Dental Braces: Orthodontic Treatment Types & Care Guide

Why Do People Get Dental Braces?

People get dental braces to correct malocclusion (bite problems), improve appearance, and prevent future dental issues. Common reasons include crooked teeth, overcrowding, gaps between teeth, overbite, underbite, crossbite, and open bite. Orthodontic treatment can improve both function and aesthetics.

Orthodontic treatment with braces addresses a wide range of dental alignment issues that can affect both how your teeth look and how well they function. While many people seek treatment primarily for aesthetic reasons, correcting misaligned teeth can also have significant health benefits that extend far beyond appearance.

The most common reason for getting braces is that teeth don't sit in a straight row. This can manifest as teeth that have rotated, teeth that lean in various directions, or teeth that are crowded and overlapping. Sometimes the upper and lower jaws don't meet properly when you bite down, creating functional problems that can affect eating, speaking, and even breathing in some cases.

Malocclusion, the technical term for improper bite alignment, comes in several forms. Understanding the specific type of bite problem helps orthodontists develop the most effective treatment plan for each patient. Here are the main types of bite problems that braces can correct:

Overbite (Deep Bite)

An overbite occurs when the upper front teeth significantly overlap the lower front teeth when the mouth is closed. In severe cases, the lower teeth may bite into the roof of the mouth, causing discomfort and potential tissue damage. Overbites are extremely common and can be caused by genetics, thumb-sucking habits, or prolonged pacifier use during childhood. Beyond aesthetic concerns, a severe overbite can cause difficulty biting and chewing, jaw pain, and uneven tooth wear.

Underbite

An underbite is the opposite of an overbite, where the lower front teeth extend past the upper front teeth when biting down. This condition often results from uneven jaw growth, where the lower jaw grows larger than the upper jaw. Underbites can make it difficult to bite off and chew food properly. In some cases, the condition can affect speech clarity. Treatment may require braces alone or braces combined with jaw surgery, depending on severity.

Open Bite

In an open bite, the upper and lower teeth don't make contact when the mouth is closed, leaving a visible gap. This can occur in the front of the mouth (anterior open bite) or on the sides (posterior open bite). Open bites often develop from habits like thumb-sucking, tongue thrusting, or prolonged bottle feeding. This condition can make it difficult to bite into foods like apples or sandwiches and may affect speech, particularly the pronunciation of certain sounds.

Crossbite

A crossbite occurs when some of the upper teeth sit inside the lower teeth rather than outside when the mouth is closed. This misalignment can affect one tooth, a group of teeth, or the entire arch. Crossbites can cause asymmetric jaw growth if left untreated, leading to facial asymmetry. They can also cause tooth wear, gum recession, and jaw pain. Early treatment in children is often recommended to guide proper jaw development.

Crowding and Spacing

Crowded teeth occur when there isn't enough room in the jaw for all teeth to fit normally, causing them to overlap, twist, or get pushed to the front or back. This makes teeth difficult to clean properly, increasing the risk of cavities and gum disease. Conversely, spacing issues involve gaps between teeth, which can occur due to missing teeth, small teeth relative to jaw size, or habits like tongue thrusting.

How Is the Need for Braces Diagnosed?

Orthodontic problems are typically diagnosed during routine dental examinations. An orthodontist performs a comprehensive evaluation including visual examination, X-rays (panoramic and cephalometric), dental impressions or digital scans, and photographs. These records help create a personalized treatment plan.

The process of determining whether you need braces begins with recognizing signs of malocclusion. For children, dentists often identify potential orthodontic issues when permanent teeth start erupting while some baby teeth remain. This transitional period, typically between ages 6-12, offers important clues about how the adult teeth will align.

During a dental examination, the dentist assesses how the upper and lower teeth meet when biting down, looking for signs of overbite, underbite, crossbite, or open bite. They also evaluate tooth spacing, crowding, and the overall symmetry of the bite. If concerns are identified, a referral to an orthodontic specialist (orthodontist) is typically recommended for a comprehensive evaluation.

