BRACES...ENCYCLOPEDIA!!

History

In 500-300 BC, Ancient Greek scholars Hippocrates and Aristotle both ruminated about ways to straighten teeth and fix various dental conditions.^[1]
Historians believe that two different men deserve the title of being called "the Father of Orthodontics." One man was Norman W. Kingsley, a dentist, writer, artist, and sculptor, who wrote his "Treatise on Oral Deformities" in 1880. Kingsley's writings influenced dental science greatly. Kingsley lived from 1829–1913 and lived in Warren Point, New Jersey. He was a founder of New York State Dental Society in 1868. Also deserving credit is dentist J. N. Farrar, who wrote two volumes entitled "A treatise on the Irregularities of the teeth and their corrections". Farrar was very good at designing brace appliances, and he was the first to suggest the use of mild force at timed intervals to move teeth.
The American dentist Edward Angle is also widely regarded as a father of modern orthodontics. Practising in the late nineteenth and early twentieth centuries, his eponymous classification of dental arch relationships is used worldwide. His textbook, "Treatment of Malocclusion of the Teeth" was first published in 1907. It went into seven much revised editions and laid the foundation of the modern specialty. After tenure as professor of orthodontics in two medical schools, he went on to found the School of Orthodontia in 1910. He designed several fixed orthodontic appliance systems including the ribbon arch and then the edgewise appliance. These have evolved into the sophisticated pre-adjusted and self-ligating systems used by the great majority of orthodontists today.

[edit] How braces work

Teeth move through the use of pressure. The pressure applied by the archwire pushes the tooth in a particular direction and a stress is created within the periodontal ligament. The modification of the periodontal blood supply^[2] determines a biological response which leads to bone remodeling, where bone is created on one side of the tooth by osteoblast cells and resorbed on the other side of the tooth by osteoclasts.
Two different kinds of bone resorption are possible. Direct resorption, starting from the lining cells of the alveolar bone, and indirect or retrograde resorption, where osteoclasts start their activity in the neighbour bone marrow. Indirect resorption takes place when the periodontal ligament has become subjected to an excessive amount and duration of compressive stress. In this case the quantity of bone resorbed is larger than the quantity of newly formed bone (negative balance). Bone resorption only occurs in the compressed periodontal ligament. Another important phenomenon associated with tooth movement is bone deposition. Bone deposition occurs in the distracted periodontal ligament. Without bone deposition, the tooth will loosen and voids will occur distal to the direction of tooth movement.
A tooth will usually move about a millimeter per month during orthodontic movement, but there is high individual variability. Orthodontic mechanics can vary in efficiency, which partly explains the wide range of response to orthodontic treatment.

[edit] Types of braces

Modern orthodontists can offer many types and varieties of braces:

• Traditional braces are stainless steel, sometimes in combination with nickel titanium, and are the most widely used. These include conventional braces, which require ties to hold the archwire in place, and newer self-tying (or self-ligating) brackets. Self-ligating brackets may reduce friction between the wire and the slot of the bracket, which in turn might be of therapeutic benefit.^[3]
• "Clear" braces serve as a cosmetic alternative to traditional metal braces by blending in more with the natural color of the teeth or having a less conspicuous or hidden appearance. Typically, these brackets are made of ceramic or plastic materials and function in a similar manner to traditional metal brackets. Clear elastic ties and white metal ties are available to be used with these clear braces to help keep the appliances less conspicuous. Clear braces have a higher component of friction and tend to be more brittle than metal braces. This can make removing the appliances at the end of treatment more difficult and time consuming.^{[citation needed]}
• Gold-plated stainless steel braces are often employed for patients allergic to nickel (a basic and important component of stainless steel), but may also be chosen because some people simply prefer the look of gold over the traditional silver-colored braces.
• Lingual braces (Incognito Braces) are custom made fixed braces bonded to the back of the teeth making them invisible to other people. In lingual braces the brackets are cemented onto the backside of the teeth making them invisible while in standard braces the brackets are cemented onto the front side of the teeth. Hence, lingual braces are a cosmetic alternative to those who do not wish to have the unaesthetic metal look but wish to improve their smile.
• Progressive, clear removable aligners (examples of which are Invisalign , Originator, ClearCorrect) may be used to gradually move teeth into their final positions. Aligners are generally not used for complex orthodontic cases, such as when extractions, jaw surgery, or palate expansion are necessary.
• For less difficult cases spring aligners are also an option that can cost much less than braces or Invisalign (one example is NightShiftOrtho) and still align primarily the front six top and bottom teeth.
• A new concept under development is the "smart bracket." The smart bracket contains a microchip capable of measuring the forces applied to the bracket/tooth interface. The goal of this successfully demonstrated concept ^[4] is to significantly reduce the duration of orthodontic therapy and to set the applied forces in non-harmful, optimal ranges.

• A-braces ^[5] are another new concept in dental appliances. In the shape of a capital letter A, A-braces are applied, adjusted, removed and completely controlled by the user. At the ends of the A's arms are angled knobbed bits that the user bites down over. The width between the bits is adjusted by turning the crossbar, housed across the arms. A user never has to experience pain because the pressure is so easy to control. A-braces may serve as self-adjustable retainers and palate expanders.^{[citation needed]}

[edit] Procedure

A patient's teeth are prepared for application of braces.

Orthodontic services may be provided by any licensed dentist trained in orthodontics. In North America most orthodontic treatment is done by orthodontists, dentists in diagnosis and treatment of malocclusions—malalignments of the teeth, jaws, or both. A dentist must complete 2–3 years of additional post-doctoral training to earn a specialty certificate in orthodontics. There are many general practitioners who also provide orthodontic services.
The first step is to determine whether braces are suitable for the patient. The doctor consults with the patient and inspects the teeth visually. If braces are appropriate, a records appointment is set up where X-rays, molds, and impressions are made. These records are analyzed to determine the problems and proper course of action. Typical treatment times vary from six months to two and a half years depending on the complexity and types of problems. Orthognathic surgery may be required in extreme cases. About 2 weeks before the braces are applied brackets are required to spread apart back teeth in order confirm enough space for the bands.
Teeth to be braced will have an adhesive applied to help the cement bond to the surface of the tooth. In most cases the teeth will be banded and then brackets will be added. A bracket will be applied with dental cement, and then cured with light until hardened. This process usually takes a few seconds per tooth. If required, orthodontic spacers may be inserted between the molars to make room for molar bands to be placed at a later date. Molar bands are required to ensure brackets will stick. Bands are also utilized when dental fillings or other dental work make securing a bracket to a tooth infeasible.
An archwire will be threaded between the brackets and affixed with elastic or metal ligatures. Elastics are available in a wide variety of colors. Archwires are bent, shaped, and tightened frequently to achieve the desired results. Brackets with hooks can be placed, or hooks can be created and affixed to the archwire to affix the elastic to. The placement and configuration of the elastics will depend on the course of treatment and the individual patient. Elastics are made in different diameters, colors, sizes, and strengths.
Modern orthodontics makes frequent use of nickel-titanium archwires and temperature-sensitive materials. When cold, the archwire is limp and flexible, easily threaded between brackets of any configuration. Once heated to body temperature, the archwire will stiffen and seek to retain its shape, creating constant light force on the teeth.

