Why alignment is a health issue

Cleaning access comes first. Overlapping teeth create tight spots that floss skips and a brush cannot reach squarely, and those spots are where decay and gum inflammation start. Patients with crowded lower front teeth often build tartar there and nowhere else, year after year, however well they brush.

Then there is wear. Teeth are meant to share the load. When a few teeth take contact before the rest, those teeth flatten, chip and eventually crack. A tooth overloaded for twenty years is a tooth that fails without warning while you are eating something soft.

Crowding also pushes teeth out of the bone meant to surround them. A tooth sitting forward of the arch can end up with thin bone and thin gum over its root, which is one route to recession and one reason alignment comes up during periodontal care.

What we look at

An orthodontic assessment is about how the teeth meet, not only how they line up in a photograph.

  • Crowding. Not enough room for the teeth present, most often in the lower front. This is the usual reason adults call.
  • Spacing. Gaps from small teeth, a wide arch, or a missing tooth that let the neighbors drift.
  • Deep bite. Upper front teeth covering the lower ones too far, wearing the lower edges and irritating the gum behind the uppers.
  • Open bite. Front teeth that never meet, so the back teeth do all the work and take all the wear.
  • Crossbite. Upper teeth biting inside the lower ones, which loads one side harder and wears it faster.
  • Tipped and rotated teeth. Usually the result of a tooth lost years ago, with the neighbors leaning into the gap.

Adults, shifting teeth, and what to fix first

The story we hear most from adults is that the lower front teeth have crowded up over the past few years and it seems to be getting worse. That is real, not imagination. Teeth drift forward and inward through adult life, and the lower incisors show it first because they are small and tightly packed.

Sometimes there is a trigger: a tooth extracted and never replaced, gum disease loosening the support, or a retainer abandoned decades ago after teenage braces. Often there is none. Either way the change is slow, cumulative, and easier to correct earlier than later.

Adults also arrive with dentistry already in place, which changes the order of the work. Straightening first often means less drilling later. Crowded, worn front teeth can sometimes be moved into line so the veneers that follow are thinner, or so none are needed. Building a straight look out of porcelain over crooked teeth means cutting into healthy tooth for the material. Moving the tooth costs time instead of tooth structure, and tooth structure does not grow back.

Clear aligners and fixed braces

Both move teeth with gentle continuous force. They differ in what they can do and in what they ask of you. Invisalign is the clear aligner brand most people mean.

Consideration Clear aligners Fixed braces
How force is applied A series of removable trays, each shaped slightly closer to the target, changed on a set schedule. Brackets bonded to the teeth and a wire that drags them toward its shape as it straightens.
Appearance Hard to notice at conversational distance, which is why most adults choose them. Visible, though ceramic brackets are less so.
Eating and cleaning Out to eat, out to brush, so hygiene stays normal. Back in immediately afterwards. Fixed in place. Cleaning takes longer and some foods have to go.
Case complexity Good for crowding, spacing, tipping and mild bite correction. Less predictable for large movements. Handles severe crowding, big rotations, root movement and larger bite corrections more predictably.
Who does the work The result depends on you wearing them twenty to twenty-two hours a day. Works whether or not you feel motivated, because you cannot take them off.

How treatment runs

The examination comes before any talk of appliances. The appliance is the last decision, not the first.

  1. Records and examination

    Photographs, x-rays and a scan or impressions. Gums and bone level are checked first, because moving teeth through active gum disease loses bone. Anything active is treated before anything is straightened.

  2. A plan with the trade-offs in it

    Which teeth move and how far, roughly how long, what the compromises are, whether a specialist is the better route, and the fee. That includes the option of leaving it alone.

  3. Active treatment

    Trays changed on schedule or wires adjusted, with periodic checks that the teeth are tracking the plan. When they are not, the plan is revised. Mid-course corrections are normal.

  4. Detailing the finish

    The last stage is small: closing a residual space, settling the back teeth so they meet evenly, refining edges. It takes longer than people expect.

  5. Retention, with no end date

    Teeth do not set in their new positions. Stretched fibers pull them back for years, and adult teeth drift anyway. A retainer at night is the price of keeping the result.

Orthodontic questions

How long does treatment take?

It depends how far the teeth have to move. Minor crowding or relapse can take a few months, and a fuller correction usually runs a year or more. We estimate from the records and update as we go.

Am I too old for this?

No. Bone remodels throughout life, which is how teeth drift in the first place and what makes treatment possible at any age. Gum and bone health matter, not your birth certificate.

Are you an orthodontist?

No. Dr. Brosi is a general dentist providing orthodontic treatment within that scope, which California permits. The responsible part is knowing what to refer. His training is on his page.

Will straightening my teeth fix my jaw pain?

Sometimes it helps, and it is not a treatment for jaw pain. The link between bite and jaw symptoms is less direct than it is often made out to be. See TMJ and jaw pain.

What does it cost?

Fees depend on how many teeth move, how far and for how long, so there is no single figure to quote. You get a written plan with the fee before you commit. See payment options and insurance.

In this area of treatment

Each of these has its own page with the detail that does not fit here.