Orthodontic
Frequently Asked Questions
What
age should my child have an orthodontic evaluation?
Why
is it important to have orthodontic treatment at a young age?
What
Causes Crooked Teeth?
/
How
Do Teeth Move? /
Will
It Hurt?
What
age should my child have an orthodontic evaluation?
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 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.
Back to Top
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. After the permanent teeth have erupted,
usually from age 10-14, 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 month 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.
Back to Top
What
Causes Crooked Teeth?
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. And then there
are the hereditary factors. Extra teeth, large teeth, missing teeth,
wide spacing, small jaws - all can be causes of crowded teeth.
Back to Top
How
Do Teeth Move?
Tooth
movement is a natural response to light pressure over a period of
time. Pressure is applied by using a variety of orthodontic hardware
(appliances), the most common being a brace or bracket attached to
the teeth and connected by an arch wire. Periodic changing of these
arch wires puts pressure on the teeth. At different stages of
treatment your child may wear a headgear, elastics, a positioner or
a retainer. Most orthodontic appointments are scheduled 4 to 6 weeks
apart to give the teeth time to move.
Back to Top
Will
It Hurt?
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.
Back to Top
Orthodontic
Terms
Arch
Wire / Brackets
/ Elastics
(Rubber Bands) / O
rings / Separator
Functional Appliances
/ Headgear
/ Retainers
Malocclusion /
Occlusion /
Openbite
/ Overbite
/ Overjet
Arch
Wire
The
part of your braces which actually moves the teeth. The arch wire is
attached to the brackets by small elastic donuts or ligature wires.
Arch Wires are changed throughout the treatment. Each change brings
you closer to the ideal tooth position.
Back to Top
Brackets
Brackets
are the “Braces” or small attachments that are bonded directly
to the tooth surface. The brackets are the part of your braces to
which the dentist or assistant attaches the arch wire.
Occasionally,
a bracket may come loose and become an irritation to your mouth. You
can remove the loose bracket and save it in an envelope to bring to
the office. Call the office as soon as possible and make an
appointment to re-glue the bracket.
Back to Top
Elastics
(Rubber Bands)
At
some time during treatment, it will be necessary to wear elastics to
coordinate the upper and lower teeth and perfect the bite. Once
teeth begin to move in response to elastics, they move rapidly and
comfortably. If elastics (rubber bands) are worn intermittently,
they will continually "shock" the teeth and cause more
soreness. When elastics are worn one day and left off the next,
treatment slows to a standstill or stops. Sore teeth between
appointments usually indicate improper wear of headgear or elastics
or inadequate hygiene. Wear your elastics correctly, attaching them
as you were told. Wear elastics all the time, unless otherwise
directed. Take your elastics off while brushing. Change elastics as
directed, usually once or twice a day.
Back to Top
O
rings
O
rings, also called A-lastics, are little rings used to attach the
arch wire to the brackets. These rings come in standard gray or
clear, but also come in a wide variety of colors to make braces more
fun. A-lastics are changed at every appointment to maintain good
attachment of the arch wire to the bracket, enabling our patients to
enjoy many different color schemes throughout treatment.
Back to Top
Separator
A
plastic or rubber donut piece which the dentist uses to create space
between your teeth for bands.
Back to Top
Functional
Appliances
These
are used to help modify the growth of the jaws in children. The
theory behind their action is that if you hold a jaw in a specific
position long enough, that it will grow into that position. What you
usually get is a combination of a little jaw growth with a lot of
tooth movement. These are not universally accepted, as they do not
always work.
The first of these appliances were removable and are still very
popular. They are made of plastic and wire. Some of their names are
Frankel, Bionator, and Twin-block. A different style is actually
fixed to the teeth and uses a spring action to hold the jaw into
position. These have names like Herbst and Jasper Jumper.
Back to Top
Headgear
Often
called a “night brace”. The headgear is used to correct a
protrusion of the upper or lower jaw. It works by inhibiting the
upper jaw from growing forward, or the downward growth of the upper
jaw or even by encouraging teeth to move forward, if that is the
case.
Back to Top
Retainers
At
the completion of the active phase of orthodontic treatment, braces
are removed and removable appliances called retainers are placed. To
retain means to hold. Teeth must be retained or held in their new
positions while the tissues, meaning the bone, elastic membranes
around the roots, the gums, tongue and lips have adapted themselves
to the new tooth positions. Teeth can move if they are not retained.
It is extremely important to wear your retainers as directed!
Back to Top
Malocclusion
Poor
positioning of the teeth.
Types
of Malocclusion:
 |
 |
 |
Class I
A Malocclusion where the
bite is OK (the top teeth line up with the bottom teeth)
but the teeth are crooked, crowded or turned. |
Class II
A Malocclusion where the
upper teeth stick out past the lower teeth. |
Class III
A Malocclusion where the
lower teeth stick out past the upper teeth. This is also
called an "underbite". |
Occlusion
The
alignment and spacing of your upper and lower teeth when you bite
down.
