I just got my new braces on last week. Funny, but I think they’re making my teeth worse! I have a gap where there wasn’t one before and one of my lower front teeth is now more crooked that when I started. Is this normal?

It is common for things to get worse before they get better
Straightening the teeth is a dynamic process; your teeth will be changing throughout treatment. During the process of alignment, especially during the first 6 months, you may notice that things look worse before they look better. Here’s why:

Dental compensations develop naturally to address jaw size problems
Although your teeth are crowded and crooked when you first come in to see me, they have usually drifted into a position where they are relatively stable and functional. Your body is amazing at adapting to problems that exist. If you have a lower jaw that is smaller than the upper for example, the top teeth will be pushed back by your upper lip and your lower teeth will be pushed forward by your tongue. We call these “dental compensations.” If the teeth are crowded, the crowding is usually spread evenly among the teeth.

Orthodontic treatment progresses in stages
We approach treatment in stages. The first stage is to unravel the crowding. If you have teeth removed, you may notice improvements in the appearance of your teeth right away. If you do not, you may actually notice changes in the alignment of your teeth that temporary make them look worse. You could get spaces where there were none before. You may notice that teeth that were once straight now overlap. You might even notice that although most teeth look straighter, one or two may actually get more crooked! This is because the braces will take all of the crowding that was spread out over several teeth and consolidate it in one or two areas. This is completely normal and necessary.

Initial alignment uncovers underlying skeletal discrepancies
In the process of removing dental compensations, you will notice changes in the relationship of the upper and lower teeth. If you have a lower jaw that is smaller than your upper, aligning the teeth may actually create more of an overbite. If your upper jaw is smaller than your lower, aligning the arches may create an underbite where there wasn’t one before. These changes in your bite are normal during treatment and should be anticipated.

The second stage is leveling the arches
After the crowding is resolved and the teeth are aligned, the next step is to level the arches. If you start with a deep bite, the goal is to “open the bite” so that your lower teeth are more visible. If you start with an open bite, we’ll want to deepen the bite so the top teeth overlap the bottom ones. About the same time we address the vertical relationship, we also work to make the width of the upper and lower arches match (coordinate the arches).

Correcting the overbite or underbite is the final step
The final stage of treatment is to improve the "overbite" or underbite. This may be done with rubber bands, functional appliances, extractions, or orthognathic surgery. Because the teeth are usually straight by this stage, this is the time that is the most frustrating for patients. This is when we start hearing “When will I be getting my braces off?”

Understanding this sequence will give you an idea of where you are in your treatment. Knowing that there will be transitional changes along the way that may actually make things look worse before they look better will make you more confident that your treatment is going as expected.

NOTE: The author, Dr. Greg Jorgensen, is a board-certified orthodontist who is in the private practice of orthodontics in Rio Rancho, New Mexico (a suburb on the Westside of Albuquerque). He was trained at BYU, Washington University in St. Louis, and the University of Iowa in the United States. Dr. Jorgensen’s 25 years of specialty practice and nearly 10,000 finished cases qualify him an expert in two-phase treatment, extraction and non-extraction therapy, functional orthodontics, clear aligners (Invisalign), and multiple bracket systems (including conventional braces, Damon and other self-ligating brackets, Suresmile, and lingual braces). This blog is for informational purposes only and is designed to help consumers understand currently accepted orthodontic concepts. It is not a venue for debating alternative treatment theories. Dr. Jorgensen is licensed to diagnose and treat patients only in the state of New Mexico. He cannot diagnose cases described in comments nor can he select treatment plans for readers. Please understand that because he has tens of thousands of readers each month, IT IS IMPOSSIBLE FOR HIM TO RESPOND TO EVERY QUESTION. Please read all of the comments associated with each article as most of the questions he receives each week have been asked and answered previously. The opinions expressed here are protected by copyright laws and can only be used with written permission from the author.