAD/CAM technology have greatly simplified the customization process. The brackets are designed and manufactured precisely to fit each tooth perfectly. The archwires are designed with the final (desired) position of the teeth in mind, and extremely precise bends are placed in the archwire by a wire bending robot. Because the brackets and wires need to be customized, lingual braces usually cost about twice as much as traditional braces.

5. Not all orthodontists are trained to provide lingual braces in North America

As mentioned above, lingual braces were almost completely abandoned by the orthodontic community in North America. While the research and development of lingual braces continued in Europe and Asia, it was not until early 2000’s before lingual braces were re-introduced in North America market again. Even today, only a selection of graduate school provides training for lingual braces, and many orthodontists graduated without having treated any patients using lingual braces.

Dr. Wang was an early adopter of the lingual braces technique and he had been providing lingual braces for more than 20 years! As such, he is not only an expert in lingual braces, he also teaches lingual braces at the graduate orthodontic program at UBC. Being a UBC alumnus, Dr. Lee was one of the students who treated patients using lingual braces under Dr. Wang’s supervision.

So here you go, these are 5 facts about lingual braces that you didn’t know before.
As usual, if you have any questions about anything related to braces, we are more than happy to answer them for you. If you like this blog, leave a comment below or like our post on social media. Also, feel free to leave a comment for any topic that you want us to cover in our next blog.

The Four Most Common Types of Dental Braces, and which one is best for you!

The Four Most Common Types of Dental Braces, and which one is best for you!

Dental braces have become more common nowadays. In fact, according to the Pennsylvania Dental Association, nearly 4 million people in the United States are wearing braces at any one time. While dental braces used to be all metal, we have many other types of braces that are more aesthetic available to our patients today.

Discovering the Different Types of Braces

If you’re considering braces for yourself or your child, there are four main types of braces available today: Metal outside braces, Clear outside braces, Lingual (inside) braces, and Invisalign clear aligners.

We’ve made the following chart to help you visualize the pros and cons of each type of braces.

Types of Braces

Still have questions? Please visit our website to read more about each type of braces. Or better yet, book a consultation with us to discuss which option will deliver the best treatment outcome and still fit your particular lifestyle! The consultation is free, and we would love to meet you!

How to Avoid Tooth Decay

How to Avoid Tooth Decay

Let’s face it – wearing braces is tough. If you didn’t like to floss or brush when you didn’t have braces, it’s going to be even tougher with braces. But as we’ve mentioned before about flossing and brushing, it is important to your oral hygiene. We’re going to emphasize again that without proper oral hygiene habits, you risk tooth decay which can impact your oral health in the future. In the short term, your teeth might be a mix of yellow and white, especially when your braces come off!

Learn Proper Brushing Techniques

Place your toothbrush at a 45-degree angle against the gums in order to clean the whole tooth, and brush gently in the area between the wiring and the teeth. Use a softer toothbrush with fluoride toothpaste for best results. Using an oral rinse every day will help, too. Rinsing with mouthwash is important regardless, but especially important when you have braces, as you need to disinfect the entire mouth, including those spots under the braces where your brush can’t always reach.

Brush after Every Meal

Since braces block food from naturally escaping your teeth after eating, it’s important that you take the time to brush and floss after every meal. The less time food has to sit on your teeth, the less likely it is to cause decay. This may seem like an inconvenience, but when you get your braces off, you will be very glad you brushed after every meal.

Eat Braces-Safe Foods

When you have braces, there are certain foods that you must avoid (read our post here). For starters, sticky foods such as caramel or gum can get stuck in your braces and are difficult to remove during brushing. Avoid hard foods, too, such as nuts and candy. Those goodies can bend wires or even break a bracket. And while you may love apples, carrots, or corn on the cob, they’re too firm or hard to bite into and can damage your braces. Crunchy treats can also harm your orthodontic appliances. It’s best to stay away from chips and popcorn, which can damage your braces. So just what can you eat? We recommend soft foods that are low in enamel-busting acids, such as bananas, mangoes, milk, water, poultry, and pasta.

Get Regular Checkups

It’s important to keep your routine appointments with your dentist and dental hygienist for a thorough cleaning twice a year or as directed. The exact frequency of these visits will be up to your dentist, as some types of braces are more demanding of a regular cleaning than others.

As long as you practice good oral hygiene and follow these basic tips, you should have no problem keeping your teeth healthy while you wear braces.

 

How Food Impacts Your Treatment

How Food Impacts Your Treatment

Whether you are a foodie or just like enjoying the diverse foods we have on the Westcoast, having braces sometimes impacts what you are able to eat. While we know there are people who still eat anything when they have braces, we advise to follow some general guidelines to make your braces treatment process as easy as possible.