Dental braces, with a transparent powerchain, removed after completion of treatment.

In many cases there is insufficient space in the mouth for all the teeth to fit properly. There are two main procedures to make room in these cases. One is extraction: teeth are removed to create more space. The second is expansion: the palate or arch is made larger by using a palatal expander. Expanders can be used with both children and adults. Since the bones of adults are already fused, expanding the palate is not possible without surgery to unfuse them. An expander can be used on an adult without surgery, but to expand the dental arch, and not the palate.
Each month or two, the braces must be adjusted. This helps shift the teeth into the correct position. When they get adjusted the orthodontist takes off the colored rubber bands keeping the wire in place. The wire is then taken out, and may be replaced or modified. When the wire has been placed back into the mouth, the patient may choose a color for the new rubber bands, which are then fixed to the metal brackets. The adjusting process may cause some discomfort, which is normal.

[edit] Post-treatment

In order to avoid the teeth moving back to their original position, retainers may be worn once the treatment with braces is complete.
Patients may need post-orthodontic surgery, such as a fiberotomy or alternatively a gum lift, to prepare their teeth for retainer use and improve the gumline contours after the braces come off.

[edit] Retainers

Main article: Retainer (orthodontic device)

Retainers are required to be worn once treatment with braces is complete. The orthodontist will recommend a retainer based on the patient's needs. If a patient does not wear the retainer as recommended, the teeth will move towards their original position (relapse).
A Hawley retainer is made of metal hooks that surround the teeth and are enclosed by an acrylic plate shaped to fit the patient's palate. An Essix retainer is similar to an Invisalign tray. It is a clear plastic tray form-fitted to the teeth and stays in place by suction. A bonded retainer is a wire permanently bonded to the lingual side of the teeth (usually the lower teeth only).

[edit] Pre-Finisher

If a person's teeth are not ready for a proper retainer, the orthodontist may prescribe the use of a pre-formed finishing appliance such as the Pre-Finisher (registered trademark of TP Orthodontics, Inc). This appliance (similar to a mouth guard) fixes gaps between the teeth, small spaces between the upper and lower jaw, and other minor problems that could worsen. These problems are small matters that dental braces cannot fix.
The Pre-Finisher is molded to the patient's teeth by use of severe pressure to the appliance by the person's jaw. The appliance is then worn for the prescribed time, with the user applying force to the appliance in their mouth for ten to fifteen seconds at a time. The goal is increasing the "exercise" time, time spent applying force to the appliance. Like the retainer, the Pre-Finisher is not a permanent addition to one's mouth, and can be moved in and out of the mouth.

[edit] Surgery

Example of prognathism, where teeth have almost reached their final, straight position by braces. This makes the prognathism more obvious, and it will take a surgery, moving the jaw backwards, to give the ultimate result.

See also: Orthognathic surgery

[edit] Complications and risks

Plaque forms easily when food is retained in and around braces. It is important to maintain proper oral hygiene by brushing and flossing thoroughly when wearing braces to prevent tooth decay, decalcification, or unpleasant color changes to the teeth.
There is a small chance of allergic reaction to the elastics or to the metal used in braces. In even rarer cases, latex allergy may result in anaphylaxis. Latex-free elastics and alternative metals can be used instead. It is important for those who believe that they are allergic to their braces to notify the orthodontist immediately.
Mouth sores may be triggered by irritation from components of the braces. Many products can increase comfort, including oral rinses, dental wax or dental silicone, and products to help heal sores.
Braces can also be damaged if proper care is not taken. It is important to wear a mouth guard to prevent breakage and/or mouth injury when playing sports. Certain sticky or hard foods such as taffy, raw carrots, hard pretzels, and toffee should be avoided because they can damage braces. Frequent damage to braces can prolong treatment. Some orthodontists recommend sugar-free chewing gum in the belief that it may expedite treatment and relieve soreness; other orthodontists object to gum chewing because it is sticky and may therefore damage the braces.
In the course of treatment orthodontic brackets may pop off due to the forces involved, or due to cement weakening over time. The orthodontist should be contacted immediately for advice if this occurs. In most cases the bracket is replaced.
When teeth move, the end of the arch wire may become displaced, causing it to poke the back of the patient's cheek. Dental wax can be applied to cushion the protruding wire. The orthodontist must be called immediately to have it clipped, or a painful mouth ulcer may form. If the wire is causing severe pain, it may be necessary to carefully bend the edge of the wire in with a spoon or other piece of equipment (e.g. tweezers) until the wire can be clipped by an orthodontist.
Patients with periodontal disease usually must obtain periodontal treatment before getting braces. A deep cleaning is performed, and further treatment may be required before beginning orthodontic treatment. Bone loss due to periodontal disease may lead to tooth loss during treatment.
In some cases, teeth may be loose for a prolonged period of time. One may be able to wiggle one's teeth for a year or two after treatment or longer.
The dental displacement obtained with the orthodontic appliance determines in most cases some degree of root resorption. Only in a few cases is this side effect large enough to be considered real clinical damage to the tooth. In rare cases, the teeth may fall out or have to be extracted due to root resorption.^[6][7]
Pain and discomfort are common after adjustment and may cause difficulty eating for a time, often a couple days. During this period, eating soft foods can help avoid additional pressure on teeth.
Removal of the cemented brackets can also be painful. The cement must be chipped and scraped off which can cause severe pain in patients with sensitive teeth. Often molar bands have been installed for an extended period of time and they may be embedded in the gums at the time of removal.
The metallic look may not be desirable to some people, although transparent varieties are available. According to a survey published in the American Journal of Orthodontics and Dentofacial Orthopedics, dental braces with no visible metal were considered the most attractive. Braces that combine clear ceramic brackets with thin metal or clear wires were a less desirable option, and braces with metal brackets and metal wires were rated as the least aesthetic combination.^[8]

