The following questions are frequently asked during the course of orthodontic therapy. Though these questions are not exhaustive,
they will hopefully help to answer many of your concerns. Invariably, additional questions will arise regarding your (or your child's) orthodontic care. Please do not hesitate to ask questions as they may arise.
Why would I need orthodontic care?
Let's face it, a bad bite or crooked teeth is not considered
life threatening. Most people pursue care so that they can feel better about themselves and, in some cases, to become more comfortable with chewing. It is also easier to keep straight teeth free of trapped food and
plaque, which can improve the long-term health of the supporting gums, jaw, and teeth. A "bad bite" can also negatively affect the health of the TMJ (temperomandibular joint), which can be associated with discomfort in
the neck, back and facial muscles. What should I expect from my first visit to the orthodontist?
You should expect an examination that includes looking at how the upper and lower jaw relates to one
another and to the rest of the face. We use a thorough diagnostic analysis to determine the alignment of teeth, function of the bite, and esthetic considerations of our new patient. You should expect that we arrive at a
tentative orthodontic diagnosis at this first appointment. We will discuss with you the diagnosis of your (or your child's) orthodontic condition so that you better understand what treatment may be indicated as
well as options for treatment. Further, after the examination, you should expect that we would inform you of anticipated fees for our services and assist in helping you with insurance and financial matters.
What happens after the need for orthodontic care has been determined?
A second appointment is made for obtaining diagnostic records (photographs, orthodontic
x-rays, and diagnostic casts). From these records, we can make a definitive diagnosis to confirm appropriate treatment. After the records appointment, we will arrange for a consultation and address any questions you may have about planned care. In most cases we can begin treatment at this consultation appointment, if you wish, and if time allows. Depending on the diagnosis, we sometimes are able to combine the records appointment with beginning treatment so that care is underway on the second appointment. We make every effort to minimize the number of appointments necessary for you by completing as much treatment per appointment as possible. We recognize that your time is valuable, too.
What about scheduling, how often do I come in, for how long, and at what time of day?
Appointments will be necessary at intervals generally between 4-6 weeks. In some cases 8-10 weeks.
Most appointments can be carried out within 20-40 minutes from the time you are seated to when you're leaving with a new appointment. How long will treatment take?
Each patient's needs are
different, but generally comprehensive treatment with braces takes 18 months - 2 years. If there are extra challenges of surgical assistance or other complexities, treatment can take 2 ½, and, occasionally, 3
years. Patient cooperation & biology can influence these estimates. If your child is undergoing early treatment in preparation for an easier final phase of orthodontic care, we try to keep this phase to 9 months or
less. Is orthodontic care uncomfortable?
With the new technological advances in gentle, resilient archwires, discomfort is much less than in the "old days". Some patients have very low thresholds for
pressure and may benefit from taking a Tylenol or Advil 1 hour before appointments. Also, chewing gum right after an adjustment can be helpful in stimulating circulation around the teeth, which helps to minimize
discomfort.
Are there braces that are not noticeable? (see Brace Wizard)
Yes. There is an orthodontic technique, which provides braces on the inside
of the teeth (lingual brackets). This procedure is less efficient than conventional means, takes up to twice as long, is generally more expensive than conventional brackets, and is valued most by actors and models. There are esthetic (clear) brackets. These are a bit more fragile than metal brackets and can slow progress down somewhat because they can require some extra attention for re-bonding. Clear brackets are still an excellent way to straighten teeth with little visibility of braces. When chosen, esthetic brackets are best used only on the
upper teeth. They are too fragile on the lowers due to different forces.
There is also Invisalign (removable, clear aligners). This procedure is somewhat less effective at straightening teeth than braces due to
lesser control of mechanical forces. However, in mild to moderate crowding cases, this is a great option for those who would not otherwise wear braces.
Does insurance pay for braces, since its cosmetic?
Most insurances do
cover orthodontic care. There is often a lifetime maximum benefit, which ranges from about 25% to 80% of typical fees with the average being about 50%. If insurances change, the maximum benefit is usually available all over again. While we may be of help to you in submitting claims on your behalf, it is a good idea to call your company directly to accurately get answers about your insurance. Insurance companies prefer to interact with the subscriber to the plan (you), rather than us.
(Back to Top) Children's Care FAQ If my
child has crooked teeth, why wouldn't the orthodontist recommend treatment right away?
We feel that in the absence of significant functional concerns,
if mal-aligned teeth do not pose a problem to the child's self esteem, it may be best to delay definitive orthodontic care until the child's optimal growth period: usually around puberty. This age can be the most
efficient window in the child's development, when we get the most change with greatest predictability.
