Frequently Asked Orthodontic Questions
Is There Any Discomfort?
Orthodontic therapy uses appliances (braces) to move teeth with gentle
pressure. There is usually no discomfort in applying the braces however
the teeth may be sore for 24-48 hours after placement or adjustment of
What is Headgear?
Headgear is an appliance, usually worn just at night, that goes around
your neck or over your head and uses these areas as an anchor to move
teeth. Your treatment may include headgear or elastics. Follow instructions
carefully to achieve good results and avoid injury. Not following instructions
regarding the wearing of these appliances could result in increased treatment
time and/or a less than ideal end result.
What About Removal of Teeth?
TOOTH SIZE ARCH LENGTH incompatibility, where the total tooth mass is larger
than the jaw length, is a common problem we see every day. Our philosophy
is to preserve healthy teeth whenever possible, however as a last resort
in such cases, extraction of permanent teeth may be considered.
At what age is the best time to begin treatment?
Orthodontic treatment can begin in the primary dentition (when baby teeth
remain) or the permanent dentition (with no baby teeth left), or anywhere
in between. Some problems can and should be treated while baby teeth remain
and the child is actively growing. Some problems can and should wait until
all the baby teeth have been replaced. Individual timing is the key to
the fastest and best result. We recommend a child be seen by about age
8 for a clinical exam to determine the best time to begin treatment (of
course there is no charge for this service)..
What is Orthognathic Surgery?
Orthodontics is aimed at aligning your teeth. In instances of open bite
or jaw size discrepancy, surgery may be required to align the jaws so
the bite is corrected. Only about 1-2% of all bite corrections require
orthognathic surgery, as well as orthodontics to repair the problem. In
cases of combined orthodontic - orthognathic surgery, an orthodontist
and oral surgeon are needed to evaluate and work together on realistic
goals and a treatment plan.
What Are Retainers?
When your braces are removed, you will wear a retaining appliance to "hold"
your teeth in position. Retainers are just as important as braces in the
treatment plan. There are different types. Your orthodontist will choose
the right one for you. You will wear your retainer for as long as it takes
your teeth to settle into better bite, and for your bones and muscles
to adapt to your new dental agreement. Your orthodontist may evaluate
your wisdom teeth during this phase of treatment.
What Will Be Expected of You During Orthodontic Treatment?
Generally speaking, excellent orthodontic treatment results can only be
obtained with cooperative and informed patients and parents. Successful
treatment is a team effort: patients, parents, staff and the orthodontist
working together. The rewards? Your pleasing smile, your healthy teeth,
and your glow of new self confidence.
For best results in the shortest time and at the lowest cost, you must:
1. Keep regularly scheduled appointments.
2. Practice good oral hygiene.
3. Wear rubber bands, headgear and retainers as instructed.
4. Call the office immediately if you experience loose or broken appliances.
5. Eat a well-balanced diet.
6. Care for the braces to reduce broken appliances.
Your failure to follow these rules could force your orthodontist to change
the procedures and goals of your treatment. As a last resort, treatment
might have to be suspended. Premature suspension of treatment may lead
to problems involving teeth, gums, jaw joints or severe relapse of tooth
positions. The consequences of early suspension may be worse than no treatment
at all. Cooperation throughout treatment is your best guarantee of achieving
a pleasing smile and a good bite.
Please remember that following directions and recommendations are your
responsibility. Your orthodontist will encourage you, but cannot assume
responsibility for making sure directions are followed.
What Problems Can Occur as a Result of Orthodontics?
1. Cavities and Decalcification
Braces do not cause cavities, but they do trap food particles and increase
the likelihood of you developing cavities or decalcification (white) marks.
Most patients are able to prevent these problems with a combination of
proper diet, good tooth brushing habits and regular checkups with the
family dentist. You should brush your teeth immediately after eating,
using the proper techniques for brushing with braces. If brushing right
away is not possible, vigorously rinsing with several mouthfuls of water
is helpful. Excellent oral hygiene and plaque removal are musts. Remember
to avoid sugar, carbonated beverages and between meal snacks.
Check for loose bands or brackets daily. If any part of your orthodontic
appliances become loose, call the office immediately to schedule an appointment.
A loose band or bracket greatly increases your chance of getting cavities.
When you miss appointments and are not seen regularly by your orthodontist,
loose bands can go undetected and may result in tooth damage.
