Dentistry is a broad medical field and while the ultimate goal is to improve oral health, there are differences between dentistry and orthodontists. The main point to note is that orthodontists specialize in treatments such as correcting misaligned teeth and jaws called malocclusions or bites.
We checked in with Orthodontist Dr. Louise Wong 黃淑興牙醫 on the different aspects regarding this field of dentistry.
Can you explain what the difference is between an orthodontist and a dentist in simple terms?
Orthodontists and general dentists share many similarities – they both work hard to help you improve your oral health, but it is important to note that an orthodontist and general dentist do not provide identical services. In fact, the services they offer are quite different-specialization is what sets an Orthodontist apart from a general dentist. It’s similar to the difference between your GP medical doctor and a specialist physician like a dermatologist (or any other medical specialist).
Orthodontists in Hong Kong are qualified dentists who complete a three year full time Master’s degree in Orthodontics first, followed by another 3 years of advanced orthodontic training leading to a fellowship in the Hong Kong Medical College. In other words, you need 6 years of further studies after dental school to qualify as a Specialist in Orthodontics.
Because we specialize in malocclusions, orthodontists have more in-depth knowledge to deliver precise treatment and choose the best option tailored to the patient’s individual needs and problems. As specialists, we are up to date with all the latest advances in dental braces and also the limitations of what can or cannot be achieved.
The main reason why the cost of orthodontic services varies so widely in Hong Kong is that general dentists – who are not specialists in the field – provide orthodontic treatment for their patients as well.
In Hong Kong, there are around 2,200 dentists but only 3-4% are qualified as Specialist in Orthodontics. If you have a heart problem, chances are you will go to see a cardiologist for your treatment rather than your family medical doctor – it is the same for Orthodontic treatment. Remember, you only have one set of permanent teeth, so it’s worthwhile to see an Orthodontist if you are thinking of having braces.
What does an orthodontist do exactly, furthermore what are your specialties?
Orthodontists are experts in their field, specializing in the diagnosis, prevention and treatment of dental and facial irregularities to help correctly align teeth, bites and jaws including straightening crooked teeth.
We have patients coming in with a whole host of problems; the most common ones being crooked teeth and difficulty in brushing due to the crowding. A lot of the demand is cosmetic, as most people only really notice whether their front teeth are straight or not. Orthodontist however, look at the whole package, not just the teeth but the jaws, the facial profile, bite and function. That’s why it’s important to have a good communication with the patient before they start treatment to see what they hope to achieve with braces and whether it’s possible to meet their expectations. You also have to assess the effects of orthodontic treatment on the patients lip profile. European and Caucasian patients have thinner and flatter lips compared to their Asian counterparts, so it’s important to try and avoid extractions which would make the face or lips sink in. On the other hand, Chinese people have thicker lips which are more full and protrusive – so an extraction option might be more aesthetically pleasing for these patients.
As Orthodontists, we move teeth in bone, so the most difficult cases are really the patients that have problems with their jaws. Jaws that are too small/large or deviated to one side, etc. can all limit the direction that we could move the teeth. If the jaw problem is severe, then jaw surgery in combination with braces would be required to fix the bite.
In my practice, we provide all types of treatment from removable to fixed appliances. The only treatment I don’t provide are Lingual braces, which are the fixed metal braces fixed to the back of the teeth. Personally, I found that patients have real difficulty cleaning their teeth properly when the appliances are at the back of the teeth, so now I offer the clear plastic removable appliances if patients really want their braces to be “invisible”.
What is the age at which children can start orthodontic care?
The Hong Kong Society of Orthodontists as well as the British and American Association of Orthodontists all recommend that children should see an orthodontist for an initial orthodontic assessment no later than the age of 7. This allows the orthodontist to determine if treatment is required and the best time to start. For some patients a short phase of treatment might be beneficial to intercept the problem before it gets worse, we call this “interceptive orthodontics”.
