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Teeth alignment depends upon the growth of jaw. Jaw bone’s growth is constantly changing over a period of time. As jaw bone is holding teeth. Growth of bone changes the normal alignment of teeth as well. Growth stops at 20 years of the age in most individuals. But there are certain factors that might lead to crooked teeth in late ages as well. Patients have reported to clinics at age more than 20 years with all of a sudden misalignment of their permanent teeth. In this article, we’ll study possible causes of late misaligned teeth and how to fix them. Causes: 1. Loss of teeth: Extractions, traumatic loss of teeth, or any other pathological diseases like enucleation in which affected tooth had to be removed left a space in arch. Adjacent teeth to that space tend to fill that space which causes crooked teeth all of a sudden. 2. Poor oral hygiene: Poor oral hygiene is the root problem for many dental problems. Calculus and plaque buildup often shifts teeth very little. The change is not visible with naked eyes. There are other things other than teeth, that should be well maintained like bone growth by maintaining good diet. Gingivitis and then periodontitis(bone loss) causes tooth mobility. Mobile teeth shifts from their original position. Gingivitis and periodontitis are severe form of gum and bony diseases which could only be solved by periodontist. 3. Age: Lower jaw growth completes mostly at 20 years of age. Increase in growth changes alignment of teeth overtime until growth stops. In some patients, growth can exceed further one to three years which might be the reason of crooked teeth in adults. 4. Late mandibular growth at 40: Cases have been reported with late mandibular growth at age 40. Whenever there will be growth, teeth alignment will change accordingly. These growth periods at late adult is rare but is possible cause of shifting of teeth. 5. Bruxism: Bruxism is unconscious jaw clenching. Patient having bruxism, grind their teeth during sleep without knowing. Bruxism is an anxiety concerned disorder. Smoking, drinking alcohol and coffee addicts are more prone to this anomaly. 6. Caries: Bacterias present in oral cavity act on food debris if oral hygiene hasn’t been kept very good for a long time. Untreated conditions leads to tooth loss ultimately which will affect the normal alignment of the teeth. 7. Inheritance: Some Individuals have family genes that cause misaligned teeth at late ages of the teeth. It’s your dentist duty to ask you about your parents, grandparents and relative’s teeth condition during history taking. In cases like this, orthodontic treatment is the ultimate option to fix this situation. 8. Orthodontic treatment: Individuals who had done their orthodontic treatment in prepubertal age often came with complaints of relapse. Retention appliances are given to them to wear for sometime or lifetime too. Those who don’t care for this, gets crooked teeth at later stage of the life. How to prevent it? There are ways to prevent this late problem. 1. Retention appliances: Those who had completed their orthodontic treatment should wear retention appliances as suggested by their orthodontist. Retention appliances keep teeth at perfect position which have been attained during many appointments for Ortho treatment. Retention appliances are called retainers which are of three types depending upon the how much time should they be worn by patients. Short term, medium term and life term retainers are used. Complicated Orthodontic problems like gap between front teeth often need long term retainers. 2. Hygiene maintenance: Brushing twice a day, daily floss is a clutch that should be followed by everyone. It helps to prevent you from caries. Caries causes tooth loss. So, if their is leas chances of caries, tooth loss probability will decrease. 3. Space maintenance after extraction: Extraction creates space between teeth. Teeth tend to fill that space and ultimately normal alignment of teeth gets disturbed. That space has to be maintained after extraction. Consult an orthodontist immediately for space maintenance appliance. Notes: Do not use space maintainers at early ages where baby teeth have been falling out. Early loss of the teeth requires this appliance. It’s not permanent. It lasts until permanent tooth has erupt. 4. How to prevent anxiety: As anxiety is a big caustic factor of bruxism. Exercise, antidepressants can prevent bruxism. Grinding of teeth will be reduced with elimination of risk factors. As bruxism can cause misaligned teeth at late ages, so preventing it will not affect the dentition. 5. Fillings: Tooth decay and caries is first step for dissolving normal dentition. Tooth loss can be prevented by eliminating decaying part of the teeth and stopping bacterias to eat teeth. Filling should be done for this. Notes: Crowning should be done after eliminating all carious part of the tooth. There are different types of crowns like metal one, porcelain and zirconia. Zirconia is the best one after filling or root canal of the tooth. Treatment plan: Treatment is done differently depending upon the risk factors. 1. Orthodontic treatment: Whenever alignment of the teeth and jaws are concerned, orthodontist name will come forward. It’s the ultimate solution to the problems that affect the perfect alignment of the teeth. Orthodontic treatment includes braces which tightened the teeth after getting them in place. Their are multiple types of braces. If aesthetics is one major concern, ceramic braces should be used. Metal braces have more strength but less pleasing in look. 2. Mouth guards: Mouth guards are mostly advised by dentist to patients having grinding problems at night. Mouth guards are very common. People with sleep apnoea should wear this. This prevents teeth from getting wear down at night. There are two types of mouth guards. Custom made and stock. Dentist makes custom made while stocks are available at market of almost every size. Custom made are more comfortable as compared to the later one.

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