Orthodontic Treatment Options

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What Is Orthodontics in Dentistry?

Orthodontics is a branch of dentistry that specializes in malocclusion treatment. In short, "malocclusion" is a condition where the teeth are not positioned correctly in the upper and lower jaws. When the teeth are misaligned, an improper bite can form, such as an overbite or underbite.

Orthodontists provide fixed and removable appliances that correct an individual’s bite. The goal is to realign their teeth and create a new, beautiful smile over time.

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Irregular, crowded, and protruding (buck) teeth have been issues for many people for hundreds of years. However, as dentistry progressed into the 21st century, approaches to correcting crooked teeth became clearer with advancements in technology.

Today, there are many different types of orthodontic appliances available for children and adults, including:

  • Braces or clear aligners, which are sometimes called "invisible braces"
  • Headgear (used in combination with braces)
  • Fixed or removable space maintainers
  • Permanent or removable retainers, depending on your preference and needs
  • Temporomandibular joint (TMJ) splints and other jaw repositioning appliances for children with jaw irregularities
  • Jaw surgery, also called orthognathic surgery

What's The Difference Between Dentist and Orthodontist?

Orthodontists specialize in correcting crooked and misaligned teeth, as well as jaw issues. Common orthodontic treatments include braces, clear aligners, headgear, and space maintainers. Dentists specialize in procedures related to your overall dental and oral health. These treatments include teeth cleanings, cavity fillings, crowns, implants, and gum disease treatment, among others.

Some dentists are qualified to perform orthodontic treatments, but orthodontists are specialists in this area.

Understanding Malocclusion of Teeth

Malocclusion simply means the misalignment of teeth. More specifically, the clearest sign of malocclusion is when the teeth are crooked or stick out. Depending on a person's teeth misalignment, an orthodontist will recommend the best treatment during an office visit. There are three different classes of malocclusion, referred to as class I, II, and III:

Normal Occlusion

Normal occlusion (the contact between upper and lower teeth) refers to the “ideal” positioning of teeth. In a "perfect" bite, the teeth sit along a straight line. Having normal occlusion without previous orthodontic treatment is rare.

Class I Malocclusion

The most common type of malocclusion is a class I. It involves some overlap of the upper teeth over the lowers. In a perfect bite, the upper teeth should fit over the lower teeth like a lid on a box. Further, a class I malocclusion means that the molar relationship is correct, but there is crowding or spacing in the anterior region. 

Class II Malocclusion

A class II malocclusion, or overbite, occurs when the upper teeth and jaw severely overlap the lower teeth and jaw. This form of malocclusion is common but less common than a class I malocclusion.

Class III Malocclusion

A class III malocclusion, or underbite, occurs when the lower jaw is pushed forward. The lower teeth and jaw also overlap the upper teeth and jaw. 

Causes of Malocclusion

Malocclusion is commonly passed down through genetics. Most people aren’t born with normal occlusion. As a result, they invest in orthodontic treatment for a long-term solution. Crowded teeth, gaps, and an incorrect bite are caused by the difference in teeth and jaw size. This means there may not be enough room for both to grow properly.

Other common reasons for malocclusion include:

  • Birth Defects — such as a cleft lip and palate
  • Childhood Habits — tongue thrusting, thumb sucking, excessive pacifier use, or prolonged bottle feeding
  • Teeth Abnormalities — impacted teeth, lost teeth, or extra teeth
  • Failed Procedures — improper placement of dental crowns, cavity fillings, retainers, or braces
  • Jaw Injuries and Problems — jaw fractures, cancers, tumors, dislocations, temporomandibular joint dysfunction (severe pain when moving the jaw), or osteonecrosis (when bones lose blood supply)

What Are The Different Types Of Orthodontic Appliances?

