A COMPLETE GUIDE FOR CANADIANS

DentalBraces

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VIDEO OVERVIEW

Introduction

The basics | What are braces | Reasons for braces

Malocclussions and Types of braces

a. Treatment for children and adults

Choosing an orthodontist

The procedure / getting them put on

Maintenance and Care

b. After braces

Financial Consideration

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2

3

4

5

6

7

CONTENTS

The benefits of braces can extend beyond creating a nice-looking smile with rows of straight teeth. By correcting bite positioning, braces can also help alleviate jaw pain and muscle tension, prevent wear on teeth surfaces and make chewing less uncomfortable. For many people, the results of wearing braces can be life-changing.

The good news is that dental braces have come a long way over the years. Metal braces are still the most common, but the spectrum of options ranges from ceramic braces that are less noticeable to fun, multi-coloured braces and elastics that can make a bold statement.

Orthodontists are a valuable source of information for anyone interested in braces. They can help explain the various processes and treatment options, as well as answer questions or address concerns. Since braces are a long-term commitment, it can be helpful to schedule appointments at a selection of orthodontic clinics to collect different perspectives and find the clinic that is the best fit.

The purpose of this guide is to provide a snapshot of orthodontic treatment options available for anyone considering braces for straighter teeth and improved dental health.

INTRODUCTION

Braces apply gentle pressure to the teeth over a period of time, eventually shifting teeth to a desired position.

Orthodontists can use braces, which are commonly a series of brackets bonded to the teeth and wires, to straighten teeth and treat a number of bite-related issues by moving teeth in a variety of ways. Braces can also help improve oral health because straighter teeth are easier to keep clean, leading to fewer cavities and reducing the risk of gum disease.

Braces apply force to one side of a tooth, causing a portion of the underlying bone to dissolve and creating space for the tooth to move into. As the tooth shifts its position, new bone builds up behind it, preventing that tooth from moving back to its original position.

A bad bite, or malocclusion, occurs if teeth don’t fit together properly when the jaws are closed. An improper bite can result in teeth that stick out or that are crooked, crowded or gapped. It can also result in upper teeth that excessively cover lower teeth or in lower teeth overlapping the upper row when the jaws are closed.

An improper bite can affect more than physical appearances. It can also affect physical health, causing conditions such as headaches as well as facial and jaw pain that can be chronic. For example, temporomandibular joint disorders (TMD) are caused by malocclusions that prevent the complex jaw joints, the muscles in the face and neck and the teeth from working together properly.

The Basics What are bracesReasons for braces

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Here are some common types of malocclusions that may require orthodontic treatment:

• Overjet — The upper teeth extend further forward than the lower and protrude over the lower.

• Crossbite — This occurs when one or more of the top and bottom teeth are not aligned properly from side to side. The upper teeth can bite inside the bottom teeth instead of outside. Upper teeth may not line up with the corresponding lower teeth.

• Open bite — There is an opening between the top and bottom front teeth when the back teeth are together.

• Underbite — The lower jaw and teeth protrude over the upper. • Gaps between teeth — Teeth that are not properly spaced can

affect physical appearances. • Crowding — Often due to a smaller jaw structure, crowding

means there is not enough space for teeth to fit properly in the mouth.

• Teeth protrusion — Protruding teeth can affect appearances and also the effectiveness of a bite.

Some of the warning signs that could signal the need for orthodontic treatment include baby teeth that fall out early or late, adult teeth that appear late or not at all, chewing and biting difficulties, teeth that don’t appear in the proper position, difficulty closing the lips together, jaws that shift or make noises and jaws that are not properly positioned.

In addition to braces, orthodontists can use other tools, including

Malocclussions and Types of braces

3

headgear and removable appliances, to help move teeth into position.

When it comes to braces, there has never been more choice. Driven by advancements in orthodontics as well as patient demand for braces that are less (or sometimes more) noticeable, braces have come a long way over the years. It’s important to note that not every style of braces will be effective in correcting all bites so it’s best to consult with an orthodontist for guidance. Here’s a look at some of the options available:

Traditional Metal Braces - Metal braces are still the most common type of braces, although they’ve also improved over the years in terms of looks, size and comfort. Most often made from high-grade stainless steel (but also available plated in gold,) this type of braces uses a system of metal brackets and arch wires to exert pressure on the teeth and move them into position. Elastics, which are hooked onto brackets and stretch from one tooth to another, can also be used to help move teeth in the final stages of treatment.

Clear/Ceramic Braces - For patients who want straighter teeth without the look of traditional metal braces, ceramic braces may be an option. These braces work the same as metal braces, but they are less visible because they are either translucent or made to match tooth colour. Ceramic braces tend to cost more and are more fragile than traditional metal braces, but cosmetic appeal has made ceramic braces a worthwhile choice for many people.

