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Orthodontics

People of any age can benefit from orthodontic treatment. Teeth that are crooked, crowded, or that stick out affect the way your teeth look and work. Orthodontic treatment not only improves the look of your smile but your health as well. Straight teeth are easier to clean and less likely to get tooth decay or injured. If you are not happy with the way your teeth look or work, orthodontic treatment may help.

What is orthodontic treatment?

Orthodontic treatment straightens your teeth so they look and work better. Braces or other appliances are used to put gentle pressure on your teeth. Over a number of months or years this pressure can move your teeth into the right position.

Why you may need orthodontics

The position of your teeth and jaws has an effect on your bite. Your bite is how your top and bottom teeth come together. When your top and bottom teeth do not fit together properly, this is called a malocclusion or a bad bite. Problems like missing, crooked, crowded or protruding teeth can contribute to a bad bite. Thumb or finger sucking may also affect your bite.

A bad bite can make it hard to chew some foods and may cause some teeth to wear down. It can also cause muscle tension and pain. Teeth that stick out are more easily chipped or broken. Crowded and crooked teeth are harder to clean and may be more likely to get cavities and gum disease. Fixing a bad bite improves your smile and your health. Different types of bad bites include an overbite, a crossbite, an overjet and an open bite.

An overjet occurs when the upper front teeth protrude.
An overjet occurs when the upper front teeth protrude.
A deep bite occurs when the upper front teeth cover the lower front teeth too much.
A deep bite occurs when the upper front teeth cover the lower front teeth too much.
An underbite occurs when the upper teeth fit inside the arch of the lower teeth.
An underbite occurs when the upper teeth fit inside the arch of the lower teeth.
An open bite occurs when the back teeth are together and there is an opening between the lower and upper front teeth.
An open bite occurs when the back teeth are together and there is an opening between the lower and upper front teeth.
Gaps between teeth
Gaps between teeth
A crossbite occurs when one or more of your upper teeth don't line up with the appropriate lower tooth or teeth.
A crossbite occurs when one or more of your upper teeth don't line up with the appropriate lower tooth or teeth.
Crowded or overlapped teeth
Crowded or overlapped teeth

Who does this procedure

Your dentist may do basic orthodontic treatment or refer you to an orthodontist. An orthodontist is a dentist who has completed a university post-graduate specialty program in orthodontics. Orthodontics is a specialty of dentistry that deals with preventing and correcting malocclusions.

Who can get orthodontic treatment

Orthodontic treatment isn't just for teens, as teeth can be moved at any age. In fact, more and more adults are having orthodontic treatment to improve the look and health of their smile. Your dentist or orthodontist can evaluate if orthodontic treatment is right for you.

In some cases it is helpful to start orthodontic treatment before all the permanent (adult) teeth come in. This is called interceptive orthodontics. Your dentist or orthodontist can do an orthodontic screening to find out if your child will need orthodontic treatment to correct a bad bite. Interceptive orthodontics allows your dentist or orthodontist to treat or stop a problem as it is developing.

How long does treatment take

Orthodontic treatment takes time. The amount of time depends on your age, the seriousness of your problem and the treatment technique used. Treatment generally involves a visit to your dentist or orthodontist on a regular basis over a period of months to years. In general, it takes longer to treat adults than children or teenagers. Most people wear braces for about 2 years.

Orthodontic treatments

Depending on the extent of your bad bite, your dentist or orthodontist may suggest one or a combination of the following orthodontic treatments to correct your bite:

  • Braces.
  • Headgear.
  • Removable appliances.
  • Retainers.
  • Oral surgery.

Braces

The most common type of orthodontic treatment used by dentists or orthodontists is braces.

How braces are done

To apply braces, your dentist or orthodontist attaches brackets (or bands) to each tooth with glue. Arch wires are fitted into all the brackets and are usually held in place with rubber or wire ties.

Close-up illustration of upper teeth with blue metal braces and orthodontic wire against a black background.

You may feel some discomfort for a while when your braces are first put on and when they are adjusted. It will take a little time to get used to your braces and they can bother your lips and cheeks. If this happens, a relief wax can be applied to your braces. To make eating easier after an adjustment, soft foods are recommended.

