[Medical Insight No. 64] Orthodontists teach middle-aged orthodontists how to correct their teeth.

□ Broadcast Date and Time: December 27, 2024 (Fri) 10:20 pm
□ Producer in charge: Lee Siwoo
□ Author in charge: Kim Bae-jung and Kim Hyun-jung
□ Cast: Cha Jung-yeol (Yeonse Severance Hospital Orthodontist)
□ Broadcast channel
IPTV - GENIE TV No. 159 / BTV No. 243 / LG Uplus No. 145
SkyLife Number 90
Cable - Delive No. 138 / Hyundai HCN No. 341 / LG HelloVision No. 137 / BTV Cable No. 152

* The text below may differ from the actual broadcast content, so please check the broadcast for more accurate information.


◆ Cha Jung-yeol: Hello, I'm Cha Jung-yeol, a dental orthodontist. The story I prepared in this time is orthodontic treatment, which has been progressing a lot among middle-aged and elderly people recently.

◇ Voice actor Park Sang-hoon: As the life expectancy and average life expectancy of tooth aging starting in the 40s and 50s increase, a growing number of middle-aged people are choosing orthodontics to have healthy and beautiful teeth. This is because choosing teeth makes oral hygiene management easier and helps prevent gum diseases. Orthodontics, which is often done in the 40s and 50s, is a method of correcting the fallen gums. Correcting distorted teeth is said to restore the lowered gums, and let's take a closer look at what dental correction methods are highly satisfactory among middle-aged people.

<Understanding Diseases>
◆ Cha Jung-yeol: Do you think it's a treatment for braces when you're young? A lot of people think so. Recently, however, middle-aged people are increasingly choosing orthodontics for oral health care and younger smiles. Why do middle-aged people choose braces? In middle-aged people, the arrangement of teeth is often distorted. As we get older, our front teeth become more crooked. In particular, there are cases where the teeth continue to twist due to gum disease. As it keeps twisting like this, there is a space between the teeth, especially between the front teeth. If a molar collapses due to the loss of surrounding teeth, it may be necessary to stand it back up and receive prosthetic treatment. There are also cases where we need orthodontic treatment when we make space between our teeth for implant treatment. Above all, even if you have orthodontic treatment in the past, your teeth may become twisted again, and you need orthodontic treatment again.

<Middle-aged malocclusion>
◆ Cha Jung-yeol: For these various reasons, middle-aged people are correcting them. So what symptoms are we talking about for malocclusion? First of all, malocclusion occurs so often that it is one of the three major oral diseases along with tooth decay and gum disease. The arrangement of teeth is uneven, and the upper and lower teeth do not bite well, and the opposite occlusion of the front teeth, the open occlusion that does not bite the front teeth, and the occlusion of the front teeth deeply. Such malocclusion can cause problems such as pronunciation and writing as well as cosmetic problems, which can reduce the quality of life, and in severe cases, can cause jaw joint pain or tooth wear. Then, what is the common malocclusion that occurs in middle-aged people? Above all, if one or two front teeth are severely twisted, we can often see them. On the other hand, as the gums weaken, gaps between teeth may occur. And it is common to see areas where malocclusion occurs as the surrounding molar collapses forward due to the missing teeth.

<History of Orthodontics>
◆ Cha Jung-yeol: So when did orthodontics start? The history of orthodontics in the world dates back to the ancient Greek and Roman times, when there was an explanation for irregular occlusal teeth. This was first mentioned by Hippocrates in 400 B.C. From the mid-century to the 18th century, attempts have been made to treat malocclusion by ligation of teeth on hoof-shaped metal plates. In modern times, Edward Angles, the father of correctional science in the 19th century, founded the taxonomy of malocclusion. It has developed an Edgewise device that can move teeth in three dimensions and is the birthplace of the current orthodontic device. Until recently, calibration devices have continued to develop, and self-ligation calibration devices have been developed that can automatically tie the calibration device and the calibration wire. The calibration device is made simpler and smaller. In addition, with the development of orthodontic wires utilizing shape memory and super-elastic characteristics, the popularization of orthodontic treatment has contributed greatly as the patient's pain and discomfort are greatly reduced by moving the teeth with very weak force. When did orthodontics in Korea start? Even under Japanese rule in 1923, the development of orthodontic treatment can be confirmed through newspaper advertisements of the Dong-A Ilbo. At that time, there were dental orthodontics specialized courses along with oral surgery as a specialized dental course at Severance Hospital, and at that time, Chosun Ilbo can also check public relations articles on the timing of orthodontics in the column. With the establishment of the Korean Orthodontics Association, a branch society of the Korean Dental Society, in 1959, Korea's full-fledged Western-style orthodontics treatment began after liberation.

