What are dental braces - Orthodontic Braces

What Are Dental Braces?

Dental braces — also called orthodontic braces or teeth braces — are fixed or removable dental appliances used to correct the alignment of teeth and jaws. They work by applying continuous, calibrated pressure to teeth over an extended period, gradually moving them into a desired position determined by an orthodontist.

Braces treat a range of conditions collectively called malocclusion: a misalignment of the teeth or jaws that affects how the upper and lower teeth meet when biting. This includes overbites, underbites, crossbites, open bites, crowded teeth, and gaps between teeth.

Modern orthodontic braces are one of dentistry’s most well-studied interventions. Their use is documented as early as the 18th century, but the materials and mechanics used today — stainless steel, nickel-titanium archwires, ceramic brackets, and clear thermoplastic aligners — are the product of decades of clinical innovation.

How Braces Work: The Mechanics of Tooth Movement

To understand braces, you first need to understand the structure they work on: the periodontal ligament, a thin layer of elastic connective tissue that anchors each tooth root to the jawbone. This ligament is not static — it remodels continuously in response to pressure.

When a brace applies directional force to a tooth:

Compression side: The periodontal ligament on the side toward which the tooth is being pushed compresses. Bone-resorbing cells called osteoclasts break down bone in this area, creating space.
Tension side: On the opposite side, the ligament stretches. Bone-forming cells called osteoblasts deposit new bone to fill the gap left behind.
The tooth moves: As old bone is resorbed and new bone is laid down, the tooth physically repositions within the jaw.

This biological process — called orthodontic tooth movement — is slow by design. Moving teeth too quickly risks root resorption (shortening of the tooth root) or bone damage. The standard rate of safe tooth movement is approximately 1 millimeter per month, which is why most orthodontic treatments take between 12 and 36 months.

The key components that generate and transmit this force are:

Brackets: Small metal, ceramic, or plastic squares bonded directly to the front surface of each tooth using dental adhesive. Brackets act as handles — they hold the archwire in place and transmit force to the tooth.
Archwire: A thin, flexible wire threaded through slots in all the brackets. It acts as a track or guide, and its memory — the tendency to return to its original shape — is what creates the force that moves teeth.
Ligatures / O-rings: Small elastic rings (or metal ties) that secure the archwire into the bracket slot. In self-ligating braces, a built-in clip replaces this element.
Bands: Metal rings cemented around back molars that serve as anchor points for the archwire and other components like elastics or headgear.
Elastics (rubber bands): Small latex or latex-free bands the patient hooks between upper and lower brackets to correct the relationship between the upper and lower jaws — particularly for overbite and underbite correction.
Springs and auxiliaries: Coil springs, power chains, and sectional archwires may be added at various stages to apply targeted forces for specific tooth movements.

What Conditions Do Braces Treat?

Braces are prescribed primarily for malocclusion — the umbrella term for any deviation from a correct bite. Orthodontists classify malocclusion using a system developed by Edward Angle in 1899 and still in use today:

Class I Malocclusion: The back teeth bite correctly (the upper first molar fits into the groove of the lower first molar), but the front teeth are crowded, spaced, or rotated.

Class II Malocclusion (Overbite / “Overjet”): The upper jaw and teeth protrude significantly ahead of the lower jaw. Colloquially called “buck teeth.” Can be dental (just the teeth) or skeletal (involving the jaw itself).

Class III Malocclusion (Underbite): The lower jaw protrudes ahead of the upper jaw. Often has a skeletal component and may require jaw surgery (orthognathic surgery) in addition to braces in severe cases.

Beyond Angle’s classification, braces also treat:

Condition	Description	Can Braces Fix It?
Crowding	Too many teeth for available space; teeth overlap	Yes — with or without extractions
Spacing / Diastema	Gaps between teeth, especially the upper front teeth	Yes
Crossbite	Some upper teeth sit inside the lower teeth when biting	Yes — often with expanders
Open Bite	Upper and lower front teeth don’t meet when back teeth are together	Often yes; severe cases may need surgery
Deep Bite	Upper front teeth excessively overlap the lower front teeth	Yes
Midline Discrepancy	The centers of upper and lower teeth don’t align	Often yes

Beyond aesthetics, untreated malocclusion can contribute to uneven tooth wear, jaw joint (TMJ) pain, difficulty chewing, speech impediments, and poor oral hygiene due to hard-to-clean overlapping teeth.

Types of Braces: A Complete Overview

Orthodontic braces are not one-size-fits-all. The right type depends on the complexity of the case, the patient’s age and lifestyle, budget, and aesthetic preference.

