Best Braces Singapore Frequently Asked Questions, Recommended Orthodontist & Braces Guide 

What is Orthodontic Braces Treatment?

Why should I have braces?

Orthodontic braces treatment can be performed for a variety of reasons. These reasons include:

  • Appearance and aesthetics

  • Improving bite and chewing

  • Improving cleaning of tooth surfaces

  • Preventing further orthodontic and dental complications

When teeth are straightened and jaws are aligned, your smile will improve and you will feel good about your physical appearance. This will improve your self-esteem and self-confidence.

Besides cosmetic reasons, orthodontic braces treatment is performed for practical reasons. Crooked and crowded teeth are difficult to clean and when left untreated, dental complications and orthodontic problems can arise, such as: 

  • Abnormal wear and tear of the teeth

  • Tooth decay

  • Gum disease

  • Tooth loss

  • Inefficient chewing function

  • Undue stress on gum tissue and bone structure

In summary, the benefits of straight teeth and well-aligned jaws are:

  • A beautiful smile

  • Easier maintenance of oral and dental health

  • Efficient chewing

  • A proper bite which reduces stress and strains on surrounding bone and tissue structure

Almost everyone with malocclusion and orthodontic problems will benefit from properly executed orthodontic treatment. If the teeth and supporting tissues are healthy, there is usually an absence of contraindications that will prevent the patient from undertaking orthodontic treatment.

What is a Malocclusion?

"Malocclusion" is a technical term used by dental and orthodontic professionals to refer to crooked, crowded, misaligned or protruding teeth which do not fit together properly. The term means "bad bite" with "mal" corresponding to bad and "occlusion" referring to the relationship of teeth with each other when the jaws are closed. As such, correcting a malocclusion would not only involve ensuring alignment and arrangement of the teeth but also a proper relationship between the teeth and jaws.

 

Malocclusion can be classified into several categories such as open bite, over bite, under bite, cross bite, overjet, misplaced midline, rotation and crowding/spacing problems. 

 

Malocclusion can affect a person's speech, appearance and ability to eat. 

What causes Malocclusions?

A proper occlusion has correct alignment of teeth, a good fit between upper and lower teeth or a good bite and a good relationship between the teeth and jaw. Ideally, the upper teeth would fit slightly over the lower teeth and the grooves of the molars should fit together.

 

Malocclusions are often hereditary and inherited. Differences between the size of the upper and lower jaw as well as the size of the jaw and teeth are passed down through generations. This results in a host of orthodontic issues such as overcrowding of teeth, too much space between teeth, extra or missing teeth, irregularities of the jaw and face and abnormal bite patterns. Additionally, birth defects such as cleft lip and palate may also result in malocclusion.

 

Besides hereditary aetiology, malocclusions can also be acquired. This includes:

  • Bad childhood habits such as thumb sucking and tongue thrusting,

  • Incorrect childhood practices such as pacifier use beyond age 3 and prolonged use of a bottle

  • Dental irregularities such as extra teeth, missing teeth, impacted teeth or abnormally shaped teeth

  • Dental conditions such as misalignment of jaw from fracture, tumours of the mouth and jaw

  • Poorly fitted dental appliances such as dental fillings, crowns, retainers or braces

Malocclusions should be treated in a timely manner as the orthodontic problems can worsen over time. As crooked and crowded teeth are hard to clean and maintain, tooth decay, gum disease and tooth loss may arise. Additionally, a bad bite can wear down tooth surfaces, present difficulty in chewing, and place undue stress on the bone and gums.

What are some common Orthodontic problems? 

Patients may suffer from a number of Orthodontic disorders, which can work against the general aesthetic and appearance of the patient. The following is a list of common Orthodontic problems:

Underbite - Underbite is a misalignment of teeth that occurs when the lower jaw outgrows the upper jaw. This results in the bottom teeth sitting in front of the top teeth and the lower jaw protruding up and beyond the upper jaw. When a patient with underbite closes his/her mouth, the lower teeth and jaw will have an abnormally pronounced appearance. Underbites vary in severity, ranging from an unnoticeable underbite in mild cases to severe underbites that greatly distort facial features and damage a patient's self esteem. Although underbites affect 5-10% of the population, patients with such a disorder may find professional and personal interactions uncomfortable and embarrassing. This makes Orthodontic treatment all the more necessary to improve the patient's quality of life.

