Chief physician Zhang Ding, deputy director of Orthodontics Department of Peking University College of Stomatology, is engaged in clinical science and education, especially good at correcting oral deformities. He studied in the Department of Dentistry of Showa University in Japan and was a postdoctoral fellow at the Health Center of Connecticut State University in the United States. (Left)
Dr. Jia Qilin graduated from Beijing Medical University majoring in orthodontics 1990. Associate Professor of Orthodontics, Peking University College of Stomatology, Master Supervisor, Member of Royal College of Surgeons, Edinburgh, UK. She has rich experience in orthodontics. (right)
Hello, audience friends! This is CCTV's live program "The Road to Health", and today we are going to talk about the problem of uneven teeth.
Moderator: What should a neat tooth arrangement look like?
Zhang Ding: As shown in the figure, the neat teeth should be arranged in a symmetrical horseshoe shape, and the teeth should be arranged closely without gaps. When the upper and lower teeth bite together, the upper midline and lower midline should be together. Viewed from the side, the tip of the upper tooth should bite at the joint of the lower two teeth to ensure a good embedding relationship between the teeth. The upper teeth should cover the lower teeth, generally not more than one-third of the crown. If it is too deep, it is not normal. The upper teeth should not be too much in front of the lower teeth, about 3 mm is appropriate, and the face shape should be very harmonious under normal occlusion. In a natural relaxed state, the lips can be naturally closed and the face is symmetrical. Seen from the side, the face is relatively straight, and there is no protrusion, which is the normal occlusion state of the teeth.
Moderator: What should I do if my teeth are not arranged neatly?
Jia Qilin: As shown in the figure, irregular teeth are medically called malocclusion. This is a patient with mandibular protrusion and malocclusion, commonly known as floor cover. In another picture, the area of the teeth covering the lower teeth in the upper left picture is much larger than 3 mm, which is called maxillary protrusion, commonly known as buck teeth. The wrong jaw in the picture below is called open jaw, because the upper and lower jaws are completely mismatched, which will seriously affect the cutting of food. The occlusion of teeth in the third picture is not the normal occlusion relationship between cusp and cusp fossa, but the occlusion relationship between cusp and cusp. In the fourth picture, although the teeth are arranged neatly, the mouth can't close, which is also a malocclusion.
Zhang Ding: There are many reasons for malocclusion. There are two main types: one is caused by heredity, and the other is caused by acquired environmental factors.
Moderator: Severe malocclusion not only brings some burdens and shadows to beauty and psychology, but also causes certain diseases to the oral cavity itself.
Zhang Ding: Uneven tooth arrangement can also lead to some oral diseases. Let's look at a picture: the patient has many bad teeth, mainly three teeth stacked together, which are difficult to clean. After each meal, food residue accumulates, and bacteria act on the residue accumulation to produce acid, which leads to tooth decay. Looking at another picture, the patient's gums have retreated and the roots have all been exposed. It is easy to loosen or even fall off when it develops.
Moderator: Ms. Liang from Beijing, 34 years old. Does orthodontics require tooth extraction?
Jia Qilin: It depends on the specific situation. Generally speaking, if the teeth are crowded or protruding seriously, they need to be extracted.
Zhang Ding: The proportion of cases of tooth extraction in clinic is still very high. At least 40% of patients need tooth extraction, but whether a specific individual needs tooth extraction depends on the specific situation.
Moderator: If the child's teeth are irregular, when is it better to correct them?
Zhang Ding: Generally speaking, it is more appropriate for most patients to start orthodontic treatment after tooth replacement (about 12 years old), but some cases need early treatment. As shown in the picture: this is a patient with a crescent face and should be treated as soon as possible, even in the defoliation period. The earliest patient we treated was about 4 years old. Look at another picture, the child's teeth protrude a lot outward, and the maxilla protrudes forward. This situation should be treated in time before the end of growth and development to limit the development of maxilla and promote the development of mandible.
Jia Qilin: Orthodontics is usually used to correct teeth. As shown in the figure: This is a fixture. Each tooth has a metal bracket. The bracket stuck to the tooth and could not be taken out by itself. You have to wear it all the time. Fixed appliance is suitable for most malocclusion. Let's look at another picture. This is a movable orthosis. Patients can take it off and put it on. This orthosis needs the cooperation of the patient. It is inconvenient to stick out your tongue after wearing it, forcing patients to correct bad habits.
