Orthodontics

This word comes from the Greek words orthos, meaning “straight, perfect or proper”, and dontos, which means “teeth”. An Orthodontic specialist is called an Orthodontist. This is a dentist who has qualified as a general dental practioner and who then continued their studies for a further 3 years to become a specialist in this field. There are only 2 recognised specialties in Ireland, these are Oral Surgery and Orthodontics. Orthodontics (Ortho treatment) is “the dental specialty and practice of preventing and correcting irregularities of the teeth, as by the use of braces”. These irregularities/positioning of the teeth when the mouth is closed is what’s known as Malocclusion.

 

Description: may be seen as crooked, crowded or protruding teeth. It may affect a person’s appearence, speech and/or their ability to eat.

 

Causes and symptoms (include, but not limited to):

  • Malocclusions may be symptomless or they may produce pain from increased stress on the oral structures. 
  • Malocclusion may develop for several reasons such as injury to the teeth, thumb/soother sucking,
    or for unknown reasons. 
  • Teeth may show abnormal signs of wear on the chewing surfaces or decay in areas of tight overlap. 
  • Some children’s jaws and teeth do not develop properly. 

 

Thumb/finger-sucking, and the use of a soother can cause malocclusion in young children. However when these habits stop, the teeth begin moving back to their normal positions. The sooner the habit stops, the better it is for incoming permanent teeth. However depending on how long the habit has been in place, Orthodontic treatment, with either removable or fixed appliances, may be needed to help with this process.

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According to an article written by journal.ie in Oct 2013 there are almost 14,000 children waiting on orthodontic treatments across the country. According to a recent survey, UK health authorities say that approximately one third of all 12 year-olds in the country probably need orthodontic treatment. So don’t delay, if you feel that you or your child can benefit from Orthodontic treatment, arrange an appointment for a consultation. The worst thing that can happen is that you finally get the smile you’ve always dreamed of.

 

 

Treatment

Orthodontics can be considered by some, as a cosmetic treatment, when in fact it is much more than that. Misaligned teeth or bite, if left untreated from a young age can begin to cause more dental problems during adulthood. Severe malocclusion may affect eating, speech and the ability to keep the teeth clean, through brushing and flossing. Treating malocclusions with removable or fixed appliances, is referred to as functional Orthodontic treatment, where the function of the patients bite is addressed. Although there is a lot more involved in orthodontic treatment than just creating a good smile, it is one of the huge benefits of treatment. 

 

 

Cosmetic Treatment

Orthodontics also includes cosmetic dentistry; this is considered when the patient’s main aim is to improve only the appearance of his/her teeth and they are not overly concerned with addressing the functional problems (if there are any). From time to time the orthodontist will discuss treatment options with a patient, that the patient themselves is not happy to go ahead with, either due to treatment length, cost, or treatment severity (i.e. surgery). In some cases (not all) it is possible to do compromised or “cosmetic” treatment. The majority of these cases will only address the position of the visible smile (Upper and/or Lower 4 – 4). Cosmetic treatments will NOT correct functional problems i.e.: open bite, cross bite, under bite etc… which should always be explained in detail to the patient before going ahead with treatment. The orthodontist will use a range of materials depending the specific requirements of each individual  treatment, including removable appliances, fixed appliances (brackets/braces either metal or ceramic), elastics, hooks/buttons etc... to help with:

 

• Straightening crooked teeth

• Making sure the incisal edges of the teeth are aligned

• Closing space between the teeth

• To improve the long-term health of gums and teeth

• To prevent long-term excessive wear or trauma (of the teeth)

• To improve speech or eating (oral function)

• Treating an improper bite

 

 

Conditions requiring treatment 

There are many different Orthodontic conditions, some of which are listed below. If you feel your child or indeed you yourself could benefit form Orthodontic treatment, then please don’t delay booking an appointment for consultation.

 

ortho 2

Crowding

If the patient has narrow jaws, in most cases there is not be enough space for all the teeth. The orthodontist may have to remove teeth to make room for the others during the course of treatment.

 

 

 

Spacing

If there are spaces/gaps between the teeth, because a tooth is missing, or the teeth have simply not filled up the mouth. The orthodontist will close the spaces during treatment, but there may also be a need for Implant or Prosthetic (crown/bridge) work after the Orthodontic treatment is completed.

 

 

Crossbite

Is when there is an abnormal relation of one or more teeth on one arch/jaw to the opposing tooth or teeth of the other arch/jaw. This is usually caused by a deviation of tooth position or abnormal jaw position. This type of bite can be treated with a combination of ortho treatment and the use of intra oral elastics, but in severe cases the patient may require surgery.

 

 

ortho 5

Deep bite (overbite)

Is when the teeth are clenched, the upper ones come down over the lower ones too much. In some cases the lower teeth will bite the gum/palate on the upper arch/jaw when the teeth are closed together and this can lead to the loss of the front teeth. 

 

 

 

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Under bite

Is when the upper teeth are too far back, or the lower teeth bite too far forward. The earlier this is treated the better the chances are to avoid requiring surgery later. The optimal time to treat this is approximately 7/8 years of age while the child is still growing. The orthodontist will use a removable appliance to help to train the jaws in a better position. The patient may still have to wear fixed orthodontic appliances (train tracks) afterwards.
In some cases (mainly adults) this treatment will involve
surgery.

