How do braces work? How do braces move the teeth?
A 11. Braces consist of brackets (mini-handles) bonded (glued) on to most of the 12 or 14 teeth in each jaw. A thin highly flexible wire is fastened to each bracket on each tooth. Suppose a tooth is incorrectly positioned; let us assume it is a tooth that is depressed inwardly and we want to bring it more forward. When we fasten (attach) the wire to all the teeth with brackets the wire flexes in to attach to the depressed tooth. Since the wire is flexible (resilient) it "wants" to "bounce" back to the shape it originally was (straight). So over a long period of time the wire gradually moves the incorrectly positioned tooth in to the desired (corrected) position, that is, in line with the other teeth. As long as the pulling is done gently over a long period of time the teeth will move through the bone without harm to the tooth, or any other teeth, and gums and bone. It can take between 4 weeks and 3 months to move a tooth 1mm (about 1/32nd -1/16th of an inch) depending on whether the tooth is a lower front incisor which is very small with a single root or a lower six year molar which is much larger and has 3 roots.
Will I need to have any permanent teeth removed when I get braces?
A 12. That depends. If your teeth are very crowded and they are protruding far forward (stick out), removing teeth may be an excellent choice for you. Typically, most orthodontist choose to extract two upper back teeth (premolars) and two lower premolars to accomplish the goals of treatment. Other choices may include the removal of only two upper teeth while still other cases may require the removal of only one lower front tooth.
When Dr. Rothstein thinks removal of teeth is the correct treatment option he recommends removing the second premolars because they are farther back in the mouth and is likely to be a cause of embarrassment because the space where the teeth were removed is likely to be visible. Furthermore, Dr. Rothstein has a Ph.D. in facial growth and development which makes him even a better judge as to when the removal of teeth is justified. The removal of teeth is always a last resort and the orthodontist should always tell you what he can and cannot accomplish by removing teeth. Dr. Rothstein removes teeth in approximately 8% of the patients he treats. In some cases the reasons for removing teeth are very compelling and to fail to remove them would be as ill-advised a treatment as to remove teeth when it barely necessary. Where it is warranted, an alternative treatment to the removal of teeth is the method Dr. Rothstein calls "slenderizing" the teeth. It is used to create the space needed to correct moderately crowded teeth. Slenderizing became a very commonly used approach to treatment of crowding when orthodontists began using braces that are bonded to only front surfaces of the teeth. This permitted the sides of the teeth to be available for small amounts of sanding. Such sanding when done on many teeth amounts to the equivalent of removing a tooth and in this way space is created to correct some problems of moderately crowded teeth. This procedure has save countless thousands of patients from having teeth removed unnecessarily.
If I do need to have teeth removed when do they have to be removed?
A 13. Dr. Rothstein usually bonds (glues) the brackets (mini-handles) on the teeth and then sends his patient to their dentist or in some cases an oral surgeon (who can give gas "conscious sedation", or handle especially difficult removals) to have the teeth removed. The first wire is generally attached to the brackets-teeth about 10 days after the selected teeth are removed, which is about the time required for the empty tooth socket to heal over.
How long does it take to glue on (bond) the braces and remove (de-bond) them?
A 14. Bonding the brackets on to each of the 12 upper teeth takes about 12 minutes and the same for the lower teeth. Dr. Rothstein usually bonds the upper teeth first and 2-5 months later bonds the lower teeth (the lower teeth are smaller and take 35% less time to straighten. Attaching a wire to the teeth take about 6 minutes. Lingual braces (braces that are bonded behind or in back of the teeth) are another story: It takes 45 minutes to put lingual braces on the upper teeth and about 25 minutes to shape and attach a lingual braces wire to the them. Removing the brackets and wire take about one minute with regular braces and about 3 minutes with lingual braces, after which the residual glue is removed and the teeth polished
Do braces interfere with intimate acts like kissing?