[edit] Treatment time and cost

Typical treatment time is from six months to six years, depending on the severity of the case, location, age, etc., although research has shown that the average duration is 1 year and 4 months).^{[citation needed]} Treatment can be accelerated using novel planning, unorthodox treatment goals^{[citation needed]} and positioning techniques.
The typical cost of braces ranges widely in various regions. The cost depends on whether both arches are being treated and the length of treatment. Typical orthodontic treatment comprises metal braces on both arches for 12 to 24 months. The 2007 orthodontic practice study done by the Journal of Clinical Orthodontics showed the United States national average cost of braces for comprehensive orthodontic treatment to be $2,000 for children and $5,354 for adults.^{[citation needed]} Some cases in the United Kingdom cost £3,500, although they can much of the time be provided free on the NHS, providing the patient is under 18, a student up to 19, a pregnant woman, a nursing mother or living on a low income.^[9]
In some European countries (e.g. Norway, Finland, Sweden, Slovenia, Slovakia, Germany, Croatia or Denmark) orthodontic treatment is available without charge to patients under 18 (or for treatment to start at 16, such as Republic of Ireland and the UK) as benefits for orthodontic treatment are provided under government-run health care systems. However, in the UK, the National Health Service will not pay for braces if the teeth do not a have protrusion of over 5mm; if there is not a protrusion, it is classed as cosmetic. In some countries (e.g. Ireland), adults can also get treatment at a discounted rate, or claim tax relief after paying a full cost with a private practitioner.
In India this treatment can cost anywhere between INR 10000 to INR 80000. The cost also depends on the type of braces, the type of city the patient is in and on the orthodontist's skill and experience.

References

1. ^ History of Dentistry Ancient Origins
2. ^ Ren Y, Maltha JC, Stokroos I, Liem RS, Kuijpers-Jagtman AM (May 2008). "Effect of duration of force application on blood vessels in young and adult rats". Am J Orthod Dentofacial Orthop 133 (5): 752–7. doi:10.1016/j.ajodo.2007.10.030. PMID 18456151. 
3. ^ Henao SP, Kusy RP (Apr 2004). "Evaluation of the frictional resistance of conventional and self-ligating bracket designs using standardized archwires and dental typodonts". Angle Orthod 74 (2): 202–11. PMID 15132446. http://journals.allenpress.com/jrnlserv/?request=get-abstract&issn=0003-3219&volume=74&page=202. 
4. ^ Bartholomeyczik J, Haefner J, Joos J, Schubert F, Ruther P, Paul O, Lapatki B (Oct-Nov 2005). "Novel concept for the multidimensional measurement of forces and torques in orthodontic smart brackets". Sensors, 2005 IEEE (Piscataway, NJ: IEEE): 4. doi:10.1109/ICSENS.2005.1597873. ISBN 0-7803-9056-3. http://ieeexplore.ieee.org/xpl/freeabs_all.jsp?arnumber=1597873. 
5. ^ World Intellectual Property Organization. WO/2008/092260. http://www.wipo.int/pctdb/en/wo.jsp?WO=2008092260&IA=CA2008000196&DISPLAY=DOCS. 
6. ^ Artun J, Smale I, Behbehani F, Doppel D, Van't Hof M, Kuijpers-Jagtman AM (Nov 2005). "Apical root resorption six and 12 months after initiation of fixed orthodontic appliance therapy". Angle Orthod 75 (6): 919–26. PMID 16448232. http://journals.allenpress.com/jrnlserv/?request=get-abstract&issn=0003-3219&volume=75&page=919. 
7. ^ Mavragani M, Vergari A, Selliseth NJ, Bøe OE, Wisth PL (Dec 2000). "A radiographic comparison of apical root resorption after orthodontic treatment with a standard edgewise and a straight-wire edgewise technique". Eur J Orthod 22 (6): 665–74. doi:10.1093/ejo/22.6.665. PMID 11212602. http://ejo.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=11212602. 
8. ^ Survey: Most Effective Dental Braces Are Least Attractive Newswise, Retrieved on July 9, 2008.
9. ^ Orthodontic treatment (braces)

Braces are Coming Off, but Teeth are Still Crooked?

Typically, braces must be worn from anywhere between 12 and 24 months. Depending on the kinds of orthodontist problem you have, your dentist will set an estimated time frame by which time your teeth should have straightened. However, if your braces are to be removed soon, but your teeth still don’t look as straight as you would like them to be, it’s a good idea to raise your doubts with your orthodontist.

It’s also very important to remember that your orthodontist is a specialist with several years of straitening teeth behind him. He most likely knows what he is doing, and if he has decided that now is the time for you to have your braces off, then he’s most probably right. It’s also possible that you’re noticing flaws in your teeth that aren’t really there. Sometimes, it’s natural to be overly critical of the end result, and see issues or flaws that are not visible to others. It takes some time to get used to seeing your teeth without braces after months of barely being able to see them.

Most of the time, an orthodontist will prescribe a retainer to be worn for several weeks after the braces come off. These retainers must be worn exactly as your orthodontist recommends. Many people fail to wear these retainers after the braces come off because of negligence or laziness. They may soon find that their teeth, that had moved to the right position, are now slowly going back to their former crooked appearance. Retainers are meant to hold the teeth in their desired place, so that the effects of the orthodontic treatment permanent.

If you don’t wear your retainers even for a couple of weeks after you get your braces removed, then you will begin to see your teeth becoming crooked again. In rare cases, it may be possible that you need to wear braces for a little while longer, so if you have doubts about your teeth looking crooked, inform your dentist, so he can see if the braces need to be left on for a few more days.

Retainers What are the types of retainers?

Retainers

What are the types of retainers?

To retain means to keep in place; therefore, an orthodontic retainer is used to keep your teeth in their new positions after your braces come off. Most orthodontists use one of these three types of retainers:

A clear plastic retainer (also called an Essix Retainer) is sometimes  placed on the upper teeth one or two days after the braces are removed. It resembles the Invisalign appliance. It is normally worn only at night and lasts an average of 24 months. After it wears out the orthodontist may replace it with a traditional wire retainer. Some people have commented that this type of retainer can be uncomfortable.