 

 

Open bite

Is when the teeth are clenched, there is an opening between the upper and lower teeth. A lot of children experience anterior (front teeth) open bites between losing their baby teeth and gaining their adult teeth, which can last 1 to 2 years. Some of the major causes of an open bite are from thumb or finger sucking, pacifier use, lip and tongue habits, inadequate nasal airway creating the need for an oral airway; enlarged tonsils and
adenoids, and skeletal growth abnormalities. 

 

 

 

When is the best time to start
Orthodontic treatment?

Usually treatment does not commence until the child is about 12 or 13 years old, when their permanent adult teeth are fully developed. Treatment may start later if the issues have not yet been noticed or addressed. You are never too old to have Orthodontic treatment. However if caught early in children age 7 or 8, the orthodontist can use various removable and fixed appliances, which mean in some cases we can avoid the need for further, more extensive orthodontic treatments. Oral hygiene will determine if/when a patient can begin Orthodontic treatment. If the oral hygiene is bad, the orthodontist will NOT begin treatment, as adding an appliance will increase the difficulty to maintain good oral hygiene. Most Orthodontists would prefer that the patient has healthy crooked teeth instead of straight teeth that will need further dental treatment. 

 

 

What to do if you are considering
Orthodontic treatment.

Book an appointment for Consultation

First ensure that it is an Orthodontist you are seeing and not a general dentist who is doing orthodontic treatments. During a full extensive oral and radiographical examination/consultation the Orthodontist will assess the patient’s teeth and prescribe a course of treatment. 

 

The treatment plan will be based on the following: 

 

• A full medical and dental health history

• A clinical examination

• X-rays of the teeth and jaw (OPG/Panoramic X-ray and Lateral Ceph)

• Intra-oral and extra oral photographs of the teeth

• Moulds/Impressions/models of the teeth 

 

Once all the records are collected the Orthodontist will carry our measurements and prescribe a course of treatment based on the patient’s specific set up.  

 

 

Orthodontic Appliances 

Fixed Braces (Train tracks)

These are the most common orthodontic appliances used. The patient can choose either traditional metal brackets or ceramic brackets (usually at an extra charge). These appliances shouldn’t affect the patient’s speech and the patient should also be able to eat as normal, however as already mentioned, extra care needs to be taken with certain foods and with oral hygiene. Some foods and drinks need to be avoided, such as carbonated drinks, hard sweets, or toffee.

 

ortho 8

The appliance consists of brackets, wires and sometimes bands. Bands (if used) are usually cemented around the first permanent molar teeth and serve as anchors for the appliance. Brackets are bonded to the front surface of the teeth. A wire is then placed connecting each bracket, the wire is tied in place with elastic or metal ligatures. These wires are usually changed or adjusted every 4-6 weeks which applies tension to the teeth, which gradually moves them into a better position. Treatment time varies depending on each individual case, but standard treatment without extractions usually takes 12-18 months.

 

Removable appliances

 

These appliances are typically used for minor problems, such as prevention of thumb/finger sucking, tongue thrusting or slightly crooked teeth. In children the orthodontist will sometimes use different removable appliances one example is a “Twin Block” which helps to train the jaws into a new/better position. The better these removable appliances are worn the better the results will be. The orthodontist will explain everything including wearing times, cleaning, flossing eating etc... Sometimes, the orthodontist may advice the patient to remove them while doing certain activities i.e.: contact sports.

 

 

Retainers (Post Treatment)

A individual’s teeth are always moving, this movement is part of aging and is known as mesial drift. Some people will notice throughout their lives that the position of their teeth in their teens is not the same in their 20’s, 30’s, 40’s and 50’s etc… and as previously mentioned it is never too late to consider having orthodontic treatment. Mesial drift will continue to occur in patients who have had orthodontic treatment and if they don’t wear their retainer’s post treatment, then over time the teeth will change position. So it is imperative that retainers are worn to hold the teeth in their new position once the treatment has been completed. There are 2 types of Orthodontic retainers Removable or Fixed (Bonded).

 

Removable retainers (Hawley) 

These are an acrylic retainer placed on the roof of the mouth, with a wire which holds the teeth in place. They are used to prevent the teeth from moving. In some cases of slight/minor movement post treatment these retainers can be adjusted to cause tension on the teeth and move them back into the correct position.

 

Removable retainers (Essix)

These are a clear plastic retainer which sit on the teeth and hold the teeth in place and prevent the teeth from moving. After treatment removable retainers should be worn every evening/night for 12 months and gradually reduce the wear to one night per week indefinitely. Detailed instructions on wearing and cleaning retainers should be given to the patient when the retainers are being fitted.

 

Bonded retainers 

These are small coaxial wires which are cemented/bonded permanently to the back of the teeth, usually 3 – 3 (canine – canine) patients bite permitting. 

 

ortho 9

These retainers are worn indefinitely and should be checked regularly to ensure that there are no breakages which would allow the teeth to move. To be sure the patient should still wear a removable retainer at night. Detailed instructions on wearing and cleaning retainers should be given to the patient when the retainers are being fitted.

 

 

ortho pricelist

 

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