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Orthodontics

General Points of Interest During Orthodontic Treatment
Orthodontic treatment is a slow process and it take a long time for results to become apparent. In order to move teeth, bone has to be resorbed (broken down). Once the tooth has been moved, bone has to be built up again. This resorption and deposition of bone are biological processes and it has to be kept in mind that bone grows very slowly. (Bone can only resorb and be deposited at a maximum rate of a millimeter per month.) This should provide you with some perspective as to why orthodontic treatment takes so much time.
There will be increased saliva flow directly after placement of an appliance. This should soon stabilise. Speech will initially be affected. This should improve gradually as treatment progresses and the patient becomes used to the appliance.
Oral hygiene remains of utmost importance during orthodontic treatment. Plaque can accumulate easier and the normal rinsing effect of saliva can be inhibited.
Never interrupt treatment. Try to compare this with a car being pushed uphill. If the car left at any point, it will start rolling backwords and you will have to restart from the bottom of the hill.

BRACES

Functional Appliances
Certain Habits, such as thumb-sucking or tongue-thrusting, can be modified with the help of removeable appliances. Growth modification can also be obtained by exerting force on the bone, e.g. a narrow jaw can be widened by exerting forces laterally, using an expansion screw.

Care and maintenance of removable appliances

• Use the orthodontic appliance entrusted to you strictly in accordance with the prescription of your dentist. A removable appliance is usually worn full-time, unless otherwise specified.
• The appliance has to be cleaned. The appliance is removed after meals to allow normal oral hygiene. Replace the appliance immediately after cleaning.
• It is advisable to remove the appliance when taking part in contact sports. Always keep it in a safe place.
• Sticky and hard foods should be avoided.
• Should an appliance break or cause pain, it should be attended to immediately.

Placing Fixed Appliances
There are several steps to the placing of fixed appliances:

1. The teeth are thoroughly cleaned.
2. The teeth are then acid-etched.
3. A band is cemented around the molars to act as anchors for the arch wires. Please note that spacers are fitted a few day prior to band placement to facilitate easy cementation of the hands. The spacers are removed just prior to hand placement.
4. The individual brackets are bonded to the teeth with resin. The brackets are not permanently fixed to the teeth and will be removed after treatment. The resin bond, therefore, is fragile and hard and sticky foods must be avoided. The brackets serve as a guide for the arch wires.
5. Once all the brackets and bands have been fitted, an arch of wire is placed in the bracket slots using tie wires or tie elastics.
6. Forcescan be transferred between the upper and lower jaws with elastic bands or from outside the mouth using headgear. Individual teeth can be tilted, rotated or bodily moved into the ideal position.

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TMJ

The temporomandibular joint (TMJ) is the medical name for the left and right jaw joint, unique in the body as one joint cannot be moved without influencing the other, ie the right side cannot move without the left doing so too. It is also complex, as it consists of two compartments separated by a cartilage disc. One compartment allows a hinge movement for opening and closing the jaw, and the other an orbiting movement for side to side chewing.
When the joint does not function correctly it may cause painful symptoms or limitations of movement and this is called temporomandibular joint dysfunction.

How do problem arise?
If the disc, situated between the base of the skull and the lower jaw, is displaced it can sublux (become misaligned), causing a clicking and grating sound when the mouth opens and shuts. This may cause pain or restriction of function, but painless joint noises do not generally require any treatment. Severe tooth grinding (bruxism) may exacerbate TMJ dysfunction. Complete dislocation of the jaw will require reduction and repositioning of the lower jaw into its correct alignment. This may damage or weaken the joint ligaments and needs exercises and care to avoid recurrence.

What can be the symptoms of TMJ dysfunction?

• Headaches/migraine type pain
• Opening or closing the jaw joint, causing clicking or grating, with or without restriction of movement
• Difficulty in opening the mouth fully (trismus)
• Atypical face pain and neuralgias
• Facila and jaw muscle aches
• Neck and shoulder pain
• Ear pain, tinnitus (ringing/buzzing in the ears)

Who gets TMJ problems?
Up to one in four people may have some symptoms and both men and women are affected equally.

What can you do about it?
Avoid overstretching the jaw joints: stifle yawns and cut up food into smaller pieces. Ask your dentist's advice; in simple cases he/she may be able to treat the problem, or may refer you to a specialist in TMJ problems.

What will the dentist do?
Diagnosing the problem correctly is essential. The dentist will take a history, consider your symptoms and palpate the muscles and joints around the jaw area. A full examination by a specialist may include muscle testing, movement analysis, X-rays and possible magnetic resonance imaging (MRI) or CT scanning.

What is the treatment?
Treatment can involve reducing any stress on the joints, wearing splints and biteguards on the teeth to attempt to realign the jaw into a more comfortable position and further prevent damage. This may improve the symptoms, especially muscular problems associated with headaches and migraine type pains. In severe cases there may be adhesions in the joint needing arthroscopy or surgical intervention.

What other therapies are helpful?
Some patients' TMJ symptoms are helped by physiotherapy, ultrasound and muscular exercises. Alternative therapies that may be of use include cranial osteopathy, osteopathy, chiropractic and acupuncture. Some TMJ problems are made worse by stress, so therapies aimed at relaxation may be helpful.