Orthodontics is a dental specialization that addresses teeth, jaws, and bite patterns that are positioned or aligned incorrectly. Orthodontists are trained to diagnose, prevent, and correct these misalignments and malpositions. Orthodontics may also focus on the growth of the facial bones themselves; this sub-specialty is called dentofacial orthopedics. According to the American Association of Orthodontics, nearly half the population in the US would benefit from orthodontic treatment for cosmetic purposes, though the number of people who need orthodontic treatment for strictly medical reasons is significantly lower. Problematically, there isn’t a proliferation of evidence that orthodontic treatment has health benefits, though patients who have undergone orthodontic treatment generally claim improved function of the teeth as well as increased self-esteem. Orthodontic treatment generally takes anywhere from several months to three or more years and involves the use of dental appliances, such as braces, to reposition the teeth and jaws. In severe cases, orthodontists may recommend jaw surgery to modify the shape and position of the jaws and teeth. Because the bones of young children are more malleable than those of adults, in many cases, orthodontic treatment is recommended before patients reach adulthood.
While orthodontics dates back to the 1800s, modern advancement in the field has greatly improved treatment efficacy and duration. As recently as the 1970s, orthodontists were still treating misaligned teeth with braces that were simply pieces of metal that were wrapped around each tooth. Now, orthodontists can use powerful medical adhesives to adhere braces to the teeth, or they can offer patients even less obtrusive types of treatment, like Invisalign trays, which do not need to be attached to the teeth at all. Most orthodontic treatment involves fixed appliances, like braces, which tend to have a better outcome than removable appliances. This is because braces and other fixed appliances are able to move the teeth in more measurable and significant ways than removable appliances, like Invisalign. For example, when a tooth needs to be rotated or angled differently in the jawline, or if more than one tooth needs to be moved, braces and other fixed appliances are simply more powerful. If a patient’s teeth need only mild correction, or if the teeth are weak or unable to commit to the duration of a treatment using fixed appliances, removable appliances may be the preferred treatment. While these may be effective for people with minor alignment or bite issues, they are not effective for more severe orthodontic issues.
Dental braces are most often made of stainless steel or porcelain brackets that are bonded to the teeth using an adhesive; these brackets are then connected with wires that control the mechanics and movements of the fixed brackets. Orthodontists may also use rubber bands or small springs to apply force to the teeth and make smaller adjustments between the teeth. While the duration of orthodontic treatment with fixed appliances like braces varies based on the severity of the problem, the amount of room in the mouth, the health of the mouth, and the habits of the patient, the average duration of treatment with braces is one to three years. Most orthodontists recommend that patients use a retainer to maintain the realignment of the teeth; the type of retainer and duration of use depends on the patient. Other orthodontic tools that can assist in properly aligning the teeth and jaws include orthodontic headgear, which is used in addition to braces to help alter the alignment specifically of the jaw, most typically in children and teenagers. Orthodontists also use dental appliances to expand the size of the palate and to perform jaw surgeries that may be needed to fix severe alignment problems.
In the United States, applicants to orthodontic programs must have graduated from an accredited dental school, and admission is highly competitive. Most orthodontic programs last for two to three years and conclude with a written examination and a clinical examination. Orthodontists must renew their professional certification every ten years.