When should I begin treatment?

The American Association of Orthodontists recommends that all children get a check-up with an orthodontist no later than age seven. Although only a few orthodontic problems need to be corrected at that age, an early exam allows the orthodontist to offer advice and guidance as to when the appropriate age to start treatment would be. Let your orthodontist guide you as to when to start treatment. Feel free to ask questions about the timing of treatment.

How long will my treatment take?

The length of treatment varies depending on the complexity of the orthodontic problem that requires correction, growth and tissue response to treatment as well as the level of patient cooperation during their treatment.  Orthodontic care requires a team approach in which the family dentist, the orthodontist and the patient play key roles that can impact the length of treatment and the quality of the end result. Generally, the length of comprehensive orthodontic treatment can range from approximately 18 months to 30 months, depending on treatment options and individual characteristics.

What are the stages of treatment?

Generally, there are two or three stages of orthodontic treatment. Most patients will benefit from an active corrective stage followed by a retention stage. Some patients will benefit from two active treatment stages often referred to as two-phase treatment. The goals of each stage should be discussed with the orthodontist so that patients and/or parents have realistic expectations.

How are teeth moved?

Teeth respond to the gentle forces that are applied that connects the brackets and provides the forces to steer the teeth in the proper direction. It’s actually the wires d to them. “Braces” are a combination of “brackets” and “wires”.  Brackets are the part of the braces that attach to the teeth. Brackets are the “handles” that help control movement of the teeth. Braces require a wire called an arch-wire that move teeth.  The interaction of brackets and arch-wires enables the orthodontist to have three-dimensional control over the movement of the teeth.  In many cases, additional forces are needed to help balance the underlying jaw structure and to help the upper and lower teeth fit properly together to make the bite right. Examples of these extra forces include: elastics (rubber bands) hooked to teeth; headgear; functional appliances; and palatal expanders.

ORAL HYGIENE

Brushing your teeth is even more important when you are wearing braces. Food can get stuck on your braces and cause staining, tooth decay, gum disease, and bad breath. Here are some suggestions on when and how to brush your teeth.

Type of Toothbrush: You can use any brand of toothbrush you like. Try to buy one that is soft and has lots of bristles. Change your toothbrush often, no less than every three months. Toothbrushes are cheap compared to cavities.

If you prefer to use an electric toothbrush, that is fine. Braun, Interplak, and SonicCare all make effective electric toothbrushes. Whether you use a manual toothbrush or an electric is a person choice. Properly used, all are effective. If you choose an electric, remember that the brush heads need to be changed as frequently as a manual toothbrush, so keep several spares on hand. A worn out head is ineffective and will not remove plaque properly.

Type of Toothpaste: You should choose a toothpaste that will motivate you to brush. Avoid frequent use of whitening toothpaste. Any toothpaste that has fluoride is preferred. Fluoride can protect and rebuild your tooth structure. Please ask as for a PreviDent 500 Plus prescription when you come in for your appointment.

Flossing: Flossing while you are wearing braces is more difficult, but well worth it. You will need a floss threader in order to floss more easily. You can get these at any drugstore, or just ask as to give you one. But remember, the most important step in good oral hygiene is to brush a lot.

Dental Maintenance: We ask that you see your dentist for a cleaning at least every six month; more frequent visits would be preferable. Maintaining ideal hygiene with braces is very difficult even for a very diligent brusher.

Frequency of Brushing: Brush at least five times a day following this schedule:

• As soon as you wake up, brush really well (at least five minutes). Plaque has had all night to build up on your teeth. Do this before you get dressed or eat breakfast so you won’t be rushed.

• After breakfast, give a quick brush. This is to remove breakfast from your teeth.

• After work/school, brush really well again. Plaque has been sitting on your teeth since the morning.

• After dinner, another quickie.

• Before you go to bed, scrub them good. Now is the time to floss if you want to.

The schedule we have suggested takes very little time. Keeping your teeth clean will eliminate bad breath, damage to your teeth, bone loss, gum infection, and will speed up the removal of your braces. If you have any question, please be sure to ask one of us.

COMMON PROBLEMS

An improper bite doesn't look good. That is the usual reason that people seek treatment from an orthodontist. In addition, an improper bite causes difficulty in chewing. In people with crowded teeth, it can lead to more cavities or gum disease. Treatment of an irregular bite can improve your overall oral health and stabilize your bite.

Incorrect bites are grouped into categories. Common bite problems include:

Crossbite

Here, the upper teeth rest significantly inside or outside the lower teeth. A crossbite often can make it difficult to bite or chew.

Crowding

Permanent teeth may not have room to move into the right position:

• If there is not enough room for the teeth

• If the teeth are unusually large compared with the size of the dental arch

• If the jaw is narrower than it should be

Upper Front Teeth Protrusion

Upper front teeth that protrude (stick out) beyond normal contact with the lower front teeth are prone to fracture. In addition, upper protrusion of the front teeth often indicates a poor bite of the back teeth (molars), and may indicate disproportionate upper and lower jaw growth. Commonly, protruded upper front teeth are associated with a lower jaw that is either too short or too small in proportion to the upper jaw. Thumb and finger sucking habits can also cause a protrusion of the upper front teeth.

Deep overbite

This occurs when the upper front teeth (incisors) overlap too far over the lower teeth. In some cases, the biting edges of the upper teeth touch the lower front gum tissue and the lower front teeth may bite into the roof of the mouth.

Underbite

A crossbite of the front teeth is commonly referred to as an underbite if the lower teeth are ahead of the upper teeth.

