Ask the Orthodontist
Q. What is Orthodontics?
A. Orthodontics (also called dentofacial orthopedics) is the branch of dentistry that specializes in the diagnosis, prevention, and treatment of dental and facial irregularities. Many types of appliances, including braces, are used to make these corrections.
Q. What is the difference between an orthodontist and a regular dentist?
A. Legally, a dentist may perform any type of orthodontic treatment he feels capable of doing. Orthodontists, however, are dental specialists who in addition to receiving a dental degree must have at least two continuous years of advance study in orthodontics as required by the American Dental Association. An orthodontist is an expert at moving teeth, helping jaws develop properly and working with the patient to help make sure the teeth stay in their new position. Only those who complete such a program and who have such expertise are eligible to belong to the American Association of Orthodontists.
Q. What are some possible benefits of orthodontics?
- A more attractive smile
- Reduced appearance-consciousness during critical development years
- Better function of the teeth
- Possible increase in self-confidence
- Increased ability to clean the teeth
- Improved force distribution and wear patterns of the teeth
- Better long term health of teeth and gums
- Guides permanent teeth into more favorable positions
- Reduces the risk of injury to protruded front teeth
- Aids in optimizing other dental treatment
Q. What are some signs that orthodontics may be needed?
A. -Upper front teeth protrude or are “bucked”
-Upper front teeth cover the majority of the lower teeth when biting together
-Upper front teeth erupt behind the lower front teeth
-The upper and lower front teeth do not touch when biting together
-Crowded or overlapped teeth
-Primary or baby teeth that will not come out
-The centers of the upper and lower front teeth do not match or line up
-Finger sucking habit that continues after 6 or 7 years old
-Difficulty chewing
-Teeth wearing unevenly
-The lower jaw shifts to one side when biting together
-Excessive spaces between the teeth even after the upper canines or eye teeth erupt
Q. What causes crooked teeth?
A. The main cause is heredity. Other contributing factors are finger sucking, gum disease, trauma, or primary teeth that are lost too early.
Q. Why should I have my teeth straightened?
A. Teeth that are crooked trap plaque more easily. Plaque is the white film that builds up on teeth and contains bacteria that cause cavities and gum disease. Poorly aligned teeth and a bad bite also lead to improper chewing and digestion. Finally, crooked teeth detract from your smile and effect how you feel about yourself. Orthodontics can boost a person’s self image as the teeth, jaws and lips become properly aligned.
Q. What is Phase I and Phase II treatment?
A. Phase I, or early interceptive treatment, is limited orthodontic treatment (i.e. expander or partial braces) before all of the permanent teeth have erupted. Such treatment can occur between the ages of six and ten. This treatment is sometimes recommended to make more space for developing teeth, correction of crossbites, overbites, and underbites, or harmful oral habits. Phase II treatment is also called comprehensive treatment because it involves full braces when all of the permanent teeth have erupted, usually between the ages of eleven and thirteen
Q. When should my child first be seen?
A. The American Association of Orthodontists recommends that a child should be seen at about age 7 or 8 or if there is an obvious problem that you or your dentist sees. Comprehensive treatment however, with any type of braces, is usually rare at this time.
Q. You told us to wait but all the young children in the neighborhood already are wearing “braces” and “retainers”, why should my child wait until he is older?
A. Although there are some orthodontic problems that should be corrected early (interceptive treatment) this in no guarantee that future treatment will not be necessary when all of the permanent teeth erupt at around age 12. Sometimes early treatment just costs more and takes longer. Recent studies have shown that for many patients the final result of two phase treatment is no better than waiting and doing a straightforward one phase treatment. This is not to say that parents should wait until all the baby teeth fall out before bring in their child for a consultation. Often there are some timely and simple things we may recommend and it is always better to be a little early than to miss the appropriate time to treat.
Q. Do you take adult patients?
A. Yes! As a matter of fact, 25% of our patients are adults. With Invisalign® we are treating more and more adults each year.
