Dental crowding is probably the most common reason seek braces or orthodontic treatment. The problem is simply caused by a disharmony between the size of the jaws (which may be too small) and the size of the teeth (which may be too big) or a combination of both.  Crowding may be caused by an early loss of one or more baby teeth which function as “space maintainers” among their other functions until their permanent successors erupt. Therefore, it is necessary to keep the baby teeth in their place for as long as possible and use space maintainers if they are lost early.

Dental crowding manifests by rotated, pushed out, pushed in or even impacted teeth. An impacted tooth is a tooth that did not erupt into the mouth because of lack of space or other reasons. The most commonly impacted teeth are third molars or usually referred to as wisdom teeth. Wisdom teeth are the last teeth to erupt into the mouth and usually there is not enough space for their eruption. Upper canines are among the other commonly impacted teeth (incidence is about 2%). They get impacted because of their long path of eruption and because the teeth on either side are usually present not leaving enough spaces for the canines to come down. While the impaction of wisdom teeth is usually managed by removal of those teeth, impacted canines or other teeth should be managed orthodontically by preventing the common causes of impactions or by orthodontically erupting those teeth using braces. Even incisors may get impacted and they should be addressed as soon as diagnosed. Impactions may be caused by the presence of abnormal structures like extra “supernumerary” teeth, cysts, etc…

The best age for orthodontic screening is about 7 years of age when the top incisors erupt into the mouth. Panoramic x-rays can be obtained at this age to evaluate crowding or eruption problems. A panoramic radiograph reveals any abnormal eruption path of any tooth. If a tooth is noted to erupt in a wrong direction (ectopic eruption), a possible option is pull out the baby tooth to “encourage” the tooth to erupt in the right direction. If an abnormal structure preventing the eruption of a tooth is detected, it should be removed as soon as possible. Sometimes, baby teeth become ankylosed (fused to the bone) because of an infection or injury. In those instances, the baby tooth does not shed on its own and should be removed to allow the eruption of the permanent tooth.

Orthodontic treatment is necessary in order to provide space in the jaws to relief crowding and/or correct tooth impactions. Crowding is sometimes corrected by braces alone but sometimes other appliances like palatal expanders may be used to provide space. In cases with severe crowding or very deeply impacted teeth, one or more teeth may be removed in the course of orthodontic treatment.
Simple cases of crowding may be treated by clear aligners (Invisalign) if the appearance of braces is undesirable. An orthodontist would recommend the use of braces or clear aligners based on the severity of the problem and your expectations.