Patient compliance is necessary for the success of orthondontic treatments.

For Life recently sought the advice of Senior Consultant Orthodontist, Dato’ Dr How Kim Chuan from the Imperial Dental Specialist Centre to learn about malocclusion, its consequences, and how orthodontic treatments can improve it. In this article, Dato’ Dr How outlines the most common types of orthodontic treatments available; their pros and cons, and how patients can help institute and prolong the effects of these treatments at home.

Dato’ Dr How Kim Chuan from the Imperial Dental Specialist Centre

But first, at what age should patients undergo orthodontic treatment?

According to Dato’ Dr How, there are three phases of orthodontic treatment based on age, and they are:

  1. Preventative orthodontics which are administered on patients as young as six years old, or when their first permanent molars have erupted.
  2. Comprehensive orthodontics which are administered on adolescents whose permanent teeth have fully erupted.
  3. Finally, compensatory orthodontics which are administered on adults of 18 years of age and above, when their bones are fully formed

In his practice, Dato’ Dr How recommends orthodontic treatment as early as possible, as this can maximise positive results even with minimal intervention.

“The first permanent molars when erupted will determine the shape of the face and affect the position and health of the lower teeth. If doctors can treat a child when he or she is young, we can intercept future problems with as little treatment as possible, while maximising results,” Dato Dr How advises.

“If parents think their six-year-olds are too young for treatment, they can wait till their children have their permanent teeth at 12 or 13, and undergo comprehensive orthodontics. Once patients turn 18 however, they will have to undergo compensatory orthodontics. Compensatory treatments often involve more invasive techniques as patients’ bones have fully formed.”

What are the different types of orthodontic appliances/treatments?

There are three major types of orthodontic treatments: functional appliances, conventional braces, and invisible aligners.

Removable appliances correct and modify class II and class III malocclusions in young patients aged 10 to 14. Conventional braces are wire-based appliances orthodontists use to correct misalignments, while invisible aligners are a series of custom-made plastic aligners that are worn by patients over time to gradually straighten and correct teeth and jaw discrepancies.

“The history of braces dates back 300 years while clear aligners are just two decades old. Newer treatments have evolved to be better than older treatments through years of peer-reviewed data and clinically proven technology,” he says.

“Invisible aligners such as Invisalign have advanced to combine the benefits of other orthodontic treatments, such as braces’ brackets and functional appliances’ bone-moving abilities into a single system, providing superior outcomes and fewer setbacks.”

What are the advantages and disadvantages of the different types of orthodontic treatments?

According to Dato’ Dr How, each orthodontic appliance has its pros and cons:

Functional appliances:

Functional appliance is uncomfortable and loose-fitting, leading to children often taking them out.

Although they deliver up to 70% improvement in teeth and surrounding bones, as well as a 40% improvement in skeletal discrepancies, compliance is a problem in children as they tend to be uncomfortable and loose-fitting, in addition to being removable.


Conventional braces:

Braces tend to look unattractive due to brackets and wires being visible on top of teeth.

Although braces are fixed onto teeth which eliminates the issue of patient compliance, they can cause pain as brackets and wires can cut into cheeks, resulting in ulcers.  Conventional braces are also 10 times more forceful than changing aligners, making wire tightening sessions more painful than when replacing removable aligners.

Patients with braces also commonly experience bad breath as food often gets stuck between brackets and wires and teeth, in spite of frequent brushing and flossing.


Invisible aligners:

For invisible aligners, patient compliance plays a major part in its efficacy

Although invisible aligners are more discreet, less painful, and offer better hygiene as patients can remove them to brush and floss their teeth, patient compliance plays a major part in its efficacy. If patients do not wear their aligners for the recommended 20 to 22 hours a day, teeth are likely to shift back to their original position, potentially undoing months of correction.

How can patients help extend the efficacy of orthodontic treatments at home?

According to Dato’ Dr How, maintaining your orthodontic treatment at home is all about optimal oral healthcare. In addition to avoiding sugar and carbohydrates which can lead to tooth decay, he also recommends using an ultrasound toothbrush, a water floss system, and a suitable toothpaste.

“Ultrasound electric toothbrushes are highly effective in killing viruses and bacteria that populate the tooth’s crown, underlying bones, and gum pockets. I also recommend water floss systems, because water pressure can clean teeth and their crevices much better than any conventional floss,” he advises.

“Lastly, I also recommend toothpastes which are prescribed by doctors over store-bought ones, as the former contains higher levels of absorbable calcium, as well as lower amounts of fluoride and zero sodium laureth sulfate, which have been linked to bone and neurological problems and cancer, respectively.”

Featured photo by Shutterstock.

All other photos courtesy of Dato’ Dr How Kim Chuan


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