Background Information:

What are the other Names for the Procedure?

• Fixing of Dental Braces
• Placement of Dental Braces

What is Dental Braces Placement procedure?

• Dental Braces Placement procedure involves the placement of dental braces by an orthodontist to correct misaligned teeth and ‘bad bites’
• An orthodontist is a qualified dental professional trained to handle malocclusions (overcrowded mouth and crooked teeth) and mal-positioned jaws
• Wearing dental braces over time, causes the application of a constant pressure on the misaligned teeth, which slowly straightens them or shifts them to a more acceptable alignment
• The procedure is commonly undertaken in children between the age of 8 and 14 years for a more successful outcome

What part of the Body does the Procedure involve?

Dental Braces Placement procedure involves the gums and teeth.

Why is the Dental Braces Placement procedure Performed?

Dental Braces Placement is performed for the following reasons:

• To correct misaligned, crooked, or protruding  teeth
• To correct bite-related issues including under-biting and over-biting
• When the upper and lower jaws do not match or meet properly
• To improve one’s overall cosmetic appearance and give a better confident smile

This procedure can help bring about a healthier mouth and reduce oral health issues into the future, including tooth cavities, loss of tooth, eating and chewing problems, increased wearing out of some teeth, gum disease, and speaking difficulties.

What are some Alternative Choices for the Procedure?

Currently, there are no specific alternatives to Dental Braces Placement.

What are the Recent Advances in the Procedure?

The advances in the field of Dental Braces Placement procedures are more to do with newer bracing techniques and materials.

What is the Cost of performing the Dental Braces Placement procedure?

The cost of Dental Braces Placement procedure depends on a variety of factors, such as the type of your health insurance, annual deductibles, co-pay requirements, out-of-network and in-network of your healthcare providers and healthcare facilities.

In many cases, an estimate may be provided before the procedure. The final amount depends upon the findings during the surgery/procedure and post-operative care that is necessary.

When do you need a Second Opinion, prior to the Procedure?

• It is normal for a patient to feel uncomfortable and confused by the information regarding Dental Braces Placement procedure and on what needs to be done
• If the patient needs further reassurance or a second opinion, a physician will almost always assist and also recommend another physician, if required
• Also, if the procedure involves multiple surgeries or has many alternatives, the patient may take a second opinion to understand and choose the best one. They can also choose to approach another physician independently

What are some Helpful Resources?

Complete Guide to Symptoms, Illness & Surgery; Written by H Winter Griffith, M.D.; Revised and updated by Stephen Moore, M.D. and Kenneth Yoder, M.D.; The Berkley Publishing Group, 5^th Edition, New York, 2006

https://www.ndcs.com.sg/ForPatientsAndVisitors/ConditionsAndTreatments/Glossary/Pages/Orthodontics-PreparingforBraces.aspx (accessed on 01/05/2018)

https://www.colgate.com/en/us/oc/oral-health/cosmetic-dentistry/adult-orthodontics/article/a-quick-guide-to-getting-braces-0213 (accessed on 01/05/2018)

http://www.mouthhealthy.org/en/az-topics/b/braces (accessed on 01/05/2018)

Prior to Dental Braces Placement procedure:

How is the Dental Braces Placement surgical procedure Performed?

Dental Braces Placement may be undertaken in any of the following manner:

• The orthodontist undertakes a complete examination of the mouth and identifies teeth that need alignment corrections
• X-rays and teeth impression may be taken to study the condition in-depth
• If there are any dental cavities or overcrowded teeth, necessary treatment or corrections (such as removal of extra permanent tooth causing overcrowding) are undertaken
• The type of braces and treatment adopted depends on the assessment of the dental professional, the severity of the condition, the individual’s personal choices, and various other factors
• Fixed braces:
  • They may consist of plastic, ceramic, and metal components
  • A set of brackets and bonds are fixed to teeth using special glue
  • Thin metal wires are tied to each bracket that rests on the teeth and fastened, based on the requirement
  • The braces may be placed in front of the teeth (usually), or bonded behind teeth (called lingual braces)
• Removable braces: It is commonly used in young children with milk teeth. These may be adjusted to accommodate increase in jaw size, as the child keeps growing
• Follow-up visits with the orthodontist may be scheduled once a month or once every two months to check the progress and make any adjustments

The fixed braces are generally removed after a few years (usually in 2 to 3 years), following an evaluation by the dental professional. After removal of the dental braces, the teeth are cleaned and polished to present a uniform appearance.

