PIECES OF THE PUZZLE

A patient’s first appointment with an orthodontist can be a little puzzling. One reason is the language barrier. The patient (one who’s reading this, for example) may speak English, but the orthodontist seems to use words in strange ways. What in the world are “orthodontic appliances”, for instance? Dishwashers for braces? Aren’t appliances labor-saving household gizmos? Well, in orthodontics some familiar English words have special meanings. In orthodontics jargon, “bands” don’t have guitar players, and brackets aren’t for college basketball teams. Is there an orthodontics glossary somewhere??

Orthodontists know how important it is to put patients at ease. It doesn’t help at all to baffle any patient, child or adult, with jargon. Human nature, though, has its way. A practicing orthodontist has been speaking, writing, and hearing the lingo daily for many years. It’s so familiar he or she takes it for granted. Most of it’s English words, not French or Latin as are many legal terms. It’s all too easy to forget to remember that for patients, it’s all new.

Let’s review, then, some of the key pieces of the puzzle. Here’s a virtual orthodontics glossary that tales a tale.

AN ORTHODONTICS GLOSSARY: APPLIANCES

What’s the definition of “appliance”? The dictionary says an instrument, apparatus, or device for a particular purpose or use. That’s what most people mean by the word. Refrigerators, washing machines, toasters.

That definition works, too, for the hardware orthodontists provide. It’s all apparatus for a particular purpose. The purpose of moving and straightening teeth. Braces are appliances. So are retainers. Braces and retainers represent the two major types of orthodontic appliances. Fixed and removable. Invisalign aligner trays are, for example, removable appliances. So are retainers.

The appliances patients most likely to be mentioned by an orthodontist are the Herbst, Forsus, Carriere Distilizer, and Bionator. These straighten teeth.  Expansion appliances such as the Schwartz, Palatal Expander (RPRE) and Quad Helix correct jaw development issues. Headgear and masks are also considered appliances.  A full list of the types of orthodontic appliances is several pages long!

PIECES OF THE PUZZLE

Let’s look into some of the smaller parts that make up these appliances. These are some of the key terms in an orthodontics glossary.

Bands are what they sound like. They’re metal bands that orthodontists cement to back molars. Their function is to serve as strong anchors for appliances. Buccal tubes, welded to the outside surfaces of bands,  are attachment points for such appliances. Removable appliances like headgear, or “night braces”, insert to buccal tubes.

Archwires are the thin silvery wires running across the teeth horizontally. Brackets are metal or ceramic fixtures bonded directly to teeth. These secure and guide the archwires. Chains are elastic pieces that hold the archwires to the brackets. A ligating module serves that same purpose. Orthodontists also secure archwires to buccal tubes back on the molars.

In this very basic outline, then, bands go on the back teeth, brackets on the other teeth. Archwires run through the brackets and anchor to buccal tubes on the bands. The archwires apply and keep the pressure on the brackets. This moves the teeth.

THE PROCESS AND PROCEDURES: EVALUATION AND CONSULTATION

An orthodontic relationship begins with an exam and evaluation of the patient.  This can include visual inspection, panoramic and cephalometric x-rays, and photos of the patient’s face and mouth interior. Making study models like wax bites and plaster casts help the orthodontist see the detailed “lay of the land”. He or she forms a judgment of the patient’s issues, stage of maturity, and overall oral and medical health.

Orthodontic treatment begins with a consultation. At this time the orthodontist will have developed a treatment plan. He or she discusses the plan with the patient during the consultation. Some patients can choose between more than one treatment option.

PHASE I TREATMENT

Sometimes orthodontists “set the table” for any later treatment. Phase I treatment goals are prevention and interception. The intent is to head off or lessen later alignment problems. Also called early treatment or pre-orthodontic guidance, Phase I treatments shape developing jaw bones, mainly when the first permanent teeth start erupting. By reducing the risks of issues like overcrowding, orthodontists try to make any later treatment less complex and shorter lasting. Phase I treatment is usually for kids. The benefits of Phase I treatment are one reason why the American Orthodontist Association (AOA) recommends evaluation for children by the age of 7.

PHASE II: ACTIVE TREATMENT

With a custom treatment plan agreed upon, the orthodontist gets to work moving the patient’s teeth. This is when he or she creates the appliance or appliances that make it happen. These can be traditional metal braces, with the aforementioned bands, brackets, and archwires. Lake Worth Orthodontics works with the full range of active treatment options. These include Damon braces, Clarity ceramic braces, and Invisalign.

Active treatment takes time. How much time depends on the starting condition (hence the role of Phase I, for kids), the type of treatment, and the patient’s constitution. It will almost certainly continue for many months, or even a couple of years. Since the patient’s teeth are moving, the orthodontist takes steps to maintain the pressures that cause this. These are adjustments. This can mean restoring tension in archwires. With Invisalign, it’s making new aligner trays that fit the changing positions of the teeth. Many orthodontists take x-ray images and photos along the way to track progress.

Adjustments are one reason why orthodontic treatment involves regular appointments. These visits are also a time for the orthodontist to check appliances and repair or head off any mechanical issues. Phase Two is also the time when most unscheduled appointments are made. Broken or loose archwires, and lost or damaged Invisalign trays are the common reasons.

RETENTION PHASE

In time (at last!) the day comes when active treatment has done its work. If the patient has braces, the wires come out. Brackets and bands are debonded and removed.  The last Invisalign tray is discontinued.  Looking in the mirror, the patient sees the pleasing smile he or she has been working toward.

Treatment’s not over at this point. Moving teeth is one thing. Keeping them where they’ve been moved to is another. Active treatment has moved the roots of the teeth through the bone in which they root. The bone has been remodeling itself to adapt to the pressure and movement. At the time Phase II  treatment is complete, this remodeling is still going on. The jaw bones have not fully re-formed around the new positions of the teeth.

Therefore, the orthodontist custom-makes a retainer for the patient. This, of course, is a removable appliance. The patient wears daily. That usually means 24/7 for the first 12 months or so. Later, this may reduce to night wear only, and then even less.  The retainer’s gentle pressures promote the jaw bones’ remodeling and solidifying around the new positions of the teeth.

A WALKING ORTHODONTICS GLOSSARY?

If you’ve read this far, you now know about the keywords and phrases in orthodontics tech-speak. Moreover, If you’ve clicked on the links, you’ve seen a detailed orthodontics glossary. This ought to take a lot of the puzzle out it all! That said, it’s best for orthodontist and patient if there’ no mystery at all. Patients should feel free to ask about anything related to their treatment. The truth is, orthodontists love to talk about their work. And each one is a walking orthodontics glossary.