Questions about braces, clear aligners, retainers and the first visit, answered

A crossbite is top teeth that bite inside the bottom back teeth or sit behind the bottom front teeth. For back crossbites in children aged 7 to 11, a 2021 Cochrane review found high-certainty evidence that the quad-helix and expansion plates were beneficial compared with observation; for a simple front crossbite, the American Academy of Pediatric Dentistry says it can be aligned as soon as it is noticed if there is enough space.

Crowded teeth have too little space, and they are straightened by making room, then moving them with braces or aligners. The American Association of Orthodontists names causes including oversized teeth, early or late loss of baby teeth and too little room in the jaw. Room can come from widening a narrow upper jaw during growth, removing a little enamel between teeth, or removing a tooth after a full space analysis.

Gaps between teeth can result from missing teeth, undersized teeth or oversized jaws, the American Association of Orthodontists says, and childhood habits, a large frenum or, in adults, gum disease can play a part. An orthodontist closes a gap by moving the teeth with braces or clear aligners, and retainers help keep it from reopening. A gap left by a missing tooth may instead be held open for a replacement tooth.

An impacted tooth, as the American Association of Orthodontists defines it, does not come in the way it should and stays stuck in the gum or jawbone or only partly erupts. The AAO says an orthodontist may create room when a lack of space is part of the cause and, when there is room and the tooth can reach a healthy position, guide it in after an oral surgeon exposes it.

Teeth that do not make contact are an open bite in the American Association of Orthodontists’ glossary; in an anterior open bite, the front teeth do not touch when the back teeth are closed. The AAO names habits such as thumb sucking among its causes and says adults can treat it with braces or clear aligners; for children, Cochrane rates the treatment evidence as weak.

An overbite, in the American Association of Orthodontists’ glossary, is upper front teeth that excessively overlap the bottom front teeth when the back teeth are closed, also called a deep bite; upper front teeth that protrude in front of the lower ones are overjet. The AAO calls braces the most common treatment for a deep bite and says clear aligners can also be used, though reviews disagree on how predictably aligners correct one.

In an underbite, the lower front teeth or jaw sit ahead of the upper front teeth or jaw, the American Association of Orthodontists’ glossary says, and the cause may be mainly the teeth, mainly the jaws or both. The AAO calls braces a reliable choice when an underbite is mainly a matter of tooth position, and says jaw surgery may be recommended when the jaws themselves are substantially out of position.

A clear retainer is rinsed and brushed, never in hot water. The American Association of Orthodontists’ 2025 guide says to rinse it in lukewarm water whenever it comes out and brush it daily with its own toothbrush and dish soap; the British Orthodontic Society’s leaflet says a toothbrush and cold water. Both say no toothpaste, which the BOS says can roughen and discolor a retainer.

The American Association of Orthodontists separates a true medical or dental emergency, which needs 911 or urgent care, from urgent orthodontic problems such as broken brackets or loose wires, which the orthodontist should hear about immediately. Its emergency signs include heavy bleeding, trouble breathing or swallowing, a suspected broken jaw and a knocked-out permanent tooth. Whether a broken bracket’s repair waits for the next visit is the orthodontist’s call.

Yes. The American Association of Orthodontists says sports can be played during treatment, with the orthodontist advising on the type of mouthguard. The American Dental Association says a properly fitted mouthguard may be especially important with braces, since a blow to the face could damage the brackets, and that a retainer or other removable appliance should not be worn during any contact sports; whether aligners come out is the orthodontist’s call.

Brackets and wires create extra spaces where plaque collects, the American Association of Orthodontists says, and plaque buildup can cause gum disease, the National Institute of Dental and Craniofacial Research says. The AAO says persistent swelling, redness or bleeding is not a normal part of treatment and that in many cases better oral hygiene helps. Pus, fever, or severe or rapidly increasing swelling needs prompt attention.

An orthodontist is a dentist who, after dental school, completed an accredited orthodontic residency, which the American Association of Orthodontists describes as two to three more years of full-time study focused on how teeth and jaws align. In the AAO’s account, a general dentist handles preventive care, routine exams, fillings and gum health, while an orthodontist specializes in moving teeth and correcting how the upper and lower teeth fit together.

At a first orthodontic consultation, the orthodontist evaluates the teeth, bite and jaws, and the office may take photos, X-rays or digital scans toward a diagnosis and a treatment recommendation, according to the American Association of Orthodontists. Its guide to a first appointment asks patients to send or bring their dental and medical history with any medications, dental insurance information, details for their general dentist and primary care physician, and their questions.

Treatment time depends on the case and the patient. The American Association of Orthodontists names the severity of the problem being corrected, the type of treatment and age, and says wearing elastics or aligners as prescribed, keeping appointments and fixing broken brackets promptly keep treatment on track. An orthodontist estimates each patient’s treatment length after an exam, and the AAO says neither braces nor aligners has a built-in speed advantage.