1. How old should children be before they start wearing braces?

A. Conventional metal braces can only be used on permanent or “adult” teeth. They cannot be put on deciduous (baby) teeth. So traditionally, children would normally be evaluated at about age 12 because that is the time just about all of the baby teeth have fallen out and are being replaced by the permanent teeth. But now in modern times we recommend children be examined by a dentist for orthodontic problems at about age 7. The reason is that now we have advanced techniques involving removable, retainer-like braces called “functional appliances” that do not need to be attached to permanent (adult) teeth. Such modern devices like this can now be used to prevent or correct many types of bad bites (malocclusions) before they get started or before they can cause further damage to the alignment of the permanent teeth and jaws.

2. What are Functional Appliances?

A. Functional Appliances are an extremely important part of the new and modern way of doing orthodontics in both children and adults. Bad bites or “crooked teeth” are called “malocclusions”. They may be thought of conceptually as biological triangles of varying degrees of 1) crooked teeth, siting in 2) crooked or misaligned jaw bones, which in turn are operated by a surrounding biological envelope of 3) “crooked” muscles, if you will. This forms sort of a 3-legged triangle of concerns. Traditional metal braces are great, and have been used for over 100 years to straighten crooked teeth. But that’s their big limitation, i.e. they generally only straighten teeth. They are very poor at straightening the crooked bones and crooked muscle environment that form the two other important components of most malocclusions (bad bites). Modern orthodontic clinicians now recognize this problem. That’s why Functional Appliances (Removable, plastic, retainer - like devices) are so important. They not only help the teeth but also the bones and muscles. There are many kinds of Functional Appliances. They were mostly developed over the last century in Europe and have now been in many ways perfected. They aren’t always as good at straightening individual teeth (like the metal braces are), but they’re TERRIFIC at straightening the crooked, misaligned bones (especially a misaligned lower jaw that’s back too far) and the misaligned muscles that work the jaws during chewing, talking and swallowing!

3. Which is better, Metal braces or removable Functinal Appliances?

A. Both are great. Each method has its own purpose. Being able to use as much of each method as needed on each case makes for far superior results compared to the old ways of being limited to using metal braces alone. This combined method of using metal braces and Functional Applicances is part of a whole new treatment approach collectively know as “Functional Jaw Orthopedics”. It represents the newest and most advanced “state of the art”, in both Orthodontics and TMJ treatments today.

4. Why is Functional Jaw Orthopedics such a superior way of doing orthodontics?

A. This is an excellent question and could involve a long complicated answer. After all, it took yours truly over 11 years of writing a 3 volume series of major textbooks, each one over 500 pages long, to explain all this to dentists, orthodontists and pedodontists, who spend their whole careers studying this issue. But really, the answer, if you will grant me a little poetic license, can be quite short and easy to understand. Basically the reason the “Functional Jaw Orthopedics” method of doing braces for bad bites is so superior to former, more technically limited treatment methods is that it can often produce much better looking faces for patients and definitely can produce much better temporomandibular joints in many patients suffering from certain types of malocclusion.

5. Why does Functional Jaw Orthopedic type orthodontic treatment produce better faces?

A. Functional Appliances are capable of bringing a small, undersized, retruded lower jaw that appears weak or sunken back too far, out forward to a more normal, pleasing position that lines up better with the upper jaw making the face appear fuller with a broader more attractive “Hollywood” smile. Metal braces cannot move a sunken back lower jaw forward in this fashion. Metal braces simply can’t change the size nor alignment of the lower jaw. When it is back too far, making for a weak looking chin, all the orthodontists could do “in the old days” with the more limited metal braces technique was to retract the upper front teeth back (sometimes only after taking side teeth out) so the upper front teeth on top could bite against the lower front teeth (which actually sit in a lower jaw that is back too far). This technique often caves in the lips and smile line and often makes for a less full, less attractive, older appearance to the face and smile. In extreme cases it has even got it’s own nickname, the “orthodontic look,” and it’s not very attractive compared to a fuller, broader smile. It’s a real problem. But not every case treated the old metal-braces-only way exhibits this phenomenon. But a goodly number do, and for the poor individual that exhibits this “look” as a result of this type of treatment, percentages aren’t much comfort. There are a number of other more serious problems however associated with the short comings of the metal-braces-only traditional orthodontic techniques for many types of cases Modern dentists are now beginning to finally understand them

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6. What is the most serious short coming of the traditional
Metal-braces-only technique?