The orthodontic consultation involves several diagnostic steps. First, a thorough visual and physical examination of the teeth, jaws, and facial structure is performed. The orthodontist examines how the lips close over the teeth, the position of the jaw joints, and any signs of jaw dysfunction. They may also assess breathing patterns and tongue posture, as these can contribute to or exacerbate orthodontic problems.

Diagnostic Imaging

X-rays play a crucial role in orthodontic diagnosis. A panoramic X-ray provides a comprehensive view of all teeth, including those that haven't erupted yet, along with the jawbone and surrounding structures. This reveals issues like impacted teeth, missing teeth, or extra teeth that may complicate treatment.

A cephalometric X-ray is a side profile view of the head that allows the orthodontist to analyze the relationship between the upper and lower jaws, the angle of the teeth, and the overall facial profile. Computer software can overlay these images to help plan treatment and predict outcomes.

Dental Impressions or Digital Scans

To create a precise model of your teeth, the orthodontist takes impressions using a soft material that hardens to capture the exact shape and position of every tooth. Increasingly, digital intraoral scanners are replacing traditional impressions, creating 3D models of the teeth that can be used for treatment planning and, in some cases, manufacturing custom orthodontic appliances.

Photographs of the face and teeth from multiple angles complete the diagnostic picture. These serve as baseline records to track progress throughout treatment and document the final results.

Based on all this information, the orthodontist develops a customized treatment plan that outlines the recommended approach, estimated treatment duration, and expected outcomes. This is the time to ask questions about different treatment options, costs, and what to expect during the process.

What Are the Different Types of Braces?

The main types of braces include traditional metal braces (most effective for complex cases), ceramic braces (tooth-colored, less visible), lingual braces (attached behind teeth), and clear aligners like Invisalign (removable plastic trays). Each type has advantages and limitations depending on treatment needs and lifestyle preferences.

Orthodontic technology has advanced significantly, offering patients more choices than ever before. While traditional metal braces remain the most common and versatile option, alternatives now exist for those who prioritize aesthetics or have specific lifestyle needs. Understanding the differences between these options helps you make an informed decision in consultation with your orthodontist.

Traditional Metal Braces

Traditional metal braces consist of small stainless steel brackets bonded to each tooth's front surface, connected by a thin metal archwire. Small elastic bands (ligatures) or metal ties secure the wire to each bracket. The wire applies continuous gentle pressure that gradually moves teeth into their correct positions.

Metal braces offer several advantages. They're the most effective option for complex orthodontic cases, including severe crowding, significant bite problems, and cases requiring tooth rotation or vertical movement. They're also typically the most affordable option and require shorter treatment times for many cases. Modern metal braces are smaller and more comfortable than those of previous generations.

The main disadvantage is visibility—metal braces are noticeable when you smile or talk. Some patients, particularly adults, find this aesthetically undesirable. Additionally, the brackets and wires can initially irritate the inner cheeks and lips, though this typically improves as tissues adapt.

Ceramic Braces

Ceramic braces function identically to metal braces but use tooth-colored or clear ceramic brackets instead of metal ones. The archwire may also be coated to match the tooth color. This makes them significantly less noticeable than metal braces, appealing to image-conscious teens and adults.

However, ceramic braces have some drawbacks. The ceramic material is more brittle than metal, making brackets more prone to chipping or breaking—particularly problematic for patients who grind their teeth or eat hard foods. Ceramic brackets may also stain if exposed to certain foods, drinks, or tobacco. Treatment with ceramic braces typically costs more than traditional metal braces and may take slightly longer in some cases.

Lingual Braces

Lingual braces are attached to the back (tongue-side) surface of the teeth, making them completely invisible when smiling. They work the same way as traditional braces but require special training and expertise to place and adjust correctly. Not all orthodontists offer this option.