Where is the Procedure Performed?

Dental Braces Placement procedure is usually performed in a dentist clinic or office.

Who Performs the Procedure?

An orthodontist or a dental professional expert usually performs the Dental Braces Placement.

How long will the Procedure take?

The time taken for the Dental Braces Placement procedure can range from 1-1.5 hours, over multiple sessions.

What do you need to tell your Physician before the Procedure?

It is very important to provide the following information to your healthcare provider. This enables your healthcare provider in assessing the risks for the Dental Braces Placement procedure and helps avoid unnecessary complications.

• Provide a complete list of medications you are currently taking to your physician. This information is useful for a variety of reasons. For example, it can help your healthcare provider prevent complications due to a drug interaction
• If you are allergic to any specific medication or food items
• If you are taking blood thinners such as aspirin, warfarin, herbal supplements, or any other such medications
• If you or your family members have a history of bleeding disorders, or if there is a tendency to bleed more than normal
• If you have diabetes, high blood pressure, chest pains, or have previously suffered from a heart attack
• If you have ever been diagnosed with blood clots in your leg (deep vein thrombosis) or lung (embolism of lung)
• If you have a history of frequent bone fractures (this may affect bone-healing if bones are involved as part of your procedure)
• A list of all previous surgical procedures you have undergone, for example: Removal of appendix, gallbladder, or any other part, of your body; surgical repair of any body part, such as hernia repair, perforation of bowel wall, etc.

What Preparations are needed, prior to the Procedure?

• The physician may evaluate the individual’s medical history to gain a comprehensive knowledge of the overall health status of the patient including information related to the medications that are currently being taken
• Some medications increase a person’s chances of bleeding and it may be recommended to discontinue them for a period of time before the procedure is performed
• Inform the physician if you are allergic to any local anesthetics, lidocaine, etc.
• Avoid application of any cosmetics, deodorant, or topical medicines on the area prior to the procedure
• It is advisable to quit smoking and the use of any nicotine based products for a while before the surgery
• Consumption of alcoholic drinks must also be avoided for a period of time, as instructed
• The patient must avoid eating or drinking at least 8 hours prior to the surgical procedure, depending on when the procedure is arranged
• For individuals suffering from diabetes, it is important that the blood sugar stays within the normal range; if not, their diabetologist may have to control blood sugar by recommending insulin and/or a combination of oral medicines

What is the Consent Process before the Procedure?

A physician will request your consent for Dental Braces Placement procedure using an Informed Consent Form.

Consent for the Procedure: A “consent” is your approval to undergo a procedure. A consent form is signed after the risks and benefits of the procedure, and alternative treatment options, are discussed. This process is called informed consent.

You must sign the forms only after you are totally satisfied by the answers to your questions. In case of minors and individuals unable to personally give their consent, the individual’s legal guardian or next of kin, shall give their consent for the procedure.

What Tests are needed, before the Dental Braces Placement procedure?

In many cases, no tests are typically necessary prior to a Dental Braces Placement. However, if required, the dentist may recommend the following tests such as:

• Routine blood and urine analysis
• X-ray of the mouth

Before the procedure, any dental issues, such as dental cavities or gum disease, may have to be addressed.

What are some Questions for your Physician?

Some of the basic questions that you might ask your physician are as follows:

• What is Dental Braces Placement?
• Why is this procedure necessary?  How will it help?
• How soon should I get it done? Is it an emergency?
• Who are the medical personnel involved in this procedure?
• Where is the procedure performed?
• What are the risks while performing the procedure?
• What are the complications that might take place during recovery?
• How long will it take to recover? When can I resume normal work?
• How many such procedures have you (the physician) performed?
• Are there any follow-up tests or periodic visits to the healthcare facility required, after the procedure?
• What are the costs involved?

During the Dental Braces Placement procedure:

What kind of Anesthesia is given, during the Procedure?

There is no anesthesia administered during the procedure.