Zhang Ding: Teeth grow in bones, and human bones are very active, especially alveolar bones, which are constantly being rebuilt all their lives. The appliance exerts a force on the teeth and transmits the force to the alveolar bone through the teeth. Alveolar bone has a characteristic that it will be absorbed after being pressed, and the tensile force will regenerate, so that under the action of pressure, one side will be absorbed and the other side will regenerate, and the teeth will gradually change their position in the bone and be in the correct position as needed. This is the principle of orthodontics.
Moderator: How long will this treatment take?
Jia Qilin: For most patients, it takes 1 year and a half to two years to treat with orthodontic appliances, especially for patients with tooth extraction. The treatment time may be slightly different according to the deformity, but the difference will not be too big.
Zhang Ding: Generally, the force exerted by orthodontic treatment on teeth is about100g, and then the pressure is gradually applied. Children may feel uncomfortable after wearing the appliance, such as oral ulcers, and their teeth will be a little sour after exertion, but these are tolerable. Clinically, there are no cases that cannot tolerate treatment for these reasons.
Moderator: What is the treatment effect?
Zhang Ding: Let's look at several cases: As shown in the picture, the patient's teeth are disordered, and the teeth are arranged very neatly after treatment. In another picture, after treatment, the occlusal relationship and face shape of the patients with Dibaotian returned to normal.
Jia Qilin: Orthodontics is to correct teeth to a new position. Because teeth tend to return to their original positions, that is, relapse, retainers are usually used to prevent recurrence. The retainer can keep the new position of the teeth well. It usually takes two years to wear. It needs to be worn 24 hours in the first year (except for eating and brushing teeth), and it is usually worn at night in the second year. For some special deformities, the specific requirements for wearing are different according to different situations.
Moderator: Why is it generally 12 years old to do corrective treatment, neither too early nor too late?
Zhang Ding: Because the teeth will be completely replaced at the age of 12, if the teeth are not completely replaced, the deciduous teeth and permanent teeth will alternate in the mouth, and a comprehensive diagnosis cannot be made at this time. If you start treatment at this time, the course of treatment will be very long. Regarding the question of whether it can wait until it is older, simple tooth dislocation can wait until it is older, but if there is a bone problem, it will delay the treatment opportunity of the child after the growth period.
Compere: If the adult's teeth are irregular, can they be corrected?
Jia Qilin: Adults can do orthodontics. For patients with severe skeletal deformity, it is not enough to use orthodontics alone, but also to use surgical methods combined with orthodontics for treatment. The time of adult corrective treatment is similar to that of children, which is about 1 year and a half to two years.
Moderator: Ms. Zhou, a native of Hebei, is 25 years old. I have two front teeth in the lower row, overlapping. Which one do I need to pull out? Will the other one fall off because it is loose?
Zhang Ding: This kind of situation is the one mentioned above, that is, the permanent teeth have grown out, and the deciduous teeth have not fallen out, forming two layers of teeth. In this case, don't pull out your teeth easily, and you should consult an orthodontist.
Moderator: Ms. He from Beijing, 28 years old. My child has just had two teeth and looks a little crooked. Do you need to take your child to the hospital for correction?
Zhang Ding: The deciduous teeth that have just grown out are a little crooked. Don't worry too much. You can observe them first.
Moderator: Can uneven teeth be prevented?
Jia Qilin: There are many factors for uneven teeth. If it is hereditary, it cannot be prevented. Other factors, such as bad habits, such as eating fingers, can be prevented by correcting bad habits.
Moderator: Ms. Yang from Tianjin, 25 years old. I am receiving orthodontic treatment now. The doctor said two days ago that I had gingivitis. Why didn't I have gingivitis before treatment, but during treatment?
Jia Yulin: One disadvantage of fixed appliance is that if you brush your teeth incorrectly, it will easily lead to gum inflammation. Patients should pay special attention to oral hygiene. It is recommended to brush your teeth five times a day. If possible, you should also wash your teeth regularly, which is what we usually call cleaning your teeth.
Moderator: Mr. Zhao, a native of Jiangxi, is 52 years old. His daughter lost one of her front teeth while riding a bicycle. She went to the hospital to insert false teeth and stuck them on. It doesn't look very beautiful now. Can it be replaced? Is it difficult?
Zhang ding; This does not belong to orthodontics, but to prosthodontics or prosthodontics. The reason why it looks bad may be that there is not enough gap when inserting teeth, and the restorer can only insert a small tooth. In this case, the orthodontist needs to enlarge the gap to the normal size, and the inserted teeth will be beautiful.
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