The primary advantage is aesthetics—lingual braces are truly invisible from the outside. However, they tend to be more expensive than other options and can be more uncomfortable initially, as the brackets are in constant contact with the tongue. Speaking and eating may be more challenging during the adjustment period. Lingual braces also typically require more frequent adjustments and may extend treatment time for certain cases.

Clear Aligners

Clear aligners, popularized by brands like Invisalign, are a series of custom-made, removable plastic trays that gradually shift teeth into alignment. Each set of aligners is worn for about two weeks before moving to the next set in the series. Treatment typically involves 20-30 sets of aligners, depending on the complexity of the case.

Clear aligners offer several advantages. They're nearly invisible when worn, can be removed for eating and oral hygiene, and cause less irritation to soft tissues than brackets and wires. Many patients find them more comfortable and convenient than traditional braces.

However, clear aligners aren't suitable for all orthodontic cases. They work best for mild to moderate alignment issues and may not be effective for severe malocclusion, significant bite problems, or cases requiring complex tooth movements. Success depends heavily on patient compliance—aligners must be worn 20-22 hours per day to be effective. They're also typically more expensive than traditional braces.

How Do I Prepare for Getting Braces?

Preparation for braces includes a comprehensive dental exam with X-rays and impressions, treating any existing dental problems (cavities, gum disease), possibly extracting teeth if severe crowding exists, and understanding the treatment plan and care requirements. Good oral hygiene habits should be established before treatment begins.

Before braces can be placed, several preparatory steps ensure the best possible treatment outcome. The preparation phase typically takes a few weeks to a few months, depending on your oral health status and treatment complexity.

The first step is ensuring your teeth and gums are healthy. Any existing cavities must be filled, and gum disease must be treated before orthodontic treatment begins. Placing braces on teeth with untreated decay or inflamed gums can worsen these conditions and compromise treatment results. Your dentist may perform a professional cleaning to remove plaque and tartar buildup.

In cases of severe crowding, tooth extraction may be necessary to create space for proper alignment. This is more common when the jaw is too small to accommodate all teeth. Typically, premolars (the teeth between the canines and molars) are removed symmetrically from both sides of the mouth. The gaps created are then closed during orthodontic treatment as teeth move into alignment.

Understanding Your Treatment Plan

Your orthodontist will present a detailed treatment plan explaining what type of braces are recommended, how long treatment will likely take, what the expected results will be, and the estimated cost. This is an important opportunity to ask questions and ensure you understand what's involved.

Discuss practical considerations like appointment frequency, what foods to avoid, how to handle orthodontic emergencies, and what happens if you miss appointments. Understanding these factors helps you commit to the treatment process fully.

Establishing Good Oral Hygiene Habits

If you don't already have excellent oral hygiene habits, now is the time to develop them. Once braces are in place, maintaining clean teeth becomes more challenging but also more important. Practice thorough brushing for at least two minutes twice daily, and make flossing a daily habit. Consider using a fluoride mouthwash to strengthen enamel and reduce cavity risk.

Stock up on supplies you'll need during treatment: a soft-bristled toothbrush (or an electric toothbrush, which can be more effective with braces), fluoride toothpaste, orthodontic wax, floss threaders or water flossers, and small interdental brushes for cleaning around brackets.

How Are Braces Put On?

Getting braces takes 1-2 hours and is painless. The teeth are cleaned and dried, a bonding agent is applied, brackets are positioned and cemented to each tooth, and the archwire is threaded through and secured. No anesthesia is required, though some pressure may be felt as the wire is tightened.

The actual process of getting braces placed is straightforward and doesn't require anesthesia. While the appointment typically lasts 1-2 hours, the procedure itself is painless, though you may experience some discomfort in the days following as your teeth begin to respond to the pressure of the braces.