A bonded retainer  is normally placed behind the lower teeth after the braces are removed. It is a wire "permanently" bonded to the teeth with composite material. Sometimes this type of retainer is used for the upper teeth, but usually this is not possible because it would interfere with your bite. A bonded retainer will remain in place for several years. 

A wire retainer (also called a Hawley Retainer) is normally placed after discontinuing use of either the clear retainer or bonded retainer. This type of retainer has the added benefit of being adjustable so that minor tooth movement is possible. Sometimes a wire retainer can be worn full time instead of braces to correct mild crowding. As you can see, the plastic part of the retainer can be made in a variety of colors and patterns.

photos from http://www.smileofyourlife.com/retainers.htm

Do I have to wear a retainer after my braces come off?

The short answer is: YES, absolutely!
The long answer is: It takes many months for your periodontal ligaments and bone to "remember" the new position of your teeth and keep them in place. The retainer helps keep them in their proper new positions. It's important to wear the retainer exactly as your dentist/orthodontist recommends. Otherwise, your teeth may shift, especially if you stop wearing your retainer in the first two years after your braces come off.
Most people wear their retainer 24/7 for at least 6 months to a year after the braces first come off. Of course, you must take your retainer out to eat or to to brush your teeth. Be sure to carry a retainer case with you to store your retainer when it is not in your mouth. Keep a few handy -- in your car, your purse, at work, etc. Many retainers have been lost in napkins at restaurants or school and thrown in the trash. A new retainer can cost as much as $300! There are also special "Retainer Maintainer" plastic bags with a "don't throw this out" symbol to use in a pinch. These are easy to stuff in your pocket, purse, or backpack "just in case."
After the initial period is over, your orthodontist will probably tell you that you can switch to wearing your retainer only at night. Be sure to wear it EVERY night for at least 4 to 6 additional months. After that, if everything seems stable, you can probably switch to wearing it only several nights per week (always be sure to ask your orthodontist what he or she recommends).
If you totally stop wearing your retainer, even after a few years, your teeth may begin to move and shift. This is especially true if you have tongue thrust issues or have had extractions. Unless you want crooked teeth again, or want to go back into braces, wear your retainer regularly for the rest of your life -- at least a couple of nights each week! This isn't as bad as it sounds. It just becomes part of your life -- another way to ensure that your smile stays beautiful and healthy!
If your retainer breaks, call your orthodontist immediately to have another one made. If you can't afford a new one, discuss this with your orthodontist and try to set up a payment plan or work out a financial arrangement.

How do I keep my retainer clean?

You should clean your retainer each night as directed by your orthodontist. If you are wearing your retainer around the clock, rinse it with warm water after taking it out of your mouth, and also before putting it back in later! This will help prevent bacterial buildup.

You can brush a Hawley retainer with a toothbrush and a tiny bit of toothpaste, but that is not recommended for a clear Essix retainer, as it can get scratched. Brushing also gets tiresome after a while. The most convenient way to keep your retainer clean is to use a product made for this purpose, or to use denture cleaner.

Several great specialty products are available to help keep your retainers clean and free of odor. Four such products are SonicBrite, Retainer Brite, DentaSoak, and Cleanse.Freshen.Go. They work great on all types of retainers and even clear Invisalign -type aligners. SonicBrite includes a portable sonic cleaner. Retainer Brite is a tablet which can be used with or without a sonic cleaner (sold separately). In both these products, the sonic cleaner helps the product to reach all the little crevices in your retainer, cleaning out all the bacteria and dissolving all of the white buildup.

Day-to-day Living with Braces and Orthodontics

Day-to-day Living with Braces and Orthodontics

What is an adjustment and how is it done?

In a nutshell, the elastic ligatures are changed, and sometimes the arch wire is also changed. For a detailed description of the procedure, read About Tightening/ Adjustment.

I seem to be drooling more, now that I have braces. Why?

Excess saliva (drool) is actually very common. Apparently your mouth mistakes the feeling of the brackets on the inside of your cheeks for food, and sometimes produces extra saliva to help digest it. 

Suddenly I've developed gaps between teeth which never had gaps before. Should I be worried?

It is very common for your teeth shift and develop gaps while treatment is underway. Your bite will change many times during your treatment. Remember than any strange gaps or bite problems will be resolved by the time your treatment is finished. If you are really concerned, mention it to your orthodontist.

Do I really need to brush my teeth after every meal when I'm wearing braces? What a pain!

Yes and no. Yes, you should, because depending on what you eat, food gets stuck in and around the brackets. Besides looking gross, it causes tooth decay and bad breath. It also feels yucky. Some people can't stand the feeling of food stuck in their brackets. You wouldn't believe how much food can get stuck -- often more than you'd imagine!

However, if you let the brushing slide every so often, it's not the end of the world. Just try to be as diligent as possible on a regular basis. At the very least, swish your mouth with water and try to pick out any food that is stuck in your brackets. It's also a good idea to floss each night, or at least a few times per week. Sometimes food gets stuck between teeth and you don't realize it until you floss it out.

Some dentists also recommend a fluoride mouth rinse, such as ACT, which is available in most supermarkets and pharmacies, and comes in many flavors (including bubblegum and mint).

My teeth really hurt! What can I do to ease the pain?

In the first weeks after you get your braces on, your mouth will be sore and your teeth will hurt. Most people take ibuprofen (Motrin/Advil) or acetaminophen (Tylenol) to help ease the pain. Cold drinks or cold foods (such as frozen yogurt, milkshakes, ice cream, or just plain ice water) may also help.

What can I eat? Should I really avoid the foods on my orthodontist's "don't eat" list?

It is best to eat only soft foods that are easy to chew. Do not take big mouthfuls. Chew carefully and slowly so that you don't gag or choke. Avoid stringy foods like melted cheese that forms big strings, and long stringy pasta -- they will get stuck in your brackets and may cause you to gag. Cut your food into small pieces. No biting into large sandwiches -- use a knife and fork until you get the hang of wearing braces! I ate hamburgers with a knife and fork the entire 3 years I was in braces!

Read our pages of Soft Food Suggestions to get some insight on what types of foods you can manage. This stage will probably only last for a few weeks, until you get used to your braces and your gums "toughen up."

Your orthodontist may have given you a list of foods that should be avoided. These include gummy sticky foods (like Gummy Bears), and very hard foods (like nuts or hard chips). But it can also include things like ice cream and popcorn. Why? Because many flavors of ice cream can include hard chunks. The unpopped shell of popcorn can get stuck in your brackets. Biting into any hard food might cause your brackets to break or your wires to bend, so you must be careful.