If functional problems do exist at a pre-pubertal age, we may advise preliminary treatment (Phase I) to
address such issues as skeletal foundation problems or to reverse detrimental habits which affect orthodontic development. This phase typically lasts about 6-12 months. The age for needed Phase I care is
usually about 9-10 years for girls and about 10-11 for boys; the late mixed dentition stage of development, where there are only a few baby teeth left. In some cases, it may be necessary to intercept problems as
early as age 6 or 7. Phase I care is advised when it is evident that such treatment would reduce the need for surgically-assisted orthodontics during definitive (Phase II) orthodontic care or when we feel that
better results overall would result. There are variations in biological age, which can affect the optimum time for care of your child. In the event that we recommend deferring treatment for
some time, it is important to return at the recommended recall appointment. Otherwise, we can miss a once-in-a lifetime opportunity to re-direct growth at a crucial time for your child. What kind of
functional problems in children are treated earlier (Phase I)? a). Narrow upper jaw (can lead to developmental problems in jaws)
b). Deep Overbite (more stable when correction done earlier) c). Retrusive Lower Jaw (sometimes best addressed in early growth) d). Protrusive Lower Jaw (sometimes best addressed in early growth)
e). Open Bite (from tongue thrust or thumb sucking) f). Cross bite (can lead to developmental problems in jaws) In many cases, early treatment can make the difference between complicated, expensive
surgery or not, as well as improve the long-term stability of eventual Phase II orthodontic correction. In some cases, early care can improve the child's self esteem at crucial times of their social development.What
if I play a wind instrument or violin; will it be a problem with braces? If you play for an hour a day or less, it is generally not a problem. What if I'm no longer a child but I have
baby teeth still present with no permanent ones behind them? Should I plan on a bridge or an implant for replacement?
Depending on the situation, we may leave the baby teeth in place as long as possible.
However, baby teeth will usually fall out by age 18-30. Sometimes, it is best to remove baby teeth sooner. Occasionally, the treatment plan could call for removing the baby tooth and closing the space left. You and your
dentist can determine how best to replace any missing teeth, should that be necessary. If a tooth is impacted (hiding under the bone), what do I do?
We make every effort to bring teeth into proper
position orthodontically, if possible, rather than extract the hidden tooth. (Back to Top)
Prevention FAQ  Why are my gums so puffy and red?
Some gum puffiness is normal
with braces. Red, swollen gums, though, are a sign of chronic infection due to inadequate hygiene. Moving teeth through gums of poor hygiene can be destructive to the gums and underlying bone, causing permanent damage.
At each appointment, we score the levels of hygiene and will help guide you to better ways of resolving these problems. Your home care, though, is very critical to successful results.
What about check-ups with my primary dentist, should I still go?
Yes! Visiting your dentist every 3-6 months for monitoring of decay and gum disease is critical so that our work doesn't further
jeopardize your health. What about progress x-rays, why are they necessary?
Because we can't directly see what's going on with the roots under the bone, panoramic (orthodontic) x-rays are our primary
means to evaluate this. When indicated, they are usually taken during the last half of treatment, often at about the halfway point. Check-up x-rays from your general dentist, every 6 months, are helpful not only
in assessing potential decay, but also root, gum and bone health. (Back to Top)
Technical FAQ
Why am I getting spaces between my teeth? Why is a tooth turning, when braces are supposed to be making things better?
There are times during treatment that, in some areas, teeth may seem to be getting worse rather than better. Usually this is due to the fact that in order to accomplish some
corrections in one area, there may be temporary compromises elsewhere, until full control is established. This is a normal part of the process. Occasionally; elastic ties do
break and can cause these same temporary events. If you're in doubt, give us a call so we can advise you of what to expect or do. I was supposed to have my braces on for 24 months, but my teeth look great after
9 months. ? Was your estimate off? Why can't the braces come off now?
Getting the teeth to look straight happens fairly soon in treatment because they are tipped into alignment. Keeping
them straight for a long time requires getting the roots upright, which takes the time of the second half of treatment. Otherwise, your straight teeth will relapse sooner than they have to. Can
I just straighten my upper or lower teeth without the other arch?
Yes. However, it is usually difficult to attain ideal results without correcting both arches. Teeth have to also function correctly
with the opposing arch, not just become straighter in one arch. Often, straightening one tooth will require moving one in the other
arch for functional reasons, for keeping the bite correct. Time-wise and cost-wise, there is not a tremendous difference between 2 arch and 1 arch treatment. I've had a couple of teeth missing for 2 years or
more, and I'm tired of the space, can we just close it with braces?
Sometimes yes. Most of the time the answer is no, especially if it's a molar that's been missing for a long time. The reason is that
the supporting bone, where the tooth is missing, substantially remodels in a way that prevents a tooth from moving into the space. Also, in cases of missing molars, if the distance is too great to move a tooth into the
space, it can be very stressful to the roots, causing unwanted compromises. When we can't close the space, we will usually recommend replacing it with an implant or bridge. My primary dentist says I
need dental work. Should I wait until I'm finished with braces?
The timing for dental work depends on each case. Often, it is best to have work done before braces for stabilization of decay and other
problems. Sometimes, it is best to wait until we're finished with braces. Ideally, a team approach between your different dentists coordinates the best sequence for all your dental care.
Will I need cosmetic work after the braces come off?