Traditional Metal Braces

The original orthodontic appliance, continuously refined over 200 years. Modern metal braces use stainless steel brackets and high-performance nickel-titanium archwires that are far smaller, lighter, and more effective than their predecessors. Colored elastic ligatures make them popular among younger patients. Metal braces remain the most versatile and cost-effective option for complex cases.

Ceramic Braces

Ceramic braces use tooth-colored or clear aluminum oxide brackets instead of metal ones, making them far less visible. The archwire may be tooth-colored as well. They work the same way as metal braces and are comparably effective, but the brackets are slightly larger and more prone to staining from coffee, red wine, and certain foods. A preferred choice for adult patients who want something more discreet than metal.

Self-Ligating Braces (including Damon Braces)

Self-ligating brackets have a built-in sliding door or clip mechanism that holds the archwire, eliminating the need for elastic ligatures. This reduces friction between the wire and bracket, which proponents argue leads to faster tooth movement, fewer tightening appointments, and less discomfort. The Damon System is the most marketed brand of self-ligating braces. Available in both metal and clear (ceramic) versions.

Lingual Braces

Lingual braces are brackets bonded to the inner (tongue-facing) surfaces of the teeth — making them completely invisible from the front. Custom-fabricated for each patient using digital scanning and CAD/CAM technology, they are the most discreet fixed appliance available. They come with a higher cost and an adjustment period affecting speech and tongue comfort. Incognito (3M) and Harmony (American Orthodontics) are leading lingual systems.

Clear Aligners (Invisalign and Alternatives)

Clear aligners use a series of custom-fabricated, removable thermoplastic trays to progressively move teeth. Each tray is worn for approximately one to two weeks before being swapped for the next in the series. Invisalign is the dominant brand, accounting for the majority of the global clear aligner market. Alternatives include ClearCorrect, Spark, and Angel Aligner. Clear aligners are effective for mild to moderate cases and increasingly competitive with traditional braces for more complex ones, though they require high compliance — the trays must be worn 20–22 hours per day.

Pediatric / Phase 1 Appliances

For younger children (typically ages 7–10), orthodontists sometimes recommend Phase 1 treatment using appliances like palate expanders, space maintainers, or partial braces. These address developing skeletal discrepancies before the adult teeth fully emerge, potentially simplifying — or eliminating the need for — later comprehensive treatment.

The Orthodontic Treatment Process: What to Expect

Understanding braces means understanding the full clinical journey, not just the appliance itself.

Step 1: The Initial Consultation

An orthodontist — a dentist who has completed an additional 2–3 years of residency training in orthodontics and dentofacial orthopedics — evaluates the patient using clinical examination, digital X-rays (panoramic and cephalometric), dental photographs, and increasingly, intraoral 3D scans. The orthodontist diagnoses the malocclusion, discusses treatment options, and provides a cost estimate.

Step 2: Treatment Planning

For fixed braces, the orthodontist prescribes a specific bracket prescription (the angle at which brackets are positioned) and an archwire sequence designed to achieve the desired tooth movements in the correct order. For aligners, a digital treatment simulation called a ClinCheck (Invisalign) is generated, mapping out every tooth movement across the entire treatment.

Step 3: Bonding / Placement Day

Brackets are bonded to teeth using a light-cured composite resin. The process typically takes 60–90 minutes, is entirely painless, and involves cleaning and conditioning the tooth surface, placing the bracket, curing the adhesive, and threading the initial archwire. Patients leave with pressure and mild soreness that typically peaks at 24–72 hours and resolves within a week.

Step 4: Adjustment Appointments

Every 4–8 weeks, the patient returns for archwire changes or adjustments. The orthodontist evaluates progress, swaps archwires for progressively stiffer ones, and addresses any issues. These appointments typically take 20–30 minutes. Each adjustment may cause 1–3 days of mild discomfort as the teeth respond to the new force levels.

Step 5: Debonding (Brace Removal)

When treatment goals are achieved, brackets are removed using a debonding instrument that gently cracks the adhesive bond. Residual adhesive is polished off the teeth. A retainer is fitted the same day or shortly after.

Step 6: Retention

Retention is the most overlooked phase of orthodontic treatment — and arguably the most important. Teeth have a natural tendency to drift back toward their original positions (called relapse), driven by the periodontal ligament’s memory. Retainers — either removable (Hawley or clear Essix-style) or fixed (bonded wire behind the front teeth) — must be worn as directed to preserve the results. Many orthodontists now recommend indefinite retainer wear.

