The Ultimate Guide to Orthodontics

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The Ultimate Guide to Orthodontics and How to Confidently Select an Orthodontist

Adults and children can benefit from orthodontics and straight smiles.

Selecting a good orthodontist can be a challenging process. Many people consider orthodontics at some point in their life. Hopefully, this guide will provide the information to help you and your child with your orthodontic treatment.

At what age should your child see the orthodontist?

This is one of the questions that parents ask me most frequently after they bring their children for an orthodontic examination. Did I bring my child too early? Did I bring my child too late? Few parents are very proactive and bring their children before or at the age of five or six; at that age, we only have baby teeth, and the definitive position of the permanent teeth is a guess at best. Few parents have a sufficiently knowledgeable dentist to recommend the first orthodontic evaluation at the time when the child is starting second grade. I’d recommend parents have their child’s first orthodontic exam at age of seven because at that time the front permanent top and bottom teeth are developing, and they lay the framework for the top and bottom jaws. An orthodontist can rule out potential problems at that age. The American Association of Orthodontists also recommends the first orthodontic exam be arranged at age seven. About nine out of ten children will not need any treatment, and they will be placed on a follow-up watch or evaluation appointment to monitor growth and teeth development.

Is my child not too young for braces at the age of 7?

Nine times out of ten this is a valid question and that is correct. For most children an orthodontic exam at the age of 7 will just be an exam and only monitoring the growth and development until your child is ready for braces. That being said, early treatment at the appropriate age can prevent potential:

  • serious problems with teeth/jaw alignment such as crossbites
  • excessive teeth wear, chips or fractures of teeth
  • periodontal gum problems such as recessions
  • teeth that do not have enough space or will not have enough space to come out
  • insufficient confidence, difficulty cleaning teeth, awkward social interactions

Some problems are best corrected at an early age. Correction at the appropriate time will save you time, finances, and help prevent problems that become more difficult and costly to fix as time goes by.

In the past, an orthodontist has recommended braces for young children with the primary goal of preventing the removal of permanent teeth. With advances in orthodontics and technology we started asking ourselves does early treatment always help or is there no difference if orthodontics is postponed until 11 to 13 years of age? Well, there are two different views some orthodontists believe strongly. There are those that believe in children having early treatment while others believe that treatments should be postponed until 11-13 years of age. Who is right? Good question. The answer will have to depend on what condition your child presents with. When it comes to correction of class 2 malocclusion and severe overjet, 2 studies from the USA (Florida and North Carolina) and one study from Great Britain found that early treatment had no benefits compared to treatment that began in adolescence. On the other hand, if the child has narrow top jaw or deficient top jaw when compared to the bottom jaw, the best time for treatment would be at an early age because the bones are softer and more moldable leading to more predictable results. Your orthodontist can guide you in determining the appropriate time for correction of those conditions. Another scenario is if your child is teased or bullied at school because of crooked/uneven teeth. This is a decision you need to make if your child can benefit from early treatment and straight teeth. The orthodontist will be there to point out trouble spots but ultimately it is your decision, your child’s future, and your finances.

What is orthodontics?

The term orthodontics comes from the Latin words “ortho”, which means straight, and “dontics”, which means teeth also known as straight teeth. To get your teeth straight the two main options are braces or clear aligners. The physiology of the process involves gentle pressure on your teeth toward the desired position and there’s a natural process of remodeling in front and behind your teeth so that your teeth move and create your new smile.

Treatment time could be as short as 3 to 6 months or, in very, very extreme cases, as long as 5 years. Average treatment time for orthodontics is 2 years. Factors that help speed up treatment include making your appointments on time, following the instructions of your orthodontist, and good oral hygiene.

What is faster than orthodontics?