Types
of Occlusion:
|
|
|
|
Openbite
- Anterior opening between
upper and lower teeth.
|
Overbite
- Vertical
overlapping of the upper teeth over the lower.
|
|
|
|
|
Overjet
- Horizontal
projection of the upper teeth beyond the lower. |
Crossbite
-
When top teeth bite inside the lower teeth. It can occur
with the front teeth or back teeth. |
Back
to Top
Fixed
and Removable Appliances
Reams have been written on the subject in the
last 200 years. In summary, orthodontics is the movement or
alignment of bone (orthopedic) and/or teeth (orthodontic). Two
methods of accomplishing changes are using fixed or removable
appliances.
-
Fixed: Precise movement is desired; more efficient system;
faster movement; requires less patient cooperation; excellent
hygiene is required.
-
Removable: Slower, more gradual tipping movements occur;
guidance for normal growth; can be more esthetic; patient must
cooperate to avoid loss or breakage.
Following are examples of appliances used in our practice and many
orthodontic offices. These are real life examples, either in use or
to be used on patients. Every appliance or series of appliances is
custom tailored for the individual patient, so each is unique.
|
Separators: Provide
space for proper fitting and placement of bands on molar teeth.
They are inserted a few days before the banding appointment, where tight
tooth contacts occur. Every tooth need not be separated, just
adjacent to the bands |
|
|
Band and Loop Space Maintainer:
This space maintainer is used for holding molar position when a baby
tooth is lost prematurely. |
 |
|
Fixed Lingual Arch: This retainer
prevents tipping or movement of molars, while stabilizing anterior
teeth. |
 |
|
Nance: This appliance maintains
the position of the maxillary molars without using any other
teeth. The plastic button on the palate provides stability. |
 |
|
Transpalatal: The maxillary
molars are maintained in position with minimum discomfort or
interference with speech. |
 |
|
Anterior Retainer: A fixed
retainer to replace missing baby teeth, aiding speech and esthetic
appearance. As permanent teeth erupt, individual teeth can be
removed. |
 |
|
Habit Appliance: Many designs are
possible in discouraging thumb or finger sucking. The appliance
allows teeth to resume their normal position. |
 |
|
Bluegrass:
This retainer performs two
functions. Expansion of the arch creates larger space for the
tongue and airway, while the Teflon roller provides counteracting forces
for tongue and finger habits. |
 |
|
Schwarz: A removable appliance to
expand the upper arch, providing chewing surfaces for additional
stability. The expansion screw is adjusted outside of the mouth,
to achieve correction. |
 |
|
Rapid Palatal Expansion: Is used
to redirect growth in a narrow, constricted arch. A crossbite is
usually present, hampering normal growth direction. The appliance
is adjusted daily in the mouth. |
 |
|
Quad Helix: This appliance
provides continual gradual pressure in as many as four directions, to
move molars, expand or contract arches, or assist with finger or thumb
habits. |
 |
|
Bi Helix: Used
to expand the lower arch
without interfering with tongue posture or movement. |
 |
|
Circumferential Hawley: This
retainer is designed as a final appliance to be used at the end of
orthodontic treatment. The arch wire does not cross the chewing
surfaces, interfering with function. Small adjustments can be made
in tooth positioning. |
 |
|
Hawley: A universally used
retainer with many applications; to remove teeth, close spaces, maintain
alignment during or after treatment. |
 |
|
Snodgrass: A fixed retainer that
replaces the extraoral Headgear and neck strap. The movement or
action expands the upper arch, while moving molars distally. |
 |
|
Spring Hawley: A removable
retainer frequently used to regain alignment of the lower anterior teeth
after treatment has been completed and relaps occurs. |
 |
|
Invisible Retainer: So named
because it is translucent, only covering the teeth. This retainer
is passive, maintaining position of upper or lower anterior and bicuspid
teeth. |
 |
|
Bonded Retainer: A retainer
designed to maintain stability for extended periods, even
permanently. This is placed on the lower anterior arch, and
sometimes can be used on the upper anterior teeth. |
 |
|
Orthodontic
Care
Braces
Care / Appliance
Care / Elastics
Care / Proper
Diet
Braces
Care
You
will be shown the proper care of your braces when your orthodontic
treatment begins. Proper cleansing of your mouth is necessary every
time you eat. Teeth with braces are harder to clean, and trap food
very easily. If food is left lodged on the brackets and wires, it
can cause unsightly etching of the enamel on your teeth. Your most
important job is to keep your mouth clean. If food is allowed to
collect, the symptoms of gum disease will show in your mouth. The
gums will swell and bleed and the pressure from the disease will
slow down tooth movement.
BRUSHING:
You should brush your teeth several times per day.
-
Brush
back and forth across……between the wires and gums on the
upper and lower to loosen any food particles.
-
Next,
brush correctly as if you had no brackets or appliances on.