In other instances, it is better to wait and monitor the child’s growth and dental development and place braces on (if needed) when the majority of the permanent teeth have come through. There are also some patients with jaw issues where it is actually best to wait and not start any treatment at all until the child stops growing.
Nowadays, we see a lot of kids asking their parents for braces (my eleven-year old daughter is one of them), but it is not just about putting the braces on and having straight teeth. Children need to know that it is a responsibility and a commitment on their part – if not, the risks can outweigh the benefits. After discussing with my daughter, she told me that she wasn’t confident of brushing well with the braces on, so she decided to wait until this year. I just put her braces on two weeks ago.
As orthodontists, we can improve most tooth and jaw problems at any age but there is usually a ‘best age’ to start treatment in terms of the amount of improvement that can be achieved and the treatment time it takes. Because every patient is different, in terms of their orthodontic problem and growth considerations, the ‘best age’ to start treatment is different for every patient. Therefore the best time for a consultation with your orthodontist is as soon as a possible problem is noticed.
As for adults, is it ever too late to receive any treatment? What are the popular orthodontic treatments for adults?
Orthodontic treatment can move teeth, whatever the patient’s age, as long as the teeth and gums are healthy. My oldest patient is 75 years old. A recent report by the American Association of Orthodontics said one out of five orthodontic patients is over age 21. Braces have become much more socially acceptable than it was 20 years ago, so more adults are seeking orthodontic treatment. In part, it is media driven with stars like Serena Williams and Kylie Minogue sporting the more obvious fixed metal or ceramic braces. Apart from the cosmetic advantage, having straight teeth can also affect your self-confidence. An online survey on 18-40 years old commissioned by The Hong Kong Society of Orthodontists found that 80% of people with crooked teeth reported low self-esteem which affected their social lives. The survey also found that 22% of those with normal teeth would be hesitant to hire or date someone with crooked teeth.
Advances in the orthodontic field mean that nowadays the appliances are more discrete and compact which is desirable for adult patients who want to be more low-key. Justin Bieber and Khloe Kardashian both chose the clear, removable, plastic aligners to correct their teeth. I had the removable invisible braces myself before I got married, which was totally different compared to the fixed metal ones I had as a teen.
The only factor which might prevent adults from having braces is if they have active periodontal disease. Periodontal disease is an infection of the gums and the bone that supports the teeth, which if left untreated can lead to tooth loss. Orthodontically moving teeth with active inflammation can cause further bone loss around the tooth leading to more tooth mobility and even worse, the teeth falling out. Since periodontal disease is a silent disease, some patients do not realize they have a problem until the teeth become mobile or they have gaps appearing which weren’t there several years ago. The 2011 Oral Health Survey conducted by the Department of Health in Hong Kong showed that only 1% of 35-44 year adults had healthy gums and 40% had the beginning of periodontal disease. But it is not all bad news, as long as the periodontal disease is treated and controlled you can still have braces and sometimes this is desirable because it moves teeth into positions that are more accessible to be cleaned.
Are there any new and exciting developments in orthodontic care?
The most profound change in the orthodontic field has been the use of digital technology in the orthodontic office. Digital x-rays are now the standard, giving orthodontists immediate access to the images and more importantly for the patient, less radiation exposure. An increasing number of orthodontists are also using 3D imaging to create three-dimensional models of the head and jaw, which makes it easier to diagnose and recommend treatment and procedure options. Our office uses a 3D oral scanner which creates a perfect digital scan of the teeth without the radiation and allows us to manufacture retainers and appliances customized for the patient.
Today’s advances in technology means that orthodontists can also provide patients with more orthodontic options than ever before. Even the rail-track type of metal braces have become more compact, modern and less noticeable. Instead of using the color elastics to attach wires to the metal brackets, we use the newer Self-ligating braces, which are braces that have little metal doors to hold the wires instead of elastic ties. This eliminates the pressure and friction that has been known to cause excessive pain to patients that have been fitted with traditional braces in the past. In the majority of cases, self-ligating brackets also eliminates the need for headgear or other orthodontic components.