<Type of orthodontic device>
◆ Cha Jeong-yeol: So what does the orthodontics need look like? Additional devices such as visible orthodontic devices, invisible orthodontic mini-screws and armpit expansion devices required for orthodontic treatment have been developed and used for treatment.

<Tube type calibration device>
◆ Cha Jung-yeol: So what are the latest orthodontic treatments for middle-aged people? First of all, let me introduce a small tubular calibration device to minimize discomfort. This tube-shaped orthodontic device made the existing attachable orthodontic device very small, reducing foreign body sensation and lowering friction, enabling rapid tooth movement. The attachment of the tubular orthodontic device is a simple technique of first processing the tooth surface, then positioning the wire and fixing it with resin, so it can shorten the treatment time and reduce the inconvenience of the patient. Let me introduce a case related to this. I'm a 54-year-old female patient in business who has already been treated with a transparent correction device. However, the wearing time of the device was very low, resulting in a problem of opening the front teeth. The patient chose a tubular correction device with low foreign body sensitivity instead of a traditional transparent device, and the severe concentration of the preposition was very well resolved through a treatment period of about 10 months. The next patient is a 47-year-old female housewife. This patient has already had a small molar removed and orthodontic treatment 20 years ago. After that, my lower teeth got twisted again and I wanted to have them corrected again. Since the patient had to undergo a second orthodontic treatment, he decided to perform orthodontic treatment through a tube-type device, a device with low foreign body sensitivity. As shown in the figure, we were able to arrange the lower teeth well for a short period of two months, and then we decided to maintain the teeth with a fixed device. Next is a 64-year-old male patient. You visited the hospital with a complaint that your upper teeth protruded and your lower teeth were crooked. This, too, allows you to stretch your front teeth well for four months through a tubular device. The patient is very satisfied with the outcome of the treatment. The next patient is a 55-year-old middle-aged woman. Most of all, you were dissatisfied because your lower teeth were bent badly. In the case of this patient, the lower teeth could be stretched well using a tubular device. In particular, if you have severe front teeth bites, it is very difficult to attach with existing devices. However, we were able to complete the arrangement of the lower teeth without any foreign substances because small-shaped devices can be attached and corrected even in this situation.

<Transparent Calibration Device>
◆ Cha Jeong-yeol: Next, we will have orthodontic treatment that does not seem to be the latest orthodontic treatment in the middle-aged, so-called transparent orthodontic treatment. The transparent orthodontic device is manufactured by planning the movement of teeth step by step through digital simulation software, printing a tooth model using three-dimensional printing, and then pressing a thermoplastic plate on it. The manufactured device is very soft and highly elastic, so we can move our teeth as we want. Recently, a transparent calibration device that directly designs and outputs the device through 3D printing without such a complex process has also been introduced and is being used in clinical practice. When I do such transparent orthodontic treatment, I don't put anything on my teeth? That's not true. White resin is attached to the tooth to strengthen the bond between the device and the tooth and to move the tooth more efficiently. Of course, it will be removed with the device after the orthodontic treatment. Then, let me introduce a case of transparent orthodontic treatment in the middle-aged. It is a 40-year-old female patient whose gums have deteriorated, causing a gap between her teeth. I'm a patient who chose a transparent correction device to eliminate these gaps. Above all, if you have problems with your gums before orthodontic treatment, gum treatment will be the priority. This patient also prioritized gum treatment for about 3 months before orthodontic treatment. After that, the device was worn step by step using a transparent calibration device, and all dental spaces were closed during the entire six-month treatment period. Next is a 47-year-old female patient. He was a person who worked on the show. You wanted orthodontic treatment because your front teeth were sticking out and your lower teeth were bumpy. The patient wanted an invisible device by occupation, so he wanted a tongue correction device attached to the inside of the tooth. However, after attaching the device, he complained of pronunciation discomfort. In the end, there was an important part of the patient's occupational pronunciation, so we decided to remove the device and change the treatment to a transparent device. You can see that the problems of the front teeth were solved well during the six-month treatment period. The following is a patient who visited the hospital at the age of 45 with a lot of upper front teeth protruding. As shown in the picture, two upper teeth stick out and a lot of lower teeth are rotated. This patient also wore a total of 14 steps through a transparent device. You can see that the arrangement of the incisors is well completed through the treatment period for about five months. To move your teeth with transparent braces, you need space around your teeth. Therefore, in order to create such a space, a formula called interdental deletion is necessary. Interdental deletion is usually done within acceptable limits. However, if it is excessive, it can change its original shape, so the teeth may turn strange. Therefore, transparent orthodontic treatment requires professional practice and is recommended to be treated through professional orthodontic treatment. In addition, transparent orthodontic devices can also be used to arrange severely protruding teeth. This 50-year-old male patient had severe rotation in his front teeth due to periodontal disease. In addition, orthodontic treatment was required along with implants in the missing front teeth. Before planting the implant, it is necessary to relieve the protrusion of the surrounding teeth. First of all, the front teeth were arranged with a transparent device, and at this time, artificial teeth were attached to the transparent device, so the patient was satisfied and wore the device well. After corrective treatment, the implant was placed in the defective area. You can see that the surrounding teeth and arrangement are very good. The next patient was a 52-year-old female patient who wanted orthodontic treatment due to a gap between her front teeth. You filled the gap between your front teeth with resin a long time ago. They say it's open again. There was also space on the front teeth below. After the molar is removed on the right side, you can also see that the back molar has fallen forward. This patient designed predictable tooth movement using a digital tooth movement simulation program to produce a transparent correction device. The gap in the front teeth was well closed through transparent correction. I was able to re-establish the molar that collapsed with mini-screw placement on the lower molar and complete the prosthetic treatment. Here, a mini screw is a small screw that sits between the teeth and can be used as a device that can effectively stand a fallen tooth. In this way, orthodontic treatment is possible effectively without attaching devices to the entire tooth.

