What kind of teeth need braces?
Rumour has it that Nick Jonas could have 3 front teeth. Well, it turns out that he has a front tooth that is slightly more protruded than the other pair. Does Nick Jonas need braces? How can you tell if your teeth need braces?
The primary concerns of those who enquire for braces are usually aesthetic concerns arising from unsatisfactory teeth arrangement, which is under the umbrella term of malocclusion. Malocclusion is usually caused by problems with the shape or size of the jaw or teeth.
Before we dive in further about how braces can improve malocclusion, we should first tell the difference between normal alignment and malocclusion. Normal alignment is the relationship that exists when all teeth are perfectly placed in the arch of the jaws while upper and lower teeth are in contact harmoniously. It has been shown that only 35% of the adult population have this ideal bite. Hence, most people have an imperfect bite in some way or another. According to AAO (American Association of Orthodontists), one is recommended to see an orthodontist when their teeth fall short of ideal alignment using Angle’s Classification of Malocclusion. It is the most common way of chairside assessment where dentists will look for the relationship between the upper and lower first molars of both sides. Below is a simple summary.
This is the most widely accepted method to help in preliminary diagnosis and a quick gauge for clinicians to decide on the subsequent steps for a final diagnosis and treatment plan.
1. Crooked Teeth and Snaggletooth
Crooked teeth usually arise in cases of insufficient space. To put it simply, it appears “sardinized” as seen in the picture below, also described as crowded teeth. This usually happens when the gum space is too small to accommodate all teeth to grow fully. It could be slanted sideways or grown out from its usual position. The reasons for insufficient space can be due to retained baby teeth, facial injury or missing teeth, just to name a few.
Crowding can also give rise to snaggletooth when there is a delay in tooth eruption or insufficient space. Canines are one of the last front teeth that emerge into the mouth. The tooth will find the least resistant path to break out from the gums (known as eruption). Hence, canines are the most common teeth seen to be “pushed out” from the gums forward or appearing like “fangs”, especially prominent when one smiles.
2. Gaps Between Teeth
The reverse could also happen when there’s too much space that causes gaps between teeth. Gaps can be present across most of the teeth (generalised) or seen only in a specific site (localised). The most prominent site is the midline space between the upper front teeth, also known as midline diastema. For children, this is a normal developmental phase called the ugly duckling phenomenon. The gap will be closed once upper canines emerge, about the age of 11 to 12 years old. According to AAPD (The American Academy of Pediatric Dentistry), midline diastema may become permanent if the ugly duckling phenomenon persists. Occurrence of this condition can be of varied reasons, but most commonly due to the soft tissue between upper gums and lips being too thick (as shown below) or missing adult front teeth.
External factors such as premature loss of baby tooth, traumatic fall, unweaned childhood habits can contribute towards poor teeth alignment. Some people might have hereditary jaw problems that lead to malocclusion as well. There are more indications that have to be judged clinically to further evaluate if braces are needed. Your dentist will have to find out the causes in order to correct the bite.
3. Increased Overjet
Overjet, also known as “gigi jongang”, is a horizontal overlapping between the upper and lower front teeth. It is the distance measured clinically between the tip of upper teeth with the body of lower teeth when the back teeth are in contact. Based on research papers, normal overjet ranges from 2mm to 4mm. It is considered an increased overjet (protruding teeth) when the distance is more than 3.5mm. Protruding teeth can be visibly distinguished especially when the two front teeth interposing upper and lower lips that makes the lips unable to form an adequate seal in a resting position. With lip seal in mind, it is both the patient and dentist’s choice whether to carry on with orthodontic intervention if there is increased overjet.
4. Increased Overbite / Buck teeth
Overbite is defined as vertical overlapping of front teeth when the back teeth are closed together. Overbite is a clinical finding upon dental examination. Based on research papers, normal overbite ranges from 2-4mm. Buck teeth are commonly known for bite that exceed this normal range. As much as overbite and overjet are used interchangeably in lay settings, they are not quite the same.
Severe overbite will appear as the top teeth obscuring more than about 30% of bottom teeth. Clinically, increased overbite/deep bite occurs when the vertical overlapping exceeds 3.5mm. According to the standard scoring system, this condition requires little need of treatment if the upper teeth are not in contact with the lower gums. Whereas for increased overbite that causes gingival or injury to the palate, orthodontic treatment is required.
