Teeth are so important not only for their cosmetic appearance in making a smile that much more attractive and beautiful but also for playing a part in chewing or mastication in the intake of food and phonation in speech. Teeth form quite early in the fetus and erupt at certain specified times in the baby and child. The first milk tooth generally erupts around six months of age and the first permanent tooth comes out around six years of age. These processes are expected to occur in an orderly fashion and a final set of neat brilliant white teeth is the accepted ultimate end result.

However, it is not always the case that one has the good fortune to have perfect teeth. Sometimes we come across a child in whom the first visual impression is being determined not only by the stature and clothes but especially by the face. The child may have clean and pleasant appearance and a nice personality. We get into conversation and despite the good looks, we immediately notice something negative such as obviously and markedly malaligned teeth or unsightly gaps between the teeth. Malocclusion refers to the impairment of the anatomical relation and functioning of the teeth and adjacent craniofacial structures. A person’s mouth and teeth are not only a central focal point of the face, they influence how charismatic or attractive a person appears and underline his or her personality. A smile is an index of happiness. A beautiful smile attracts others and a set of good and well aligned teeth improve one’s profile and personality.

Crooked, or malaligned teeth are not only an aesthetic concern but they also pose a health risk. Among others, there are two main health risk areas. The first is functional and the second is hygienic. Each of the teeth in the mouth has a specific form and they are made to provide specific functions. For example the incisors, which are made for cutting food, are also a critical component to protecting the molars when moving the jaw forward. They are also critical for clear and correct speech. The cuspids, or canine teeth, are designed for tearing and are vital in balancing the bite and protecting the molars from lateral fracture. The bicuspids and molars have specific roles in mastication of food and jaw stabilization. Malalignment or crookedness of teeth compromises the function of the entire mouth by forfeiting their role. When just one key tooth is non-functioning, the rest of the dentition must react to compensate. This creates unnatural and harmful stresses and forces on the other teeth and the jaw joint. Malaligned and particularly crowded teeth are also more difficult to clean. This increases the likelihood of getting gum disease called gingivitis or possibly a worse condition affecting the deeper supporting structures of the teeth called periodontitis. Along with these two health risks malaligned teeth are also contributors to eating and speaking problems, especially in children.

For some strange reason, in some children teeth may erupt in a manner in which they come out crooked, crowded and malaligned. In addition to the natural way in which the teeth erupt, there are other habits that increase the risk of developing malaligned teeth later on. Some children are more prone to these than others. It is now known that things such as thumb sucking, lip biting, tongue thrusting, unusual biting patterns and mouth breathing do play a part in the development of crooked or malaligned teeth. The ultimate end result may be a set of grotesquely unattractive set of teeth. Some children have crowded or crooked teeth. In others the upper front teeth can stick out and look unsightly. These ‘prominent’ teeth are also more likely to be damaged. In others, the way the upper and lower jaws meet can cause teeth to look unsightly and lead to an incorrect bite. When the teeth do not meet correctly, this can put some strain on the muscles of the jaw leading to jaw and joint problems as well

One way of getting crooked or malaligned teeth attended to is by orthodontic treatment with braces and retainers. The word orthodontics has been derived from the Greek words orthos meaning straight or proper and odons meaning tooth. Orthodontic treatment works by exerting gentle pressure over time to straighten teeth that are growing, or have already grown and, are out of place. This type of treatment could be used for malocclusion of teeth, malalignment of teeth or for poor appearance of teeth. During the preteen and teenage years, the jaws are growing and maturing and it is easier to shift teeth at this stage rather than later on in adult life. Teeth can slowly be moved and shifted into proper position by applying pressure in certain directions. Bands, wires and elastics are placed on the teeth to move them in the right direction. This takes place slowly and carefully over an extended period of time. Irregular, crowded and malaligned teeth can be beautifully sorted out by orthodontic treatment. It may be necessary to extract some crowded teeth but some forms of orthodontic therapy attempts to retain teeth as much as possible. The ultimate end result of proper orthodontic treatment is often quite astounding.

Dental impressions are taken before braces are put in place. A gummy paste is placed in the mouth to get an impression of the teeth and gums. From these impressions, models of the teeth are made. Following this, the dental surgeon would make a decision about how exactly the orthodontic procedure is to be carried out. It depends on whether the patient is in phase one or two of the treatment. Sometimes treatment only has one phase; other times there are two. When this happens, it’s usually because there is a problem with the bite that needs to be fixed before the teeth can be aligned.

The standard braces have three basic components. These are :-

1) Brackets, which are attached to each tooth

2) Bonding or band, which is the material that attaches the bracket to the tooth

3) Arch Wire, which is a thin metal wire that runs from bracket to bracket

Braces have come a long way from the "train track" look of years ago. Today, many orthodontic patients can even get braces that attach to the backs of the teeth or they could use transparent brackets. Braces are well known in children and teenagers for correcting malaligned teeth. For many children there is no stigma attached to the medical necessity of wearing permanently fitted braces long term. The opposite is the case and they wear them with confidence and pride. Sometimes braces can be a status symbol of sorts for quite a few youngsters.

The most commonly used brackets are made of metal. The newer composite brackets are very appealing to the eye but these could undergo some discolouration. They are not as robust as the metal brackets and are therefore strengthened with metal, which subsequently reduces their aesthetic quality. There is however the latest option of ceramic brackets which are almost as strong as those made entirely of metal. These ceramic brackets are practically invisible and look as though they were a part of the tooth. Ceramic brackets do not undergo discolouration. They are almost invisible and the natural tooth colour shines through the brackets. The arch wires and ligatures which connect the arch to the bracket are also tooth coloured and barely visible. This is a well proven and assured method of correcting malaligneed teeth without the aesthetical disadvantages. Ceramic brackets are outstandingly biocompatible with no risk of allergies. The exceptionally smooth surface and slightly rounded edges make the brackets so much more comfortable to wear. When braces are placed on teeth, it is important to instruct the child to brush well around the braces as it is vital to maintain proper oral hygiene. Perfect oral hygiene is essential during any type of orthodontic treatment. It is crucial to understand that teeth can pulled into a perfect smile but they cannot be prevented from decaying unless they are taken care off.

Retainers are often used, after the braces have finally been removed, to hold the teeth in their new position until they are stable. A retainer is a custom-made, removable appliance that helps to keep teeth in their new straightened position after braces have been removed. They hold the teeth in the corrected position while the surrounding bone reforms around them. Retainers are generally worn full-time for a short period, perhaps 6 months to a year and then worn periodically, especially at night, for as long as the orthodontist recommends. It is possible for the teeth to stay aligned without regular retainer wear but there are many reasons teeth will crowd as a person ages. Thus there is no guarantee that teeth, orthodontically treated or otherwise, will stay aligned without retention. For this reason, many orthodontists recommend periodic retainer wear for many years or indefinitely after orthodontic treatment.Retainers can also be used by themselves to treat more minor orthodontic problems. Shifting teeth back into a functional position can take months to years, but eventually the child or teenager will be repaid by the cosmetic end result. It is important to wear the braces or an appliance for however long it takes. If one quits at any point during treatment, the teeth can shift back into their old position.

The desire to get malaligned teeth or teeth with malocclusion corrected depends on several factors. Some parents and even children may choose to disregard the dental problems and elect to live with the deformed teeth. Others may believe that what Mother Nature has provided should not be tampered with. In some societies, cultural taboos would be an impediment to orthodontic therapy. It must be documented that orthodontic treatment is now available both in the public as well as the private sector in Sri Lanka.