Lingual braces - These customized braces are applied to the back of teeth instead of the front making them almost completely undetectable. Lingual braces are usually worn for the same amount of time and work in the same way as traditional metal braces. They are usually more costly, but can be appealing for cosmetic reasons.

Clear Aligners - This tooth-straightening option uses a series of clear aligners to gradually move teeth according to a treatment plan predetermined by an orthodontist. The aligners, which are custom-made trays worn over teeth for about 20 to 22 hours per day, are removable so patients can brush and floss normally and

are not restricted on what they can eat during the course of treatment.

Ligatures

A key component of braces is ligatures, traditionally small rubber bands or clips, which serve as connectors between wires and braces. The rubber bands, which can be coloured or clear or can be single or in a chain, provide the source of pressure needed to help braces move teeth and close gaps between teeth.

Self-ligating braces are a newer treatment option. Instead of using rubber bands, they hold arch wires in place by using a component, often a type of clip, that can be adjusted by an orthodontist. Self-ligating braces work in the same way as braces with rubber bands, by using gentle pressure to slowly move teeth into position.

Elastics

Elastics are hooked onto brackets and stretch from one tooth to another. Elastics add increased force and can help braces move teeth.

Headgear

Headgear attaches to braces, and is worn around the head or neck. It is another device that orthodontists can use to address bite issues in some patients. Headgear, which is most commonly worn during the evening and overnight, can direct tooth movement and jaw development in a patient who is still growing.

Orthodontic treatment can help with dental issues at many different stages of life. Although braces were long regarded as a tool to correct bite issues in children and teenagers, more adults than ever before are finding that braces can help correct long-standing bite issues.

According to the Canadian Association of Orthodontists, children should see an orthodontist by age seven. Early treatment can sometimes help prevent the need for more intensive treatment, including possible jaw surgery, later on in life. That’s because some issues are easier to treat before the rate of jaw growth has slowed. Orthodontists can examine children for proper tooth, jaw and bite development and can initiate interceptive treatment if necessary. Even if no treatment is prescribed at the time, an early visit can help an orthodontist develop a treatment program that can be implemented at a later stage.

Braces are most commonly applied on teenagers. That’s because while all adult teeth have normally come in by that stage, the jaw and facial structure is still growing. Orthodontists can combine orthodontic treatment with that natural growth to gently move the new adult teeth into position.

For adults, orthodontic treatment can help create a straighter smile as well as address other concerns such as issues with chewing or biting, teeth grinding or many jaw-related issues, including shifting or noises during jaw movement. Since teeth can be moved at any age, orthodontic treatment can be successful for adults as well.

Treatment for children and adults

3a

Orthodontists are dentists who specialize in treating crooked teeth and misaligned jaws. Orthodontic training, which can be taken upon completion of a dentistry degree, consists of several additional years of specialized education, on-the-job training and completion of a process of stringent exams.

Choosing an orthodontist is an important decision and a long-term commitment, especially since treatment can last two years or more. That’s why it’s a good idea to visit several orthodontic offices before making a choice.

No referral is normally required to see an orthodontist and many offices offer a first visit either free-of-charge or for a nominal fee.

At the introductory visit, you should have a chance to meet the staff and have a tour of the office. You can also expect to meet the orthodontist and have your questions answered and any concerns addressed.

Here are some other factors to consider when deciding on an orthodontist:

• Education - Ask about degrees, certificates and specialized orthodontic training. Find out how many years they’ve been practicing, what types of procedures they offer and how much experience they have in completing the procedures.

• Goals - Whether you are considering orthodontics for medical or cosmetic reasons, it’s helpful to know what you want to get from

Choosing an orthodontist

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treatment. That way, you can review your goals and discuss the orthodontist’s vision for your unique treatment plan, starting at the first visit.

• Recommendations - Your own dentist, as well as friends and family, can all be valuable sources in your search for an orthodontist. It can sometimes be helpful to rely on the experiences of others to narrow down choices.

• Fee - It’s important to find out what is included in the fees to ensure there are no hidden costs along the way. Normally all costs are included in the fee quoted, but it can be helpful to ask about costs of follow-up visits, x-rays, photos, appliances and retainers.

• Financing - There’s no doubt braces are costly so it’s important to understand your options for payment, including any financing plans offered. (As an aside, the entire cost of braces is an eligible expense with a Health Spending Account.)

• Technology - Visit the web sites of orthodontists you are interested in interviewing. A tour of an orthodontic office at the introductory visit can give you a good idea of the technology they utilize.

