Orthodontic treatment uses appliances, teeth removal, or surgery to fix the way teeth and jaws are aligned. There are many ways to treat poor bite (malocclusion). Expert opinions differ about when to start treatment. Your dentist or orthodontist may give you a choice between early or later treatment or may prefer one specific approach.

The general categories of orthodontic devices (appliances) are functional and fixed.

Functional appliances use the muscle action from speaking, eating and swallowing to create forces that move teeth and align the jaws. See an illustration of a functional appliance.

• Some functional appliances are removable, while others are bonded to the teeth.
• A functional appliance may fit between the upper and lower teeth (a splint) or may span across the mouth between the molars, pressing the bone outward.
• Headgear can attach to bands on the teeth to speed up treatment time.

Fixed orthodontic appliances are sets of wires and brackets cemented to the teeth. These are commonly called braces. Over a period of about 24 to 28 months, the wires are tightened and adjusted, gradually applying enough force to move the teeth (bone remodeling).

Retainers are removable appliances made of molded plastic and wire. They hold the teeth in place after braces are taken off. If the teeth start to move back out of position, the orthodontist may bond a short retaining wire to the back of some teeth. This will hold the teeth in place until the wire is removed.

Child and adolescent treatment

The aim of treatment in the childhood and teen years is to move permanent teeth into place. The orthodontist will time the treatments to match your child's natural growth spurts.

Treatment for crowding, the most common malocclusion problem, may mean removing (extracting) some permanent teeth, but orthodontists avoid removing permanent teeth when they can.

The malocclusion treatments for children and adolescents are:

• Extraction (serial removal). Removing some baby teeth may ease severe crowding.
• Growth modification. This involves wearing fixed or functional appliances during the day and night to move the jaw into a better position.
• Fixed appliances (braces) gradually move the teeth. For children and teens, this treatment phase usually lasts about 24 months; for adults, about 28 months.
• Retainers. Retainers hold the teeth in place after orthodontic treatment. Some orthodontists recommend that retainers be worn for many years, because teeth have a natural tendency to drift out of place.
• Space maintainers, made of metal or plastic. Spacers keep the surrounding teeth from moving (drifting) into open spaces created when teeth are pulled or lost in an accident.

Adult treatment

Orthodontic treatment for malocclusion is a popular option for adults, due in part to better technology. In the past, wide silver bands held braces in place. Today they are less obvious. Instead of the wide bands, a small metal or ceramic fastener is bonded to each tooth, and a narrow wire passes through the fasteners.