The appointment begins with a thorough cleaning and drying of the teeth. Any moisture can interfere with the bonding process, so keeping teeth dry is essential. A dental dam or lip retractors may be used to keep the cheeks and lips away from the teeth and maintain a dry working environment.

Next, a conditioning solution (often called "etch") is applied to the front surface of each tooth where a bracket will be placed. This slightly roughens the enamel surface to help the adhesive bond more effectively. The etch is then rinsed off and the teeth are dried again.

A bonding primer and adhesive cement are applied to the back of each bracket. The orthodontist carefully positions each bracket on the appropriate tooth surface and removes any excess cement. A special curing light is used to harden the adhesive quickly, securing each bracket in place.

Once all brackets are positioned and bonded, the archwire is threaded through the slots in each bracket. The wire is then secured to each bracket using small elastic bands (ligatures) or metal ties. The orthodontist may cut and bend the ends of the wire to prevent them from poking the inside of the cheeks.

Before you leave, the orthodontist or assistant will explain how to care for your braces, what foods to avoid, and how to handle common issues like a poking wire. You'll receive orthodontic wax to place over any brackets that irritate your cheeks or lips. Your next appointment for adjustment will be scheduled, typically 4-8 weeks later.

What Happens During Orthodontic Adjustments?

Adjustment appointments occur every 4-8 weeks and typically last 15-30 minutes. The orthodontist checks progress, replaces elastic bands, and may change the archwire to a thicker or differently shaped wire to continue tooth movement. Some soreness is normal for a few days after adjustments.

Regular adjustment appointments are essential to the success of orthodontic treatment. These visits allow the orthodontist to monitor progress, make necessary modifications, and ensure teeth are moving as planned. Missing or delaying appointments can extend treatment time and compromise results.

During a typical adjustment appointment, the orthodontist first examines the teeth and braces to assess how treatment is progressing. They compare the current position of the teeth to the treatment plan goals and may take progress photographs or X-rays at certain milestones.

The old elastic ligatures securing the wire to the brackets are removed. The archwire may be removed and replaced with a new wire, often one that's thicker or has a different shape to apply the appropriate force for the next phase of treatment. Treatment typically starts with thin, flexible wires that apply gentle pressure, progressing to thicker, more rigid wires that can create more precise movements.

New elastic ligatures are placed to secure the wire to each bracket. Some patients enjoy choosing colored elastics to personalize their braces, while others prefer clear or tooth-colored bands for a more subtle appearance. In some cases, additional appliances like springs or elastic bands (rubber bands that connect upper and lower teeth) may be added to achieve specific tooth movements or bite corrections.

After each adjustment, teeth typically feel sore for a few days as they respond to the new forces being applied. This discomfort is a normal sign that the teeth are moving and usually resolves within 3-5 days. Over-the-counter pain relievers and eating soft foods can help during this period.

How Do I Care for My Teeth with Braces?

Caring for teeth with braces requires meticulous oral hygiene: brush after every meal using proper technique around brackets, floss daily using floss threaders or water flossers, use fluoride products, and avoid hard, sticky, and chewy foods that can damage braces. Regular dental checkups remain essential.

Maintaining excellent oral hygiene during orthodontic treatment is more challenging but also more critical than ever. The brackets and wires create additional surfaces where food particles and plaque can accumulate. Without diligent cleaning, this can lead to cavities, gum inflammation, and permanent white spots (decalcification) on the enamel around brackets.

Brushing Techniques

Brush your teeth at least twice daily, ideally after every meal and snack. Use a soft-bristled toothbrush and fluoride toothpaste. Start by brushing along the gumline at a 45-degree angle, then brush the tops of the brackets, then underneath. Make sure to brush all surfaces of every tooth, including the chewing surfaces and the areas behind the teeth.

An electric toothbrush can be particularly effective for cleaning around brackets and along the gumline. Some electric toothbrushes have orthodontic brush heads designed specifically for braces. Regardless of toothbrush type, brush for at least two minutes each session.