Caring for your teeth with braces

Proper brushing and flossing is even more important for people with braces because plaque can easily build up around the edges of your braces. If this plaque is not properly removed, white or brown marks may appear on the enamel surface of your teeth and these marks may be permanent.

Brushing and flossing with braces take longer. It is important to brush your braces as well as the front, back and chewing surfaces of the teeth. Your dentist or orthodontist will give you tips on how to brush and on how to floss using floss threaders. Parents should supervise their children to make sure they do a good job cleaning their teeth and braces and follow the advice of their dentist or orthodontist.

Caring for your braces

If you have braces, do not bite on hard things such as ice cubes and nuts. Do not chew the ends of pens or pencils. Also avoid sticky treats like chewing gum or toffee because they can loosen braces, distort wires and even pull braces off your teeth. If any of these problems happen, you will need to have your braces repaired by your dentist or orthodontist.

If the elastics or ties come off the bracket, you may be able to put them back around the bracket using small tweezers. If a wire is sticking out and bothering your lip or cheek, you may be able to push it back into place with the rubber eraser end of a pencil or it may be carefully cut off with a nail clipper. When a problem happens, always contact your dentist or orthodontist to have your braces checked as soon as possible. Problems that are not fixed can cause the treatment to last longer.

Choices in braces

Today's braces are smaller and less noticeable. Besides the traditional metal braces, there are tooth-coloured ceramic braces that are less noticeable. Clear aligners are also available for adults. Braces and elastics can also be multicoloured. Speak to your dentist or orthodontist about all your choices.

Headgear

This treatment uses an appliance that fits around the head or neck. It guides the direction of tooth movement and jaw growth in someone who is still growing. There are different types of headgear and they may be worn during any part of the orthodontic treatment. Your orthodontist or dentist will show you how to put on the headgear and tell you how long to wear it each day. In most cases it is worn during the evening and at night.

Removable appliances

Although removable appliances are not as precise as braces, they can move a tooth or a group of teeth. They are fitted by your dentist or orthodontist. Removable appliances can be worn before braces are applied, while braces are worn, or on their own to treat specific problems.

Retainers

Once your braces have been removed, a retainer can be used to keep your teeth in the right place. Retainers are fixed (attached to the teeth) or removable. They may need to be worn all the time or part of the time.

Oral surgery

Tooth removal may be needed if your teeth are crowded or if a tooth is badly out of position. Jaw surgery (or orthognathic surgery) may be needed when there are major differences in the size or position of the upper and lower jaws. If your orthodontist thinks you will need jaw surgery, he or she will refer you to an oral and maxillofacial surgeon.

Person holding a lit cigarette with visible smoke rising from the tip.

Know the warning signs

Early detection of oral health changes is critical. Learn about the signs of tobacco-related conditions like oral cancer and gum disease that require immediate attention from your dentist.

Frequently asked questions

Find answers to some of the most common questions about oral health, dental treatments, and more.

Do I really have to go to the dentist every six months?

How often you go for dental exams depends on your oral health needs. The goal is to catch small problems early. For many people, this means a dental exam every six months. Your dentist may suggest that you visit more or less often depending on how well you care for your teeth and gums, problems you have that need to be checked or treated, how fast tartar builds up on your teeth, and so on.

Ask yourself the following questions:

  • Do I floss every day?
  • Do I brush twice a day with a fluoride toothpaste and follow my dentist's instructions on how to brush properly?
  • Do I eat a well-balanced diet, including food from all food groups, and limit sweets and sticky foods?
  • Do I smoke?
  • Do I have a history of cavities or gum disease?
  • Is my overall health good?

The answers to these questions are all factors that affect your oral health. They will help you and your dentist decide how often you need to visit for dental exams. It's worth noting that you should not determine your need for dental care on what your dental plan covers.

Do I need x-rays at each visit?

How often you need to have x-rays also depends on your oral health. A healthy adult who has not had cavities or other problems for a couple of years probably won't need x-rays at every appointment. If your dental situation is less stable and your dentist is monitoring your progress, you may require more frequent x-rays.

If you are not sure why a particular x-ray is being taken, ask your dentist. Remember that dental x-rays deliver very little radiation; they are a vital tool for your dentist to ensure that small problems don't develop into bigger ones.

