Once the braces have been placed, wires are attached into the braces with very small rubber bands (elastic ties). These are most commonly seen as the colors on the braces, although clear elastic ties can also be used if the desire is to have the braces be less noticeable.
The wires used today are very flexible and return to their original shape, thereby applying a continuous and gentle force on the teeth. The pressure applied to the teeth through the braces will reduce over time as the elastic ties holding the wire into the brackets weaken and stretch. Regular “adjustment” appointments are therefore needed to replace the weakened elastic ties and re-establish the forces necessary to move the teeth.
The appointments also give the orthodontist an opportunity to evaluate the tooth movement and make the necessary recommendations in treatment. Usually the original treatment plan predicts the process throughout the whole treatment time. Since the teeth are constantly moving during treatment, every adjustment presents a new set of circumstances for the orthodontist to evaluate. The patient is essentially re-diagnosed at each appointment throughout the treatment plan, following the original plan as a guide.
Since the changes in tooth movement require a minimum of 3 weeks to take effect (the biological requirement for tooth movement), most adjustment appointments are made in the 3-8 week range. Longer times between appointments may be recommended in some patients since many of the wires used today have a very long working range, and more frequent visits may not be necessary. A normal adjustment appointment may include the following:
- Remove the colored ties that hold the wire into the braces.
- Remove the wires.
- Allow the patient to brush and floss.
- The orthodontist will check the patient and recommend treatment (i.e. new wires, rubber bands, etc).
- Replace the new colors onto the braces
It is not unusual for a patient to feel tightness during and immediately after the adjustment appointment. The tightness tends to progress into soreness about 4-6 hours after the adjustment. The tightness and soreness is usually a result of wire changes or adjustments in the wires that eventually result in additional tooth movement. The recommendations for managing the pain are the same as when braces are first placed (i.e. over the counter pain medication). The pain will usually decrease over the next 3-5 days.