Alternative ways of making teeth appear straight include veneers, fillings, crowns or any other type of material that is glued to teeth. One benefits is that results are instant or almost instant. However, some of these restorative materials for veneers, fillings, or crowns eventually may need to be replaced, adding additional cost. Aesthetics might change over time if those restorations start to leak and further removal of tooth structure will be required if replacement is needed. Sometimes the position of the teeth is not normal or the space between them teeth is too much or too little to make normal looking veneers, fillings or crowns. For that reason, your dentist may request that you complete your orthodontic treatment before they do veneers on your teeth. Think of it as a car that has been damaged in a car accident. If the garage technicians only repair the outside visible damage, the internal car damage will be masked and will worsen in time and give you problems down the road. However, the car will look great on the outside. Similarly, just as teeth are crooked, spaced or malpositioned, if you choose to mask their appearance with veneers and/or crowns, their malposition most likely would still remain. These underlying conditions can lead to difficulty in keeping the teeth clean leading to additional bacterial plaque pocket formation and creating other problems in the future. Veneers, fillings, and crowns are great options if used appropriately and have their indications for smile improvement.

What is orthopedics?

Orthopedics plainly means bone changes. When there is a skeletal imbalance, treatment may require orthopedics at the appropriate age. Sometimes treatment requires both orthodontics and orthopedics also at the appropriate age. If the child has a narrow top jaw viewed from the side or a deficient top jaw viewed from the front when compared to the bottom jaw, the best time for treatment would be at early age because the bones are softer and are more moldable, leading to reducing the chance of surgery in the future. Orthopedics can be explained in this way: if a child is sucking their thumb for periods of time it produces bone changes. In some instances, there is also tooth movement. In essence, the child is doing their own orthodontics and orthopedics combined because of these habits. For those reasons, if there’s a suspected mouth habit, you should discuss this with your orthodontist to find possible solutions.

Why is there an appropriate age to achieve best results?

Well, depending on your child’s mouth conditions it could be as early as 7, it could be 11 -13 years of age or your child might not even need braces at all. There are some children who have perfect teeth and do not require any orthodontics. For other children waiting to 11 -13 years of age can be too late if orthopedics is required, excessive tooth wear is occurring or there are persistent social concerns. Please schedule an orthodontic exam with your orthodontist.

Will I need teeth slenderizing with clear aligners or braces?

What is teeth slenderizing? Good question. It is a procedure that is routinely performed by orthodontists, which involves very minimal reshaping between teeth. Your orthodontist may perform teeth slenderizing to fit your teeth better and to get the optimum aesthetic results regardless of whether you have clear aligners or braces; most of the time you will not even realize that you have had this procedure done on you. Here we go again, this is another reason to select an orthodontic specialist for your orthodontic treatment compared to your family, cosmetic dentist. To give you the best fit of your teeth and the optimal aesthetic results, orthodontists perform these procedures routinely and are very comfortable with them. General dentists perform such a procedure rarely. For example, if your house AC breaks who do you call? Do you call the AC technician or do you call the general handyman? Even though the general handyman may be able to fix the AC, you have a higher chance of getting a more predictable and faster fix from the AC technician. Unlike your AC parts, your smile and teeth are not easily replaceable. So why would you take chances with your smile?

What is the biggest mistake people make?

This question needs to be reworded differently along the lines of what is the biggest regret parents have about their child’s smile and teeth condition? Well, well… It is not bringing their child for an orthodontic exam at an early age so that potential problems can be ruled out. Common responses that I get from parents are, “No one told us,” and, “I wish we knew about this earlier.” Of course orthodontics can be helpful at any age; however, best results are achieved when there is the least amount of damage to the teeth. A single misaligned tooth can wear at such a high rate due to improper teeth position that by the time the child gets orthodontic consultation the tooth might need a veneer, filling or a crown. Improper bite can damage permanently the surrounding gums and cause gum recession. Even though there are many teeth replacement options, I believe that your natural, untouched teeth are the best teeth PERIOD.

How do I find the right orthodontist?

People have two options for their orthodontic treatment. The first is to go to an orthodontist that specializes in straightening teeth and the second is to go to a family, cosmetic dentist. What we see in the medical field is that people who have severe heart conditions go to a cardiology specialist for their heart treatments even though they continue to see their primary physicians on a regular basis. In addition, when a young family is expecting their child, they see an OBGYN specialist for their questions and not a general physician. There is a reason for that. In straightening teeth, the orthodontist is a dentist who has 24 -36 months of additional training specifically to straighten teeth and, when appropriate, to help with bone development. Most likely the orthodontist has treated 100s or 1000s of cases similar to yours. All that experience and training can lead to more predictable outcomes. The fact is that 100 % of orthodontists are dentists but only 6 % of dentists are orthodontists.