Related Resources

I want to find a new dentist. How can I find a Dentist, and how can I get my records transferred?

The first step in choosing a new dentist is to list your needs, which might include:

  • Location
  • Hours of practice
  • Language(s) spoken
  • Generalist or specialist practice
  • Asking your family and friends if they can recommend a dentist. Other members of your community, such as your doctor, may be able to offer suggestions. Some provincial dental associations have Web sites that allow you to search for a dentist in your area (see "Other Resources" below).

Yellow Pages advertising may also prove helpful. It will list each dentist's location, and may include other details that will help you in your search.

Once you have narrowed your list to two or three names, call the dentists to see if they are accepting new patients. This initial call may also give you some sense of the office environment, but there's nothing like the first visit to help you decide if it's a good match for you.

How can I get my records transferred?

Original dental records belong to the dentist who provided the treatment, and not the patient, because dentists have to keep all of their records for a period of time, as set out by their provincial dental regulatory body. Once you have selected a new dentist, you can request that a copy of your records be transferred from your former dentist.

You may be required to sign a release form from your former dental office and you may also be charged an administrative fee for having your records copied and sent to another dental office. If you have questions about the records transfer process in your province, ask your dentist or contact the provincial dental regulatory body.

Other Resources

Provincial Regulatory Authorities and Provincial Associations

Does my dentist need to wear gloves and a mask, and how do I know he or she is using clean tools?

Your health is very important to your dentist. One of the ways that your dentist helps you stay healthy is by preventing the spread of germs. One of the best ways to do this is to use barrier protection such as gloves and masks.

Your dentist and other dental team members also wash their hands regularly. In addition, they sterilize equipment used in the dental office and clean the furniture and fixtures in the examining rooms. This system is referred to as "standard precautions." It means that every patient is treated in the same way because patients don't always know if they're sick. It's always better to be safe than sorry.

If you would like to know how this system is carried out in your dentist's office, ask to be shown how it's done. Dentists welcome the opportunity to ease their patients' concerns, rather than have them leave the office with unanswered questions. Once you see the work that goes into making the dental office a clean and safe environment, you will feel reassured.

It is worth noting that even though standard precautions are used, it is still important to tell your dentist of changes in your health. This will help your dentist suggest the right choices of treatment for you.

When should I take my child to the dentist for the first time?

It's important to get an early start on dental care, so that your child will learn that visiting the dentist is a regular part of health care. The first step is to choose a dentist for your child.

It may be your own dentist or one who specializes in treating children (called a pediatric dentist). Once you have selected a dentist, call the office to find out at what age he or she prefers to see child patients for the first time. CDA encourages the assessment of infants, by a dentist, within 6 months of the eruption of the first tooth or by one year of age.

It's important to make the first visit a positive experience for your child - one reason why it's best to visit before a problem develops. If you think there is a problem, however, take your child to the dentist right away, no matter what age.

If you are a nervous dental patient, ask your spouse or another family member to take the child for the appointment. If your child senses that you are nervous, he or she may feel nervous too. When you talk to your child about going to the dentist, explain what will happen without adding things like "it won't hurt" or "don't be scared."

Be sure to get an early start on regular dental care at home. Start cleaning your child's mouth with a soft damp cloth before teeth come in and continue with a soft toothbrush once he or she has a first tooth. Limit the number of sugary treats you give your child, and focus on healthy food choices from the very beginning.

Other Resources

Why doesn't my dentist just accept payment from my insurance company? I don't have dental insurance and can't afford to go to the dentist. What can I do and why does dentistry cost so much anyway?

Dental plans, offered by many employers, are a means to help you pay for your dental treatment. Most Canadians enjoy dental plans and the insurance companies that provide them are actually benefit carriers. Carriers reimburse patients based on the level of coverage decided by the patient's employer.

When you visit the dentist, it's the dentist's role to make a treatment plan based on your oral health needs. Your needs may be different from what is covered by your dental plan. It is your right to decide whether or not to go ahead with any treatment.

You should not decide based on what your plan covers. If you agree to have the treatment, it's your responsibility to pay for it. It is the responsibility of the benefits carrier's to reimburse you for the amount covered by your dental plan.

