Orthodontics: Methods, Costs, and How Fast It Works

Orthodontics is a specialized area of dentistry that focuses on the alignment of teeth and jaws for function and aesthetic appearance. Orthodontists design and fit fixed appliances, like braces, and other corrective devices, like clear aligners and expander plates, to bring the teeth or jaws into alignment.

The time it takes for orthodontic treatments to work varies. Depending on the severity of the misalignment, it can take anywhere from six months to three years to achieve the desired results with braces and other fixed appliances. The cost of treatment also varies, although most dental insurance providers offer at least partial coverage for medically necessary treatments.

This article covers the types and benefits of orthodontic treatments. It also discusses how long it takes to achieve results, and what to expect from an orthodontic treatment plan.

Benefits of Orthodontic Treatment

Well-aligned, straight teeth may be desired for aesthetic reasons, but, more importantly, they generally indicate an overall healthier mouth. 

Misaligned teeth and jaws can be related to uneven tooth wear, gum problems, breathing difficulty, poor oral hygiene (due to hard-to-clean teeth), speech development, and damage of the jaw joint.  

Orthodontic treatment can often deliver a smile that not only addresses these issues but helps you (or your child) feel more confident.

Indications

You may simply notice that your teeth (or those of your child) are not as straight as you'd expect (or like) them to be. Some people are more susceptible to crooked teeth, though many of these problems can be caused by what someone is exposed to, such as breastfeeding or thumb-sucking/pacifier use. 

Alternatively, your dentist may detect a problem that orthodontia can help with, such as:

• Crowded teeth
• Underbite
• Open bite
• Crossbite
• Spaced out teeth
• Wisdom teeth
• Missing teeth
• Impacted teeth

The teeth and jaw relationship begins right from birth, so it’s important to pay close attention to a child’s jaw development. By the time a child is 7 years of age, it's usually quite obvious to a dentist/orthodontist if a patient will have orthodontic problems, as most of the adult teeth should be present.

Primary care and ear, nose, and throat (ENT) doctors may also have a hand in suggesting orthodontic treatment. Your teeth are an indication of how your jaw and face are developing, and a poorly developed jaw may contribute to issues with airway function. Today, orthodontics can be performed to actually help people breathe better.

There are some signs that indicate that you/your child aren’t breathing properly, including:

• Mouth breathing
• Open mouth at rest
• Daytime sleepiness
• Dark circles under the eyes
• Snoring
• Bedwetting
• Poor sleep

A doctor may suggest orthodontic work as part of treatment for these concerns, sometimes after other assessments have been completed, such as a sleep study.

Orthodontic Treatment Options

There are many types of orthodontic treatments available. Treatments can broadly be grouped into devices that are fixed to your teeth, and treatments that are removable.

Fixed appliances include:

• Traditional braces: Braces involve small brackets fixed against the teeth with thin wires called archwires. Braces are usually metal, but may also be ceramic. Traditional braces use elastic bands or metal ties (ligatures) to secure the archwires.
• Lingual braces: These braces work similarly to other types of braces, except they are fixed to the back of the teeth, allowing them to be virtually invisible from the front.
• Self-ligating braces: Unlike traditional braces, self-ligating braces use a specialized, built-in clip or "door" to secure the brackets, without the need for ligatures.
• Palatal expanders: These custom-made oral devices are fitted to the roof of the mouth and work by gently applying pressure against the upper molars to gradually expand the upper jaw.
• Bonded retainers: While some retainers are removable, others are fixed. Also known as bonded retainers, these appliances involve a single metal wire fixed to the back of the teeth to hold the teeth in their corrected alignment.

Removable devices include:

• Aligners: These removable devices are clear plastic trays custom-fitted to the wearer's teeth to gradually align them.
• Retainers: Removable retainers are also custom-fitted, clear plastic trays. But unlike aligners, retainers are designed to prevent previously corrected teeth from moving.

Each of these treatments offers different benefits and may be used to treat different dental conditions. The right treatment for you will depend on a number of factors, including your age, the severity of misalignment, and overall dental goals.

