People with crooked teeth have a number of different choices to fix the problem, and which one they pick largely depends on the severity of the misalignment and cause of the shifting. For minor imperfections, tooth reshaping, bonding and veneers are all good options. Traditional and invisible braces work for more moderate adjustments and are usually coupled with follow-up retainer use. Pulling teeth or even breaking the jaw sometimes is needed in extreme cases, but because these are more invasive techniques with a higher risk of complications and infection, dentists usually recommend them only when no other straightening method will provide sufficient results.
As the name implies, this option involves manually contouring the teeth, usually through gentle abrasion and polishing techniques. By doing this, the dentist can remove small imbalances, chips and other minor imperfections that contribute to a crooked look. Often, he can complete all the work in one session, but because the method relies on a person's natural teeth, he generally examines them and performs basic procedures, such as getting X-rays, to confirm they're strong enough first. The results of dental contouring are very minimal, so it isn't right for someone who has teeth that are very misshapen.
In many cases, tooth reshaping is done in combination with another procedure called bonding, which involves applying a mixture of quartz and resin right on the natural tooth. The dentist sculpts this material so that it looks smooth and blends well, after which he cures it with a laser and polishes it. Although having this done is cheaper than some other options, the composite that goes on the teeth can stain and is sensitive to high pH and pressure, meaning that it's not good for people who consume lots of acidic or discoloring foods and drinks, or who grind their teeth.
People often see veneers as a more durable, longer-lasting alternative to bonding. With this method, the dentist smooths down or shaves the enamel of the tooth. He then attaches a personalized piece of porcelain to the front with an acid-resistant bonding material. Depending on the way the veneers are made, they can be as little as 0.01 inches (0.33 millimeters) thick, with strength increasing as size goes up.
Veneers can completely change a person's smile, as they cover the whole surface of each tooth involved rather than just a small section. They can wear out over time, however, and usually must be replaced within 15 years. Although they are durable, they are made of porcelain and can chip or crack. This method can also be quite expensive.
Dentists commonly turn to braces to pull very crooked teeth back into proper alignment. The traditional versions are made of small metal brackets, which attach to the teeth with special glue. Wires go through the brackets, and they gradually pull the teeth straight with increased tightening each month.
Metal braces tend to be less expensive than other newer types, but they can cause some irritation to the inside of the mouth from the metal rubbing the checks and lips. Patients usually need to wear them for at least a year or two, and they have to brush consistently after each meal to prevent food buildup around the brackets and wires. Many individuals don't like the "metal mouth" appearance this technique gives, so when it's possible, some dentists try to apply them to the back of the teeth where they can't be seen as easily.
Invisible braces work essentially the same way as traditional ones, in that they gradually pull the teeth into a better position. They are made from a custom-made, clear plastic tray, which a patient wears over his teeth. To accommodate the fact there aren't any wires to use for tightening, a typical treatment requires several trays that a patient progresses through over time, each with a slightly different shape. Each one is usually removable for brushing and cleaning.
This method of straightening crooked teeth usually is promoted for its aesthetic appeal, because it's harder to see the clear trays than metal braces. Dentists often recommend it for people who work a lot based on appearance, such as actors or models. It is not for everyone, however, because it tends to work best when the amount of misalignment isn't too severe.
Once a person gets his braces off, he normally has to wear retainer to keep the teeth from shifting back to their original location. This tool usually is a contoured piece of plastic that fits to the roof of the mouth, and which has a metal wire that surrounds the front teeth. Newer versions replace the metal wire with a clear one called ASTICS, giving a more natural look, or they use a clear, tray-like design that fits over the teeth like invisible braces. It's sometimes necessary to wear one 24 hours a day for good results, but individuals often are able to wear them for a shorter time, often just while sleeping.
Pulling and False Teeth
In some instances, teeth shift out of their proper position because there isn't enough room for them all in the jaw. The solution often is to pull at least one of the teeth, which provides the space necessary to proceed with other straightening methods, such as braces. This can be quite painful, but patients usually can manage any discomfort after the procedure with over-the-counter medications. Sometimes, the gap from the extraction is large enough to require further work, such as a dental bridge or implant. These two techniques use false teeth to fill in the space from missing real ones.
Occasionally, it is the shape or positioning of the jaw itself that contributes to crooked teeth — this is often due to a genetic issue or because of disproportionate growth of the facial bones. If the problem is severe enough, the dentist might suggest breaking the jaw. This does not involve a true "break" exactly, but rather usually refers to making incisions in the bones and sliding them into a good place. It's generally done in conjunction with the use of braces, and because it is a surgical procedure requiring general anesthesia, dentists usually have patients stay in the hospital for a day just for observation. Only about 10% of cases need to have their jaw wired shut as the bones initially heal, with the rest using small rubber bands to maintain the new alignment.
This procedure is typically considered to be a last resort, but it can be the only way to ensure a proper, straight bite. It can provide other benefits aside from better functionality of the teeth, such as relief from extreme jaw tension and related headaches. Breaking the jaw drastically can change the appearance of the face, as well, and although it can take time to get used to the new look, most people find the results very pleasing.