<Orthodontic treatment with wisdom teeth>
◆ Cha Jeong-yeol: There is an orthodontic treatment in middle-aged people that uses wisdom teeth instead of implants when they lose their molar and fall out due to the latest orthodontic treatment. You can see the radiographs of a patient in his 40s in the picture. I am a patient who has severely decayed molar teeth, so I have extracted the tooth and planned an implant. However, my wisdom tooth was in good condition, so I decided to do orthodontic treatment to tow my molar forward. By attaching orthodontic mini screws and orthodontic devices, it is possible to treat molar and wisdom teeth sequentially moving forward. However, in the case of molar teeth, it has several roots and is large, so it usually takes one to two years of orthodontic treatment, so it can be said that it is a difficult treatment.


<Orthodontic treatment for gums>
◆ Cha Jeong-yeol: Finally, the latest orthodontic treatment for middle-aged people is orthodontic treatment for gums. Next, a female patient in her 40s visited our hospital with a complaint that her gums have gone down a lot. As shown in the picture, you can see that the front tooth gums have gone down a lot. This lowering of the gums is caused by the roots of the teeth coming out of the gums. Usually, it will be treated through gum treatment or gum transplantation, but since the patient's teeth have already come out of the bone, it is necessary to send the teeth back to the gums through orthodontic treatment. Eventually, through eight months of orthodontic treatment, we were able to effectively put back the roots of the teeth that came out of the gums. Through this orthodontic treatment, the gums that went down could narrow again. Later, through a gum transplant, I was able to find a strong gum again.

<Misunderstanding and Truths Related to Orthodontics>
◆ Cha Jeong-yeol: There are many misunderstandings and truths related to orthodontics. Many people say that orthodontics weaken their gums. Actually, that's not the case. In fact, gum inflammation is sometimes caused by orthodontics, but it is often caused by neglect of oral hygiene, apart from unreasonable movement of teeth. Gum inflammation can be improved if you pay more attention to brushing your teeth during orthodontic treatment or if you receive gum treatment on the symptom area, and there are few aftereffects left. According to a recently reported literature review, orthodontics can stabilize the condition more for patients with weak gums and greatly help improve function and aesthetics. Even if your gum health is weak, you can correct your teeth, and if you correct it with minimal power in a non-inflammatory state, it does not negatively affect your gums. One of the misconceptions about orthodontics is, 'Can we sustain it for life once we do orthodontics? That's what I think. I'm afraid not. Even after
orthodontic treatment, the tooth has the property of returning to its original shape. That's why you should wear the retainer well so that it doesn't get twisted again. In particular, if the maintenance device is neglected between six months and a year after treatment, the tooth is very likely to move again. Among the other misunderstandings, many people think that it takes a long time to get braces. That's not always the case. It is true that orthodontic treatment generally takes longer than other dental treatments. Depending on the individual condition, the treatment period may take a few months or more than a year. In some cases, tooth movement may appear late due to differences in bone metabolism processes in the gums from person to person. In addition, if you work well with regular treatment and install the device correctly, you can prevent unnecessary extension to the duration of treatment. A recent report found that among the various factors affecting orthodontic treatment period, the presence or absence of extraction of patients and the severity of initial malocclusion were very major factors. The important fact is that age does not affect the duration of treatment if it is a permanent dental period. So is braces a painful process? By attaching the device of the teeth, of course, you can feel a foreign body in the oral cavity. You may feel uncomfortable. In particular, at the beginning of treatment, the mouth may become loose and feel pain for about a week. Recently, as these devices are getting smaller and minimized, discomfort and adaptation periods are getting very fast. Usually, the pain increases quickly after attaching the correction device. It will peak on the first day. However, it will gradually decrease during the first week. If the pain is severe, we can take painkillers. Nonsteroidal painkillers such as aspirin and ibuprofen can sometimes reduce tooth movement. Therefore, acetaminophen-based painkillers may be effective for pain relief for orthodontic treatment because they do not affect such tooth movement. Then, will orthodontic treatment cause cavities? That's not true. Orthodontic treatment itself does not cause tooth decay. If you neglect to brush your teeth during treatment, not only cavities but also gum disease can easily occur. Therefore, if gum care is difficult, we should prioritize oral hygiene for patients before orthodontic treatment. If necessary, it is also effective to use an interdental toothbrush or dental floss in addition to a regular toothbrush and receive regular fluoride application.