2. Swollen Gums and Periodontal Problems
Your braces may press on your gums in some areas of your mouth. This gum
tissue may get sore and swollen if you do not brush well. Your gums and
braces need to be brushed and cleaned thoroughly after eating to keep
them healthy. Let your orthodontist know right away if you suspect you
have a periodontal (gum) problem.
Periodontal disease may lead to receding gums and gradual loss of supporting
bone for your teeth. Some people are more susceptible to the disease than
others. The exact causes are unknown, but there are some well-established
contributing factors, including unsatisfactory oral hygiene, accumulation
of plaque and debris around teeth and gums, incorrect brushing and general
If severe periodontal disease occurs during orthodontic treatment, it may
be difficult or impossible to control bone loss and subsequent loss of
teeth. Consultation and treatment by a periodontist, a dentist who specializes
in treating gum disease, may be advised. If periodontal problems during
orthodontic treatment cannot be controlled, treatment may be discontinued.
3. Root Resorption
Root resorption is a shortening of the tooth roots. It can occur with or
without orthodontic appliances and it is impossible to predict susceptibility
to this condition. Some patients are predisposed to this occurring, while
most are not. Slight changes in root length are usually insignificant,
but occasionally with severe changes, the longevity of the teeth involved
may be jeopardized. The incidence may increase with extended orthodontic
treatment. Your cooperation during treatment is very important in the
prevention of root resorption.
4. Ceramic Braces
Ceramic (clear) braces have been designed to improve aesthetics, especially
for the adult patient. These modern appliances have helped many adult
patients receive the benefits of orthodontic treatment without it being
obvious they are in treatment. Due to their brittle nature, however, occasionally
ceramic brackets have been known to break. Ceramic braces on the lower
teeth may cause wear of the opposing teeth. Enamel damage can occur at
removal, but is uncommon. Your orthodontist will help you determine which
braces will provide the best treatment results with a minimum of potential problems.
5. Loss of Tooth Vitality
On rare occasions, teeth that have been previously traumatized, have large
fillings, or periodontal problems, may experience tooth discoloration
and/or nerve degeneration during orthodontic treatment. In such cases,
root canal treatment might be necessary to maintain the health of a tooth.
Bleaching may also be recommended to restore a more natural tooth color.
6. Impacted Teeth
Teeth are "impacted" when they stay partially or completely under
the gum. While impaction usually occurs when your teeth are too crowded
for a new tooth to emerge, it can also happen for no apparent reason.
Treatment depends on the cause and the importance of the impacted tooth
to the jaw structure.
The common impacted teeth are the "wisdom teeth". These teeth
may not grow into place properly because the jaw does not have sufficient
room to accommodate proper eruption. Your orthodontist may recommend their
An oral surgeon may be required to uncover and move an impacted tooth prior
to tooth movement. The roots of nearby teeth may be damaged by the presence
or movement of an impacted tooth. Not all impacted teeth can be successfully
moved, which may necessitate their extraction.
7. Ankylosed Teeth
In some instances, teeth will not move because they are attached to the
jawbone (ankylosed). When a tooth is ankylosed, adjacent teeth may be
forced to move, which may affect your bite. An ankylosed tooth may require
surgery, for movement into place, or removal.
8. Injuries from Appliances
A number of orthodontic appliances are used in orthodontic treatment. It
is important that you closely follow your orthodontist's instructions
regarding their use. However, there is always some risk of injury in the
use of appliances.
BRACES - Because your braces may protect your teeth, a blow to the face
can scratch or cut the inside of your lips or cheeks. Loose or broken
wires and bands can also scratch or irritate your cheeks, gums or lips.
Your orthodontist will give you soft wax to cover problem areas like this.
If problems develop, call the office for an appointment.
Dislodged or broken braces can be swallowed or inhaled. The risk of dislodging
your braces is increased when sticky or crunchy foods are eaten. Do not
eat hard candy, ice, caramel, or similar foods. Your orthodontist will
review foods that are not to be eaten.
RETAINERS. If your retainer breaks, stop wearing it immediately. Call your
orthodontist as soon as possible so that your retainer can be repaired
or replaced. Unless otherwise told, retainers are to be worn during waking
HEADGEAR. You must follow your orthodontist's instructions for safe
and effective use of headgear. Do not engage in physical sports or activities
while wearing your headgear. You may be seriously injured if another person
pulls your headgear off accidentally or intentionally. Headgear or neckgear
that is pulled away from the head can snap back and seriously injure your
face and/or eyes. Always remember to release all tension before removing
the headgear or neckgear.