Overbite - Overbite is a type of malocclusion in which the upper teeth excessively cover the lower teeth. Overbites are usually hereditary but can also be cause by the jaw not forming properly. Bad habits in childhood such as thumb-sucking or prolonged bottle feeding/pacifier use may aggravate this condition. It is essential to correct an overbite as an overbite, when left untreated, may cause dental complications such as gum damage/recession arising from the contact between the teeth and the opposing gum line, difficulty speaking and chewing as the patient may need to overcompensate to articulate certain words, tooth wear and damage resulting from the lower teeth biting into the roof the mouth, sleep apnea especially if the overbite is due to the lower jaw being set back and jaw pain arising from temporomandibular joint disorder (TMJ/TMD).

Overjet - Overjet differs from overbite as it deals with the horizontal extent of overlap rather than the vertical extent of overlap between the upper teeth and the lower teeth. Overjet happens when the top front teeth protrude over the bottom teeth towards the lip and is otherwise known as "buck teeth". Overjet is commonly due to a lower jaw which is underdeveloped compared to the upper jaw. Having such a condition is challenging for patients as they experience embarrassment and self-consciousness and would often try to hide their teeth when they smile. An overjet protrusion can increase the risk of damage to the upper teeth in an accident and can cause chewing issues and uneven wear and tear of the teeth. Braces can fix and treat an overjet by guiding the teeth back into the correct alignment and position.

Crowding - Crowding occurs when the teeth do not have enough space to grow in the mouth. Without much space to erupt, the teeth can become crowded and crooked as well as twisted and displaced. Crowding arises from an imbalance in the tooth to jaw size relationship or when the teeth are larger than the available space. Crowding can also be caused by early or late loss of primary teeth or improper eruption of teeth. Orthodontic treatment would help to resolve this issue by expanding the jaw so that there is enough room for the teeth to sit comfortably. If left untreated, crowding may result in a host of dental complications such as obstruction to proper cleaning of tooth surfaces, higher risk of dental decay, increased chances of gum disease, impairment of proper teeth function and a less attractive smile. Orthodontic treatment to resolve crowding issues involves creation of extra space in the mouth by expansion of arches or extraction of teeth. After creating space, braces are implemented to help hold the teeth in the correct position and preserve teeth alignment.

Spacing - Spacing, the opposite of crowding, occurs when there are gaps between the teeth, creating an unsightly appearance. This generally occurs when the teeth are smaller than the available space. Spacing issues can also be attributed to missing teeth, impacted teeth, protrusive teeth, a wide dental arch or abnormal tissue attachments to the gums. Spacing issues should be corrected as it can result in gum problems due to lack of protection, impairment of proper function of teeth and a less attractive smile. Spacing issues can be corrected by moving the teeth together and achieving proper alignment within the arch.

Crossbite - Crossbite is an abnormal alignment of teeth which comes in two types, an anterior crossbite and a posterior crossbite. An anterior crossbite refers to the front of the teeth and happens when the front top teeth close behind the front bottom teeth. A posterior crossbite refers to the back of the teeth and happens when the top molars touch the inner cusps of the bottom molars rather than the outer cusps of the bottom molars. A posterior crossbite can happen on one side of the teeth (unilateral) or both sides of the teeth (bilateral). Crossbites are often hereditary, however they can be aggravated by other factors. For example, if there are a delayed loss of baby teeth, the adult teeth may come in behind them resulting in a crossbite. Crossbites may cause dental complications such as TMJ/TMD, lock jaw as well as shoulder and neck pain. The excessive pressure on the jaw may cause wear and tear of teeth, loose teeth, gum recession and facial asymmetry.