Interdental brushes (small, cone-shaped brushes) are invaluable for cleaning between brackets and under the archwire. Use these to scrub the surfaces that your regular toothbrush can't easily reach.

Flossing with Braces

Flossing with braces requires a bit more effort but is essential for preventing cavities between teeth and gum disease. Floss threaders allow you to thread regular floss under the archwire so you can floss between teeth normally. Alternative tools like orthodontic flossers and water flossers (like Waterpik) can make the process easier and more thorough.

Water flossers use a pressurized stream of water to flush food particles and plaque from between teeth and around brackets. While not a complete substitute for traditional flossing, they can be an excellent supplement, particularly for reaching areas that are difficult to clean with string floss.

Foods to Avoid

Certain foods can damage braces by breaking brackets or bending wires. Avoid hard foods like nuts, hard candy, ice, popcorn kernels, and raw carrots or apples (unless cut into small pieces). Sticky foods like caramel, taffy, gummy candies, and chewing gum can pull brackets off teeth. Chewy foods like bagels and hard rolls can also loosen brackets.

Sugary foods and drinks increase the risk of cavities, which is already elevated when wearing braces due to the difficulty of cleaning around brackets. Limit consumption of soda, sports drinks, candy, and other sweets. If you do consume sugary items, brush your teeth as soon as possible afterward.

Regular Dental Care

Continue seeing your regular dentist for checkups and cleanings every six months during orthodontic treatment. Your dentist can monitor for cavities and gum disease and perform professional cleanings that reach areas difficult to clean at home. Some patients may need more frequent dental cleanings during orthodontic treatment.

What Happens When Braces Are Removed?

Braces removal takes about an hour. Each bracket is carefully detached from the tooth surface using special instruments, the adhesive is polished off, and teeth are cleaned. This process may be slightly uncomfortable but isn't painful. Retainers are fitted immediately to maintain the new tooth positions.

The day braces come off is an exciting milestone, but the process itself requires care and precision. The orthodontist uses specialized instruments to gently squeeze each bracket at its base, breaking the adhesive bond without damaging the tooth enamel. You may hear some cracking sounds during this process, which is normal—it's the adhesive breaking, not your teeth.

After all brackets are removed, the adhesive cement that held them in place must be carefully removed from each tooth surface. This is done using a special dental bur or polishing instrument. The orthodontist takes care to remove all adhesive while preserving the enamel beneath. The teeth are then polished to remove any remaining residue and restore a smooth surface.

Some patients experience sensitivity during and immediately after bracket and adhesive removal. The teeth may also feel loose or strange without the brackets—this sensation is normal and typically resolves within a few days as the teeth settle into their new positions.

Getting Your Retainers

Immediately after braces removal, impressions or scans are taken for your retainers. Retainers are custom-made appliances that hold teeth in their corrected positions while the bone and ligaments around them stabilize. Without retainers, teeth will gradually shift back toward their original positions.

There are two main types of retainers: removable and fixed. Removable retainers are typically made of clear plastic (similar to clear aligners) or a combination of wire and acrylic. They can be taken out for eating, brushing, and flossing. Fixed retainers consist of a thin wire bonded to the back surface of the front teeth, providing constant retention without any effort from the patient.

Your orthodontist will provide specific instructions for retainer wear. Initially, most removable retainers must be worn full-time (except when eating) for several months. After this stabilization period, wear time is gradually reduced to nighttime only. Many orthodontists recommend wearing retainers at night indefinitely to prevent long-term relapse.

Can Adults Get Braces?

Yes, adults can absolutely get braces and achieve excellent results. About 25% of orthodontic patients today are adults. Treatment may take slightly longer in adults due to denser bone structure, and certain complications are more common. Clear aligners and ceramic braces are popular options for adults who prefer discreet treatment.

