Frequently Asked Questions
What Can You Expect:
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 appliances.
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 health problems.
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 extraction.
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 hours only.
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 as scheduled.