5. Underbite/Reverse Overjet
Meanwhile, underbite is the reverse of the above conditions, instead of the upper teeth appearing to roof over the lower teeth, the lower teeth are extended forward farther than the upper teeth. It is also known as reverse overjet. It can be due to undergrowth of the upper jaw or overgrowth of the lower jaw, or both. Such misalignment can lead to tooth wear and pain in your joints and jaw.
But does it REALLY matter to have an imperfect bite? Much in many ways! From chewing difficulties to poorer sleep quality, a malocclusion can negatively impact your quality of life. Cleaning your teeth will be difficult especially in between the gaps of crooked or overlapped teeth. This can potentially increase the likelihood of inflamed gums and tooth decay. In prolonged cases, it can cause gradual bone loss that will lead to mobile teeth.
In severe overbite or overjet conditions, soft tissue injuries such as cheek bite, lip bite and tongue bite may occur. Persistent injuries may lead to unwanted marks or lump in your mouth.
In some cases, young children with malocclusion can experience speech difficulty. This is because crooked and twisted teeth may change the placement of your tongue or allow excess air to pass between your teeth, creating a whistle when one speaks.
Could malocclusion be prevented?
Preventive measures can be taken by getting your teeth checked regularly by a professional. Given how most of the malocclusions come from childhood habits, it is highly recommended for an infant to see a child dentist at the age of one. Yes, you’ve heard me right, as early as that! This is the time when timely advice on diet and proper dental care can be given. At age 4, your dentist can detect any bad oral habits which can be corrected by reinforcement strategies. By age 7, orthodontists will assess the front-to-back and side-to-side relationships of the child’s teeth when the first molars start erupting. From there, potential future dental problems can be identified early to implement necessary steps to solve those issues.
Having said that, it is never too late to start your braces journey as an adult! The two most effective methods by far are braces or aligners (invisible braces). Both options help in moving your teeth by exerting constant pressure within the permissible biological range on individual teeth for extended periods of time. The shape of your jaw gradually adapts to conform to this pressure too. Movement of teeth and reshaping of the jawbone are the science behind what makes an ideal bite.
Treatment: Proper teeth alignment
In children and teens, early treatment such as growth modification can be initiated. The child will be given a device to be worn that helps to move the growing jaw into a better position. Treatment may be followed up by braces that will help to further move the teeth to the optimum position. This treatment works tremendously well in growing children especially around the age of 11 for girls and age 13 for boys. This period is known as the growth spurt where major changes can be done with lesser time required.
The approach for adults, on the other hand, is focused on the movement of teeth. The outcome of having straightened teeth with braces treatment is therefore promising. Only in cases that require manipulation of the jaw will surgical intervention be performed. Removal of tooth may be necessary when there is insufficient space for all your permanent teeth to be positioned in their proper place. Your dentist will advise you on whether it is necessary with all other options considered.
Things to note before you start
Patient’s role in teeth alignment is of utmost importance in the entire braces journey. A successful outcome of the treatment depends largely on the patient’s compliance to the proposed treatment plan. For instance, patients have to diligently clean their teeth as food particles get trapped around the brackets quite often. Invisible braces are a great alternative to alleviate this problem. Having no diet restrictions is also very appealing to most people as you can remove the trays during meals. Nonetheless, you will still need to take proper care of your invisible braces by cleaning it routinely.
Similarly, post-treatment compliance is of no less significance. Natural teeth have the tendency to drift back to its original position post-treatment. Hence, a retainer may be required to prevent your teeth from moving from its corrected position. Retainers are removable devices made of molded plastic and wire to hold teeth in place. Some people may wear a retainer for many years after treatment.
How do you know if your teeth need braces?
All in all, braces aren’t just about aesthetically-pleasing smiles. There is so much more to what braces do! However, not everyone gets the exact same treatment as everyone has their own unique set of teeth.
A series of diagnostic steps which include a dental status check and assessment of your gum and bone health are needed to determine if you are suited for braces. Your orthodontist will need to take study models, facial photographs, and maybe X-Rays which are essential for a thorough treatment plan.
It is undoubtedly a huge decision to commit to in order to achieve the desired smile. Hope these little insights can help you in making an informed decision on your journey to a new confident smile.