The notion that braces are only for teenagers is outdated. Adults of any age can benefit from orthodontic treatment, and the number of adult patients has increased significantly in recent decades. Improved aesthetics, better oral health, and relief from bite-related discomfort are among the common motivations for adults seeking treatment.

There are some differences between orthodontic treatment in adults versus children and teenagers. Adult bone tissue is denser and more rigid than growing bone, which means teeth may move more slowly. This can result in slightly longer treatment times for adults with similar orthodontic issues. The average treatment time for adults is 18-36 months, though this varies based on the complexity of the case.

Adults are also more likely to have had previous dental work—fillings, crowns, bridges, or missing teeth—that can complicate orthodontic treatment. Missing teeth may require implants or other restorations either before, during, or after orthodontic treatment. Teeth with large fillings or crowns may require special bonding techniques for bracket attachment.

Gum disease (periodontal disease) is more common in adults and must be treated before and monitored during orthodontic treatment. The forces applied by braces can worsen existing gum problems if not properly managed. Adults with periodontal concerns may need to see both an orthodontist and a periodontist during treatment.

Despite these considerations, adult orthodontic treatment is highly successful when properly planned and executed. Many adults find that the benefits—improved smile aesthetics, better bite function, reduced jaw pain, and enhanced oral health—far outweigh the temporary inconvenience of wearing braces.

For adults concerned about the appearance of braces, several less visible options exist. Clear aligners are popular among adults because they're nearly invisible and can be removed for important meetings or social events. Ceramic braces blend with tooth color and are significantly less noticeable than metal braces. Lingual braces, attached behind the teeth, are completely invisible from the outside.

What Are the Risks and Complications of Braces?

Potential complications include tooth root shortening (resorption), white spots from decalcification, gum inflammation, tooth sensitivity, and relapse if retainers aren't worn properly. Most complications can be prevented or minimized with proper oral hygiene and following orthodontist instructions.

While orthodontic treatment is generally safe and effective, like any medical procedure, it carries some risks. Understanding these potential complications helps you take appropriate precautions and recognize warning signs early.

Root Resorption

When teeth are moved through bone, some shortening of the tooth roots (root resorption) is common and typically minimal. However, in some patients, this shortening can be more significant. Factors that increase the risk include the distance teeth must move, the duration of treatment, genetic predisposition, and certain tooth shapes. The orthodontist monitors for excessive root resorption with periodic X-rays during treatment. If significant resorption is detected, the treatment plan may be modified.

Decalcification and White Spots

Poor oral hygiene during orthodontic treatment can lead to decalcification—the loss of minerals from tooth enamel, appearing as white spots around where brackets were placed. These spots may be permanent. The risk is highest when plaque accumulates around brackets due to inadequate brushing. Using fluoride toothpaste and mouthwash, and maintaining excellent brushing habits, are the best prevention.

Gum Problems

The gums can become inflamed (gingivitis) when plaque builds up around brackets. Symptoms include red, swollen, or bleeding gums. If not addressed, gingivitis can progress to more serious periodontal disease. Thorough brushing along the gumline and regular professional cleanings help prevent these problems.

Allergic Reactions

Some patients may have allergic reactions to metals in braces, most commonly nickel. Symptoms can include mouth sores, irritation, or a rash. If you have a known nickel allergy, inform your orthodontist before treatment begins. Nickel-free alternatives are available, though allergic reactions to orthodontic materials are actually quite rare.

Tooth Damage

In rare cases, the forces applied by braces can damage teeth, particularly teeth that already have large fillings or have undergone root canal treatment. The orthodontist considers the condition of each tooth when planning treatment. If a tooth doesn't tolerate movement well, the treatment plan may need to be adjusted.

Relapse

After braces are removed, teeth naturally tend to shift back toward their original positions. This is why wearing retainers as prescribed is essential. Failure to wear retainers consistently is the most common cause of relapse. Even with perfect retainer wear, some minor shifting is normal as teeth naturally change position with age.