First off, always make sure you brush and floss your teeth regularly. The last thing you want is to have your braces taken off but your teeth have numerous cavities. Plaque is never your best friend, so it is important to maintain top oral hygiene. We’ve talked about brushing and flossing before, so feel free to check out those blog posts.

Now in terms of food, the best way to ensure your comfort during orthodontic treatment is to eat a braces-friendly diet. Certain foods are better suited for the purpose, as opposed to hard and sticky foods that can cause damage. So what types of foods should you eat if you have braces?

The best are low in sugar and do not require excessive chewing. For breakfast, try eggs, yogurt, wheat toast, or oatmeal. Lunch may steer toward a banana rather than an apple, a salad without nuts, and string cheese instead of chips.

A healthy dinner might include most types of vegetables, as long as they are cooked to an appropriate softness. Pair that with a lean protein such as fish or chicken, and follow up with dessert. Just be sure to brush afterward!

Post-Tightening Foods

If you’ve just had your braces tightened, you’re probably feeling a bit of discomfort. That’s completely normal and should disappear in a day or so, but in the meantime, you’ll want to stick to easy-to-chew foods. Some of our favourites include:

  • Pudding
  • Mashed potatoes
  • Soup
  • Ice cream
  • Cottage cheese
  • Peas
  • Pancakes
  • Pasta

Foods to Avoid

Anyone who wears braces—whether fixed or removable—should avoid excessive snacking and aim to eat a healthy and balanced diet. It’s also important to avoid foods that could cause damage to your braces, including:

  • Hard candies
  • Gum
  • Nuts
  • Popcorn

Hard, crunchy, or chewy foods can bend wires, or even rip a bracket right off your tooth! Any kind of damage will result in a longer treatment time and additional office visits. You won’t have braces forever, so save the sticky snacking for after they’re removed.

If you have any questions, feel free to contact us!

 

How to Brush Your Teeth Properly

How to Brush Your Teeth Properly

Let’s be honest, brushing teeth is no one’s favourite activity, especially when braces are involved. However, oral hygiene is very important to maintain because it can make your health much worse as you get older. We don’t want that to happen to anyone, so we want to share some tips when it comes to brushing your teeth and making sure your teeth actually get clean!

Top mistakes people make when brushing:

  • Brush too quickly: Most people have between 24 to 28 teeth in erupted in their mouth. Each tooth has at least three surfaces exposed to be brushed (cheek side, biting side, tongue side), and each surface needs to be brushed at least 6 times. That is between 72 to 84 surfaces, and up to 500 strokes each time you brush your teeth! That is why the Canadian Dental Association recommends spending at least 2 minutes each time you brush your teeth!
  • Not brushing around the gum: This area is the most commonly missed area and the result is devastating! The gum does not stick tightly unto the tooth surface; instead, there is a rim of pocket between your gum and your tooth. If you do not aim the brush properly to brush into the gum, you will have gingivitis (bleeding gums), which will turn into periodontitis (bone loss) if it’s left untreated for extended period of time. Eventually, you may have so much bone loss that the tooth just fall out on its own!
  • Not brushing your teeth at 45 angle: Angle your toothbrush this way allows you to get the brush bristles in between tooth surfaces, braces, and underneath the gum. Your braces have a lot of tiny crevices to accumulate plaque, so remember to brush thoroughly to get your teeth as clean as possible
  • Not brushing the inside portion of your teeth: Just because they can’t be seen by others, doesn’t mean plaque doesn’t live there
  • Not changing your toothbrush regularly: Once your toothbrush starts looking like it’s been used too much (the bristles are no longer straight) or it’s been 3 months, it’s time to change your toothbrush. If your toothbrush gets worn out before then, you may be brushing too hard!
  • Brushing too hard: You do not need to scrub your teeth like scrubbing a dirty frying pan to clean them. Brushing too hard will not only harm your gum (recessions), but will actually damage your tooth surface also!

 

There are also electronic toothbrushes available for those who feel like they can’t get a good enough clean with a conventional toothbrush. An electronic toothbrush provides consistent spins of the bristle at a high frequency, hence greatly increase the efficiency of the process of brushing. However, the brush can only cleans where you place it at, so the concept of angling the toothbrush still applies.

 

When you go for your regular braces appointments, take the opportunity to get a really good clean of your teeth when your wires come off. During this time, it will be the easiest to clean your teeth because you have less obstructions.

 

A strong daily oral hygiene habits crucial! We know that it can be hard at the beginning, but we can assure you that with some good tips and practice, everybody will be able to master the skills of brushing and flossing, and get your teeth squeaky clean 😀

 

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