Treatment Stages

Orthodontists typically suggest starting treatment as soon as a problem is identified to prevent problems from becoming more serious or complex.

Ideally, treatment should start at an early age while the child is still growing. Research shows that beginning treatment from an early age:

• Minimizes the duration of treatment
• Prevents the need for more expensive or substantial treatment later in life
• Improves the child's quality of life early on

From start to finish, orthodontic treatment usually involves several stages:

1. Expansion: A special orthodontic device is used to expand the width of the palate or jaw, if necessary. This helps make more room for the teeth so they can come in as straight as possible. 
2. Correction: A correction device is then fitted to help correct the existing teeth. Adjustments are made as teeth move during treatment.
3. Retention: A second device, called a retainer, is fitted and expected to be worn regularly for another 12 months to prevent teeth from moving back into their old position. In the following year, patients are usually required to wear the retainer just at night.

Your orthodontist will meet with you periodically to check the progress of your treatment. Once the correction and/or retention phases are complete, you will also have follow-up appointments to check on the stability of your results.

What to Expect With Braces

Modern braces are vastly improved from what they were decades ago. They can be made from stainless steel, metal, ceramic, or plastic.

While ceramic or plastic braces may look better aesthetically, you need to consider that plastic may stain and discolor by the time you reach the end of your treatment.

In some cases, it may be suitable to use invisible, removable aligners that are changed every two weeks. They allow you to brush and floss normally, unlike traditional braces.

In addition to your orthodontist's recommendation, you will need to factor in your budget, insurance coverage, lifestyle, and habits when deciding on the type and look of braces you choose.

Fittings and Adjustments

The process of being fitted with an orthodontic appliance begins with your orthodontist determining which one is suitable for your mouth. If braces are required, the first step is placing little brackets on your teeth and bonding them to the tooth with a special adhesive. Metal bands are applied to the back teeth, and wires are placed inside the brackets.

When you are fitted, your appliance will be fine-tuned by your orthodontist or dentist to apply slight pressure on your teeth, so they move in the desired direction. Because your teeth will move during treatment, you will need to have adjustments from time to time.

Cost

What you end up spending can vary depending on the extent of the treatment, what modalities are used, and your insurance coverage.

Traditional metal or ceramic (clear) braces start around $5,000. Behind the teeth, or sublingual, braces range from $5,000 to $13,000. Clear aligners, like Invisalign, can range from $3,000 to $8,000 depending on how many adjustments are needed.

At your initial consultation, your orthodontist or dentist should discuss options and costs. You should ask any questions during this time so that it's clear what is required to achieve the final treatment outcome from a time, commitment, and financial investment standpoint.

Many orthodontic offices will allow you to set up a payment plan for treatment.

How Long Do Braces Take?

There is no official consensus for how long braces need to be worn to achieve the desired results. Treatment is highly individual and will depend on you or your child's unique circumstances.

According to a review published in the Dental Press Journal of Orthodontics, the average treatment time for fixed appliances, such as braces, is 14 to 33 months.

This same review found that 41% of adolescents expected to wear their fixed appliances for six months or less, and 43% of adults expected to wear them for six to 12 months.

The review shows that treatment times are commonly longer than expected, which can have an impact on your quality of life.

While you cannot control how long it takes for your teeth to completely correct, you may be able to reduce the duration of your treatment by:

• Starting treatment as soon as a problem is identified
• Seeing your orthodontist regularly for progress checks, and making it to all scheduled appointments
• Practicing excellent oral hygiene consistently
• Complying with your orthodontist's recommendations for replacing accessory devices, such as elastic bands, routinely

Summary

Orthodontics is a field of dentistry that specializes in correcting the alignment of teeth and jaws. There are two main categories of orthodontic treatments: fixed appliances, such as braces, and removable devices, such as aligners. While the length of treatment varies from person to person, the average treatment time for fixed appliances ranges from 14 to 33 months. You may be able to help minimize treatment duration by fostering open communication with your orthodontist, and staying on top of your daily dental care.