Will my brackets pop off?

Sometimes a bracket will spontaneously pop off. There are a number of reasons this can happen. Remember that your brackets are glued on, so if the glue bond is broken, the bracket will come off. If this happens to you, call your orthodontist immediately to get it re-glued. It is normal for a bracket to pop off occasionally. But if a bunch of brackets keep popping off by no fault of your own, speak to your orthodontist about it. Gluing on brackets can be tricky and it may take a few tries to get it exactly right.

I don't want to wear my headgear during the day. Why can't I wear my it only at night?

Nobody likes to wear headgear, but it serves a specific purpose in your treatment. If you don't wear it as many hours as your dentist recommends, your treatment won't progress as fast, and you might wind up wearing the headgear additional months. It's best to just go along with what your dentist recommends and get it over with sooner.  Read A Few Words About Headgear for more information.

Why do I need to wear elastics?

Elastics help fine-tune the alignment of your teeth and your bite. There are many different ways that you can wear elastics for specific reasons.  You should wear the elastics the number of hours that your dentist recommends to help your treatment progress properly. (Wearing them "double time" or "double strength" to make up for time you spent without them is NOT advisable -- that could harm your teeth). Most people take elastics out before a meal, brush, then replace them after a meal.

How can I cope with canker sores when I have braces?

There are many ways to cope with canker sores. If the sore is near a bracket, you  can put some dental wax or dental silicone on the bracket to create a barrier, then apply some canker sore medication to the sore area. For more detailed information, read Ouch! I Have a Canker Sore!

Do ceramic (non-metal) braces stain?

The brackets themselves usually do not stain. It's the elastic ligatures that hold the arch wire to the bracket that stains. These are changed at each adjustment, when you get fresh clean ones. So, if your ligatures or power chains stain, you'll only have to live with it for a short time.

What foods stain the ligatures of your braces the worst?

Foods like curry, mustard, black coffee, and red wine create the worst stains. For more details, read Help! Did I Stain My Braces?

What colors of ligatures or power chains resist stains the best?

Clear or white ligatures show yellow stains the worst. The best colors, according to ArchWired readers (and my own personal experience) are: smoke, pearlescent, glow-in-the-dark, and any dark vibrant colors. I have also worn light blue, which turn a pleasant teal color when stained by curry (i.e., blue ligatures plus yellow curry make greenish blue ligatures).

Can I change my elastic ligatures ("o rings") myself at home?

Unless your orthodontist has given you the go-ahead to do this, it is NOT recommended! Yes, there are places on the web where you can buy elastic ligatures and power chains, but even THEY do not recommend that you change them yourself at home. The reason is: putting extra pressure on your teeth at inappropriate intervals can interfere with your treatment. Read Changing Your Own Ligatures for more information on why it is a bad idea to change your own ligatures.

Can I smoke cigarettes, cigars, or pipes with braces on my teeth?

Yes, you can smoke or chew tobacco, but both of these habits will stain your ligatures and may possibly stain ceramic brackets.

Is it OK to have braces if you are pregnant, or plan to become pregnant?

Yes, many pregnant women have had orthodontic treatment. Your teeth may be a bit looser than average because of the hormonal changes and the effect on your periodontal ligaments. But as long as you maintain good periodontal health, it shouldn't be a problem to wear braces if you're pregnant. For a reader's perspective on the subject, read Braces and Pregnancy.

Can you wear braces if you snorkel or scuba dive?

Yes, you can. It's probably best to have the braces on for a few months before snorkeling or scuba diving, so you can get used to the extra hardware in your mouth. For a reader's perspective on the subject, read Braces and Snorkeling/Scuba.

Can you wear braces if you play a wind instrument?

Yes, you can. Several companies make mouth guards and lip protectors specifically for this purpose. Ask your orthodontist for one that he/she recommends. Some orthodontists can make a custom lip guard for you.

How can I keep my braces clean after eating at a restaurant or traveling?

Most people who have braces carry a little dental kit to help them in such situations. A dental kit should contain a dental pick, some floss and floss threaders, a toothbrush, and some toothpaste. A travel cup is also a good idea. All these items are compactly offered in a product called DentaKit Braces Survival Kit.

A wire at the end of my braces is poking my cheek. What should I do?

This is always an annoying and tricky situation. If possible, gob a bunch of dental wax at the end of the wire to stop it from poking you. You can also try a bit of cotton. Call your dentist or orthodontist and ask to come in ASAP so they can clip the wire. Please don't suffer needlessly with a poking wire. After a day or two it can really painfully tear up the inside of your cheek, so don't wait to get it clipped! Some orthodontists let you come in "as needed" for a clipping without an appointment.

By the way, the wire pokes you because your teeth have moved, displacing the end of the arch wire. Although this is annoying, it's a good sign that your treatment is progressing!

What about braces and sports?

Depending on the sport, it is probably a good idea to wear some sort of lip protector or mouth guard so the braces don't cut up the insides of your mouth (and also to protect your teeth and braces). Light contact sports will be made safer with a simple lip protector. Many heavy contact sports require a larger mouth guard. If you are not sure what is appropriate for you, ask your orthodontist. Sometimes, orthodontists make custom-fitted mouth guards and lip protectors.

How often should I get my teeth cleaned when I have braces?

Most dentists recommend that people get their teeth cleaned twice per year. For people with braces, this is especially important. Even if you brush and floss very well, a professional cleaning will ensure that you don't develop decay. When you have braces, you should consider getting one or two extra cleanings per year. They do not take off your arch wires or brackets to do a cleaning. They usually work around your braces, or use a device called a Cavitron, which is like a high-powered Waterpik.

Keeping Your Braces Clean and Comfortable

Keeping Your Braces Clean and Comfortable

Do I need to use a special toothbrush or other gadgets when I have braces?

Yes and no. You  can use a regular soft toothbrush, but most orthodontists recommend an orthodontic-cut toothbrush, where the bristles in the middle are lower than the bristles on the edges and cut into a "v" shape. You can also use any electric toothbrush, such as a Sonicare or Oral-B Braun. These do an especially good job of cleaning your teeth.

To floss your teeth, you don't necessarily need special floss. You can use any type of floss with a plastic threader needle such as BridgeAid. The plastic threader helps you bring the floss under the arch wire for each bracket.