-
Start
on the outside of the uppers with the bristles at a 45 degree
angle toward the gum and scrub with a circular motion two or
three teeth at a time, then move on.
-
Next,
do the same on the inner surface of the upper teeth.
-
Then,
go to the lower teeth and repeat steps A & B.
Look
in a mirror to see if you have missed any places. Your teeth,
brackets and wires should be free of any food particles and plaque.
Note:
If your gums bleed when brushing, they are not receiving enough
stimulation. Do not avoid brushing, but rather
continue stimulating the area with the bristles. Be sure to angle
your toothbrush so that the area under your gum line is cleaned.
After 3 or 4 days of proper brushing, the bleeding should stop and
your gums should be healthy.
FLOSSING:
Use a special floss threader to floss with your braces on. Be sure
to floss at least once per day.
FLUORIDE
RINSE OR GEL: May be recommended for preventive measures.
Back to Top
Appliance
Care
Clean
the retainer by brushing with toothpaste. If you are wearing a lower
fixed retainer be extra careful to brush the wire and the inside of
the lower teeth. Always bring your retainer to each appointment.
Avoid flipping the retainer with your tongue, this can bother your
mother. Place the retainer in the plastic case when it is
re-moved from your mouth. Never wrap the retainer in a paper napkin
or tissue, someone may throw it away. Don't put it in your pocket or
you may break or lose it. Don't place in hot water to clean or
sterilize. Excessive heat will warp and ruin the
retainer.
Back to Top
Elastics
Care
If
elastics (rubber bands) are worn intermittently, they will
continually "shock" the teeth and cause more soreness.
Sore teeth between appointments usually indicate improper wear of
headgear or elastics or inadequate hygiene. Wear your elastics
correctly, attaching them as you were told. Wear elastics all the
time, unless otherwise directed. Take your elastics off while
brushing. Change elastics as directed, usually once or twice a day.
Back to Top
Proper
Diet
| Avoid Sticky
Foods such as: |
|
| Caramels |
Skittles |
| Candy bars with
caramel |
Starbursts |
| Fruit Roll-Ups |
Toffee |
| Gum |
Gummy Bears |
| Candy or caramel
apples |
|
| |
|
| Avoid
Hard or Tough Foods such as: |
| Pizza Crust |
Ice cubes |
| Nuts |
Bagels |
| Hard Candy |
Popcorn Kernels |
| Corn Chips |
|
| |
|
| Cut
the following foods into small pieces and chew with the
back teeth: |
| Apples |
Pears |
| Carrots |
Celery |
| Corn on the Cob |
Chicken wings |
| Pizza |
Spare Ribs |
| Back to Top |
|
Orthodontic
Emergencies or Problems
Loose
Bracket / Poking
Wire / Wire
out of Back Brace
Poking Elastic (Rubber
Band) Hook / Sore
Teeth
Please
feel free to contact the office if you are experiencing any
discomfort or if you have any questions. Below are a few simple
steps that might help if you are unable to contact us or if you need
a “quick fix”.
Back to Top
Loose
Bracket
Occasionally,
a glued bracket may come loose. You can remove the loose bracket and
save it in an envelope to bring to the office or leave it where it
is, if it is not causing any irritation. Call the office as soon as
possible in order for us to allow time to re-glue the bracket.
Back to Top
Poking
Wire
If
a wire is poking your gums or cheek there are several things you can
try until you can get to the office for an appointment. First try a
ball of wax on the wire that is causing the irritation. You may also
try using a nail clipper or cuticle cutter to cut the extra piece of
wire that is sticking out. Sometimes, a poking wire can be safely
turned down so that it no longer causes discomfort. To do this you
may use a pencil eraser, or some other smooth object, and tuck the
offending wire back out of the way.
Back to Top
Wire
out of Back Brace
Please
be careful to avoid hard or sticky foods that may bend the wire or
cause it to come out of the back brace. If this does happen, you may
use needle nose pliers or tweezers to put the wire back into the
hole in the back brace. If you are unable to do this, you may clip
the wire to ease the discomfort. Please call the office as soon as
possible to schedule an appointment to replace the wire.
Back to Top
Poking
Elastic (Rubber Band) Hook
Some
brackets have small hooks on them for elastic wear. These hooks can
occasionally become irritating to the lips or cheeks. If this
happens, you may either use a pencil eraser to carefully push the
hook in, or you can place a ball of wax on the hook to make
the area feel smooth.
Back to Top
Sore
Teeth
You
may be experiencing some discomfort after beginning treatment or at
the change of wires or adjusting of appliances. This is normal and
should diminish within 24-72 hours. A few suggestions to help with
the discomfort:
-
Rinse
with warm water, eat a soft diet, take acetaminophen (Tylenol)
or ibuprofen (Advil) as directed on the bottle.
-
Chewing
on the sore teeth may be sorer in the short term but feel better
faster.
-
If
pain persists more than a few days, call our office.