• Location - You can expect to see your orthodontist on a regular basis for follow-up visits once your braces are in place. Proximity to an orthodontic office can mean less time away from school or work.

• Office - Choose an orthodontic office that makes you feel comfortable. Is the office welcoming and friendly? Does the orthodontist genuinely listen to your concerns and address your questions?

The idea of straighter teeth and an improved smile after braces can be exciting, but the decision can also raise many questions and can sometimes cause anxiety, especially in younger patients. It’s worth taking the extra time to carefully research orthodontic offices to ensure your experience with braces will be a positive one.

For help searching for an orthodontist, visit the Canadian Association of Orthodontists web site at http://www.cao-aco.org or Orthopages at www.orthopages.com.

That way, you can review your goals and discuss the orthodontist’s vision for your unique treatment plan, starting at the first visit.

Getting braces can be exciting, but it can also bring feelings of anxiety. It takes about two hours for traditional metal braces to be put on top and bottom teeth. An orthodontist can choose to put braces on upper and lower teeth at the same time, or in some cases, treatment may be more effective by starting with upper followed by lower at a subsequent appointment.

Although there can be some discomfort associated with getting braces put on and subsequently adjusted, tenderness normally lasts for a day or two and your orthodontist can help you manage any pain you may experience. For example, orthodontic wax can be used to relieve sore spots in the mouth by coating brackets.

The orthodontist will have already taken x-rays, photos and impressions of your teeth and will have developed a treatment plan based on those findings. Teeth will be cleaned and dried and devices will be used to keep the mouth open and also to ensure the working area of teeth remains dry.

Metal bands will often be placed on the back molars for anchorage. Then, a bonding agent will be applied to the teeth and a bracket placed on each tooth. A special light is used to make sure the brackets are firmly adhered to the teeth. Once the brackets are securely in place, the wires are attached to the brackets and held in place either by small rubber bands or, if self-ligating braces are used, by a type of small clip. Wires are trimmed to ensure they fit comfortably inside the mouth.

Regular follow-up visits will be scheduled to check that brackets are intact, to adjust arch wires and to ensure teeth are moving according to plan.

The Procedure

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Teeth with braces will require some extra care and attention. Your orthodontist will provide all the information you need to ensure your braces are kept clean, intact, comfortable and functioning.

Here are some things to consider when caring for teeth with braces:

• Brushing - It’s especially important to pay attention to cleaning teeth with braces because food can easily become trapped within the braces. If plaque develops and is left too long, it can lead to stains on the teeth and gum disease. Brushing the braces, the gumline, as well as the front, back and chewing surfaces of all teeth, can help ensure plaque is removed efficiently.

• Flossing - The Canadian Association of Orthodontists recommends flossing once a day. Floss threaders are usually used to clean between teeth with braces. These thin, looped plastic lines make getting the dental floss underneath the arch wires easier. Another all-in-one type of floss for braces has a built-in floss threader at one end and floss at the other. Once the floss has been threaded underneath the wires, plaque can be removed by running the floss between the teeth and under the gumline. Your orthodontist can demonstrate the proper flossing technique to use at home.

Maintenance andCare

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• What not to eat - Since braces can be damaged while eating, it’s important to closely follow the orthodontist’s list of foods to avoid during treatment. Basically, foods that are hard, crunchy, sticky or chewy should be avoided. Examples of some foods to avoid are popcorn, gum, ice, small seeds and grains and any type of crunchy or hard cookie or cracker. It’s a good idea to stay away from most types of candy while wearing braces. Not only can hard, sticky or chewy candies damage braces, high levels of sugar intake can contribute to tooth decay.

• What to eat - Soft foods, such as cooked vegetables, soft fruits, yogurt and boneless meat, offer some of the best choices to avoid damaging braces. It’s best to avoid using front teeth when biting into any type of hard food while wearing braces. Hard foods that can be eaten with caution (for example, if they are cut into small pieces) include raw vegetables, some fruits, pizza with thin or crunchy crusts, hard buns and bagels and certain types of tougher or stringy meat.

After about two years of wearing braces, it’s exciting to finally have them removed and to get a glimpse of your new smile.

To remove braces, the orthodontist breaks the bond that holds the brackets onto each tooth. A cleaning tool is then used to polish away any remaining adhesive from the teeth.

Once the braces are off, care for your new smile doesn’t stop there. In fact, retainers are a crucial part of orthodontic treatment. Usually, you can expect to wear your retainer at all times for the first while after having your braces removed. Then, you may be able to switch to night time wear only.

