Braces Basics

Q: How can I tell if my child needs braces?

A: It’s not always easy for parents to tell if their child has an orthodontic problem. Here are some signs or habits that may indicate the need for an orthodontic examination:
• Early or late loss of baby teeth
• Difficulty in chewing or biting
• Mouth breathing
• Thumb sucking
• Finger sucking
• Crowded, misplaced or blocked out teeth
• Jaws that shift or make sounds
• Biting the cheek or roof of the mouth
• Teeth that meet abnormally or not at all
• Jaws and teeth that are out of proportion to the rest of the face If any of these apply to your child, please be sure to make an appointment with our office – we can do a thorough evaluation, and together we can decide on the best course of treatment for your child.

Q: What age should my child have an orthodontic evaluation?

A: The American Association of Orthodontists (AAO) recommends an orthodontic screening for children by the age of 7 years. At age 7 the teeth and jaws are developed enough so that the dentist or orthodontist can see if there will be any serious bite problems in the future. Most of the time treatment is not necessary at age 7, but it gives the parents and dentist time to watch the development of the patient and decide on the best mode of treatment. When you have time on your side you can plan ahead and prevent the formation of serious problems.

Q: What Causes Crooked Teeth?

A: Crowded teeth, thumb sucking, tongue thrusting, premature loss of baby teeth, a poor breathing airway caused by enlarged adenoids or tonsils can all contribute to poor tooth positioning. There are also hereditary factors: extra teeth, large teeth, missing teeth, wide spacing, small jaws – all can be causes of crowded teeth.

Q: How Do Teeth Move?

A: Tooth movement is a natural response to light pressure over a period of time. Pressure is applied by using a variety of orthodontic appliances. I use appliances that are designed to move only a few teeth. Most orthodontic appointments are scheduled 4 to 6 weeks apart to give the teeth time to move. If your child needs more extensive tooth movement, I will refer him/her to an orthodontist.

Q: Will it be Uncomfortable?

A: When teeth are first moved, discomfort may result. This usually lasts about 24 to 72 hours. Patients report a lessening of pain as the treatment progresses. Pain medicines such as acetaminophen (Tylenol) or ibuprofen (Advil) usually help relieve the pain.

Q: Why is it important to have orthodontic treatment at a young age?

Research has shown that serious orthodontic problems can be more easily corrected when the patient’s skeleton is still growing and flexible. By correcting the skeletal problems at a younger age we can prepare the mouth for the eventual eruption of the permanent teeth. If the permanent teeth have adequate space to erupt they will come in fairly straight. If the teeth erupt fairly straight their tendency to get crooked again after the braces come off is diminished significantly. After the permanent teeth have erupted, usually from age 12-14, complete braces are placed for final alignment and detailing of the bite. Thus the final stage of treatment is quicker and easier on the patient. This phase of treatment usually lasts from 12 – 18 months and is not started until all of the permanent teeth are erupted.
Doing orthodontic treatments in two steps provides excellent results often allowing the doctor to avoid removal of permanent teeth and jaw surgery. The treatment done when some of the baby teeth are still present is called Phase-1. The last part of treatment after all the permanent teeth have erupted is called Phase-2.

Q: What are the advantages of beginning orthodontic treatment early?

A:Children who begin a course of orthodontic treatment fairly early (say by age 7 or so), gain several benefits, including:
• Guiding jaw growth
• Lowered risk of trauma to protruded front teeth
• Correcting harmful oral habits
• Improved appearance and self-esteem
• Guiding permanent teeth into a more favorable position
• Improvement in the way lips meet Once we have evaluated your child’s orthodontic needs, we can more clearly decide if these benefits will apply to your child’s treatment.

Q: What is interceptive orthodontic treatment?

A: Interceptive orthodontic treatment is performed for problems that, if left untreated, could lead to the development of more serious dental problems over time. The goal is to reduce the severity of a developing problem and eliminate the cause. The length of later comprehensive orthodontic treatment may be reduced. Examples of this kind of orthodontic treatment may include correction of thumb- and finger-sucking habits; guiding permanent teeth into desired positions through tooth removal or tooth size adjustment; or gaining or holding space for permanent teeth. Interceptive orthodontic treatment can take place when patients have primary teeth or mixed dentition (baby and permanent teeth). A patient may require more than one phase of interceptive orthodontic treatment.

Q: What is comprehensive orthodontic treatment?

A: Comprehensive orthodontic treatment is undertaken for problems that involve alignment of the teeth, how the jaws function and how the top and bottom teeth fit together. The goal of comprehensive orthodontic treatment is to correct the identified problem and restore the occlusion (the bite) to its optimum. Treatment can begin while patients have primary teeth, when they have a mix of primary and permanent teeth, or when all permanent teeth are in. Treatment may consist of one or more phases, depending on the nature of the problem being corrected and the goals for treatment. If your child requires comprehensive orthodontics, he/she will be referred to an orthodontist. Orthodontic care may be coordinated with other types of dental treatment that may include oral surgery (tooth extractions or jaw surgery), periodontal (gum) care and restorative (fillings, crowns, bridges, tooth size enhancement, implants) dental care. When finished with comprehensive treatment, the patient must wear retainers to keep teeth in their new positions.

Q: What is a space maintainer?