Openbite - In an openbite, the upper and lower teeth do not make contact when the back teeth are clenched and the jaw is closed. This creates a gap between the teeth which is highly pronounced. An open bite causes difficulty with speaking and may result in speech impediments such as a lisp. Openbites are due to three main causes. First, the gap can be caused by problems in the jawbone. Second, for some children, the space develops when they have a mix of permanent and baby teeth. The teeth are not in alignment until the baby teeth fall off and are replaced by the full set of adult teeth. Third, bad habits can result in the formation of the gap. Tongue thrusting, which happens when a person pushes the tongue through the teeth while swallowing or speaking contributes to an open bite. This habit is common in childhood and children who do not outgrow it develop problems with their bite and speech. Thumb sucking and chewing on foreign objects play a part in the development of an openbite. This habit tends to cause problems when it persists even after the onset of adult teeth. Open bite is a more challenging form of malocclusion to treat compared to other types of misaligned teeth according to a study by the American Journal of Orthodontics and Dentofacial Orthopedics. However, sometimes, the openbite will resolve when adult teeth erupt and replace the baby teeth. If an openbite is left untreated, there are several repercussions. First, an openbite may affect a patient's self esteem and self confidence as the patient becomes self conscious of the gap during personal and professional encounters. Second, a lisp may develop which reduce the clarity of speech and causes people to have difficulty perceiving what the patient has said. Third, an openbite results in an unstable bite which causes problems during chewing and eating as food and drinks can seep out of the mouth if the tongue is not used to plug the gap. However, this remedy is only temporary and would aggravate the condition even further. Fourth, the posterior teeth experience a higher degree of wear and tear due to constant friction and the greater pressure placed on the rear teeth.

Impacted canines - Canines are the corner teeth and are often known as "fangs" or "eye" teeth. Canines can become impacted by not growing into the mouth but staying buried in the jaw bone under the gum. Canine teeth in the top jaw are more commonly impacted in the roof of the mouth. Impacted canines affect up to 3% of the population and 85% of these cases are under the gum in the roof the mouth. If impacted canines are left untreated, the buried tooth could damage the roots of the front teeth or a cyst may grow around the buried canine.  

Abnormal eruption - Abnormal tooth eruption is caused by genetics and may result in malocclusion. Having an abnormal tooth eruption would compromise the functionality of bite and disrupt the alignment and harmony of the teeth. Correcting this condition would greatly enhance a person's aesthetic and appearance. 

How do I know if I need Orthodontic treatment? 

It is difficult for the general public to determine if orthodontic treatment and intervention is required since orthodontic problems could exist despite the front teeth looking straight. To the untrained eye, assessing proper bite and correct function may not be so simple. Although asking a general dentist could provide some insight into the dental condition of the patient, the best resource is a trained and certified orthodontist. A trained orthodontist is able to perform a comprehensive initial assessment and follow up with personalised consultations and a robust treatment program to correct existing orthodontic problems as well as mitigate future complications if the present problems are left untreated.  

At what age should a child visit an Orthodontist?

According to the American Association of Orthodontics, a child should be evaluated by an orthodontist by age seven. Having an early orthodontic screening no later than the age of seven would help an orthodontist to assess and evaluate orthodontic problems that exist and formulate a comprehensive treatment plan to arrest the orthodontic problems before they get worse if left untreated. Orthodontists are trained to spot subtle problems with jaw development and emerging teeth while the baby teeth are still present. While the checkup may reveal a normal bite, other possible outcomes may include an identification of a developing and an orthodontist recommendation that the condition be monitored until an appropriate time for treatment in the future or a problem that benefits from early treatment and immediate intervention. Early treatment and intervention offers a host of benefits such as preventing serious problems from developing and reducing the treatment time and complications at a later age. Sometimes, an orthodontist is able to achieve results which is more difficult when the face and jaws have finished growing. In summary, early treatment presents an opportunity for the orthodontist to guide jaw growth, reduce the risk of trauma to protruding front teeth, correct and intercept harmful oral habits, improve aesthetic appearance, guide permanent teeth into a better position and improve the way the lips meet. By pursuing early orthodontic evaluation and assessment, a child is given the best opportunity for a healthy teeth, optimal bite and a beautiful smile.

Top Orthodontist Singapore Questions by patients prior to Orthodontic Braces treatment | Best Orthodontist and Orthodontics Singapore guide for patients who are considering Orthodontic Braces treatment  

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