To make things easier, there are also several types of "threader floss" which is a length of floss that has a built-in stiff threader end. Some popular brands of threader floss are Thornton 3-in-1 Floss, SuperFloss, Crest Glide Threader Floss, and SturdyFloss which was created by a dental hygienist. An enterprising orthodontic patient even invented a tool he calls "FlossFish" to help you floss under your brackets with any type of regular dental floss. Many of these flossing tools can be found at DentaKit.com or many online drugstores.

You might also want to get a small spiral dental brush (sometimes called an "interproximal brush" or a "proxi-brush") or a rubber-tipped stimulator to help clean food debris out from between the brackets before you brush. A WaterPik or a device like Oral Breeze's QuickBreeze (which attaches to your sink faucet) or ShowerPik (which attaches in your shower) are also helpful.

And finally, you will need some dental wax, because inevitably, the brackets will irritate the insides of your cheeks at first and you will want some relief from the irritation.

Why do you need to use wax when you have braces?

Wax helps to create a barrier between the bracket and the inside of your cheeks and lips. It helps prevent the bracket from irritating your cheeks or gums. At first you will probably use a lot of dental wax, but as your get used to your braces and the insides of your cheeks "toughen up" you may wind up using less.

How do you use orthodontic dental wax on your braces?

To use dental wax, break off a tiny bit of wax from the container, smoosh it with your fingers a bit to mold it, then place it directly on the bracket that is causing the irritation, as shown in this photo. Dental wax is non-toxic, so it's ok if you swallow it. Wax tends to break down over time, so you'll probably have to apply more after eating a meal. Take off the wax before you brush your teeth, or it will gunk up your toothbrush.

Dental silicone, such as Ortho-Sil is a little different. It lasts longer than regular dental wax. Your brackets must be extremely dry when you apply dental silicone, or it will not stick to them. Some people love dental silicone and some prefer regular wax. If you have never used OrthoSil, ask your orthodontist for a small packet, or buy just one container to try before buying a large quantity.

Usually your dentist/orthodontist gives you some dental wax after you get your braces put on. Most pharmacies (both online and local) carry dental wax. DentaKit.com also carries silicone dental wax, as well as several types of lip protectors which are alternatives to wax.

What else can you use to ease irritations inside your mouth in the first weeks of braces?

A warm salt water rinse, several times per day, can be very soothing. But if that isn't enough, try a mouth rinse called Rincinol PRN, which helps to heal mouth sores. You can find this product at many stores online, or at your local drugstore or pharmacy. You may also want to read our page of suggestions about canker sore remedies, which contains many suggestions.

How do you brush your teeth with braces on?

First, rinse with warm water a couple of times to dislodge any food particles. You can also use a rubber-tipped gum massager to dislodge any particularly stubborn particles that are badly stuck in your brackets. Now you can use a small amount of toothpaste and brush your teeth.

It is best to use circular, vibrating motions around the gum line. Angle your toothbrush above and below the brackets. Scrub each surface of every tooth with 10 strokes of the toothbrush. This should take several minutes -- be as thorough as possible. Don't forget to also clean the surfaces of the molars and to also brush your tongue!

Can you use whitening toothpaste when you wear braces?

It's probably best not to use a whitening toothpaste until after your braces come off. If you use a whitening toothpaste on a daily basis, the teeth underneath the brackets may not be as white as the rest of your teeth when your braces come off!

How do you floss your teeth with braces on?

It's a little tricky at first. You must thread the floss under the arch wire between each tooth, floss under the gumline, then remove it. Repeat for each tooth. At first it will take about 15 minutes to floss all of your teeth, but with practice you will get faster and more efficient at doing it. It is important to floss EVERY NIGHT. Even if you use a Waterpik device, you should still floss. Braces are notorious for hiding tiny pieces of food you could have sworn were rinsed away!

You can use any type of floss that is comfortable. Most people attach the floss to a plastic needle called a Floss Threader, or use floss that has a stiff end, such as SturdyFloss or Glide Threader Floss, as mentioned a few paragraphs earlier. 

How can I keep my braces clean after eating at a restaurant or traveling?

Most people who have braces carry a little dental kit to help them in such situations. A dental kit should contain a dental pick, some floss and floss threaders, a toothbrush, and some toothpaste. A travel cup is also a good idea. It is easy to put one together yourself.

The Braces: How They Work and How They Feel

The Braces: How They Work and How They Feel

common parts of braces

What is an arch wire?

The arch wire is the metal wire that goes across your braces, from one end of your mouth to the other. You have two arch wires; one on top and one on bottom. The pressure from the arch wire is what helps to move your teeth.

What is a ligature?

A ligature (also called an "o-ring") is a tiny elastic that holds the arch wire onto each bracket of your braces. Ligatures come in a variety of colors. Some brackets are "self-ligating," which means that they do not need the little elastics to hold the arch wire onto the brackets -- instead they have a "sliding door" system for keeping the arch wire attached to the bracket.

Why do I need to have spacers put in before braces?

Sometimes there isn't enough space between certain teeth to insert a metal band or other appliance. Spacers help move the teeth slightly to create space that is needed for your treatment. For more information, read What are Orthodontic Spacers?

How do braces work?

In a nutshell, the ligament surrounding the teeth is loosened, allowing the teeth to move. For a more detailed explanation, and illustrations of the parts of braces, read How Do Braces Work?

Is there a big difference between metal and ceramic braces? 

All the pros and cons are outlined in What Type of Braces are Best? Also, visit ArchWired's Links page.

Why are there hooks on my brackets? 

Hooks are for attaching elastics (rubber bands). At some point in your treatment, your orthodontist may tell you to wear rubber bands that attach from a hook on the top brackets to a hook on the bottom brackets. Elastics help to close up your bite and correct things like midline problems. This all refers to the way your top and bottom teeth meet and align with each other.

Why are there little tubes on my molar brackets? 

The tubes (often called "buccal tubes") on your molar brackets may be used for attaching an appliance like headgear or a facebow. Don't be alarmed -- just because you have them, it doesn't mean that you are going to get headgear or a facebow! Some molar brackets have the tubes "by default." My molar brackets had tubes but they were never used for anything in the three years I had my braces!   (picture from braces.org)

How long have braces been around?  

Braces, in one form or another, have been around since ancient times! For an interesting article about the history of braces, read A Short History of Braces and Orthodontics.

Do braces hurt when they are on your teeth?

