What Are Braces?
Braces are dental tools that help correct problems with your teeth, like crowding, crooked teeth, or teeth that are out of alignment. Many people get braces when they’re teenagers, but adults get them too. As you wear them, braces slowly straighten and align your teeth so you have a normal bite. Some people get braces to adjust their smile.
If you have crooked teeth and/or a misaligned bite (an underbite or overbite), there are a variety of treatments that can help straighten teeth, including braces and retainers, custom-made, removable or fixed tools that cover the outside of your teeth and help keep them in position.
Many general dentists do basic alignment and treat other tooth problems, but orthodontists specialize in correcting issues with your teeth. An orthodontist has 2 to 3 years of advanced orthodontic education and training beyond dental school. They specialize in straightening teeth, correcting misaligned bites, and jaw problems.
The dentist or orthodontist you choose will ask questions about your health, do a clinical exam, take a digital scan of your teeth, take photos of your face and teeth, and order X-rays of the mouth and head. They’ll come up with a treatment plan based on this information.
You might only need a removable retainer. If you have an extreme overbite or underbite, you could need surgery. But most people need braces.
Types of Braces
Braces are the most popular way to straighten teeth and correct misaligned bites in children. They’re not the shiny mouthful of metal of years past. Many more options are now available.
If braces are indeed the solution for you, the dentist or orthodontist will prescribe an appliance specific for your needs. The braces may consist of bands, wires, and other fixed or removable corrective appliances. No one method works for everyone.
- Metal/traditional braces: Traditional braces are made of metal. They include brackets that are attached to the front of your teeth or bands that fit around each tooth, as well as flexible wires or arch wires that hold the brackets or bands together. Some braces also include rubber bands or metal ties that link the brackets to the wire. These bands create more pressure to help straighten and align your teeth. Sometimes, your orthodontist will have you wear a device called headgear at night. It provides added pressure to help straighten your teeth. You can put it on and take it off.
- Ceramic braces: The brackets in traditional braces are now also made in tooth-colored ceramic, so you don’t notice them as much. They can also be made with stainless steel, clear materials, or gold.
- Lingual braces: The brackets on these braces are attached to the backs of your teeth, facing your tongue. Lingual braces are harder to see.
- Clear aligners: You might also hear them called invisible braces. These are clear plastic trays that fit snugly onto your teeth. They use pressure to gently move your teeth into the correct positions and straighten your smile. You remove the aligners to eat, brush, or floss, but you should keep them in at least 22 hours each day for them to work. The orthodontist may also place tooth-colored attachments onto your teeth to hold the aligners in place.
How Do Braces Work?
Braces work by putting pressure on your teeth over a period of time to slowly move them in a specific direction. The bone under them changes shape, too.
Braces are made up of these things:
- Brackets are the small squares that go on the front of each tooth. The dentist uses a special bonding agent or attaches them with orthodontic bands. Brackets act like handles, holding the arch wires that move your teeth. There are several types of brackets, including stainless steel and tooth-colored ceramic or plastic. Dentists use these a lot because they’re harder to see. Sometimes the dentist will cement brackets to the backs of your teeth, in order to hide them from view.
- Orthodontic bands are stainless steel, clear, or tooth-colored materials cemented to your teeth. They wrap around each tooth to provide an anchor for the brackets. The clear or tooth-colored bands look better, but they also cost more than stainless steel. Not everyone gets bands. Some people have only brackets and no bands.
- Spacers fit between your teeth to create a small space for the orthodontic bands.
- Arch wires attach to the brackets and act as tracks to guide the movement of your teeth. Some arch wires are made of metal. Others are clear or tooth-colored.
- Ties are small rubber rings or fine wires that fasten the arch wire to the brackets. They can be clear, metal, or colored.
- A buccal tube on the band of the last tooth holds the end of the arch wire securely in place.
- Tiny elastic rubber bands, called ligatures, hold the arch wires to the brackets.
- The orthodontist may place springs on the arch wires between brackets to push, pull, open, or close the spaces between your teeth.
- Elastics or rubber bands attach to hooks on the brackets. They go between your upper and lower teeth in various ways. They use pressure to move your upper teeth against the lower teeth to get a perfect fit. You can choose your favorite color. Many kids choose their school colors or decorate their mouth during holidays (for example, orange and black for Halloween).