A 15. When you begin orthodontic treatment Dr. Rothstein bonds (glues) brackets (mini-handles) on your teeth and then fastens (attaches) a flexible wire to them which is what causes the teeth to begin moving because the wire exerts a light but continuous pull (or push) on them. Typically he will "tighten" (adjust) your braces 3-5 times for the upper teeth and 3-5 times for the lower teeth. What this really means is that he gives you the next thicker (stronger) wire in the series he has chosen for you. On average he changes the wire every six weeks. He chooses the wire very carefully and gradually in order that he does not cause you an excessive amount of soreness to your teeth. It is very rare to experience any pain/discomfort at all in the office. In fact most of the discomfort/pain is experienced 2-3 days after the new wire is fastened to your teeth. The first wire is very light and thin. In fact it is so light and thin you have very little awareness of anything even happening at all. By the next day, however, your teeth will begin to feel sore and if you try to eat hard foods you will cause yourself even further discomfort. By the third day after the wire is placed the discomfort has reached its maximum and three days after that the discomfort is entirely gone. Now here is the answer to that pesky little question you asked up above: Since kissing requires the partners to press on each other’s mouth, this causes pressure on the teeth. If the pressure is excessive during the period of the 2-5 days after the wire is placed across the teeth the pleasure of the kiss will be diminished by the pain caused by the excessive pressure. Doctor Rothstein therefore recommends a less passionate kiss in favor of a more gently placed kiss in consideration of the partner who has just had his/her wire recently placed. Dr. Rothstein speaks from personal experience.
Is it harder to take care of your teeth when you are wearing braces?
A 16. Yes. Your gums tend to become more easily swollen because the braces prevent your teeth from getting the stimulation they normally get from the food which contacts them. furthermore, food particles tend to get stuck in the braces and lodge more easily between the teeth. Dr. Rothstein guides his patients with the rule of "33". That is, you should brush your teeth 3 times every day for 3 minutes each time after breakfast, dinner and before bed time. It is also important to remember that braces cause your breath to lose its freshness in half the time it usually takes, because the braces have hidden surfaces where bacteria can flourish. For this reason it is prudent to use an antiseptic mouth rinse when closeness is imminent.
Do braces harm your teeth or gums?
A 17. Yes and no. No, if you follow Dr. Rothstein’s instructions for the care and maintenance of the braces, keep your appointments and brush your teeth regularly. Every time you come to the office to have your braces adjusted the very first step that Dr. Rothstein takes is to look for any possible harm the braces are doing to your teeth or any discomfort you may be experiencing, and then he corrects the cause of that harm. To better understand how the braces can harm you have to know what braces consist of: Braces consist of brackets (mini-handles) that are bonded (glued on) to the teeth and a wire that the doctor fastens to the brackets to make the teeth move. He also attaches mini-elastics (rubber-bands) which can push or pull the misplaced teeth into their appropriate positions. If brackets break (which can happen when you eat crispy, crunchy or crusty foods (like fried chicken)), the brackets can shift and slide into the gums causing them to become inflamed and bleed. Broken brackets can also lead to the wire poking into the gums and cheeks. Other parts of the braces can irritate you and feel sharp. That is why Dr. Rothstein provides you with wax to cover over the offending part of the brace and that is why he will want to see you the same day if you report that you are having pain. It is for that same reason that all of his patients are provided with his home telephone. It may be comforting to know that once the problems are corrected the gums usually heal in 1-3 days. Another possible harm occurs when the teeth are improperly or infrequently brushed over along period of time. This causes the surface of the teeth to develop white spots which may eventually need to have fillings. Dr. Rothstein provides his patients with a complete list all the possibilities for harm that braces can cause. Fortunately, it is uncommon for harm to come when treatment is rendered by a specialist in orthodontics who is university trained. A general dentist is not a specialist in orthodontics. Most dentists who are not university trained are not as competent as a specialist in orthodontics who does no other kind of dentistry but straighten teeth. Dr. Rothstein is one of those specialists and he has straightened the teeth of almost 3000 patients.
What is a retainer?
A 18. A retainer is a simple, removable device that is fitted to your teeth to hold them in their corrected position after the orthodontist removes the fixed (bonded) braces that were used to straighten your crooked teeth. Doctor Rothstein prefers to have his patients wear their retainers (upper and lower, nights only, 6 nights a week for 3 years, and then 2 nights a week for as long as they want their teeth to remain as perfect as they were the day the braces were removed. Dr. Rothstein uses a retainer that is virtually invisible because it is made of a durable shell of clear-transparent plastic that covers the teeth, similar to the way some items in grocery stores are vacuum-wrapped in a clear tough cellophane covering.
Why do teeth get crooked after the braces are removed?
A 18A. The problem of "relapse" of recently straightened teeth is not uncommon.
In spite of the careful attention given to informing the patients how important retainers are to prevent the teeth from returning to their crooked position, relapse occurs disconcertingly to the patient and the orthodontist too frequently.
This occurs because teeth need time to "permanently set" or grow into their new positions like poured cement setting around a newly placed parking meter. The teeth are held in place by millions of elastic-like threads in the bone socket holding the tooth (ligaments). When teeth are orthodontically turned toward a new "corrected" position the ligaments twist with them. The body in time rebuilds new tooth-socket bone and "straight" ligaments around the teeth -- that takes time (24-36 months).