How much Blood will you lose, during the Procedure?

There is no blood loss involved during the Dental Braces Placement.

What are the possible Risks and Complications during the Dental Braces Placement procedure?

There are general factors that increase the risk of getting complications during surgery and they include:

• Obesity: Generally, the greater the degree of obesity, the greater the surgical risk
• Smoking: The longer the smoking history (in pack years smoked), the greater the surgical risk
• Advancing age
• Poorly controlled diabetes, as evidenced by a high hemoglobin A1c and a high fasting glucose
• Poorly functioning kidney, as evidenced by increased BUN (blood urea nitrogen) and blood creatinine
• Poorly functioning liver, as evidenced by increased blood liver function tests
• Hypertension (increased blood pressure), especially if it is poorly controlled
• Poor nutritional status (malnutrition with mineral and vitamin deficiencies)
• Poor lung function, as evidenced by abnormal lung function tests
• History of bleeding disorders
• Longstanding illness, such as autoimmune disorders and chronic infections
• Poor immune system due to a variety of causes

What Post-Operative Care is needed at the Healthcare Facility after the Dental Braces Placement procedure?

At the healthcare facility, usually there is no requirement for any post-procedure care, unless any complications arise.

After the Dental Braces Placement procedure:

What are the possible Risks and Complications after the Dental Braces Placement procedure?

Risks and complications after a Dental Braces Placement procedure may include:

• Pain in gums and teeth
• Tooth sensitivity
• Poorly fixed braces

What is the Prognosis after the Procedure?

The prognosis after a Dental Braces Placement is usually good for a majority of individuals. In many cases, the desired outcomes (i.e., realignment of teeth) are successfully met; however, individual results may vary.

When do you need to call your Physician?

Do contact your physician if you notice any of the following symptoms:

• Pain involving the teeth or gums that worsen: Usually severe pain is not felt, but discomfort may be noted after the placement. In such cases, if required, pain medications may be taken
• Swelling around the gums and teeth
• Loosening of the braces
• The occurrence of any symptom that causes uneasiness such as nausea or vomiting
• Signs of an infection
• Headache
• Fever, feeling sick

What Post-Operative Care is needed at Home after the Dental Braces Placement procedure?

At home, the following post-operative care is recommended after a Dental Braces Placement procedure:

• Follow instructions of the dental professional on how to clean and take care of the braces
• Have soft foods for a period of time until one gets used to the braces
• Avoid smoking or chewing tobacco
• Eat healthy food rich in vegetables and whole grains
• Avoid sugary foods, sticky foods, to prevent the buildup of plaque or dental cavities
• Brush and floss regularly after taking food, or twice daily

How long does it normally take to fully recover, from the Procedure?

Typically, there is no recovery period involved, in majority of cases. However, most individuals experience some amount of pain and discomfort for about a week to 10 days following the procedure.

Additional Information:

What happens to tissue (if any), taken out during the Procedure?

Generally, the procedure does not involve the surgical removal of any tissue.

When should you expect results from the pathologist regarding tissue taken out, during the Procedure?

Usually, no tissue is sent for a pathological analysis.

Who will you receive a Bill from, after the Dental Braces Placement procedure?

It is important to note that the number of bills that the patient may receive depends on the arrangement the healthcare facility has with the physician and other healthcare providers.

Sometimes, the patient may get a single bill that includes the healthcare facility and the consultant physician charges. Sometimes, the patient might get multiple bills depending on the healthcare provider involved. For instance, the patient may get a bill from:

• An out-patient surgery center facility, the dentist or oral surgeon’s clinic/office, or a hospital
• An anesthesiologist (if anesthesia was administered)
• A dental professional expert or an orthodontist

The patient is advised to inquire and confirm the type of billing, before the Dental Braces Placement procedure is performed.

Thanks and Gratitude:

We sincerely acknowledge and thank Dr. Douglas J. Jones for reviewing the article. His valuable input and feedback has helped enrich the contents of this article.

Douglas J. Jones, MD FACS
Board Certified General Surgeon and Faculty Member
University of Illinois, College of Medicine at Urbana-Champaign
506 S. Mathews Ave., Urbana, IL 61801, USA