What to expect on your first visit.
We will review your medical and dental history, as well as provide a thorough oral exam. After gathering all relevant information, we will review possible treatment options (including no treatment) along with giving you financial plans that work with you and your insurance, if applicable.
The first appointment (of actually placing appliances) requires about 40 to 60 minutes. Most subsequent appointments require approximately 20-30 minutes. We will make every effort to schedule your appointments conveniently around your busy schedule. From that point forward, most appointments are scheduled at intervals of every 4-8 weeks.
Frequently Asked Questions
Sometimes we are surprised to hear that kids just want to get braces. Whether it is because they want to look better or be like their friends, it is important for us to understand what our specific goal is with any treatment we propose to do. In other words, our treatment needs to address, what is called, the patient’s “Chief Complaint”. Occasionally, patients come to our office without a Chief Complaint or parents just want to be sure things are developing OK with their children. In these cases, if we find that there is no underlying functional reason or urgency to begin orthodontic care and our patient is otherwise happy with their smile (even though teeth are not perfectly aligned) we will usually suggest not undergoing treatment until a Chief Complaint does arise, because there would be no other reason to do so. If we do note a functional problem that needs addressing, we will let you know of any recommendations. Sometimes, no treatment is the best treatment when there is no Chief Complaint.
Some cases with braces can require as few as 4-6months, depending on treatment goals. On the longer side, cases can require up to 30 months. The average time is 18 to 22 months, depending on the complexity of the case. In some cases, a short term with braces (4-6 months) can be combined with a longer term with clear aligners, like Invisalign.
Braces are a series of attachments placed onto teeth that allow precise positional changes with your teeth. They offer 3 dimensional controls of teeth positions, in ways that removable appliances cannot. Removable appliances (Invisalign) are limited in their precision with orthodontic correction, as compared to braces. Their usefulness really depends on how complex the alignment challenges are. There are ceramic braces (tooth colored) that are barely noticeable, metal braces with multi-colored elastic ligature ties and metal brackets without elastic ties (self-ligating brackets like Damon, Time, GAC). There are even brackets that can be placed on the backside of teeth (lingual braces) so that they are not seen at all). Each kind of appliance has advantages and disadvantages and we will be happy to review them all with you.
In growing children, the profile changes considerably throughout all the years up to the age of about 14 or 15, without any orthodontic treatment! Our goal is to achieve the most esthetic facial profile possible, and our treatment decisions can sometimes play a role. We will discuss with you the advantages and disadvantages of any proposed treatment plans before treatment begins. Some of the more challenging decisions regarding facial profile relate to what we call “borderline extraction” cases.
In the accompanying schematic drawings, you can better visualize the various trade-offs of treatment decisions. The two easiest treatment decisions about extractions are when the facial profile is already very protrusive in the lips region before treatment starts, with lots of pre-treatment crowding. In these infrequent situations, it is easy to visualize that removing teeth is the best decision, because not removing teeth would only make matters worse as teeth would move even more forward as we expand the arch’s size to make room for straighter teeth. The other situation is when the profile is already very “flat” in the lips region and there is little pre-treatment crowding. In this case, extractions of teeth would definitely make matters worse because extractions would; more than likely cause the lips to move even further inward, which would be less esthetic. The trickier decisions are when the facial profile is already well balanced and we have to consider treatment effects on the profile. In very mild crowding cases with an already well-balanced facial profile, the profile changes will change very little after orthodontic treatment. In moderate crowded cases, the profile could change more than a little, especially if teeth are extracted because extractions of teeth may provide more space than we actually need to for ideal alignment. With the proper thought, communication and treatment techniques of aligning teeth and improving the bite, “surprises” are something that we are fortunately able to minimize, in any case.
Individual brackets are positioned onto teeth in a way that is generally centered on the fronts (or opposite aspect) of teeth. If teeth are crooked, the brackets will appear crooked also. The wire that is placed into the brackets, however, is a flat, smooth curve before it is engaged into all the brackets. Once the wire is placed into the “crooked” brackets, the wire becomes deformed or bent. However, within the next several months the memory of the wire wants to return the wire to the original flat, smooth, curved shape. The cells within the jawbone act to “soften” the surrounding bone of each tooth and, before you know it, the teeth begin to migrate in such a way that the wire becomes relaxed as it was before the wire was placed into the “crooked” brackets and the teeth become straighter. It takes time to do this in a comfortable, physiologic way, but is very effective. There is not much more magic to the process, other than making critical diagnostic decisions to also correct the bite. It is the correction of the bite that requires the majority of the orthodontist’s advanced training. Without correction of the bite to a physiologic, specific standard, the effort put into aligning teeth will soon relapse and can also allow unnecessary stresses on the TMJ (Temperomandibular Joint).
Like facial profile, the more we move front teeth forward, the more the front teeth tend to lean forward. The more we move front teeth backwards, the more front teeth lean backwards. In some instances, we must decide to accept a slight forward flare to front teeth as we seek to optimize the facial profile, or we accept a slightly compromised, flatter facial profile as we seek to achieve ideal up righting of front teeth. Again, with proper thought, communication and treatment techniques in planning, the less apt we are to run into any “surprises”.
We first obtain diagnostic records (models, x-rays and photographs) to confirm our preliminary diagnosis at a records appointment, separate from the exam appointment. If time permits, we can sometimes save you a visit by getting these records on the same visit as the exam.
An orthodontist is a dental specialist who has been trained in a 2-3 year ADA-approved residency. This training can only be done after completion of 4 years of dental school. Orthodontists not only straighten teeth, but also are trained in managing necessary skeletal changes of the middle and lower face for achieving successful outcomes, whether through surgically assisted orthodontic treatment or the use of bone implants to assist with challenges of minimizing unwanted compensations during orthodontic treatment. Because the orthodontists’ job is concerned with how a proper bite is established, it is also the orthodontist who plays a pivotal role in recognizing and treating TMJ problems.
Our starting premise with our treatment plan is always “can it be done without removing teeth”? After all, we were designed with a full compliment of teeth—we really should have a very compelling reason to advise any extractions. In “borderline” extraction cases, we will often start treatment and evaluate how things are progressing without extractions. Overall, our recommendation for extractions is definitely the exception, rather than the rule of treatment.
It is impossible to give an exact cost for treatment until we have examined you. We will cover the exact cost and financial options during the initial examination. We have many financing options available to accommodate your needs, and we will review these with you. We will also review your insurance policy and help to maximize your benefit and file your claims.