<Caution for Treatment>
◆ Cha Jeong-yeol: When I look at middle-aged patients who want orthodontic treatment in an outpatient clinic, there are cases where they have chronic diseases and have various concerns about orthodontic treatment. In particular, it is important to discuss your condition with your doctor in advance because it affects your orthodontics if you have underlying diseases such as diabetes, osteoporosis, and arthritis. If you take osteoporosis or arthritis drugs, these drugs can slow down the movement of your teeth. Therefore, corrective treatment can be effectively performed by temporarily reducing or lowering the dose of the drug during the corrective treatment period. Diabetes among patients with periodontal disease and poor gums may worsen during orthodontic treatment. However, if this is controlled diabetes, the correction treatment can be completed without worsening the gum condition by receiving periodic gum treatment and continuous gum care during the treatment process. Above all, it is necessary to inform your doctor of your systemic disease before corrective treatment and come up with a management plan together.

<Medical AI Q&A>
◆ Cha Jung-yeol: Viewers have sent me a lot of questions about orthodontics for middle-aged people. Shall we check it out together?

◇ Y-ON (AI Anchor): I'm planning to get my orthodontics, but my molar is rotten, so I got crown treatment first. Can I get braces even in this state?

◆ Cha Jeong-yeol: In general, cavity treatment is done before orthodontic treatment. However, if the cavity treatment is severe enough to receive crown treatment, it is recommended that you stay as a temporary tooth during orthodontic treatment and then do the final crown when the treatment is over.

◇ Y-GO (AI Anchor): Planted a mini screw for orthodontics. It didn't hurt because I was anesthetized when I planted it, but do you also anesthetize it when you remove it?

◆ Cha Jeong-yeol: In general, the pain is very low when removing the mini screw and anesthesia is not performed. However, if the mini screw is located deep in the gums and is buried in the gums, anesthesia may be performed. In addition, if the patient himself/herself is concerned about the pain, we can always anesthetize and remove it if he/she asks for anesthesia. However, in general, there is only a very small pain when removing a mini screw, so you don't have to worry too much.

◇ Y-ON (AI Anchor): Is it true that if you get braces, you get a balance and you get dental caries?

◆ Differential heat: Due to differences in the individual dental structure of the patient, there may be a lock on the surface when removing the orthodontic device. It is hard to see, but the fine locking of the surface of the tooth does not affect the structure of the tooth or the shape function of the tooth. Therefore, it does not cause caries.

◇ Y-GO (AI Anchor): A woman in her 40s. Two weeks ago, I attached a bracket and connected a wire to correct my teeth, but the pain is so severe that it is difficult to eat food. Should I put up with it? Do you think I need to get my correction done again?

◆ Cha Jeong-yeol: Orthodontic treatment is indeed uncomfortable, but it is generally common for the pain to increase briefly after the visit to the hospital and decrease to a tolerable degree in a week. However, if the pain continues to increase and is severe, take painkillers first and there may be irritation sources, so you need to visit the hospital again for a checkup. Usually, in this case, there is only one case where the orthodontic wire continues to poke the gums or there is inflammation around the orthodontic mini-screw. However, you don't have to worry too much because a simple formula can relieve this pain at the hospital.

<Let's just remember this>
◆ Cha Jung-yeol: It's really not easy to start braces in your 40s and 50s when you're in a social life. Please remember that orthodontics for middle-aged people not only helps with psychological improvement but also helps with dental care, and if you plan to get treatment, I would like to ask experienced medical staff to get treatment. I hope my story today helped you to live a happy and healthy life. Thank you.