I provide my patients with retainers the day after their braces are removed with the following bit of dogma - "Keep them in your face or in the case" I'm giving you and never wrap them in a napkin". Of course I am always bothered when a patient returns complaining of relapse and a bit angry since I put my heart and soul into straightening the teeth in the first place. I always ask to see their retainers. The inevitable response is that they lost them. How? I ask. "I wrapped them in a napkin at dinner and it was thrown out with the trash".
I would be remiss if I did not note that many orthodontists consider the erupting wisdom teeth to be a cause of teeth becoming crooked again. It is wise to know that wisdom teeth in females are starting to erupt around 17 (males 18-19) and can be a powerful force causing the teeth (especially the lower front teeth) to "relapse" if the patient completely stops wearing their retainers. Consequently, after wearing your retainers every night for three years, if you want your teeth to remain as straight as they were on the day that the braces were removed, then continue wearing them two nights/week forever.
These days I also offer an inexpensive three year retainer insurance plan which encourages patients to return immediately for replacements when they lose their retainers ($195). Generally speaking if retainers are not worn at all one can expect the teeth to slowly relapse 5%-15%. In adults relapse sometimes occurs when gum problems spread beyond the gums into the bone socket.
When I have accomplished the straightening of the teeth I provide my patients with a comfortable, transparent, thin, hard plastic covering that fits precisely over the front eight teeth, unlike the old-fashion retainers that have a metal bar that lays across the upper front teeth and covers the palate.
I advise them to wear it nights only for 3 years and then 2 nights each week for as long as they desire their teeth to stay as straight as the day the braces were removed. I give this advice because your teeth throughout life are continuously erupting into your mouth and never stop migrating forward as well. This is particularly evident in the lower front teeth where relapse is usually the first place to be observed when it occurs, especially when one completely stops wearing the retainer. When the lower front teeth relapse they can deliver forces to the upper front teeth that can cause them to relapse also.
As for the solutions for relapsed teeth: 1. You can restart retainers (transparent) to hold the teeth exactly as they are (fee $385). 2. You can reapply removable retainers (metal-plastic) and correct the relapsed teeth. I find this approach to be less than 100% accurate and unpredictable except where only one tooth is involved. 3. You can have fixed braces reapplied for 4-8 months assuming the corrections are minor. ($785-1485)Will I have to have my wisdom teeth removed for the treatment?
A 19. When Dr. Rothstein was younger and less experienced he would frequently recommend the removal of wisdom teeth. After treating almost 3000 patients he rarely sees the need for having wisdom teeth removed. The only time it is absolutely necessary to remove them is when they are preventing the molars in from of them from erupting or they are diseased or are causing harm to other teeth. Dentists and orthodontists often argue with each other and between themselves about the benefits and disadvantages of removing wisdom teeth. Some practitioners believe that removing wisdom teeth minimizes the crowding and re-crowding of teeth, especially the teeth in the lower jaw in the front which frequently do re-crowd when the patient stops wearing their retainer. Dr. Rothstein believes that if the wisdom teeth are not chronically bothering you do not remove them. Better yet, wear retainers to hold the lower anterior teeth straight. Removing wisdom teeth should be considered very carefully as to the benefits and possible detriments of their removal. A candidate for removal of wisdom teeth should always ask the dentist about the serious or harmful possible consequences of removing wisdom teeth and the possible alternatives to their removal. You may now download an article that appeared in the health section of the New York Times that addresses the question of "When wisdom teeth should be removed".
Go to Occasionally Asked Questions
Home [Back to Site Additions] Before & After Dr. Ted's Book Meet Dr. Ted / Consultation
[Back to Jaw Wiring directory] [Back to Site Additions] Special NY Times Article on the founding of Invisalign
[Email Us] Home [Site Additions] Consultation [Lingual Braces Menu] [Download an Office Brochure]
[ Q & A ][ Consultation ][ Meet & Hear Dr. Ted ][ Tooth Whitening ]
Jaw Wiring FAQ's Jaw Wiring Informed Consent Jaw Wiring Link Sites
[ For Orthodontists][ Wisdom Teeth] [Email Us] [Somnoplasty to Eliminate Stop Snoring][Invisalign: the "no-braces" braces and so much more] [Menu for Small Claims Court Info]
The Orthodontic Glossary of the American Association of Orthodontists