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problems, such as a few crowded or twisted teeth, your dentist may recommend orthodontic treatment for cosmetic reasons or to prevent more serious problems. However, if your teeth are severely maloccluded, your dentist will probably recommend that you see an orthodontist for immediate treatment to prevent damage to or loss of your permanent teeth. An orthodontist is a dentist who specializes in treating malocclusion. Orthodontists undergo 2 to 3 years of additional training after graduating from dental school to obtain a certificate in orthodontics.

If you have a minor alignment problem, the orthodontist may remove some teeth or fit you with braces to correct the crowding or malocclusion. Many adults are choosing to wear braces and do not feel self-conscious about them. For some people, crowns (see page 1109) and bridges (see page 1110) can help correct the problem.

In some cases, severe malocclusion or jaws that protrude or recede may result from the size and shape of the jaw. In such cases, a person may need orthodontia or oral surgery to align the teeth and stabilize the bite. An oral surgeon can reposition or remove pieces of the jawbone and some teeth to correct the problem and create a normal occlusion.

If your child’s teeth appear to be growing in crowded or misaligned, take him or her to a dentist for an examination. Depending on your child’s age, the dentist may recommend that you take him or her to an orthodontist for evaluation and possible treatment. Orthodontia is usually most effective during childhood and early adolescence, when the teeth and jaws are growing and developing. Also, it is easier to move the teeth at this time because the bone that surrounds the teeth is soft and is still developing.

Before beginning treatment, the orthodontist takes X-rays of the teeth and jaw to determine if all of the child’s permanent teeth have formed and are likely to emerge and to evaluate the development of the bones in the jaw, face, and head. The orthodontist also makes plaster casts of the teeth and jaw. If crowding is the problem, one possible treatment is to create a space by removing an adjacent tooth that has already appeared. But the usual treatment for irregularly positioned teeth is to wear braces over a period of months or years.

Types of Malocclusion

Occlusion is the relationship between the upper and lower teeth when the mouth is closed. Malocclusion occurs when the upper and lower teeth are misaligned. Normal occlusion and four types of malocclusion are shown here.

Normal bite

Crowded teeth

Overbite

Underbite

Open bite

Braces are either bands that are fitted around the teeth or brackets that are bonded directly onto the teeth. A wire is threaded from tooth to tooth. The wire applies gentle pressure that moves the teeth into the correct position. The bands, brackets, and wires are made of metal. To make braces less visible, brackets may also be made of ceramic or plastic material and may be clear or tooth-colored.

Fixed braces are often used when a child’s upper incisors protrude and the canines are prominent and crowded. For severely crowded teeth, some premolars may be removed first so that the canines can be moved into the correct position. Once the canines are aligned, the incisors can be retracted to make them less prominent and to prevent spaces from forming between the front teeth. This type of treatment usually begins at about age 12 and takes about 18 to 30 months. The person (whether a child or an adult) returns to the orthodontist every 5 to 6 weeks to have the braces adjusted.

After the malocclusion has been corrected, the braces are removed and a removable device called a retainer is custom-made to hold the teeth in their new position. The retainer is used, usually at night, for several years to make sure that the surrounding tissue has enough time to stabilize. Often a permanent retainer is bonded into place on the back of the lower front teeth. Once the person’s third molars (wisdom teeth) erupt or are extracted, the fixed retainer may be removed.

Braces