To be sure that you are seeing an orthodontist, you could ask the doctor if he has completed orthodontic specialty training 24-36 months past dental school. You can also ask staff members if the doctor performs dental procedures such as fillings, crowns, bridges, and root canals. Orthodontists almost never perform such procedures. Look around in the office for a display of the doctor’s postdoctoral certificate of proficiency in the specialty of orthodontics and dentofacial orthopedics and confirm if this is the 24 – 36 months training or a weekend course.

When you choose to see an orthodontist for your child’s orthodontic consultation, your child will be seen by a specialist with 24 – 36 months of training specifically in orthodontics. A specialist can rule out potential problems at a young age. Teenage patients that want straight teeth will have an orthodontist create a customized plan for their individual needs. Most likely the orthodontist has treated 100s or 1000s of cases similar to your child’s. All that experience and training is invaluable.

Why is good diagnosis crucial for your final smile result?

The key to a radiant final smile that people notice from far away and compliment you on is good diagnosis. A good diagnosis is everything. The clinical aspect in orthodontics like putting on ties, changing wires, replacing the bracket, activating the expander, and fitting bands is very easy. The skill that makes orthodontics difficult is proper diagnosis. For example, you can choose one of two building contractors to do the foundation of your family dream house. Building contractor number one recommends you build your house foundation in a sandy area with a lot of underground water. Building contractor number two checked previous land history, made sure that there’s no underground water, made sure that the soil is stable and can sustain your house, and then he recommends you proceed further with building your foundation for your family dream house. Who would you trust with this important job that your family livelihood depends on? Will the final outcome be different?

As a clinician you need to be able to diagnose patients with an increase in vertical facial proportions and not extrude molars in their treatments. You need to be able to diagnose patients with large mandibles (class 3 pattern) and to recognize when the appropriate time for their treatments. You need to be aware that there’s no ideal orthodontics system including clear aligners, there’s no ideal bracket, and there’s no ideal wire. You have to know and spend the time learning different techniques so that you can use the correct technique for the appropriate case. Those are just a few examples of the extra knowledge required for proper diagnosis.

What happens at the orthodontist consultation?

Many questions that parents like you have and have shared with me at some point are related to answering what will happen from the time when you call the orthodontist to schedule an exam to the actual orthodontic consultation. This is fairly easy, you will be greeted by a receptionist, who is also your scheduler, she will walk you through the process and to better serve you she will ask you a few questions. Then she will schedule the appointment for your child’s or your consultation at a time that is convenient for you and your child. Following this phone call, you will be sent a packet with general information, health history, and a map with directions to our practice for your convenience and time efficiency. At the day of your appointment, when you walk into the practice, you will be greeted by the receptionist and offered refreshments from the refreshment bar. Then, while enjoying the refreshments, you will be introduced to your treatment coordinator; she will take care of you from now on and review your personal information, health history, and the main concerns for your child’s smile and teeth or your smile and teeth. You could use this time with your treatment coordinator to ask questions that you may have or ask questions that you do not feel comfortable asking the doctor directly. During this time your child will have panoramic and cephalometric x-rays taken. Those x-rays are crucial to help the doctor form the proper diagnosis. When the doctor comes into the room, he will greet you and will try to find out what he can do for your child and handle any concerns you might have about the teeth or the smile. So that you are aware, the doctor might request other records such as pictures or molds of your teeth in order to accurately diagnose the conditions. Sometimes they can be done the same day. The doctor will lean your child back on a chair, he will perform an evaluation, and he will dictate findings to the treatment coordinator. This is a good time for you to become familiar with the situation in your child’s mouth. At the consultation, the doctor will go into detail and explain his findings, potential problem areas, and individualize your child solutions and options. This is a good time to ask the doctor questions and see if you feel comfortable with the orthodontic treatment. Don’t be surprised if the doctor recommends no treatment at this current time and periodic follow-up visits until your child is ready for braces.

