Maria Ksyondzyk, LIGA.net
A good orthodontist will never start treatment without a thorough preliminary diagnosis.
“For example, a patient’s main complaint may be crooked teeth. They want orthodontic treatment with aligners. However, tooth crowding may hide a forced position of the lower jaw and adaptive positioning of the temporomandibular joints. If treatment begins without stabilizing the joints in a musculoskeletal stable position, we may achieve straight teeth that the patient cannot use. Temporomandibular joint dysfunction will occur. In simple terms, the joint position must be correct relative to the skull and the body as a whole,” explain the orthodontists at Yarema Dental clinic.
What can happen if diagnosis is ignored and treatment starts immediately?
Imagine placing a bracket on a tooth with caries. In the best case, the carious process may worsen; in the worst case, a tooth may be lost.
“For instance, no matter how much an orthodontist normalizes a child’s upper jaw size, if the child has grade III adenoid vegetations with complications, an ENT specialist is necessary. This may be one of the main reasons for a narrow upper jaw and improper jaw growth,” add the experts.
“If wisdom teeth are not removed, they will begin to erupt, deforming the dental arches. This can cause hypercontacts, which the lower jaw will attempt to avoid in various ways, leading to incorrect micro-movements in the temporomandibular joint and eventually dysfunction. Then repeat orthodontic treatment will be necessary, which will be much more complicated,” explain Yarema Dental doctors.
Ignoring patient history about chronic diseases or discomfort from the temporomandibular joints can also cause complications.
For example, complaints of joint pain throughout the body are a reason to test for “rheumatic markers” and perform MRI to confirm or rule out rheumatoid arthritis. If confirmed, active orthodontic treatment is impossible without a rheumatologist’s supervision and cannot occur during an exacerbation. Otherwise, complications in the temporomandibular joint may occur.
Thus, a good orthodontist must not only have excellent knowledge of anatomy and physiology but also understand gnathology, therapy, surgery, and orthopedics to visualize the final treatment outcome.
This knowledge allows the orthodontist to involve specialists from related fields if necessary: therapists, surgeons, periodontists, etc., and perform additional diagnostics: condylography, TENS, MRI, CT, etc.
Regarding prices, Yarema Dent explains that a good orthodontist will not offer promotions for treatment, as orthodontic courses are among the most expensive in dentistry. An orthodontist who respects themselves will not devalue their knowledge and time: “If you see promotions, think about the clinic’s quality.”
When should you visit an orthodontist?
The first visit should occur in childhood. The best start for orthodontic treatment is at 6–7 years old, when:
- children are more aware
- primary teeth start to change to permanent teeth, first permanent molars (large back teeth) and central incisors erupt in both jaws.
At this stage, the orthodontist can perform several examinations to evaluate jaw growth, occlusal contacts, airway volume, tongue position, space deficiency, and plan orthodontic treatment if necessary.
According to Yarema Dental orthodontists, a visit can occur even earlier, usually for consultation and adaptation.
By interacting with the child, they assess posture, speech, breathing, tongue position, harmful habits, and, if necessary, refer to an ENT, speech therapist, osteopath, etc.
If incorrect bite formation is observed, treatment may start earlier. Also, if a child loses a primary tooth prematurely, neighboring teeth may tilt into the gap, creating space deficiency for permanent teeth and starting bite anomalies. Each primary tooth holds space for a permanent tooth.
“Timely visits help prevent and correct issues in the simplest way and allow the child to grow and develop harmoniously,” emphasize the doctors.
Although modern orthodontics has no age restrictions, adult treatment is longer and more complex. Therefore, a beautiful smile and correct bite should be cared for from childhood.
“After 30, a person is fully developed. Expecting the smile to improve on its own is unrealistic. An orthodontist can help in any case, but the complexity must be understood. Sometimes even orthognathic surgery is considered, as a beautiful smile must also be functionally healthy,” add the doctors.
How does the first orthodontic consultation proceed?
The administrative part: the patient/client fills out a questionnaire with important health information and warnings that the doctor must consider. Next is a direct consultation with the orthodontist.