9. Injuries During Treatment Procedures
Your orthodontic treatment may involve the use of instruments that could
accidentally scratch or injure your mouth. It is also possible to accidentally
swallow or inhale a small orthodontic appliance.
Although your orthodontist will use great care in applying and removing
your braces and other bonded attachments, damage may occur to teeth previously
weakened by cracks in the enamel, undetected cavities or weak fillings.
10. Jaw Joint Pain and/or Clicking
Occasionally problems may occur in the jaw joints, i.e. temporomandibular
joints (TMJ) and associated muscles, causing joint pain, limited opening,
muscle aches and joints noises, i.e. clicking. Earaches and headaches
are sometimes related complaints. Multiple factors are usually responsible
for these signs and symptoms, including some which are controlled by the
central nervous system.
Some of the most common causes of TM disorders (TMD) are, chronic muscle
tension associated with clenching or gnashing of the teeth, habits such
as gum chewing or stressed jaw posture at work or during sleep. The symptoms
may originate with a joint disease, such as arthritis or result after
previous trauma, such as a blow to the face or sometimes from a whiplash
type injury. The severity of the symptoms may be affected by tension,
mood, and emotional distress. Neck and shoulder muscle tensions may be
a major contributor by referring pain and tightness to the jaws and face.
Severity of symptoms may be exaggerated by faulty function of the pain
suppression system at various levels of the nervous system.
In the past, it was believed that an imperfect bite (dental malocclusion)
or a malpositioned lower jaw was the cause of TMD problems. However, occlusion
as a cause of TMD has not been well demonstrated, despite many investigations
seeking to test this relationship. "Bite problems" that occur
with TMD are most often the result of the problems rather than the cause
of the problems.
TM disorders are musculoskeletal problems similar to aches and pains in
other joints of the body. A TM disorder is most often treated as a medical
problem and not necessarily a dental problem. Treatment may require specialized
care from other health professionals such as a TMD specialist, physical
therapist, and/or stress control specialist. These procedures are beyond
the scope of the usual orthodontic treatment, and if they are indicated,
additional costs may be incurred.
If your TMD symptoms prevent you from wearing elastics, or any other appliance
to correct your bite, your orthodontist may recommend an alternative,
or compromise treatment. Any TMD signs or symptoms should be reported
promptly to your orthodontist.
11. Tooth Attrition and Enamel Loss
The biting surface of adult teeth are frequently worn down by tooth grinding
or jaw clenching behavior. Tooth interferences during jaw movements can
also contribute to tooth wear. As your teeth move during orthodontic treatment,
your bite will steadily change and new interferences may arise.
Halting enamel loss is not easy. It is difficult for orthodontics alone
to establish a bite completely free from interference during jaw movement.
Psychological stress or conditioned habits may be the cause of grinding
or clenching. The biting surface of teeth may need reshaping by special
dental procedures. In some cases, an appliance to control the rate of
enamel wear may be considered. Such procedures are beyond the scope of
usual orthodontic therapy.
12. Risks With Orthognathic Surgery
You may need both orthodontic treatment and surgery to modify the size,
shape, or position of your jaws. As with surgical procedures, the risk
of complications with oral surgery is a possibility. Discuss these risks
thoroughly with your oral surgeon if your orthodontist recommends surgery.
Will My Teeth Go Back To The Way They Were?
"Relapse" refers to the movement of the teeth back toward their
original positions after your braces have been removed. Ideally, your
teeth should remain stable after retention. However, teeth can move at
any time, whether or not they have had orthodontic treatment. The most
vulnerable teeth are those in the lower front.
Periodontal disease, mouth breathing, and harmful tongue or oral habits
can cause teeth to move. For these reasons, and many others beyond the
control of your orthodontist, it cannot be guaranteed that your teeth
will remain in a perfect position for the rest of your life.
Your teeth are unlikely to "relapse" to their original position
if you use your retainer properly; but if you do not, you may undo much
or all of the progress you have made. Some patients must wear a retainer
indefinitely to keep their teeth aligned. If you do not wear your retainer
as directed, your orthodontist cannot assume responsibility for undesirable
tooth movement. Make sure you keep appointments for retention adjustment