Maria Ksyondzyk, LIGA.net
A good orthodontist will never start treatment without a proper diagnosis.
“For example, the patient’s main complaint is uneven teeth. He wants orthodontic treatment with aligners. However, the crowding of teeth hides the forced position of the lower jaw and the adaptive position of the heads of the temporomandibular joints. If we start treatment without stabilizing the joints in a musculoskeletal stable position, we will get straight teeth, which the patient will not be able to use. TMJ dysfunction will occur. In simple terms, the position of the joints should be correct in relation to the skull and the body in general,” the orthodontists of the Yarema Dental clinic explain.
What can happen if you ignore the diagnosis and immediately start orthodontic treatment?
Imagine if you fix a bracket on a carious tooth, at best there will be a complication of the carious process, at worst – minus one tooth.
“For example, no matter how much the orthodontist normalizes the size of the child’s upper jaw, if she has third-degree adenoid vegetations with complications, ENT cannot be dispensed with. Since this can be one of the main reasons for the child’s narrow upper jaw and improper growth of the jaws,” they add experts
“Without removing the eights (wisdom teeth), they will begin to erupt, deforming the tooth rows, which can cause hypercontacts, which the lower jaw will try to avoid in every way, which will cause incorrect micromovements in the TMJ, and eventually lead to their dysfunction. Then it will be necessary to consider repeat orthodontic treatment, which will be much more difficult,” Yarema Dental doctors explain.
Ignoring anamnestic data about the patient’s chronic diseases or discomfort from the TMJ can also cause complications.
For example, a patient’s complaints of joint pain throughout the body is a reason to pass an analysis for “rheumatological tests” and do an MRI to confirm or deny rheumatoid arthritis. And if the diagnosis is confirmed, then we understand that active orthodontic treatment is impossible without the control of a rheumatologist and does not occur in the acute stage. Otherwise, you can get TMJ complications.
That is, a good orthodontist must not only have a thorough knowledge of anatomy and physiology, but also understand gnathology, therapy, surgery and orthopedics in order to visualize the final result of treatment.
Such knowledge allows him, if necessary, to involve doctors of related disciplines in cooperation: therapist, surgeon, periodontist, etc. and to conduct additional examinations: condylography, TENS, MRI, CT…).
Regarding prices, Yarema Dent explains that a good orthodontist will not set promotions on treatment. Because orthodontic courses are one of the most expensive in dentistry. And a self-respecting orthodontist will not devalue his knowledge and time: “You see promotions – think about the quality of the clinic.
When should you see an orthodontist?
The first visit should be in childhood. The best start of orthodontic treatment is at the age of 6-7 years, when:
- children are more aware,
- temporary teeth begin to change to permanent, the first permanent molars (large angular teeth) and central incisors on the upper and lower jaws erupt.
The orthodontist can then conduct a number of studies to assess the growth pattern of the child’s jaw, occlusal contacts, airway volume, tongue position, space deficiency and plan orthodontic treatment if necessary.
According to the orthodontists of Yarema Dental, the visit to the specialist can be even earlier, it is usually of a consultative and adaptive nature.
Communicating with the child, we evaluate his posture, speech, breathing, tongue position, presence of bad habits and, if necessary, refer him to: ENT, speech therapist, osteopath, etc.
If we see the formation of an incorrect bite, of course, we will start orthodontic treatment earlier.
Also, if a child prematurely loses a temporary tooth, the adjacent ones begin to lean towards the missing tooth, thereby causing a lack of space for the permanent eruption and the beginning of bite anomalies. After all, each temporary tooth holds a place for a permanent one.
“A timely visit to the doctor will help prevent and correct everything in the simplest way and will give the child the opportunity to grow and develop harmoniously,” the doctors emphasize.
Despite the fact that modern orthodontics has no age restrictions, the treatment of adults will last longer and be more difficult. Therefore, it is necessary to take care of a beautiful smile and correct bite from childhood.
“After 30 years, a person is fully formed. Expecting that a smile will become more beautiful on its own is pointless. An orthodontist can help in any case, but it is necessary to understand the complexity of the situation. For example, sometimes we even consider orthognathic surgery, because a beautiful smile must be functionally healthy.” , the doctors add.
How is the first examination at the orthodontist?
Administrative part, the patient/client fills out a questionnaire, which indicates important information and warnings regarding the state of health, which the doctor needs to pay attention to. Next is a direct consultation with an orthodontist.
First, we discuss the reason for the appeal and the desired result. At the stage of communication, the doctor evaluates the posture, facial expressions, smile and carefully collects the medical history.
Muscle palpation and intraoral examination are performed.