Even the wires we use incorporate NASA technology and are lighter and more comfortable. The Nickel-titanium wires we use have shape-memory which moves the teeth faster and require fewer adjustments. They are also thermo-active which means that the wire becomes softer and less pressure is exerted on your teeth if you eat or drink cold food or beverages.
For patients that require their braces to be less noticeable – mostly adults – you have the option of tooth colored, ceramic self-ligating braces instead of the metal ones, and also the invisible, removable braces. Clear aligners (such as Invisalign®) are a personalized series of clear, removable trays that are custom-made using 3D computer imaging technology to fit over your teeth. They work to straighten teeth and are nearly invisible, so you can smile with ease during and after treatment. You need to wear the aligners for approximately one or two weeks removing them only to eat, drink, brush, and floss. For Invisalign to work, you need to be disciplined and wear the aligners 20-22 hours a day. As you replace each aligner with the next in the series, your teeth will move slowly but surely week by week, until they have straightened to their final position.
While braces such as Invisalign® have a number of advantages over traditional braces, the truth is, it is not suitable for everyone and case selection is important. For some cases, the fixed appliances maybe more efficient and predictable than Invisalign®. That’s why it’s important to consult a Specialist in Orthodontics to determine which treatment would be most suitable for your individual needs.
How long and costly are orthodontic treatments in Hong Kong?
Everyone’s mouths are unique, so orthodontic treatment time can vary from patient to patient. While your age, the type of treatment you choose, the severity of your case and your level of compliance all play a role in how long you’ll be in treatment, other factors like biology factor in as well. Every patient is different and teeth move at different speeds. On average, the treatment time can be anywhere from 12-36 months. However, if you constantly have emergencies with braces coming off, wear your aligners poorly or have inflamed gums due to poor tooth brushing, then chances are your treatment time will take much longer. Treatment costs can vary depending on the type of appliances used, the severity of the case and whether your treated by a dentist or an Orthodontist and generally ranges from HK$30,000 to $150,000.
If my braces were installed in another country, how difficult is it to be treated in Hong Kong?
If you plan to have orthodontic treatment, then do consider the time it would take to complete it before starting the treatment. In the majority of cases, transferring from one orthodontist to another will always lead to longer treatment times. That’s because each orthodontist has his/her own way of placing the brackets on, or the type of appliances they would use to get from A to Z. I had one patient who came to see me, that had relocated from 3 different countries and he was still in fixed braces after ten years.
In Hong Kong, not every orthodontist would accept transfer cases, so my best advice would be to ask your orthodontist in your country for all previous and current records and email the new Orthodontist to see whether they are familiar with the system and willing to see you for a consultation first.
How would you recommend choosing an orthodontist in HK? In your opinion what are the improvements needed in this field specifically in Hong Kong?
I am an Orthodontist and also a mother. My advice on choosing an Orthodontist is the same advice I would use myself when I choose any professional services for myself or my family. First and foremost is whether the qualifications are there. Due to an orthodontist’s combination of specialized training and greater amount of experience, the orthodontist is more capable of recognizing the difference between a simple case and a complex one. Just as important, when a case becomes more challenging, (such as when Invisalign cases do not progress as expected), orthodontists are more prepared to properly handle unexpected problems as they arise.
The second factor is whether you have a rapport with the orthodontist. Good orthodontic care begins with open communication which works both ways. You should be comfortable and confident with the treatment recommendations given to you and understand their limitations. If you are confused and have unaddressed concerns after leaving the office, then consider that a warning sign.
At the end of the day choosing the right orthodontist is a personal decision and comes down to finding one that you can trust to give you the treatment you want in an environment that makes you feel comfortable. If in doubt, then always go for a second or third opinion. After all, a good and healthy smile is a lifelong investment and you want to make sure you get it right.
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