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Orthodontics
Doctors talk about crooked teeth. The position of our teeth in our jaw isn’t fixed – our teeth wander. Why? Our body doesn’t like pressure! You know this – press a point on your skin with your thumb and the area goes white. This is because the blood vessels in the area have been pressed closed by your pressure. There’s no blood in that area and the skin goes pale. Doing this for a short time is harmless, as soon as you let go the blood returns to the skin. Being bedridden for long however causes tissue to die via the same mechanism, though the pressure here comes from the body’s own weight and not from a thumb. Doctors call it decubitus.

Pressure is bad for our tissues. Our body has “suspended” our teeth with a connective mechanism known as the desmodont. The desmodont conists of a lot of small fibres which stretch between root and bone. By means of the desmodont chewing pressure is converted into a tensile loading. When you press with your teeth a pull on the bones results.
Teeth are not immovably anchored in the bone, on the contrary they are “moveable”. If you apply pressure on the tooth with a brace for example then the desmodont will reposition itself and movement of the tooth takes place. This is what the principle of the brace is built on.
Our teeth’s position comes about from a balance between tongue pressure and cheek pressure, since our tongue and facial muscles also exert pressure on our teeth. People with large tongues tend to have slightly splayed out teeth as opposed to those with strong chewing muscles, whose teeth tend to overlap or are lean inwards.

Whilst our teeth move together over the first two decades, causing crowding (tertiary crowding), which is created by the ever strengthening facial muscles, their behaviour changes completely from the 5th decade on. Due to the weakening facial musculature, the fading tone of the tissues and the constant tongue pressure the teeth tend to wander apart. Lip pressure also declines, just like facial muscle tone (especially the buccinator) and tongue pressure rules, pushing the teeth out from within. In addition, with a natural decline of the gums, or one caused by illness (periodontitis) and the accompanying loss of bone the teeth are no longer so stably fixed in the jaw. All this eventually leads to a very slow sliding apart of the front teeth. The teeth slide forward and create gaps. The longer the process goes on the quicker the teeth move until finally the patient realises and asks for advice.

Cooked teeth can be acquired or inherited. A typical symptom of inherited crooked teeth is their slow shifting.

Natural movement of teeth needs to be separated from processes caused by illness in the bones. Any space-consuming lesion in the bonescan be accompanied by tooth movement and therefore by displaced teeth. X-rays will easily identify such processes.

Risk factors for acquired incorrect positioning of the teeth are

  • early loss of milk teeth
  • caries in milk teeth
  • injury to the jawbone

Protection of milk teeth plays a central role in jaw orthopaedics. Treatment of crooked teeth is by means of a fixed brace, or with a removable brace.

There are two indications of brace treatment: Aesthetics and the health risk of resultant damage to one’s chewing apparatus.

Contraindications for braces are any infection in the mouth, e.g. periodontitis, caries, or gangrene of the pulp and also poor oral hygiene.

The risks of braces include decalcification of the dental enamel, discolouration of the dental enamel, damage of the dental enamel, periodontal damage, root resorption and loss of teeth.

Different braces?
Every brace has its advantages and disadvantages. Removable braces make sense only at the early growth phase, i.e. in childhood and then only in particular cases. Formerly almost every defective dentition was treated by means of a removable brace but today we know that despite using a removable brace in childhood a fixed one will inevitably follow and so the removable braces are being avoided more frequently, for the benefit of the children. What are called aligners hardly allow treatment of tooth rotations, especially in canines. The advantage of an aligner, however is that they are practically invisible, just like the lingual technique. The lingual technique is very costly and is usually felt to be very uncomfortable by patients.

Can braces be used at any age?
In principle, yes but moving teeth becomes more difficult with advancing age. In younger years a removable brace is often enough. The body is still developing and it’s enough for the body to get an impulse in the right direction, such as, for example with a removable brace. When development is over teeth can still be brought into ‘rank and file’ and this for life. If the result has to be maintained, that is to say if a ‘retainer’ needs to be used depends on whether an optimal dentition (known as Class 1) has been achieved. In addition there are a lot of other factors such as musculature, tongue size and others which can affect the tendency for teeth to wander back following successful treatment.

Fixed brace or not?
Removable braces can be used in young people due to their ongoing development. It’s enough to provide impulses to the teeth and the brace doesn’t need to be worn permanently. If development is complete a fixed brace is required since the force needed to reposition the tooth should work on it all the time.

Invisible braces?
Invisible braces, such as aligners also permit the correction of crooked teeth but the rotation of canines is very difficult to treat with them.

Kissing and braces, a contradiction?
Regardless of whichever brace you wear you can always kiss, no lingual acrobatics are needed! Eating and laughing are no problem either with modern braces.

Treatment duration
Most crooked teeth can be corrected within two years. Whatever needs longer should be operated on as a rule. In these operations the jaws, rather than the teeth are placed in the correct position in relation to each other.

Can tinnitus be treated with a brace?
Tinnitus (whistling in the ears) may be caused by a misalignment of the jaw and a correction of the alignment may in such cases provide some relief. Poor dental work can also change the dentition and therefore also the state of the jaw. Over the years the chewing apparatus can be so destablised that the mandibular condyle is dislocated. If when closing the mouth the mandibular condyle is moved well backwards towards the middle ear this will cause enormous pressure on the 2 nerves lying in between. The middle ear and the jaw joint lie very close to each other and are only separated by a thin wafer of bone. Imagined noises in the ear, known as tinnitus, or pain in the temples may result. A very thin splint of transparent plastic, used to bring the mandibular condyles back into their original position, may be of help in such cases. The patient wears this pivot-splint day and night for at least 4 weeks in his upper jaw, which is slightly raised at the back in order to correct the incorrect alignment. When the mouth is closed the lower jaw is directed by this object and pulls the jaw-joint downwards. The individually fitted splint is adjusted and ground into shape regularly until the ideal bite is fixed.