The important thing to remember is that not wearing a retainer ac-cording to your orthodontist’s instructions can mean teeth and jaws may slowly begin to move back to their pre-braces positions.

In order to create a retainer, orthodontists will have taken another mould of your teeth. Retainers can be either fixed or removable. Fixed retainers are permanently applied to teeth, while removeable retainers can be taken out for eating, brushing and flossing. Whenever these types of retainers are removed, it’s important to store them carefully in their case so they are not damaged or lost. • Hawley retainers are the most common types of retainers. They are

made up of a plastic base, customized to fit the shape of the patient’s mouth, and wires that fit around the teeth. The wires help to hold the teeth in place and prevent them from growing back to their original position.

After braces

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• Essix retainers are tray-like devices that are worn over the teeth. They are clear and can be appealing for cosmetic reasons.

• A permanent or bonded retainer is a customized wire that an orthodontist glues to the back of teeth. It is meant to last for years and should only be removed by an orthodontist.

It’s best to consult with your orthodontist to determine which type of retainer will work best for you, as well as for tips and products on how to keep retainers clean.

Although it’s difficult to put a price tag on a beautiful smile and healthy teeth and jaws, there’s no doubt braces are a significant financial invest-ment.

Prices can vary between orthodontic clinics. It’s important to take the time to do your research before making a decision. Consulting with sev-eral orthodontists of your choice can help determine a price range for your treatment.

Some of the factors that can go into determining cost can be treat-ment complexity, treatment duration, type of braces, technology and orthodontist experience. Even location can be a factor. Braces can cost less in rural areas than in urban and less in the Maritimes than in the rest of Canada.

The time of year that you decide to undergo treatment might play a factor as well. For example, you might be able to negotiate a better price at certain slower times of the year, such as during the summer months or Christmas holidays, when many people are on vacation and choose not to undergo treatment.

It can be worthwhile to check into Schools of Dentistry at nearby uni-versities. Teaching clinics at universities train up-and-coming dentists and orthodontists and may offer orthodontic services for significantly reduced fees.

Due to wide variations in pricing, costs for braces can range from about $3,500 up to $10,000 and beyond. Typically, you can expect to pay a

Financial Consideration

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premium for the newer types of cosmetically appealing braces compared to the cost of traditional metal braces.

Here’s a look at price ranges for various types of braces:

• Traditional metal braces - The most common type of braces can cost anywhere from about $5,000 to $8,000. • Ceramic or clear braces - There is usually a slight premium for these types of braces compared to traditional metal

braces since they are more costly to purchase. They can start at about $4,000 and go up from there, depending on the treatment required.

• Invisalign - This type of treatment can cost anywhere from $3,500 to $8,000, depending on the complexity of the treatment and how many aligners will be needed to achieve results.

• Lingual braces - These types of behind-the-teeth braces are more expensive, ranging from about $8,000 to over $10,000. One of the reasons for the higher cost is the skill required and the length of time it takes to apply the brac-es behind the teeth.

Once price is established, it’s time to determine a payment method that will suit you best. Check into your employer’s insurance plan to see whether orthodontic treatment is covered. Braces are also an eligible expense under a Health Spending Account. If you are a small business owner, you can deduct the entire cost of braces as a pretax ex-pense.

Federal and provincial governments offer some tax credits for medical expenses, including orthodontics. However, treatment for purely cosmetic reasons is not eligible. Canada Revenue Agency states that eligible medical expenses can be claimed in any 12-month period, providing these expenses were not claimed in the previous year’s tax return. When claiming orthodontic work as a medical expense, it’s important to keep receipts for all services performed.

If paying for orthodontic work completely out-of-pocket, many orthodontists are willing to work with their clients to ease the financial burden. For example, some will give discounts if the entire amount is paid up front or will offer zero or low interest payment plans that can be spread out over the course of treatment.

CONCLU

SION

By fixing bite issues, braces can straighten smiles and help improve overall oral health for people of almost any age. However, there’s a lot to consider when deciding whether braces are right for you and which type of braces will address your concerns.

If considering braces, the best source of information can be ortho-dontists and orthodontic clinic web sites. It’s helpful to bring a list of questions that will help make the initial consultation as productive as possible.

Cost is always a primary concern so it’s important to gain a solid un-

derstanding of the total price for treatment and what type of insurance plan, health spending account or financing plan will work for you.

When it comes to braces, it’s best to be prepared for a long-term

commitment. Treatment will often continue with follow-up visits to your orthodontist, as well as the use of retainers, after your braces are removed.

Regardless of what type of orthodontic treatment is chosen, a straight-

er smile can improve lifestyles in many ways and there’s no doubt braces can help accomplish that.

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Dental Braces

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