Many dentists are willing to contact a patient's benefits carrier, on a patient's behalf, to find out if a treatment is covered. The patient has to pay the portion that's not covered and the dentist may offer a payment plan to help.

I don't have dental insurance and can't afford to go to the dentist. What can I do and why does dentistry cost so much anyway?

If you do not have a dental plan and cannot afford to pay your entire bill at once, ask your dentist about a payment plan. If you cannot afford care, even with a payment plan, contact the nearest:

  • Social services agency to see if you qualify for government-funded dental care
  • Dental school where senior dental students provide treatment at a reduced cost

Dental services may seem expensive. In Canada, we don't have to pay directly when we visit a doctor or hospital, so we may not realize the high cost of providing health services. Overhead costs are high for dentists. They have staff, equipment and other operating costs.

The good news is that you can avoid costly dental treatment by brushing, flossing and visiting your dentist regularly for a dental exams. Regular dental exams cost money, but they are less expensive than fixing serious dental problems that stem from neglect.

Other Resources

What's the difference between the bleaching I can do at home with a kit from the store and the bleaching that my dentist does?

Dentists have been doing what's called "non-vital" bleaching for many years. Non-vital bleaching is done on a damaged, darkened tooth that has had root canal treatment. "Vital" bleaching is done on healthy teeth and has become more popular in recent years.

Vital bleaching, also called whitening, may be carried out in the dental office or the dentist may instruct the patient on how to do the bleaching at home. There is also a wide variety of products for sale in stores. Not all products are the same and not all give you the same results.

Different products, including those used by dentists, may also have different risks and side effects.

Here is an overview:

Whitening toothpastes with abrasive ingredients are really not bleaching products at all, but work on surface stain only. These products are sold in many stores.

Some whitening toothpastes do contain a chemical ingredient (or "bleach") that causes a chemical reaction to lighten teeth. Generally, they have the lowest amount of "bleach." They may not whiten as well as stronger products, but they have less chance of side effects. These pastes are brushed onto teeth and rinsed off, like regular toothpaste.

Bleaching kits sold in stores stay on your teeth longer than toothpaste and contain stronger "bleach". These store-bought products do not come with the added safety of having your dentist monitor any side effects. They also come with a one-size-fits-all tray that holds the "bleach" and is more likely to leak the chemical into your mouth.

Dentists may use products with stronger "bleach", but they give patients careful instructions to follow. They are also trained to spot and treat the side effects that patients sometimes report during bleaching. In addition, if a tray is needed to apply the "bleach", dentists supply custom-made trays. Because products used by dentists are strong, they tend to produce the best results.

Patients should be aware that the long-term use of whitening or bleaching products may cause tooth sensitivity or tooth abrasion. Please consult with your dentist before using a whitening or bleaching product.

My dentist is recommending treatment (I know nothing about). What should I do?

Ask questions. It sounds simple enough, but sometimes we feel embarrassed to ask simple questions. There is no need to feel that way.

You will feel much better, and be able to make a better decision, if you understand the dental procedure that is recommended to you. If you don't say anything, your dentist may think that you already understand.

Here are some tips when asking questions. Ask:

  • If you can see any pictures of the procedure or what it looks like when it is done;
  • How many times your dentist has done this procedure in the past;
  • How much it will cost;
  • How long it will take;
  • If it will need to be redone in the future;
  • If there are alternatives to the procedure and if so, what are the pros and cons of each option.

The final decision about how and when to proceed with any treatment is yours. To help you understand what is involved in the treatment, your dentist may give you some printed material to read.

If you have already left the dental office without asking questions, call back later. Be careful about getting information from unknown sources, including sources on the Internet. Some of this information may not be reliable.

After all your questions have been answered, if you are still uncertain, you may wish to get a second opinion from another dentist. Often, a second opinion will give you confidence that your dentist has planned the right treatment for you.

How do I make a formal complaint concerning the professional services received in a dental office in Canada?

CDA is not responsible for handling complaints since we have no mandate to regulate dentists. Formal complaints concerning the professional services received in a dental office are handled by your provincial regulatory body.

A directory of provincial dental regulatory authorities is available on CDA's website at: Regulatory Authorities & Provincial Associations.

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