Possible treatment options, their estimated cost and “therapeutic readiness” are explained to the patient/client (whether the teeth are affected by the carious process or those that cannot be saved and need to be removed, etc.).
If everything suits the patient and his oral cavity is cleaned, the doctor proceeds to diagnosis/functional analysis.
It includes:
- photo protocol;
- scan of jaws/imprints for diagnostic models;
- for adult patients – obtaining data from the facial arch and plastering in an articulator – a mechanical device designed to reproduce the movements of the lower jaw.
The next meeting with the patient is in 1-2 weeks. Based on the results of the analysis, a treatment plan is discussed. The patient must clearly understand what is being done to him, why and what the final cost is. In the course of treatment, it can be adjusted, because the human body is a complex dynamic system, and if necessary, we must take this into account during treatment. For example, there may be a need for an additional mini-implant, a bow, a set of caps. All this is also discussed in advance.
The main task is stabilization of the TMJ in a musculoskeletal stable position, elimination of pain, and only after that it is planned to restore occlusal contacts (ratio of the jaws and movement of the teeth), taking into account the aesthetics of the face.
That is, adult patients are first subjected to:
- condylography – recording of temporomandibular joint movements;
- TENS – electromyostimulation to normalize muscle tone;
- a cap/splint is made, with which the patient must spend a certain period of time.
And only then do we start planning treatment on aligners/bracket systems/devices.
After installing any equipment, the rules of use, care features, potential causes of discomfort (rubbing of the cheek, tongue, and lips) and methods of their elimination should be explained to the patient/client. We are always in touch with the patient and he can be sure that he will receive the proper help when he needs it.
Can a good orthodontist give guarantees?
“Often patients come to us with photos of stars: “I want that smile!”. However, the anatomical structure of the skull or the shape of the teeth do not allow this. No matter how much Angelina Jolie wants to become Madonna, or vice versa, it is unrealistic. The possibilities of an orthodontist are limited and adapted to a specific patient,” the doctors explain. That is, a person at the age of 70 will not look the same as when he was 20. Everything changes, and so does the smile.
There may be guarantees for dental restorations and prosthetics, but they are not lifelong. Since there is physiological mobility, the wear of the teeth and the bite that a person receives after removing the device may change after a year.
“However, if the patient follows all the doctor’s recommendations, the changes are so small that it is almost impossible to notice them visually,” the orthodontist adds.
What is the approximate term of treatment?
A good orthodontist will not set a specific end date for treatment. There is only an approximate time.
“When patients miss visits and neglect recommendations, the duration of treatment increases. A good orthodontist will never remove the system before the deadline, because, for example, braces create discomfort in the patient’s sexual life or because patients want to be without braces in wedding photos. After all, what is the point of treatment ?”, experts say.
Who needs braces, devices, aligners?
“It is individual. Not all children at the age of 4-5 years need an orthodontic device. If there is no crossbite (violation of the normal ratio of dental arches), which can cause the formation of facial asymmetry, we would postpone orthodontic treatment until 6 years, provided that it, indeed, it will be necessary,” the doctors explain.
A similar situation with bracket systems and aligners. They should be installed only out of necessity, not because it is “trendy”. The need is determined during diagnosis.
“Each action must be logical. After all, you don’t go to the beach in the summer in a fur coat because it’s fashionable. However, sometimes after hearing a refusal from our doctors, patients go to “their” orthodontist, who installs braces. But this is already a story about bad doctors.” , – adds the orthodontist.
Such situations can lead to complications. In this case, the patient should take an extract from his card with initial data and a detailed treatment plan from the previous clinic.
“The new orthodontist will conduct a re-diagnosis. If he agrees with the previous treatment plan, the process will continue. However, if the doctors have different views, there is a possibility of returning to the initial point of treatment,” the doctor notes.
Orthodontists also work with: fixed devices with bone support, mouthguards and aligners, etc.
- Fixed appliances with bone support are used to correct the size of the jaws and the position of the teeth, as a result, they give a beautiful and stable result that does not overload the teeth and are the best to date.
- Caps have several functions. The most popular are to protect teeth from sports injuries (for example, during wrestling) and for the purpose of whitening. There are also gnathological mouthguards (splints, splints), which are used in case of dysfunctions of the temporomandibular joint. Any mouthguards are made according to individual parameters.
- Aligners are an alternative to braces. These are transparent thin mouthguards, they are made according to individual parameters from a special material (Smart Track/polycarbonate) and are used to correct an incorrect bite.
The choice of the device depends on the desired result and the individual treatment plan developed on the basis of the diagnostic results.