How a fixed brace works
There are two levels of explanation when we look at how braces work. There is a fairly simple one: the details of their mechanical function and what they do to the teeth. That answer explains how they apply continuous pressure to move the teeth gradually into the right position — whether to improve a smile, straighten uneven teeth or correct a crooked bite. We will come to that below, but first let us explain how a brace works in general.
A brace only works if the patient is determined to use it effectively. In other words, they must maintain thorough oral hygiene after it is fitted and use the retainer as prescribed once it comes off. Both components matter equally. An orthodontist can make the ideal brace for a patient’s needs, but it is only useful if the patient looks after their teeth by brushing regularly and making moderate dietary changes, such as giving up sugary sweets.
The mechanism behind it
We will not go too deep here, but there will be some information. That is because of the great variety of braces, each serving a particular purpose. Impacted canines, for example, can be treated with a brace, or the aim of interproximal reduction, as the jargon has it, may be to reduce the gap between teeth. A patient may have a variety of anomalies: crooked teeth, an underbite, an overbite or a combination. In an orthodontic consultation — which includes a clinical examination of the mouth, additional material such as impressions of the patient’s teeth, images of the mouth and X-rays — the details of the brace are settled. It is important to know that in some cases only a removable brace is needed. The brace is then adjusted or built to match the patient’s requirements exactly.
What makes up a brace
Brackets
These are the tiny squares bonded to each tooth, usually on the front, but also on the back of the teeth (a lingual brace), so that they are not visible. Sometimes brackets are used on both the front and the back of the lower teeth, since the lower teeth are less conspicuous, while the upper brackets are used for the upper teeth, which are more visible when speaking. Brackets come in various colours, including less conspicuous clear ones.
Modules
These are tiny coloured elastic bands placed around the brackets. Some patients even change the colour at every visit.
Separators
To create a little space between the teeth so that bands can be placed around them, separators can be fitted between the teeth.
Archwires
These wires are attached to the brackets and control the movement of the teeth. Like the brackets they can be made of metal or coated in white, which makes the brace less conspicuous.
There are further components, some more common than others, but it would be pointless to write 3,000 pages here about all the numerous small differences.
Although it certainly varies from patient to patient, a brace is usually worn for one to three years. That is because it takes time to move the teeth safely into the desired position, as opposed to forcing them. After the brace is removed, a retainer is often worn overnight for a few days before being worn full-time for some months. Since teeth are constantly changing, they must be prevented from gradually returning to the position they originally had to be corrected from. The retainer therefore becomes a fixed part of the patient’s lifelong oral care.
Who should wear a brace?
Although in adolescents most of the teeth need to have come through, a brace can be suitable for most age groups. Braces for adults are becoming more and more popular, partly because of more discreet solutions such as clear aligners: a series of practically invisible, removable trays, each made specially for the patient and worn for a few weeks. To approach the desired result step by step, the patient wears a series of these trays.
Why braces work differently than you think
This is what we meant about it being a collaboration. If you want to wear a brace, thorough dental hygiene is decisive, since it may have to be worn for years. That way you can avoid hazards such as decalcification (white spots on the teeth), permanent staining and possibly a longer treatment. You will be advised to clean your teeth, clean between them and clean around your brace, but you have to follow those instructions. Fitting a brace may not be a wise decision if the patient is unable to keep to that hygiene.
The good thing is that wearing a brace can lead to good, lifelong oral health. The person wearing it acquires habits they keep long after it comes off. Children who wear a brace are not only prepared for anomalies but also for lifelong oral health, reducing the risk of periodontitis or of more serious gingivitis, in which bacteria gather and lead to bone and gum loss. Anyone wearing a brace must see their dentist and orthodontist regularly to make sure the expected tooth movement is actually happening.
The effect of a brace on health
It is obvious that a brace supports oral health, since it can put right problems such as a crooked bite and straighten crooked teeth so that they are easier to clean.
There are further known benefits
Many twelve-year-olds find it hard to eat or brush their teeth, or are embarrassed to grin or laugh because of their teeth. It is fair to assume that a child who compensates for these problems with behaviours such as smiling with a closed mouth, eating with only one set of teeth or covering their teeth when speaking will keep those behaviours into adulthood, damaging their confidence or causing dental problems that can be expensive to put right.
The following extract from a parent’s interview with the British Orthodontic Society perhaps puts it best. Joel and his mother will always remember the day the brace was fitted. The boy reflected in the mirror was no longer the same. When his mother explained to him that the lines around his eyes were smile lines, Joel asked what those were. «I probably never saw them before because I never used to grin», he replied.