Initially, the reason for the visit and the desired result are discussed. During this stage, the doctor assesses posture, facial expressions, smile, and carefully collects the patient’s history.
Palpation of the muscles and an intraoral examination are performed.
The patient/client is explained the possible treatment options, approximate cost, and “therapeutic readiness” (whether teeth are affected by caries or are unsalvageable and need extraction, etc.).
If everything is satisfactory and the oral cavity is treated, the doctor proceeds to diagnostics/functional analysis, which includes:
- photo protocol;
- jaw scan / impressions for diagnostic models;
- for adult patients – facebow data collection and mounting on an articulator, a mechanical device designed to reproduce lower jaw movements.
The next appointment occurs in 1–2 weeks. Based on the analysis results, the treatment plan is discussed. The patient must clearly understand what is being done, why, and the total cost. During treatment, adjustments may be needed, as the human body is a complex dynamic system. For example, additional mini-implants, arches, or aligners may be required; this is discussed in advance.
The main task is to stabilize the temporomandibular joint in a musculoskeletal stable position, eliminate pain, and only then plan occlusal contact restoration (jaw relationships and tooth movement) considering facial aesthetics.
For adult patients, initially:
- condylography – records movements of the temporomandibular joints;
- TENS – electromyostimulation to normalize muscle tone;
- a splint/mouthguard is made, which the patient wears for a certain period.
Only then does treatment planning begin with aligners, braces, or other appliances.
After installing any appliance, the patient/client is explained the usage rules, care features, potential discomfort (cheek, tongue, lip irritation), and ways to relieve it. The clinic always remains in contact to provide assistance as needed.
Can a good orthodontist give guarantees?
“Patients often bring photos of celebrities: ‘I want this smile!’ However, anatomical structure of the skull or teeth shape may not allow it. No matter how much Angelina Jolie wants to look like Madonna, it’s impossible. The orthodontist’s capabilities are limited and adapted to the individual patient,” explain the doctors.
Guarantees may exist for dental restorations and prosthetics but are not lifelong, as physiological movement, wear, and bite changes may occur after appliance removal.
“However, if the patient follows all recommendations, changes are minimal and almost imperceptible,” adds the orthodontist.
Approximate treatment duration
A good orthodontist does not give an exact end date, only an estimated duration.
“When patients skip visits or neglect recommendations, treatment time increases. A good orthodontist never removes the system early, e.g., because braces interfere with sexual life or for wedding photos. What is the point of treatment?” – experts note.
Who needs braces, appliances, or aligners?
“It’s individual. Not all 4–5-year-old children need orthodontic appliances.If there is no crossbite (misalignment of dental arches), which can cause facial asymmetry, treatment may be delayed until age 6 if truly necessary,” explain doctors.
The same applies to braces and aligners. They should only be applied when necessary, not because it’s “trendy.” Necessity is determined during diagnosis.
“Every action must be logical. You don’t wear a fur coat in summer just because it’s fashionable. Sometimes patients reject our advice and go to ‘their’ orthodontist who installs braces. That’s a story about poor practitioners,” adds the orthodontist.
Such situations may cause complications. In this case, the patient should take records and detailed treatment plans from the previous clinic.
“The new orthodontist will repeat diagnostics. If they agree with the previous plan, treatment continues. If opinions differ, there is a risk of returning to the starting point,” explains the doctor.
Orthodontists also work with: removable bone-supported appliances, splints, and aligners.
- Bone-supported fixed appliances are used to correct jaw size and tooth position, providing excellent stable results without overloading teeth.
- Splints serve multiple purposes: protection from sports injuries, teeth whitening, and gnathological therapy for temporomandibular joint dysfunction. All splints are custom-made.
- Aligners are an alternative to braces: clear, thin trays made to individual specifications from special materials (Smart Track/polycarbonate) used to correct bite misalignment.
The choice of appliance depends on the desired result and individualized treatment plan developed from diagnostic results.
This article does not replace a medical consultation. For complete and personalized information, please consult your dentist.