- Some people need headgear, a wire gadget that moves your upper molars farther back in the mouth to correct bite problems or make more room for crowded teeth. The orthodontist will add headgear tubes to two bands on your upper teeth to hold the facebow part of your headgear in place. The rest of this horseshoe-shaped piece surrounds your face and connects to a strap at the back of your head. If headgear is needed, it usually has to be worn only while sleeping or at home.
Newer “mini-braces,” which are much smaller than traditional braces, may be an option for some. Another method of straightening teeth uses removable plastic retainers. This may also work if your teeth aren’t too crowded. Your orthodontist will discuss the various types of braces with you and figure out which option is best.
How Long Will I Have to Wear Braces?
The time required for braces varies from person to person. It depends on:
- How severe your problem is
- The amount of room inside your mouth
- The distance your teeth must travel
- The health of the teeth, gums, and supporting bone
- How closely you follow instructions
On average, once braces go on, they usually remain in place for 1 to 3 years. After braces come off, most people need to wear a retainer all the time for the first 6 months. After that, you have to wear it only while you’re asleep, but you may do it for many years.
The orthodontist will want to see you about every month or so in order to make sure the braces are putting steady pressure on your teeth. They’ll adjust the wires, springs, or rubber bands to create more tension and pressure. In some cases, braces alone won’t be enough to straighten your teeth or shift your jaw. That’s when the orthodontist will suggest headgear.
Will Braces Be Painful?
There may be some discomfort when braces are put on, when they are adjusted, or when you start using a new appliance, such as rubber bands or headgear.
Over-the-counter pain relievers like acetaminophen or ibuprofen can help. Tell your orthodontist if you have a lot of pain after each adjustment. They may be able to make the adjustments a bit differently or provide special wax to cover the sharp areas on the braces.
Can You Be Allergic to Braces?
Some people are allergic to certain metals, such as nickel. When this happens, other materials can be used instead. People can also be allergic to the latex gloves used by the orthodontist and the assistants.
Braces can sometimes irritate gums, causing swelling. This is not an allergic reaction but is still something to watch for.
Caring for Teeth With Braces and Retainers
Braces, wires, springs, rubber bands, and other appliances can attract food and plaque, which can stain teeth if not brushed away. Most orthodontists recommend brushing after every meal or snack with fluoride toothpaste and carefully removing any food that may have gotten stuck in your braces. Some orthodontists will also prescribe or recommend a fluoride mouthwash, which can get into places in the mouth that a toothbrush can't reach. A Waterpik or AirFlosser is also sometimes helpful to flush out stuck food.
To floss teeth if you have braces, feed the short end of the floss through the space between the main arch wire and the upper portion of the tooth closest to the gum. Use a gentle sawing motion to work the floss on each side of the two teeth the floss is between. Be careful not to pull with too much force around the arch wire.
Begin brushing teeth by using a regular soft toothbrush. Brush down from the top and then up from the bottom on each tooth with braces. Next, brush your teeth with a Proxabrush or "Christmas tree" brush. This brush is specially designed for cleaning between two braces. Insert the brush down from the top and then up from the bottom between two braces. Use several strokes in each direction before moving on to the next space between two braces. Repeat the procedure until all teeth have been cleaned.
Every time you brush your teeth, brush your retainer as well, but not with toothpaste. Once a day or at least once a week, disinfect the retainer by soaking it in a denture cleanser, such as Efferdent, Polident, or other brand-name solution. Add the cleanser to a cup full of warm -- not hot -- water. Thoroughly rinse the retainer with plain water before putting it back in your mouth.
What Foods Are Off-Limits With Braces?
Braces are delicate. Breaking part of the appliance can result in the teeth moving in the wrong direction and in longer treatment. Avoid anything that is hard, sticky, or chewy, including:
- Hard candy
- Chewing gum
- Chewy candy, like caramel
- Hard or tough-to-bite foods, such as apples or bagels
- Corn on the cob
- Hard pretzels
Braces and Age
Your dentist can tell you when to seek evaluation from an orthodontist. The American Association of Orthodontists and the American Dental Association recommend that all kids be evaluated for orthodontics by age 7. By this age, the orthodontist can spot subtle problems with jaw growth and emerging teeth. Most kids begin active treatment between ages 9 and 14. Orthodontists recommend that you correct dental problems while your child is still growing.