If orthodontic treatment makes sense at this time, your treatment coordinator will guide you to the next step. She will be the one to make this fit your budget, work out specifics in financing, and maximize every single dollar for you. There are a few forms that she will ask you to complete before the actual braces or clear aligner treatment can start.

What x-rays are required for a proper orthodontic exam?

Cephalometric and Panoramic x-rays provide important diagnostic information. A Cephalometric x-ray, which is a full side view of the head, provides information about the skeletal growth pattern, position of teeth, bones that are too big, too small, too far apart or too close together. A Panoramic x-ray, which is a view of all teeth and top and bottom jaws, provides information about impacted, missing, extra, misshapen teeth and short, long, or misshapen roots.

These two x-rays will be crucial in determining the appropriate diagnosis, and with the appropriate diagnosis you can further determine if your child will need orthodontics, which plainly means tooth movement, or orthopedics, which means that there is a skeletal imbalance that would require correction of bone deformities at the appropriate age. Sometimes treatment involves both orthodontics and orthopedics and that’s why it is important to have these two x-rays available.

As a caring parent you can verify that both diagnostic x-rays are included in your child’s exam. A Cephalometric x-ray is going to look like a side view picture of the head. A Panoramic x-ray is going to look like a frontal view picture of all teeth and top and bottom jaws.

This is important; again those x-rays provide the orthodontist with all current dental and skeletal information so that he can identify, diagnose, and treat a wide range of dental conditions. Ultimately, diagnosis is the key, better diagnosis correlates with better outcomes.

What is to be expected daily with braces?

Life with braces has improved very much over the last 20 to 30 years. Orthodontic appliances now are smaller, comfortable, and accepted by other individuals as normal. Unlike 20 to 30 years ago, when braces were not common, people today associate braces with high status, taking care of your child’s health and yours. Technology has allowed braces to be more polished, smaller, and less visible than before. Comfort has been improved since the development of nickel titanium wires borrowed from NASA so that teeth soreness is minimized and your day continues as normally as possible.

What are some soft foods ideas?

  • Mashed Potatoes
  • Macaroni and Cheese
  • Soup
  • Boiled and Poached Eggs
  • Jell-O
  • Soft Fruits
  • Soft Rice
  • Fish
  • Cooked Vegetables
  • Smoothies
  • Shakes
  • Soft Pasta
  • Yogurt
  • Oatmeal

How can I eat questionable foods?

Some hard foods can be eaten if properly prepared. Normally hard foods need to be cut into small pieces or grated. Meats that have bone need to be separated from the bone.

  • Apples – cut into small pieces, don’t bite
  • Raw Carrots – cut into small pieces or use blender
  • Corn on the Cob – slice off the corn before eating
  • Bagels and Hard Bread – tear into small pieces
  • Chicken Wings and Ribs – remove meat from the bone, don’t bite off

How often should I brush?

TIP: Clean teeth move faster than dirty teeth and this is a great reason to keep them clean ALL THE TIME!

Good news—taking care of braces is easy. After all, you want a nice, beautiful, radiant smile and at the same time a healthy smile. It is important to brush all surfaces of the teeth and especially the border between the teeth and the gums (most commonly missed areas). I recommend my patients to brush and floss in the morning, before they go to bed, and after each meal. If they don’t have available a toothbrush and floss during the day, they should rinse their mouth well with water. Patients often ask me, “Do I need to floss if I use a water pick?” The answer is yes, a water pick is a good additional cleaning aid between meals; however, brushing and flossing is the main way to keep your teeth clean and healthy. Let’s take a second and look into this. If your neighbor’s car was not washed for 5 months, would a spray of water remove the dirt? Obviously not, he would need to scrub it to remove the dirt. The same is true for the spray from the water pick that is unable to remove microscopic food particles that are stuck to the teeth. A good and easy way to keep your teeth healthy is with the help of an electric toothbrush (oral B/sonic care) and orthodontic flossers (Platypus/Plackers).

