Chapter 1: Pain and Extractions and 3 Years, Oh My!

Other than cost, the main questions every patient asks are:

• How much will this hurt?
• Do I need to have teeth pulled?
• How long is this going to take?

In this book these questions will be answered. As an adult, most of us remember our orthodontic experience not as a fun and fond memory, but in varying degrees of negativity to these 3 questions.

Spectacular Smiles, Superior Customer Service: Today’s Orthodontics 

Bill M. Dischinger, DMD

Key Takeaways

• Modern orthodontics is significantly less painful and lengthy due to major technological advancements.
• The development of dental adhesives reduced the need for tooth extractions.
• Innovations like the straight wire appliance and nickel-titanium wires have led to shorter treatment times and fewer, less painful adjustments.

Thankfully for anyone having treatment today, orthodontics is no longer like walking to school in the snow, uphill both ways. Braces have historically been viewed in the same light as having a colonoscopy: a necessary evil in life.

Although the resulting beautiful smile was “worth it in the end,” wouldn’t it be great if the process was not like training for an ironman triathlon? “I’m so glad I did it, but I couldn’t go through that again.”

The Power of Technology in Orthodontics

Why was orthodontics of the past so much more difficult than today? Why is orthodontics today so much less painful and long than in the past? The answer is technology and the super smart people that advanced it along the way!

Technology has changed everything in our lives. When I was growing up, we had 5 channels, including the public broadcasting channel which was pretty much worthless after Sesame Street ended each morning. Today’s TV world isn’t even really TV any longer.

It is so overwhelming in its streaming choices that at times, the entertainment is just scrolling through to see what we are missing rather than actually watching shows. Cassette tapes? Remember sitting with your finger hovering over the “play/record” button, waiting for that song to come on the radio?

You knew things were getting serious when you received that “mixed tape”. Thanks to Steve Jobs and the iPod, now even CDs are obsolete. And then there is the greatest invention in the history of man. The car? No. Airplanes? No. American Football? Almost. The smart phone.

How in the world did we survive before cell phones, let alone smart phones? Just the maps feature alone has saved many a marriage. “Honey, let’s just stop and ask for directions”. “Dear, I know where we are,” without Siri, 30 minutes have passed and they are still not at their destination and all conversation has stopped. If they are talking, Honey and Dear are long gone.

The first year I had my iPhone, I didn’t know there was more than the first home page. When I discovered that side swipe to get to page 2, I thought, “Why would I ever need that many apps?” Now I’m 10 pages deep and counting.

These examples of technology have changed our lives forever, but only if we embrace them. They all had a learning curve with some frustration along the way. All new technology does. Orthodontics is no different.

Breakthrough 1: The Arrival of Adhesives

The first great invention in orthodontics came in the form of a chemistry breakthrough: Adhesives. My early memories of braces was the classic “railroad tracks” look. Orthodontists used to have to put a band (or ring) around each tooth to secure the brace to it.

This was quite the “joyful” experience. Orthodontist: “I’m going to lightly tap on this band to place it around your tooth.” “Bang, bang, bang!” At this point you were usually hovering somewhere between horror and passing out.

By the 1970’s new technology in the world of adhesives had found its way into orthodontics. It allowed orthodontists to glue a brace onto the front of the tooth rather than use all those bands.

The advantages of this process were many. One of the biggest advantages of not having all the extra metal of bands in between the teeth was that more cases could be treated without the extraction of teeth.

Breakthrough 2: The Straight Wire Appliance

Later that decade, an amazingly brilliant orthodontist named Larry Andrews invented the straight wire appliance. Historically, braces were a way to grab a hold of the tooth. The orthodontist would use a series of stainless steel wires that he/she put various bends into to straighten the teeth. The wire provided all the angles, bends, tips, etc. to properly align the teeth.

The braces were just the means to attach the wire to the teeth. Dr. Andrews changed that. He built braces that had all these angles, tips, etc. built into them.

Each tooth in the mouth had a specific brace, with its own set of movements preprogrammed into it. This allowed the orthodontist to place the wire into the braces and the teeth would get pretty close to where they were supposed to be.

The orthodontist would then just need to make minor adjustments in the last wires to get those final details done. This shortened treatment times and helped make visits to the office less frequent and slightly less painful. It also made the job much easier for orthodontists; allowing them to delegate more of the work to dental assistants.

By doing this, orthodontists could treat more patients in a day, allowing them to keep the cost of orthodontics affordable. The inflation of orthodontic treatment over the past 40 years is miniscule compared to the actual inflation rate; in particular the inflation rate within the medical world.

Breakthrough 3: Space-Age Wires

Around the same time that Dr. Andrews invented the straight wire appliance, the world of orthodontics borrowed some technology from NASA. The space shuttle was where they tested many metal combinations. From these tests came the perfect blend to go along with Dr. Andrews’ braces. Nickel and Titanium.

When blended together, these wires can be shaped into a perfect mouth arch form. The beauty in these wires is that they have memory and retain their original shape after being distorted, bent and twisted. This means that when put in a mouth of crooked teeth, the wire slowly straightens back out to its original shape, thus straightening the teeth.

No longer did orthodontists have to keep putting in stainless steel wires that continually were deformed. Appointments could be spread farther apart as adjustments didn’t need to occur as frequently. The wires also delivered less force to the teeth, which we will learn in chapter 4 is very important.

Orthodontics, like the world around us, has greatly changed with the technology advancements of the past 40 years.

Frequently Asked Questions

Q: Has orthodontic treatment really become less painful?
A: Yes. Modern technologies like nickel-titanium wires deliver less force to the teeth, and advancements like the straight wire appliance mean fewer and less painful adjustments are needed compared to older methods.

Q: Is it still common to have teeth pulled for braces?
A: The need for extractions has been significantly reduced. The invention of adhesives allowed orthodontists to glue braces directly to teeth, eliminating the extra metal bands between them and creating more space to align teeth without pulling them.

Q: Have treatment times for braces gotten shorter?
A: Absolutely. Innovations such as the straight wire appliance and nickel-titanium memory wires allow for more efficient tooth movement. This means treatment is often completed faster and with fewer appointments than in the past.