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How does orthodontic treatment work?

A brief guide to how an orthodontist actually straightens teeth.

Ariel Harris
Contributing Writer

Believe it or not, orthodontic treatment has been around for hundreds of years. When Pierre Fauchard published his seminal work The Surgeon Dentist in 1728, this two-volume treatise was dentistry’s first-ever, peer-reviewed and complete textbook. It included roughly 50-pages that went over Fauchard’s “Twelve observations on deformed and poorly arranged teeth’’ that would go on to become the modern science of orthodontics. 

More than 100 years later, Edward H. Angle, the “father of modern orthodontics” would create the specialized school of orthodontia as its own specialty branch within dentistry. Angle coined the term “malocclusion,” classified various maladies of the teeth and jaw, and he invented the first modern tools for teeth bracing that would lead to the tools orthodontists still use today. 

The tools have changed quite a bit since Dr. Angle’s time. But even back then, the answer to the question, what is orthodontic treatment? was basically the same: It’s the application of continuous pressure over time to slowly move the teeth and jaws into a different, healthier position. 

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How it works — in today’s terms.

Today, orthodontists use appliances like traditional or invisible braces and clear aligners to move your teeth into new positions. Of course, that makes it sound simple: the fact is, your teeth don’t want to move. In the case of braces, your orthodontist will bond a single metal bracket to each of your teeth, then connect those brackets with wire and those tiny rubber bands to apply pressure. Knowing how to apply the right pressure — and where — is the orthdontist’s specialty. It’s not just about teeth shifting or straightening; often teeth need to be tilted and turned into place as well. As your teeth move, bone remodeling begins to take place within the periodontal ligament, which is the gum tissue around the root of each tooth.

Clear aligners work the same way, except instead of wire and brackets applying the pressure, it’s specially designed plastic molds. These molds, called trays, are fitted to your teeth using an impression or 3D scan. Then, the orthodontist maps out your orthodontic treatment plan. Usually it involves providing you with a new, slightly different clear aligner that you wear most hours of the day, for a few weeks at a time. Each one progressively shifts your teeth and jaw. Today, clear aligner technology is so advanced that there aren’t many issues that can’t be solved this way. 

In either the case of aligners or braces, the process takes time. How long depends on how much your teeth need to move. But the thing that takes the longest is the bone remodeling.

The most opportune time for orthodontic treatment is during childhood and adolescence. That’s because your teeth and your jaw are still growing, making your bone more easily re-modeled. In fact, if malformations are caught early, your orthodontist can use the tools of interceptive orthodontics, like a palatal expander, to begin shifting your teeth and jaw into a better position, so you need less serious interventions later on.

That said, it is not uncommon for people to still need the full monty — comprehensive orthodontic therapy. That could mean you need multiple levels of therapy, a palatal expander and braces and headgear, for example — regardless of how much early intervention is possible. Still, others only need limited orthodontic therapy, like a few sets of clear aligners to fix a single gap. 

Orthodontic therapy for crowded teeth is probably the most widely known reason to seek out an orthodontist, but there are many other reasons to consider braces or the like. Beyond the cosmetic reasons to seek out orthodontic therapy, straight teeth reduce your risk for tooth decay and gum disease by making it easier to brush and floss. A healthy, aligned jaw can reduce pain in the jaw joint headaches, and other symptoms of temporomandibular joint disorders, aka TMJ.

Each year, hundreds of thousands of adults seek out orthodontic therapy. The American Association of Orthodontics estimates its members were treating 1.6 million adult patients in 2016. That’s a lot of smiles!

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