Who Needs Braces? Candidacy by Age

Orthodontic treatment is appropriate across a wide age range, with different considerations at each stage.

Children (ages 6–10): The American Association of Orthodontists (AAO) recommends every child have an orthodontic screening by age 7. At this age, a mix of baby and permanent teeth allows an orthodontist to identify early problems like crossbites or severe crowding. Most children don’t need treatment this young, but early detection allows monitoring and timely intervention.

Tweens and Teens (ages 11–17): The most common time for comprehensive orthodontic treatment, because all or most permanent teeth have erupted and the jaw is still growing — meaning the bone responds well to orthodontic forces. Treatment during adolescence tends to be faster and more predictable than in adulthood.

Adults (18+): There is no upper age limit for orthodontic treatment. Tooth movement is possible at any age as long as the teeth and supporting bone are healthy. Adult treatment may take slightly longer due to denser bone, and adults are more likely to have complications like gum disease or missing teeth that require coordination with other dental specialists. The growth in clear aligner technology has driven a significant increase in adult orthodontic treatment over the past decade.

Benefits of Orthodontic Braces

The case for orthodontic treatment extends well beyond cosmetic improvement, though that is often the primary motivating factor for patients.

Functional benefits:

Improved chewing efficiency, which aids digestion
Reduction of jaw joint (TMJ) stress caused by uneven bite forces
Correction of speech issues caused by tooth positioning (lisps, for example, are sometimes linked to spacing or open bites)
Prevention of abnormal tooth wear from misaligned contacts

Oral health benefits:

Straighter teeth are easier to clean — properly aligned teeth reduce plaque accumulation in hard-to-reach overlapping areas, lowering the risk of cavities and gum disease
Reduced risk of tooth trauma — protruding upper front teeth are more likely to be chipped or knocked out in an accident or fall
Prevention of bone loss around teeth subject to abnormal forces

Psychological and social benefits:

Multiple studies demonstrate associations between orthodontic treatment and improved self-esteem and quality of life
A 2023 systematic review in the American Journal of Orthodontics and Dentofacial Orthopedics found significant positive effects on psychosocial wellbeing following orthodontic treatment, particularly among adolescents

How Much Do Braces Cost?

Cost varies significantly by treatment type, geographic location, case complexity, and provider experience. As a general reference for the United States in 2026:

Type	Average Cost Range
Metal Braces	$3,000 – $7,000
Ceramic Braces	$4,000 – $8,000
Self-Ligating Braces	$3,500 – $8,500
Lingual Braces	$8,000 – $13,000+
Invisalign (comprehensive)	$4,500 – $9,000
Invisalign Lite (mild cases)	$2,500 – $5,000

Many orthodontic practices offer in-house payment plans, and some cases are partially covered by dental insurance — particularly for patients under 18. Medicaid coverage for braces varies by state and typically requires the case to meet a severity threshold.

→ See our full guide: How Much Do Braces Cost?

Braces vs. Clear Aligners: Which Is Right for You?

One of the most common questions orthodontists field is whether to choose traditional braces or clear aligners like Invisalign. The honest answer is: it depends on the case and the patient.

Choose braces if:

Your case involves significant rotation, vertical movement, or skeletal issues
You prefer not to track and swap trays every 1–2 weeks
Budget is a primary concern (metal braces remain the most affordable option)
You’re treating a child or teen who may not maintain aligner compliance

Choose clear aligners if:

Your case is mild to moderate in complexity
Aesthetics during treatment are a high priority
You want the flexibility to remove the appliance for meals and photos
You can commit to wearing them 20–22 hours per day without fail

In many contemporary cases, experienced orthodontists can achieve equivalent outcomes with either approach. The key is choosing a qualified provider, not fixating on the appliance.

→ See our detailed comparison: Braces vs. Invisalign: 10 Key Differences

Risks and Considerations

Orthodontic treatment with braces is safe and well-tolerated for the vast majority of patients, but there are genuine risks to be aware of:

Root resorption: Orthodontic tooth movement can cause minor shortening of tooth roots. In most patients this is clinically insignificant, but in rare cases — particularly with prolonged treatment or genetically susceptible patients — it can be more pronounced. Monitoring via X-ray during treatment is standard practice.

Enamel demineralization (white spots): The most common complication of fixed braces. If plaque is not adequately removed around brackets, the acids produced by bacteria can etch the enamel, leaving permanent white or chalky lesions after the braces are removed. Meticulous daily brushing and fluoride use are the primary preventive measures.

Gum inflammation: Brackets create areas that are more difficult to clean, making gingivitis more common during treatment. Good oral hygiene and regular professional cleanings mitigate this risk.