Q. Can you be too old for orthodontic treatment?
A. NO. Assuming the teeth and gums are healthy there is no age limit for orthodontic treatment. The only major disadvantage to treating adults is that many orthodontic problems are skeletal in nature (overbites, crossbites, etc) and it is not possible (short of surgery) to change bone alignment in adults like we can with children. This means we sometimes have to compromise on the bite with adults but we can always get the teeth “straight”. On the plus side adults are often more cooperative and may get done faster and Invisalign® treatment usually allows us to treat without any “braces” at all!
Q. Can I still have braces if I have some teeth missing?
A. Absolutely! Often when teeth are missing, adjacent teeth will drift into the empty space causing a periodontal (gums), esthetic or functional problem. Orthodontic treatment will correct and prevent this from happening and also provide the proper alignment for your dentist to replace the missing teeth if you so choose.
Q. How do braces straighten crooked teeth?
A. Braces use steady, gentle pressure over time to move teeth into their proper positions. The brackets we place on your teeth and the archwire that connects them are the main components. The bracket is a piece of specially shaped metal or ceramic that we affix to each tooth. The archwire threads through the brackets; and as the wire tries to return to its original shape, it applies pressure to actually move the teeth. With pressure on one side from the archwire, the bone gives away, and the tooth moves. New bone then grows in behind. As the teeth move, they will loosen slightly, which is normal. Thanks to new materials and procedures, all this happens much more quickly than ever before, and the amount of pressure placed on the teeth is much lighter.
Q. How long will treatment take?
A. Depending on the complexity of the situation, and the level of patient cooperation, active treatment time can vary from as little as several months to two years or longer. Occasional visits are necessary after treatment to ensure teeth remain in their new positions.
Q. If treatment is started early, will the teeth move back out of alignment?
A. We intercept many orthodontic problems early by using better techniques for influencing growth and development, which means we get better and more stable results. When we are finished with treatment, our patients wear retainers to keep the results they have obtained in treatment.
Q. What are brackets?
A. Brackets are the small metal or porcelain parts that are bonded (glued) to the teeth. They do not move the teeth but act as a handle for the arch wires and elastics which produce the actual movement.
Q. I’ve heard about the new hi-tech braces like the Speed and Damon brackets that are suppose to radically shorten treatment time and “grow” jaws to avoid extractions. Do you use them?
A. Orthodontic companies are always coming on the market with new appliances, promising orthodontists that they can perform “miracles”. Over the years we have tried many of these supposedly supper braces…. and guess what? Braces are pretty much braces….it’s the skill of the orthodontist that determines the quality and speed of the treatment. Not that we do not invest in the best appliances but there is no magic way of doing orthodontic treatment. If there were every orthodontist would be using it. As of now we know of no good scientific study that shows this brackets to be any better or faster than the traditional brackets we use. We are always open to new ideas. As a matter of fact we were the first orthodontic practice in the Midwest to use Invisalign (which really does work wonders!) so if some new appliance does prove to be superior you can be assured we will be one of the first to adopt it.
Q. What do rubber bands do?
A. Attached to your braces, rubber bands or elastics exert the force that creates the right amount of pressure to move the teeth. It is important to wear your elastics like we ask you to and change them 3-4 times per day so the force is constant. In general, elastics help the dental arches and the teeth fit together the way they should.
Q. What are the colors I see on everyone’s braces?
A. The colors are tiny rubber bands called O-rings that hold the archwire in the bracket. These O-rings are changed at each appointment. Many patients coordinate their O-rings with upcoming holidays or school or team colors.
Q. What foods will I be able to eat?
A. You should be able to eat just about anything after a period of adjustment to your braces. Apples, corn on the cob, and raw vegetables should be cut into small pieces and placed into the mouth. Hard candy, ice, nuts, sticky candy, and bubble gum should be avoided.
