Straight Facts About Crooked Teeth

Probably the most common complaint expressed by patients in dental offices has to do with their crooked teeth. Many do indeed have teeth that are not in perfect alignment. And while most of these patients do not require treatment, many can benefit from some form of tooth-straightening therapy.

Consequently, there are so many people seeking treatment for various forms of tooth misalignment that orthodontists—dentists who specialize in straightening teeth—are in great demand.

Understandably, those who have crooked teeth often want to know more about it. How does it affect them? What causes it? And what are some of the ways it can be corrected?

Are Crooked Teeth Really a Problem?

Patients have good reason to be concerned about their crooked teeth. Tooth misalignment compromises their appearance and can adversely affect their health, happiness, and self-esteem.

Besides the obvious effect on a patient's appearance, crooked teeth can also be harmful in another way. They can cause a defective bite, known as "malocclusion." This means that the upper and lower teeth do not properly meet. This can make effective chewing difficult and contribute to other problems, such as temporomandibular (jaw) joint disorders, and perhaps even nutritional and digestive issues.

Crooked teeth can also make it difficult for patients to perform effective oral hygiene procedures, such as brushing and flossing. This puts them at higher risk for dental diseases, like cavities and gum disease.

Patients have good reason to be concerned about their crooked teeth. Tooth misalignment compromises their appearance and can adversely affect their health, happiness, and self-esteem. 

Causes of Tooth Misalignment

Tooth misalignment can have many causes, most of which are beyond the control of the patient. Teeth tend to grow into the mouth crooked because of space and crowding issues. The upper and/or lower jaws are sometimes simply too small for the size and number of teeth that develop. Thus, when the teeth erupt, they push each other aside to make enough space to come in. Sometimes, they are unable to erupt at all, in which case they are said to be "impacted." Impacted teeth are of concern because they can form cysts and other types of destructive tumors problems later in life.

Other factors can also sometimes cause crowding and tooth misalignment. Habits, such as thumb-sucking or chewing on a pencil or pipe stem, can move teeth out of their proper position. Another common reason for crowding is early loss of baby teeth without the placement of any subsequent space maintainer. This leaves insufficient space for the permanent tooth to erupt and can cause it to either remain impacted or come into the mouth in an incorrect position.

Treatment of Crooked Teeth

The dental profession has developed many different methods for orthodontically correcting tooth misalignment and malocclusion. They can range from simple to complex, but all operate on the same principle. Orthodontic tooth movement is a complex physiological response to pressure that is intentionally applied to the tooth with brackets, wires, and other means. This pressure causes the bone supporting the tooth to slowly remodel by resorbing (dissolving) on the pressure side and simultaneously forming new bone on the tension side. This results in movement of the tooth through the bone to the desired location. The one requirement for any orthodontic tooth movement is that there must be available space into which the tooth can move. The type of treatment selected will depend, in part, on the severity and nature of the patient's tooth arrangement and jaw anatomy.

Single or Minor Tooth Movement – The simplest form of orthodontic treatment is pressure applied to a single tooth to move it into place. This can be accomplished in many ways. The easiest might be, for example, a patient applying daily pressure to a tooth with a tongue blade to orthodontically move it into place. Single tooth movement can also be accomplished by a simple prosthesis the dentist fabricates for the patient to wear. This device is designed to exert pressure on a tooth to move it into proper position.

Conventional Orthodontic Treatment – Patients with more generalized orthodontic problems will require more complex treatment, or "braces." This generally involves the extraction of selective teeth to first create space, followed by the placement of the braces—i.e. brackets and wires—augmented in certain situations with an external headgear apparatus. The brackets are bonded or glued to the teeth and the wires are attached to the brackets. The wires are then adjusted to place the appropriate amount of pressure on the teeth that need to be moved. This treatment is a slow, methodical process that requires months or even years of treatment and regular orthodontic adjustments throughout.

Orthognathic Surgery – The most complicated orthodontic treatment plans are multidisciplinary approaches that include full orthodontic therapy in conjunction with orthognathic (jaw) surgery to alter the anatomical structure of the jaw bones. Oral and maxillofacial surgeons surgically move the jaw forward or backward to allow it to fit better with the opposing arch. Then, the orthodontist moves the teeth into their proper position, using orthodontic principles.

Clear Aligners – Another technique for achieving straighter teeth that has become popular in recent years is the use of clear aligners. These are clear, removable plastic prostheses that patients wear over their teeth to slowly move them into proper position. These devices have certain limitations but have proven effective in situations where they are indicated. They are relatively easy to fabricate and insert, and they are more esthetic than braces, in that the patient can remove and insert them whenever they want.

Certainly, not all crooked teeth need to be straightened. However, those patients who have a "crooked" smile or are concerned about their ability to chew should not hesitate to consult with their dentist. For those cases in which orthodontic therapy is indicated, patients have several options to help them achieve their goals.

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