Yes, at first they do. For me, it felt like I had been hit in the teeth with a baseball -- but everyone's experience is different. Your teeth will ache to some extent and your gums will probably get sore in specific places. This is because your teeth are not used to the pressure, and your cheeks are not used to the metal or ceramic rubbing against them. 

After wearing braces for a few weeks, the pain and discomfort begin to diminish. You can use dental wax and topical anesthetic to help create a barrier between the braces and any sores that develop on your gums (the sores usually heal within a few weeks). You can also use a lip protector.

In a few months, pain is less of an issue, and it goes away. You sometimes even forget that you're wearing braces! Your teeth may also hurt again for several days after your monthly adjustment, but by then you're used to it and it doesn't bother you as much.

How long will braces cause pain and discomfort?

When you first get braces on, your teeth will hurt or you may be in some amount of discomfort for several weeks. After about a month, it is better. In a few months, you may even forget that you are wearing them. Within 3 months you will be able to eat almost anything you like. In six months, you might even be biting into hard cookies, chips, and crusty bread once again. Eat these things in moderation and always be careful. "Forbidden" foods and soft foods are mentioned in the next section.

I just got my braces recently and my teeth feel loose. Why? Is it OK?

The periodontal ligament, which helps to hold your teeth in place, is loosening up. Yes, this is perfectly normal, although it is very disconcerting. The teeth should stop feeling loose after a few weeks. If you're very concerned about it, or if the teeth feel loose for months on end, talk to your dentist about it.

GETTING FRIENDLY WITH BRACES!!

Thinking About Getting Braces

Can you be too old for braces?

There is no age limit for braces. As long as you have good periodontal health, braces can be used to straighten your teeth and correct your bite. More people over age 30 are getting braces today than ever before. Most ArchWired.com readers are between the ages of 25 to 55! However, if you have been on a Bisphosphonate drug for osteoporosis (such as Fosamax or Boniva) you need to talk to your orthodontist or dentist first. Read this article to find out why this is very important.

I wore my retainer for a while when I was younger, but then I stopped wearing it and my teeth shifted years later.  Is this common?

Yes, it is more common than you think. The teeth are actually more dynamic than you'd expect. Sometimes, when wisdom teeth erupt, your bite can change in adulthood. A large percentage of adults in braces are in them for a second time!

My kids just got braces and now I'm thinking of getting them, too. 

Many adults "finally get their teeth done" when their kids go in for orthodontic treatment. It's more common than you think! Several ArchWired.com readers have an entire family in braces!

What is it like to have braces put on your teeth? Does it hurt?

Getting braces put on your teeth does not hurt, and does not require Novocain injections or anything painful. For a full description of the process, read Braces Basics: When the Braces Go On.

How much do braces cost?

The average cost for a full set of braces in a typical two-year treatment is about $5,000 US. The cost varies depending on where you live. Major metropolitan areas tend to be slightly higher in cost than rural areas. Generally, metal braces cost less than ceramic ones. Invisalign treatment can be just as costly as traditional braces, and sometimes is even slightly more expensive. Here is a survey we did on the subject a few years ago.

Does dental insurance cover the cost of braces?

Many people in the U.S. have dental insurance through their employers or as individuals/families. This insurance usually cover orthodontic treatment for children up to age 18, but does not cover adult orthodontics -- or only covers it up to a certain dollar amount. If your plan covers adult braces, consider yourself in the lucky minority. I can't speak for dental plans offered overseas, as I know very little about them, and some are government-run (such as the NHS in the United Kingdom).

Remember, most insurance plans and discount dental plans do not cover treatment that is already in progress. So, if you are going to sign up for a dental plan or insurance plan, do it before any treatment begins. Also, beware of any waiting periods your dental plan may enforce. And by the way, jaw surgery or extraction is sometimes covered under your medical plan, so be sure to look into this, too.

How can I find an orthodontist or a discount dental plan?

To help find an orthodontist near you, it's best to get personal recommendations. Ask friends who have braces (or whose kids have braces). If your insurance covers orthodontics, see if it is limited to specific dentists/orthodontists. Or, post a query on ArchWired's Metal Mouth Message Board; our readers are all over the US and around the world, and are very helpful!  

Dental plans come and go; some are better than others. Please read the fine print carefully before you sign up for anything and check with the Better Business Bureau. If you don't have dental insurance, you can sign up for a discount dental plan. A discount dental plan is not insurance -- it is a cooperative of dental professionals who have contracted with a company to offer their services at a discounted rate. Many are available, offered by different companies. You can search for discount dental plans on Google or DentalPlans.com. Or, ask a trusted insurance agent or your own dentist.

I can't afford dental insurance or a dental plan. What can I do?

If you don't have dental insurance and can't afford a a discount dental plan, there is still an alternative. If there is a dental school in your area, call them and ask if they have a clinic. Often orthodontists and dentists in training will practice on patients in the school clinic, under the watchful eye of experienced teachers who are themselves dentists and orthodontists. This service is offered to the public at a minimal cost.

Can I get those invisible braces (Invisalign) instead of traditional ones?

That depends on your specific case. Invisalign braces are usually not recommended for very complicated cases, or cases that involve extractions. Only a qualified dental professional who has examined your mouth can decide whether Invisalign is right for you. If you are very concerned about your appearance with braces, another thing to consider is lingual braces, which are behind the teeth (such as iBraces). An orthodontist must take special training to do lingual braces -- not every orthodontist does them.

What is the difference between a dentist and an orthodontist?

An orthodontist is a dentist who has taken several years of extra training beyond the basic dental degree. Here is what the American Association of Orthodontists (AAO) says:

"It takes many years to become an orthodontist. As in medicine, the educational requirements are demanding.

First, an orthodontist must complete college.

Next is a three- to four-year graduate program at a dental school in a university or other institution accredited by the American Dental Association (ADA).

Finally, there are at least two or three years of advanced specialty education in an ADA-accredited orthodontic residency program. The program is difficult. It includes advanced knowledge in biomedical, behavioral and basic sciences. The orthodontic resident learns the complex skills required to both manage tooth movement (orthodontics) and guide facial development (dentofacial orthopedics).

Only dentists who have successfully completed this advanced specialty education may call themselves orthodontists."

Should I get braces done by a dentist or by an orthodontist?

My personal opinion leans toward orthodontists.