Q. Do you treat TMJ patients?
A. We do treat patients experiencing pain and dysfunction of the jaw joint and facial muscles. Initial consultations for patients who visit our office for this type of treatment will be charged and office visit fee. Treatment fees vary widely depending on the scope of treatment necessary. In some cases only behavioral changes are needed.
Q. Will braces correct TMJ problems?
A. Braces may or may not improve jaw joint problems. More conservative approaches should be tried first.
Q. Will I need to wear a retainer after treatment?
A. Yes. Even after our best orthodontic treatment, teeth will have a tendency to move slightly. A retainer is the only way to minimize this movement.
Q. Can I eat with my retainer or biteplate?
A. Remove for eating, and be careful not to lose it!
Q. Will my speech be affected by my braces and appliances?
A. Yes, for a few days. Since some sounds are made between the tongue and the teeth, tongue and palate, and lips and tongue, it can take a few days for normal speech to return. The more you wear your appliance, the sooner your speech will return to normal.
Q. Can all of my appointments be after school?
A. We are aware of and sympathetic to children’s school schedules. Therefore, we strive to minimize the number of times our patients have to miss any school. Sometimes, especially for procedures that require more time and more of the doctor’s attention, we need to schedule these appointments in the morning or early afternoon. We are also able to schedule a few of the longer appointments on Monday evenings and Saturday mornings.
Q. How costly is orthodontic treatment?
A. The actual cost of treatment depends very much on the individual patient and depends largely on the length and complexity of treatment. Many orthodontic problems require only limited treatment. After the doctor has a chance to see your child (complimentary consultation) he will be able to give you a good estimate on the expected cost.
Q. What about clear braces?
A. Esthetic, clear or tooth colored braces are made from porcelain, plastic, and synthetic sapphire materials. In the past we have discouraged the use of clear brackets because they were made of plastic and so were easily broken and stained. We now use plastic only for limited short-term treatment. Recently, new brackets made of translucent porcelain and synthetic sapphires have been developed. We have used these new appliances since they have become available, and they work as well as the metal brackets. Disadvantages of these brackets are their higher cost and some extra “chair time” in treatment. Their extreme hardness also means that it is important to keep them out of biting contact. This limits their use to the upper teeth in some cases. For these reasons there is an additional charge for their use.
Q. Why does it seem that orthodontist never agree on treatment plans, some use headgears, others not; some want to extract teeth, others never do; etc.?
A. Like every other aspect of medicine and dentistry there are always different ways to treat similar problems. Orthodontics is a complicated field that must factor in function, esthetics and stability so it is not surprising that there are multiple ways to achieve a good result. Nonetheless orthodontists do agree on most aspects of treatment, but there are still problems that have no “ideal” correction, so there are alternative treatments and their accompanying pros and cons. Beware of any practitioner who tells you he or she has a “breakthrough” approach to treatment. Orthodontic history is full of “new” improved ways of avoiding extractions, headgears, and radically speeding treatment that have proven to be no better, or even worse, than traditional treatments. For every Invisalign® that really is a major improvement, there is an appliance that was tried and failed. When in doubt there is nothing wrong with getting a second opinion.
Q. Why do I need: extractions, headgear, rubber bands, braces, etc.
A. Ask us, we will be glad to explain in plain English the reasons for what we do. We believe an informed patient is a better patient!
Q. Do braces hurt?
A. The placement of bands and brackets on your teeth does not hurt. Once your braces are placed and connected with the archwires you may feel some soreness of your teeth for one to four days. Your lips and cheeks may need one to two weeks to get used to the braces on your teeth.
Q. Will braces interfere with playing sports?
A. No. It is recommended, however, that patients protect their smiles by wearing a mouth guard when participating in any sporting activity. Mouth guards are inexpensive, comfortable, and come in a variety of colors and patterns.
Q. Will braces interfere with playing musical instruments?
A. No. However, there may be an initial period of adjustment. In addition, brace covers can be provided to prevent discomfort.
Q. Should I see my general dentist while I have braces?
A. Yes, you should continue to see your general dentist every six months for cleanings and dental checkups.