A. Metal braces are called “fixed appliances”. The word “fixed” to a dentist means “glued in”, i.e. not removable from the mouth at will by the patient. Because metal braces only move teeth THROUGH the bone of the jaws, generally they cannot change the jaw bone size nor most importantly can they change the lower jaw to upper jaw, front to back, alignment at full bite (what dentists call full occlusion). A bite (occclusion) that forces the lower jaw too far back when the teeth close together puts tremendous pressure on the jaw joints back where the lower jaw is attached at the base of the skull back by the ears. This is called the “temporomandibular joint”. It is a sliding ball and socket affair. But the back of the jaw socket has a big nerve and artery complex in it and with enough time and pressure during biting and chewing, a lower jaw that is forced back just a bit too far during chewing damages this nerve and artery complex and causes tremendous pain, often pain that is neurologically referred to other areas in the face and head in the form of chronic recurrent headaches and sore, tired jaw muscles. Metal braces are poor at correcting this and can even push the bite further back sometimes making this condition worse. However, Functional Appliances, of various sorts, are designed to realign the lower jaw forward more properly. They also “reset” the improperly operating musculature around the lower jaw. By virtue of their ability to realign the entire bite FORWARD, Functional Appliances not only relieve the headache-causing pressure created by the lower jaw in its own socket, but also serve to fill out the face, and correct a weak looking chin with its retruded lower facial profile. This also fills out the smile line frontally to a fuller, broader “hollywood” type smile. So lower jaw position prior to treatment means a lot. Dentists argue ferociously about all this and some of the trandition lists who use only metal braces say none of the above is true. But it is, and now days it can be proven!

7. Can adults wear braces?

A. Yes. You are never too old to wear either fixed metal braces or to be treated with removable Functional Appliances if you really need them. Often removable Functional Appliances, in conjunction with special kinds of removable appliances designed especially for chewing, called “splints”, are used to cure painful, headache -causing temporomandibular joint (TMJ) problems in both children and adults.

8. How Long does treatment for orthodic or combined orthodontic/TMJ problems take?

A. Treatment time can vary, but in modern times, it is often much faster than with previously used techniques. Treatment can usually range from 12 to up to 30 months in case of severely deformed bites. Again much of it can be done with European Style removable Functional Appliances.

9. Do “invisible braces,” the clear plastic see-through type, work?

A. Yes, they work very well in both teenage children and adults and because they are totally invisible, painless and very comfortable to wear, they are becoming very popular. Trouble is, only certain types of malocclusions (crooked bites) qualify for their use.

10. How much does orthodontic treatment cost?

A. It can vary due to the complexity and severity of the malocclusion (crooked bite) and whether or not there are TMJ (jaw joint pain – headache) problems. Treatment for children who have a TMJ problem that is caused by, or worsened by, a crooked bite that drives the lower jaw back too far during chewing, might cost a little bit more than treatment just for a regular malocclusion, (40% of children that need braces have some form of TMJ (jaw joint) damage, even before treatment!! But the slight extra expense is well worth it as it will usually prevent life long problems of chronic recurrent headache and jaw pain. Fees can range from $4000-$6000 depending on complexity. There are usually extra fees for the initial orthodontic records, which by the way should include a specific x-ray of the jaw joints, either a “transcranial” or “tomogram”. Panoramic radiographs or cephalometric radiographs do not qualify as “specific x-rays” of the temporomandibular joints.These special jaw joint x-rays are most important prior to initiating any sort of major orthodontic treatment.

11. Do some types of malocclusions (crooked bites) require surgery?

A. Lower jaws that are way too long can only be corrected (reduced) by means of surgery. But most undersized lower jaws that used to be enlarged or lenghtened by surgical advancement procedures can now be corrected by properly employed Functional Appliances. Surgery is almost never used for these types of retruded lower jaw type problems anymore, or at least shouldn’t be!

12. Is there a “big fight” going on behind the scenes amongst dentists as to the proper way to do orthodontics?

A. Boy, is there! The traditonal American orthodontic specialists who were taught to use metal braces never thought much of the European style removable Functional Appliances nor believed that they actually worked. They were prejudiced against them from the start because they were never properly trained by their respective Universities in their proper use. The fact that they were developed by European physician – dentists and promoted heavily by American general practitioners (who were often open minded enough to see their benefits) didn’t exactly help matters much either. Many (though not all) American orthodontic specialists still insist Functional Appliances don’t work, don’t cure TMJ problems, and aren’t really superior to metal braces with regard to improving the face. Well guess what? They Do work. They Do cure TMJ, and they ARE better for the face! That’s why so many dentists, both specialists and generalists alike are gradually changing over to this entire new system known as Functional Jaw Orthopedics.