A: Baby molar teeth, also known as primary molar teeth, hold needed space for permanent teeth that will come in later. When a baby molar tooth is lost early, a space maintainer will hold the space until the permanent tooth comes in.

Q: Why do baby teeth sometimes need to be removed?

A: Removing baby teeth may be necessary to allow severely crowded permanent teeth to come in at a normal time in a reasonably normal location. If the teeth are severely crowded, it may be that some un-erupted permanent teeth (usually the canine teeth) will either remain impacted (teeth that should come in, but do not), or come in to a highly undesirable position. To allow severely crowded teeth to move on their own into much more desirable positions, sequential removal of baby teeth and permanent teeth (usually first premolars) can dramatically improve a severe crowding problem. This sequential extraction of teeth, called serial extraction, is typically followed by comprehensive orthodontic treatment after eruption of permanent teeth has brought about as much improvement as it can on its own. After all the permanent teeth have come in, the extraction of selected permanent teeth may be necessary to correct crowding or to make space for necessary tooth movement to correct a bite problem. Proper extraction of teeth during orthodontic treatment should leave the patient with both excellent function and a pleasing look.

Q: How can a child’s growth affect orthodontic treatment?

A: Orthodontic treatment and a child’s growth can complement each other. A common orthodontic problem to treat is protrusion of the upper front teeth. Quite often this problem is due in part to the lower jaw being shorter than the upper jaw. Upper teeth may also be the primary cause of the protrusion if they stick out too far. While the upper and lower jaws are growing, orthodontic appliances can be beneficial in reducing these discrepancies. A severe jaw growth discrepancy may require orthodontics and corrective surgery after jaw growth has been completed, although this is rare.

Q: What kinds of orthodontic appliances are typically used to reduce the severity of jaw-growth problems?

A: A process of dentofacial orthopedics (guiding the growth of the face and jaws) with orthodontic appliances may be used to correct jaw-growth problems. The decision about when and which appliances to use for this type of correction is based on each individual patient’s problem. Some of the more common orthopedic appliances include:
• Headgear: This appliance applies pressure to the upper teeth and upper jaw to guide the direction of upper jaw growth and tooth eruption. The headgear may be removed by the patient and is usually worn 10 to 12 hours per day.
• Fixed functional appliance: The appliance is usually fixed (glued) to the upper and lower molar teeth and may not be removed by the patient. By holding the lower jaw forward, it reduces the protrusion of the teeth while the patient is growing and helps bring the teeth together. The appliance can help correct severe protrusion of the upper teeth.
• Removable functional appliance: This removable appliance holds the lower jaw forward and guides eruption of the teeth into a more desirable bite while helping the upper and lower jaws to grow in proportion to each other. Patient compliance in wearing this appliance is essential for successful improvement; the appliance cannot work unless the patient wears it.
• Palatal Expansion Appliance: A child’s upper jaw may be too narrow for the upper teeth to fit properly with the lower teeth (a crossbite). When this occurs, a palatal expansion appliance can be fixed to the upper back teeth. This appliance can markedly expand the width of the upper jaw. For some patients, a wider jaw may prevent the need for extraction of permanent teeth.

Q: Why does orthodontic treatment time sometimes last longer than anticipated?

A: Estimates of treatment time can only be that – estimates. Patients grow at different rates and will respond in their own ways to orthodontic treatment. We have specific treatment goals in mind, and will usually continue treatment until these goals are achieved. Patient cooperation, however, is the single best predictor of staying on time with treatment. Patients who cooperate by wearing rubber bands and appliances as directed, while taking care not to damage appliances, will most often lead to on-time and excellent treatment results. Keeping your child’s appointments at the scheduled interval is very important, as well.

Q: What is patient cooperation and how important is it during orthodontic treatment?

A: Good “patient cooperation” means that the patient not only follows my instructions on wearing appliances as prescribed and tending to oral hygiene and diet, but is also an active partner in orthodontic treatment. Successful orthodontic treatment is a “two-way street” that requires a consistent, cooperative effort by both the patient and me. To successfully complete the treatment plan, the patient must carefully clean his or her teeth and appliances, wear rubber bands and appliances as prescribed, avoid foods that might damage appliances and keep appointments as scheduled. Damaged appliances can lengthen the treatment time and may undesirably affect the outcome of treatment. The teeth and jaws can only move toward their desired positions if the patient consistently wears the forces to the teeth, such as rubber bands, as prescribed. To keep teeth and gums healthy, regular dental check-ups must continue during orthodontic treatment

Q: What is two-phase treatment?

A: Two-phase treatment simply means that the treatment is carried out in two stages. The first is the interceptive orthodontic phase (see above) and the second is the comprehensive orthodontic phase (see above).

Q: Some of my children’s friends have already started treatment, while other friends are waiting until they are older. Why is there a difference in treatment?

A: Each treatment plan is specific for that child and his/her specific problem. In some cases, children mature early (e.g.: get their permanent teeth early) and in some cases early treatment is indicated to prevent a more severe problem from occurring. Together, we will decide the most optimum treatment plan. If you have questions, please feel free to ask me anytime.

Q: My child has an allergy to nickel. Can my child still have orthodontic treatment?

A: Yes, there are appliances available which are nickel-free. Please be sure to let us know of any of your child’s allergies.