Open bite

If your upper and lower front teeth don't meet when you bite down, this is called an open bite. Because the front teeth don't share equally in the biting force, the back teeth may receive too much pressure. This makes chewing less efficient. It can lead to premature wear of the back teeth.

Spacing problems

Some people have missing teeth or unusually small teeth in a normal sized jaw. This can result in large spaces between the teeth. People who have lost one or multiple teeth may have uneven spacing because adjacent teeth may drift into the unoccupied areas.

Dental Midline Position

When dental midlines don't match, the back bite will not fit and match correctly. This could have a negative impact on the jaw and proper dental function.

EMERGENCY INFO

True orthodontic emergencies are very rare, but when they do occur we are available to you. As a general rule, you should call the office when you experience severe pain or when you have a painful appliance problem that you can't take care of yourself. We'll be able to schedule an appointment to resolve the problem.

You might be surprised to learn that you may be able to temporarily solve many problems yourself until you schedule an appointment with our office. When working with your appliances, you need to know the names of the parts of your appliances so you are able to identify what part is broken or out of place. After alleviating your discomfort, it is very important that you still call our office as soon as possible to schedule a time to repair the problem. Allowing your appliance to remain damaged for an extended period of time may result in disruptions in your treatment plan.

The following orthodontic emergencies and their treatments are listed in the order of the least severe to the most severe. Only the most severe emergencies require immediate attention by an orthodontist. The majority of these are easily treated with a follow-up appointment.

Food Caught Between Teeth

This is not an emergency, but can be a little uncomfortable or embarrassing for the braces wearing patient. It is easily fixed with a piece of dental floss. Try tying a small knot in the of the floss to help remove the food, or use an interproximal brush or toothpick to dislodge food caught between teeth and braces.

Ligature Comes Off

Tiny rubber bands or small, fine wires, know as ligatures, hold the wire to the bracket. If a rubber ligature should come off, you may be able to put it back in place using sterile tweezers. If a wire ligature comes loose, simply remove it with sterile tweezers. If the wire ligature is sticking out into the lip but is not loose, it may be bent back down with a Q-tip or pencil eraser to eliminate the irritation.

Of course, when one ligature pops off or breaks, others may follow. Be sure to examine all ligatures. If multiple rubbers or wire ligatures are lost, please call the office to schedule an appointment.

Discomfort

It’s normal for a patient to have discomfort for a day or two after braces or retainers are adjusted. But it can make eating uncomfortable. This discomfort is both normal and temporary. It could be helpful to initially eat soft foods and rinse the mouth with warm salt water.

Mouth Sores

Some patients are susceptible to episodes of mouth sores. While braces do not cause them, they may be precipitated or exacerbated by an irritation from braces. One or several areas of ulceration of the cheeks, lips or tongue may appear. This is not an emergency, but may be very uncomfortable for the patient. Prompt relief may be achieved by applying a small amount of topical anesthetic (such as Orabase or Ora-Gel as well as BraceRrelief, given during the appliance placement appointment), directly to the ulcerated surface using a cotton swab. The gel should be reapplied as needed.

Irritation of Lips and Cheeks

Sometimes new braces can be irritating to the mouth, especially when the patient is eating. A small amount of non-medicinal relief wax makes an excellent buffer between metal and mouth. Every patient is given a package of wax during the initial bracket placement appointment. If wax can not be located it can be purchase in most pharmacy stores. Simply pinch off a small piece and roll it into a ball the size of a small pea. Flatten the ball and place it completely over the area of the braces causing irritation. The patient may then eat more comfortably. If the wax is accidentally ingested, it’s not a problem, the wax is harmless.

Protruding Wire

Occasionally, the end of a wire will work itself out of place and irritate the patient’s mouth. Use a Q-tip or pencil eraser to push the wire so that it is flat against the tooth. If the wire cannot be move into a comfortable position, cover it with relief wax. (See Irritation of Lips of Cheeks above for instructions on applying relief wax.) Make sure that you make the orthodontist aware of the problem so we can schedule an appointment.

In a situation where the wire is extremely bothersome and the patient will not be able to see the orthodontist anytime soon, you may clip the wire.

Reduce the possibility of the patient swallowing the snipped piece of wire by using folded tissue of gauze around the area. Use a pair of sharp clippers and snip off the protruding wire. Relief wax may still be necessary to provide comfort to the irritated area.

Loose Brackets, Wires or Bands

If the braces have come loose in any way please notify the office when possible to schedule an appointment for a repair.

Brackets are the parts of braces attached to teeth with a special adhesive. They are generally positioned in the center of each tooth. The bracket can be knocked off it the patient has eaten one of those hard or crunchy foods orthodontic patients are instructed to avoid, or if the mouth is struck while at play.

If the bracket is off center, the adhesive may have failed. If the loose bracket has rotated on the wire and is sticking out you can temporarily put protective wax to alleviate discomfort. To put the bracket back in place, use sterile tweezers to slide the bracket along the wire until it is between two teeth. Rotate the bracket back to the proper position, then slide it back to the center of the tooth.

FOODS TO AVOID

Chewy foods: bagels, hard rolls, licorice

• Crunchy foods: popcorn, ice, chips

• Sticky foods: caramels, gum

• Hard foods: nuts, candy

• Foods you have to bite into: corn on the cob, apples, carrots

• Chewing on hard things (for example, pens, pencils or fingernails) can damage the braces. Damaged braces will cause treatment to take longer.