Orthodontists specialize in correcting malocclusion related problems using different devices and treatments. Contemporary treatment types include:

  • Closing gaps in teeth
  • Straightening teeth
  • Correcting bites
  • Speech and chewing improvement
  • Aligning tips of teeth
  • Improving gum and teeth health

Orthodontic specialists recommend both fixed and removable appliances to improve teeth alignment and fix a patient’s incorrect bite:

Fixed Appliances

Fixed orthodontic appliances are attached to the teeth for short or long periods of time, depending on the severity of a patient’s alignment issues. It is possible to continue eating normally during the time these appliances are attached to the teeth. Although, dentists recommend that patients do not ingest foods or drinks that are high in sugar, such as candy and soda. Carbonated drinks, hard candy, and sticky foods are hard to remove from the appliances and can ruin them over time.

Types of fixed appliances include:

Braces

Braces, including traditional metal braces and clear braces, are made of individual brackets (attached to each tooth) and metal wires.

To hold the appliance together, small rubber bands (ligatures) are wrapped around each bracket. Braces realign teeth, close gaps, and fix an incorrect bite within 18 months to three years.

teeth with ceramic clear braces
Space Maintainers

Space maintainers are often used for children who lose a tooth early or from dental decay. A space maintainer keeps the space open in the gums, allowing the permanent tooth to grow in. There are fixed and removable options available. 

Removable Appliances

Unlike fixed orthodontic appliances, removable appliances do not attach to the teeth, meaning the patient can remove them at any time. These appliances must be taken out before eating, flossing, or brushing.

Removable appliances are used to correct minorly crooked teeth or prevent children from sucking their thumbs. A few common treatments include:

Clear Aligners

Clear aligners are thin, plastic trays that are formed specifically to a patient’s teeth. You must wear each aligner for up to three weeks. This moves the teeth a fraction of a millimeter at a time.

Instead of wearing braces, many people turn to aligners to fix crooked teeth, especially adults. 

Invisalign braces or invisible retainer isolated on white background
Retainers

Retainers keep teeth in place after orthodontic treatment (braces) is complete. Since jawbones are living and changing tissues, retainers are necessary to ensure teeth stay straight. There are also permanent options available. 

hawley metal retainer
TMJ Splints & Jaw Repositioning Appliances

Repositioning the temporomandibular joint, which opens and closes the mouth, incorporates the use of splints (jaw repositioning appliances). They stabilize the relationship between teeth and joints, while also eliminating occlusal interferences. 

Headgear

Headgear fixes a child’s overbite. This appliance moves the jaw and teeth bones back. And, in turn, keeps the front teeth from sticking out. The growth of the upper jaw slows down, giving the lower jaw time to catch up. 

Reverse Pull Headgear

Does Dental Insurance Cover Orthodontics?

Depending on an individual’s insurance plan, some orthodontic treatments may be covered. Insurance carriers, such as Delta Dental and Humana, offer discounts for braces, Invisalign, and retainers with certain plans.

If you have orthodontic benefits, then your dental insurance will pay the same amount for Invisalign or other aligner therapy as it would pay for braces. However, you should check with your provider to determine the best option.

Questions and Answers

Do orthodontists pull teeth?

Orthodontists may recommend pulling teeth before orthodontic treatment, but only if it is completely necessary. Tooth extractions may be necessary if you have severe dental crowding, if your teeth are sticking out too far, or if your teeth are protruded.

What is the perfect bite for teeth?

A "perfect" or healthy bite is when your upper and lower teeth fit slightly over each other. The grooves of your back molars should also line up.

Should top teeth touch bottom teeth?

Yes, when your jaw is closed, your top and bottom back molars should touch. Your front teeth should overlap.

How do you know if your bite is misaligned?

Your bite may be misaligned if only one or a few of your back teeth touch when your jaw is closed. You may also have difficulties chewing or feel like your teeth are higher on one side.

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Resources

“Malocclusion of Teeth: MedlinePlus Medical Encyclopedia.” MedlinePlus, U.S. National Library of Medicine, medlineplus.gov/ency/article/001058.htm

“Orthodontic Treatment Options.” American Association of Orthodontists, www.aaoinfo.org/orthodontic-treatment-options/

Proffit, William R., et al. Contemporary Orthodontics. Elsevier/Mosby, 2019.

Updated on: October 20, 2020
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Alyssa Hill
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Lara Coseo
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