The mechanical process used to move teeth with braces is the same at any age. That means braces can help both children and adults. The main difference is that some corrections for adults may require more than braces alone. The treatments could also take longer because adult bones are no longer growing.
Sports and Braces
If you have braces, you can take part in any sport you choose. If there’s a chance you might get hit in the face, you’ll need to wear a specially designed mouthguard to protect the inside of your mouth. It’ll be made of durable plastic and designed to fit comfortably over your braces and will protect the soft tissues inside your mouth.
What to Do if a Bracket or Wire Breaks
Broken braces, loose bands, or protruding wires can cause problems but rarely require emergency treatment. But call your orthodontist to set up an office visit to fix the problem. If you have a more severe mouth or facial injury, get help right away. Here are tips to get through some of the more common problems until you are able to see your orthodontist:
- Loose brackets. Apply a small piece of orthodontic wax to temporarily reattach loose brackets, or place wax over the bracket to provide a cushion between the bracket and your gums and other soft tissues of the mouth. Your orthodontist usually gives you orthodontic wax when you get braces.
- Loose bands. These will need to be replaced or recemented into place. Save the band and schedule an appointment for the repair.
- Protruding or broken wire. Use the eraser end of a pencil to move the wire to a less bothersome position. If you can't move it out of the way, apply a small amount of orthodontic wax over the protruding end. Do not attempt to cut the wire, because you might accidentally swallow it or inhale it into your lungs. If a mouth sore develops from the wire poking the inside of your mouth, rinse your mouth with warm saltwater or an antiseptic rinse. An over-the-counter dental anesthetic can also be used to numb the area.
- Loose spacers. These will need to be repositioned or replaced if they slip or fall out completely.
Other Problems With Braces and Retainers
Because braces and retainers brush up against the inside surface of the mouth, you may be more prone to developing canker sores. If a canker sore develops, your orthodontist or dentist may prescribe a corticosteroid ointment or a prescription or nonprescription solution to ease the pain and irritation and help heal the sore.
After your braces come off, the orthodontist will thoroughly clean your teeth. They may want to take another set of X-rays and bite impressions to check how well the braces straightened your teeth and if you’ve developed any wisdom teeth. If your wisdom teeth are beginning to come in after the braces are removed, the dentist or orthodontist may suggest you get them pulled to prevent newly straightened teeth from shifting.
Your dentist or orthodontist will also fit you with a retainer, which is a very important part of post-braces care. Even though braces may have successfully straightened your teeth, they aren’t completely settled in their new position until the bones, gums, and muscles adapt to the change. Also, after long periods of time, teeth tend to shift. That’s why the time frame for wearing a retainer will vary from person to person.
How Much Do Braces Cost?
The price varies, depending on how much work is being done, the type of braces being used, and where you live, but you can expect traditional metal braces to cost about $5,000 (or less in rural areas). Some insurance carriers provide partial coverage for orthodontic treatment, so check to see what your policy covers.
Most orthodontists offer payment plans and will let you make payments over the course of treatment without charging interest. Ask your orthodontist about all treatment fees and payment plans they offer before treatment begins.
If your child could benefit from braces but you can't afford them, there may be other ways to cover the cost, including:
- Financial aid programs. Low-income families can apply to the Smiles Change Lives program. This gives access to orthodontic treatment for children between the ages of 11 and 18. If accepted, the child can receive braces for $250 to $500. To be accepted, you must meet certain income requirements (for example, a family of four cannot earn more than $40,000 per year), and your teeth must be moderately to severely crooked.
- Medicaid. Medicaid may cover braces, especially if your child's teeth cause problems with talking, eating, or swallowing. This coverage varies from state to state.
- Dental schools. If you live close to a dental school with an orthodontics program, you may be able to get treatment from a student (supervised by an experienced orthodontist) for a lower cost.
- Dentists. Some general dentists provide orthodontic treatment and may be able to take care of your orthodontic needs at a reduced rate since they are not orthodontists.
Deciding to have orthodontic treatment may not be easy, but an improved smile can make a huge difference in appearance and self-esteem.