Some dentists incorporate orthodontics into their practices. They have probably completed some extra coursework in tooth movement management and facial development. Some dentists who practice orthodontics have completed more coursework than others. Don't feel shy about asking a dentist about his orthodontic qualifications -- what extra training he has completed, and how many orthodontic patients he has seen. Just because a dentist says he or she "can do braces for you" doesn't mean that they have all the training necessary to successfully handle complicated treatments. Some dentists confer with their their orthodontic colleagues to ensure that they're doing things optimally. If you have minor orthodontic problems, your dentist might be able to handle your case. Complicated cases are probably best handled by an orthodontist who has more training.

If you're considering getting braces, you should probably get at least one opinion from an orthodontist to ensure that you are getting the correct type of treatment.

How many orthodontic consultations should I get?

You can get as many orthodontic consultations as you want. In a consultation, an orthodontist looks at the alignment of your teeth and your facial aesthetics and gives you a general opinion of what he or she would do to correct your problems.

Usually the consultations are free or of minimal cost. While an orthodontist can look at your teeth and give you a general opinion, he or she can't put together a comprehensive treatment plan for you until teeth molds and panoramic x-rays have been done.

There is usually no one right way to correct orthodontic problems -- there are many ways, and different orthodontists may give you different opinions. That is why it's a good idea to consult with two or three orthodontist before you start treatment, especially if they recommend extractions, headgear, or jaw surgery.

What are some of the risks of getting braces as an adult?

Just like any medical or dental procedure, there are some risks involved in orthodontic treatment, no matter your age.  The forces involved in braces can cause some amount of trauma to the dental tissues and structures. However, most adults successfully complete their treatment without any major complications. Orthodontists often give their patients a booklet outlining some of the risks that may be involved and make them sign a waiver that they understand these risks, which include:

• Root resorption - The structure of the tooth's root may break down, causing its destruction.
• Gum recession - The loss of gum tissue around the tooth, which in severe cases can expose the tooth's root. The "triangle" of gum tissue surrounding some teeth may also recede.
• Allergic reactions - If you are already allergic to nickel or latex, tell your orthodontist. There are alternative brackets and bands which are nickel and latex free. You may be sensitive to these substances and not realize it until you get braces. If you develop unusual swelling or tenderness in your gums during your treatment, or any sort of hives or rash on your face and mouth, allergy may be the culprit.

What is a "bite" and what is malocclusion?

Occlusion is another word for your bite -- how the teeth in your top and bottom jaw meet with each other. Mal comes from the Latin root meaning "bad." So, a malocclusion means a bad bite -- a bite with problems. It means that your top teeth do not line up properly with your bottom teeth.

What are the "classes" of malocclusion?

Malocclusion is most often caused by hereditary factors such as an abnormal relationship between the size of the teeth and the size of the jaws. Malocclusion may also result from missing teeth or habits such as thumb sucking or tongue thrusting.
Malocclusions are classified based on the relationship of the maxillary (upper jaw) and mandibular (lower jaw) first permanent molars. 
There are three basic classes of malocclusion, Class I, Class II, and Class III:

Class I malocclusion involves crowding, spacing, or overlapping of the teeth. In this classification the upper jaw is in a normal relationship to the lower jaw; that is, neither jaw protrudes.

Class II malocclusion occurs when the bottom jaw is in a more posterior (backward) position than normal. The top teeth appear to protrude out over the lower teeth. One example of this type of malocclusion is often referred to as "buck" teeth.

Class III malocclusion occurs when the lower jaw is in a more anterior (forward) position than normal. The lower teeth protrude out beyond the upper teeth. This is often the most difficult type of malocclusion to correct.

photos and illustrations from  http://www.dentallearningsystem.com andhttp://www.bracesnfaces.com.au/disorders/

What are the "types of bite" and what do they mean?

The most common types of bite problems are:

images from http://www.colgate.com 

• Overbite. Patients with overbites appear "bucktoothed" and have a receding chin. The lower front teeth are positioned too far behind the upper front teeth. This condition can result from a horizontal overdevelopment of the upper jaw or an underdevelopment of the lower jaw or a combination of both. 
• Underbite. Patients with underbites have a strong jaw with a chin that juts straight out. The lower front teeth are positioned in front of the upper front teeth. This condition is caused by the horizontal underdevelopment of the upper jaw, the horizontal overdevelopment of the lower jaw, or most frequently a combination of both.
• Crossbite. This occurs when the upper teeth are biting inside the lower teeth. This is frequently the result of a narrow upper jaw. Crossbites also occur because of a mismatch in jaw size and position between the upper and lower jaw. Some crossbites also lead to asymmetry of the lower jaw by causing the jaw to be abnormally deflected to one side when closing the teeth together. Proper diagnosis determines how and when a crossbite needs correction.
• Open bite. This occurs when the upper front teeth cannot meet or overlap the lower front teeth even though the back teeth have closed together. Sometimes this this makes eating difficult. Open bites are caused by the overdevelopment of the back portion of the upper jaw in a vertical direction. As the back portion of the upper jaw grows vertically downward, the lower jaw will open in a clockwise direction. This explains why open bite patients have a long facial appearance. 

Can I get braces just on the top or bottom?

That depends on your case. Orthodontics isn't just about making your teeth straight or making them look better. Most dentists and orthodontists take a lot of things into consideration when recommending treatment, such as:

• how the top and bottom teeth meet with each other (i.e., your bite)
• how well you can chew your food
• whether you have a tongue thrust problem
• whether extraction or surgery will be necessary to correct your problems
• whether you will need any appliances in your treatment, such as a palate expander or headgear (yes, some adults do wear headgear)

So you see, it isn't just a matter of making your teeth look pretty. There are lot of other factors to take into consideration. This is why you sometimes need a full set of braces, even if you think that you only need them on top or bottom. Of course, some people are lucky. Their bites are good and perhaps they only need a bit of straightening. People in this position often can get braces only on top or bottom  

When will I begin to see changes in my teeth after the braces are put on?

According to a recent ArchWired.com poll, most people begin see changes in their teeth in the first 2 to 6 weeks of treatment.

Are people going to think I look geeky or weird with braces on my teeth?

Of course you're self-conscious because it is YOUR mouth, but frankly most people don't give a hoot. Your braces are a conversation piece for about 3 minutes; after that, nobody pays much attention. Really. And most people don't think you look geeky. In fact, they probably think you look cute, or applaud that you are doing something positive to improve your appearance and your dental health. Whenever you become self-conscious about your braces, think about how great you'll look after they come off!