The desire for well-aligned teeth is hardly new; ancient Egyptian mummies have been unearthed wearing crude metal bands on their teeth that suggest early attempts at orthodontic treatment. Writings left behind by Hippocrates and Aristotle, among the greatest thinkers of ancient Greece, discuss options for straightening teeth as well as treating other dental conditions.
Needless to say, dentistry has advanced considerably since ancient times. In the world of orthodontics—the dental specialty concerned with the growth and development of the jaws and teeth and the treatment of malocclusions (literally “bad bites”)—much of that change has occurred since the 1960s and ‘70s when clunky metal braces were the only game in town and not so many kids were wearing them.
Aesthetics have always been a driving force in seeking orthodontic treatment. A pleasing smile makes a great first impression on others, and can boost self-image and self-assurance as well. There can be health benefits, too. Poorly aligned teeth are more difficult to brush and floss effectively, increasing the risk of tooth decay and periodontal (gum) disease, which can be painful and, without appropriate treatment, can lead to tooth loss.
Fixed metal braces are still considered the “gold standard” when it comes to repositioning teeth and correcting malocclusions. They’re made of a durable material and can be relied on to achieve extensive and complicated tooth movement. But they’re not the “train tracks,” “tinsel teeth,” or “metal mouth” that some of us may recall from childhood—the bane of every young teen’s existence.
Today they consist of miniature brackets that are bonded directly to the front of teeth so that much more tooth and a lot less metal are revealed when the wearer smiles. Brackets affixed to wider bands that are slipped over teeth and then bonded to them, at one time used throughout the mouth, are now, if needed, reserved for the back teeth where they’re out of sight. The arch wires threaded through the brackets, which apply the constant but controlled pressures that move teeth in predictable ways, are thinner, too.
For those who wish to be more discrete about the fact that they’re undergoing orthodontic treatment, clear braces featuring brackets made out of a ceramic material that blends into the tooth color are another state-of-the-art option. They look and work like metal braces, except the only component visible is the thin metal arch wire. Ceramic is not as durable as metal and can fracture under some types of stresses so they may not be the optimal solution in certain complicated cases. They typically cost more than their full-metal counterparts as well.
Clear braces are not the same as Invisalign® clear aligners, which are a series of clear plastic trays—each pair (top and bottom) slightly different than the preceding one—that fit over teeth and incrementally direct them into their desired positions. Aligners can be removed temporarily for eating, brushing, flossing and special occasions.
Lingual braces are even more discrete than clear ones. They are made out of metal but are bonded to the inside, or tongue-facing, surface of teeth where they are entirely out of sight. Lingual braces can be harder for orthodontists to work with, however, which may prolong the duration and increase the cost of treatment, depending on what is required. They may also be a little more difficult to get used to wearing.
Braces, even metal ones, no longer pose the stigma they once did for adolescents and teens. More and more families can afford orthodontic treatment for their children as more and more insurance plans are covering part of the cost. Consequently more kids are wearing them, including the popular football captain and head cheerleader. These days, braces are pretty much accepted as a rite of passage into adulthood. Rubber bands (elastics), which may be used in conjunction with braces when additional force is required, now come in a variety of colors specifically intended to appeal to teens by allowing them to “customize” the look of their orthodontic appliance.
Meanwhile, adults now constitute one out of every five patients undergoing orthodontic treatment. In fact, Invisalign® clear aligners were initially created for grown-ups to make it easier for them to interact in business and social situations without self-consciousness.
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