It is generally necessary only if the size or shape of teeth needs modifying. We usually discuss this before we begin treatment. Occasionally, it
is not known until after treatment has begun. In any case, your general dentist can help you with these concerns of veneers, bleaching or making crowns or bridges and carry out whatever cosmetic work might be required.
What if I move away or leave for extended periods?
Often, we can still finish treatment in our office if we're toward the end of treatment, especially if we can plan for a
somewhat earlier finish. If it's early or middle treatment, we can transfer your care to another orthodontist using our worldwide directory. What about the space between my two front teeth?
In 8-11 year old children, some space here is normal and will eventually close by itself. Often, there is an overabundance of muscle tissue from the lip frenum, which extends through the upper or lower 2 front
teeth, at the midline. This muscle fiber will push the two teeth apart if it is not modified (which is a very simple procedure, usually done at the end of treatment). Sometimes, a space will inadvertently open in the
front because we are trying to make other corrections of the front teeth. We will try to pre-advise you of this temporary spacing. Why does the bracket on my porcelain crown sometimes become de-bonded?
The bond strength of brackets to porcelain crowns is usually less than ideal due to mechanical/chemical limitations of bonding materials currently available today. Sometimes we have to place a band around
the whole tooth, other times we'll re-bond. In certain situations we may defer re-bonding toward the later stages of treatment, especially if the tooth is already well aligned.
(Back to Top) Treatment Instructions FAQ
What if a bracket or band comes loose? (see emergency info)
Unless it is uncomfortable because of a loose wire, loose brackets or bands are not an emergency situation. It
is a good idea to call us before your next appointment so that we can allow the extra time to re-bond the bracket or band.
What if a wire is poking me? (see emergency info)
You can try using the eraser on a
pencil to nudge the wire away from soft tissue. Or, if it's a floppy wire, which is poking you, you can use wire cutters closest to the next forward bracket and cut it, removing the loose pieces. Don't hesitate to call
us if you have tried to take care of it on your own and are still uncomfortable. What if I loose my rubber bands or run out?
You can call us and we'll send new ones to you through the mail. What if I wear rubber bands part time instead of full time, as recommended?
Treatment can be slowed tremendously
by compromising with rubber bands! Some patients have a hard time committing to full time wear of rubber bands, sometimes because they forget or they hurt. If they hurt, it's usually because of lack of consistency, like not committing to wearing new shoes that are a little tight. For rubber bands to work at all, they need to be worn a
minimum of 16-18 hours per day. Anything less than this will, unfortunately, not be productive because teeth will not begin to move until 14 hours have gone by in a day, which seems illogical, but its
true. The hours don't have to be continuous, just total at least 16-18 hours per day, 20 or more being best. What about headgear, how much do I wear it and do I wear it outside of the house?
Headgear is a lot like rubber bands; it only begins to work after 12-14 hours per day. It does not need to be worn outside of the house; after school and at night works fine. (Back to Top) Extractions/Surgical FAQ
How do you feel about taking out teeth for orthodontic purposes?
Getting back to the Golden Rule: we presume that every patient would like to keep all
of his or her teeth. Occasionally, we know from the outset that it makes no sense to try to resolve severe crowding without removing teeth to create room for alignment. However, in most cases, removing teeth is
considered only after alternatives have been ruled out. Our philosophy is that it is better to try the more conservative approach of non-extraction therapy than to be resigned to removing teeth from the beginning.
I went to another orthodontist who said I needed surgery and orthodontic care, is it really necessary?
There are some patients who will not achieve acceptable results without surgery, usually
because the skeletal foundation severely limits what can be done just with braces. However, each orthodontist has different ideas about how to resolve these challenges. Our feeling is that surgery is a last resort and,
if possible, even with a degree of compromise, a non-surgical approach can lessen risks to the patient. (Back to Top) Retainers FAQ Will my teeth shift after the braces come off? How long do I have to wear a retainers?
Teeth will tend to shift. Each patient has a unique tendency for this to happen. Most patients will need to continue for at least a few years with
retainer wear, on a consistent basis. Consistency is more important than sporadic, long hours of wear. Patients who suddenly find their retainer not fitting are usually inconsistent with wear and are experiencing a
shift. Tight retainers at night mean the teeth have shifted during the day, which means more consistency, hours or both are needed with retainers. What if I lose my retainer or it's broken?
Call us as soon as the problem arises, especially
if the braces have just come off. Teeth tend to relapse a lot even in 1-2 days if retainers were just placed. For children, leaving retainers in a wadded up napkin on the cafeteria table is the most common way of losing a retainer. Dogs also love chewing on retainers. Appliances should be put in the retainer case when not worn, off the table, placed in a backpack or purse. Replacing retainers are costly because of laboratory costs as well as our time.
Will my wisdom teeth wreck my straight teeth by pushing on them?
Generally not. However, there are other reasons to consider having wisdom teeth removed or retained. Between your primary dentist and
your orthodontist, the optimum time to address this concern can be determined, which, for children, is generally toward the end of treatment. Can I order a special design for my retainer?
Several
options are available for special retainers. Some treatment plans require appliances that do not offer this option of special designs.
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