Non-removed plaque from the teeth can cause cavities and permanent staining regardless of whether you have or you don’t have braces. Non-removed plaque near the gum area can cause infection and the gums to swell and bleed. Normally, when children see their gums bleeding, they stop brushing and flossing those areas. This is counterintuitive and they should be brushing and flossing more frequently in those areas. With better brushing and flossing, within a week or so the swelling and bleeding should lessen or disappear. It is important that you follow up with your regular dental checkups and teeth cleanings. If your child is young or is not brushing properly, make sure you are brushing their teeth for them until they can do it on their own.

Do clear aligners need to be brushed?

Absolutely, you brush your clear aligners from inside and from outside to remove any plaque that has accumulated on them. Most people like brushing their clear aligners in the morning when they wake up and at night before they go to bed. It is important to keep in mind that you should not be eating with them on or drinking liquids other than water with them on. Eating or drinking liquids except water with your clear aligner on can cause sugars/acids to be trapped underneath them and make you more susceptible to cavities and gum-related problems.

Is it normal to feel tender with biting pressure?

Absolutely, once the braces have been placed or adjusted, about 3 hours after you can start to feel the moving teeth and some discomfort may be present. Tenderness on biting pressure is normal and it can continue for the first 4 to 10 days. Of course, not all children are the same and tenderness can vary from child to child. Softer foods are recommended and over-the-counter pain relievers such as Tylenol if needed. Please be sure to follow manufacturer’s recommendations.

What types of retainers are there?

There are three main types of retainers and their variations. There are clear retainers (removable), Hawley retainers (removable), and lingual retainers (fixed). Which one is my child getting? Retainers are selected based on your individual needs and your orthodontist can guide you through the process of choosing the best retainer for your specific needs.

Clear retainers (removable)
Clear retainers are the latest retainer invention in orthodontics. They are custom made to fit perfectly over your teeth and are made of see-through plastic. It is the most invisible option for retainers that hold all teeth and fit your teeth like a hand inside a glove. Your new smile is not going anywhere. Another advantage is that they cover the biting surfaces of your teeth and prevent direct teeth wear from teeth grinding. Obviously, because of their teeth wear protective functions they may need to be replaced more often if you grind your teeth.

Hawley retainers (removable)
Hawley retainers have been in orthodontics for many years. They are many different designs and customizations available (different colors, adding sparkles or even a picture). As a parent, you are probably familiar with them. They have a metal wire that goes in front of teeth that is attached to a solid plastic piece that goes inside the mouth. The good thing about them is that they allow for slight teeth adjustments if needed for your child’s orthodontic treatment.

Lingual retainers (fixed)
Lingual retainers appear as a metal wire glued on the back of your teeth. You might have heard about them being referred as permanent retainers. They generally hold your upper incisors on the top jaw and lower incisors and canines on the bottom jaw. In certain situations, lingual fixed retainers can be very efficient in maintaining the position of the anterior teeth. Two good things to consider are that they stay in place and are generally not removable. However, this makes cleaning and flossing between teeth more difficult. In addition, they are generally placed on the front teeth and hold only the front teeth. They do not provide a barrier to grinding and teeth wear. If your child has lingual retainers, be sure to periodically monitor the retainers for single tooth glue breakage. It is best to fix the broken glue area before any tooth unnoticeably and unexpectedly moves out of place.

Should I whiten my teeth after my braces come off?

Without a doubt this is the number one thing that my patients ask after their braces come off. They want to complete their new smile with a teeth whitening. I think teeth whitening is beneficial even for people who never had braces or clear aligners because we only take care of things we love. If we don’t like something, we ignore it or forget about it. The same is true with our mouth, teeth, and smiles. If we don’t like what we see in the mirror, we don’t take care of it and that turns into cavities, gum disease, and oral systemic health issues. If you try tooth whitening and like the results, your mind is now focused on your mouth and you start brushing and flossing better, seeing your dentist regularly, and even consider straightening your teeth. It’s a win-win situation.

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