Discomfort: Expected and temporary, primarily in the 48–72 hours following placement and each adjustment. Managed effectively with over-the-counter pain relief and orthodontic wax for bracket irritation.

Relapse: As described above — teeth will drift without consistent retainer wear. This is not a failure of the braces; it is a property of the periodontal system.

Caring for Braces: The Essentials

The effectiveness and safety of orthodontic treatment depend heavily on how well the patient cares for their braces between appointments.

Brushing: After every meal, or at minimum twice daily, using a soft-bristle toothbrush angled at 45° above and below the brackets. An electric toothbrush improves plaque removal. Interdental brushes (proxy brushes) clean around brackets and under archwires where a regular brush cannot reach.

Flossing: Daily flossing is non-negotiable. Floss threaders or orthodontic flossers allow thread to pass under the archwire. Water flossers (oral irrigators) are an effective complement but do not replace string floss.

Diet: Avoid hard, sticky, and chewy foods that can bend archwires, break brackets, or dislodge bands. Common culprits: popcorn, hard candy, ice, bagels, raw carrots, corn on the cob, and caramel. Cut apples and other firm fruits into small pieces.

Wax: Orthodontic wax applied over sharp or poking brackets provides immediate relief from lip and cheek irritation while tissue adapts.

Mouthguard: Athletes wearing braces should use a mouth guard specifically designed for orthodontic patients to protect both teeth and soft tissue during contact sports.

→ See our full guide: How to Care for Braces: Daily Routine

Frequently Asked Questions

Are braces painful?

Braces are not painful to have placed, but they cause soreness for 2–4 days after each adjustment as teeth respond to new forces. Most patients describe it as pressure or achiness, not sharp pain. Over-the-counter ibuprofen or acetaminophen, and soft foods during those days, make it very manageable.

How long do braces take?

Treatment length depends on the complexity of the case, patient compliance (especially for aligner patients), and biological response. Simple cases may be complete in 12 months. Comprehensive cases commonly take 18–24 months. Severe skeletal cases can run 30–36 months, sometimes combined with surgery.

At what age should you get braces?

The AAO recommends a first orthodontic evaluation at age 7. Comprehensive braces treatment most commonly begins between ages 11 and 14. But there is no upper age limit — adults of all ages successfully complete orthodontic treatment.

Do braces work for adults?

Yes. Tooth movement is biologically possible at any age, provided the teeth and bone are healthy. The process may take slightly longer in adults, but outcomes are equivalent.

Can you eat normally with braces?

You can eat most foods, with some restrictions. Hard, sticky, chewy, and crunchy foods should be avoided. Soft foods are best immediately after adjustments. Once you adapt (usually within a few weeks), eating with braces becomes second nature.

What happens after braces come off?

Retainers are fitted on the day of or shortly after debonding. Most orthodontists prescribe full-time wear for the first 3–6 months, transitioning to nighttime-only wear indefinitely. Without a retainer, teeth will gradually shift back.

Are there alternatives to traditional braces?

Yes. Clear aligners (Invisalign and others) are the most popular alternative. Lingual braces offer a completely hidden fixed option. For minor cosmetic issues, some dentists offer composite bonding or veneers as non-orthodontic alternatives, though these don’t move teeth or correct bite.

Glossary of Key Terms

Malocclusion — Any misalignment of the teeth or jaws affecting the bite.
Bracket — The small fixed component bonded to each tooth that holds the archwire.
Archwire — The wire threaded through all brackets that exerts force on the teeth.
Ligature — The elastic or metal tie that secures the archwire into the bracket slot.
Osteoclast — A cell that breaks down bone on the compression side of a moving tooth.
Osteoblast — A cell that deposits new bone on the tension side of a moving tooth.
Periodontal Ligament (PDL) — The connective tissue connecting tooth root to jawbone; the biological mechanism of tooth movement.
Debonding — The process of removing brackets at the end of treatment.
Retention / Retainer — The phase of treatment (and the appliance used) to hold teeth in their new positions after braces are removed.
Root Resorption — Shortening of tooth roots, a potential side effect of orthodontic movement.
Overjet — Horizontal protrusion of the upper front teeth relative to the lower.
Overbite — Vertical overlap of the upper front teeth over the lower front teeth.
Phase 1 Treatment — Early orthodontic intervention in young children to address developing skeletal problems.
Self-Ligating Bracket — A bracket type with a built-in clip to hold the archwire, eliminating elastic ligatures.
ClinCheck — The digital 3D treatment simulation used in Invisalign planning.