Frequently Asked Questions
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?
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 or
orthodontist 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
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. If the permanent teeth have adequate space to erupt
they will come in fairly straight. If the teeth erupt fairly straight
their tendency to get crooked again after the braces come off is
diminished significantly. After the permanent teeth have erupted,
usually from age 12-14, 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
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.
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.
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.
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
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
4-5 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 using ten strokes, 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, 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
FLUORIDE RINSE OR GEL: May be
recommended for preventive measures.
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 cause damage to your teeth. 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. Excessive heat will
warp and ruin the retainer.
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.
Avoid Sticky Foods
Candy bars with
Candy or caramel
Hard or Tough Foods such as:
the following foods into small pieces and chew with the back
Corn on the Cob
Emergencies or Problems
/ Poking Wire
out of Back Brace
Poking Elastic (Rubber
Band) Hook /
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”.
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.
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.
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
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.
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
- If pain persists more than a few days, call our office.
Orthodontic (Two Phase) Treatment
/ Phase 2 /
Association for Orthodontists recommends that every child have an
orthodontic evaluation by the age of 7. Early detection and treatment
gives your child the edge: a much better chance for natural and normal
development. By working with the natural growth instead of against it, we
can prevent problems from becoming worse, and give your child a lifetime
of healthy smiles!
Early treatment should be initiated for:
- Habits such as tongue thrusting and thumb sucking
- A constricted airway due to swollen adenoids or tonsils
- Mouth breathing or snoring problems
- A bad bite
- Bone problems (i.e. narrow or underdeveloped jaws)
- Space maintenance (for missing teeth)
Phase One - Functional (Growth) Appliances and/or Limited
Braces - Ages 5 to 12
In the first
phase, the doctor is interested in the position and symmetry of the jaws,
future growth, spacing of the teeth, breathing and other oral habits which
may, over a period of time, result in abnormal dentofacial development.
initiated in this phase of development is often very successful and some
times, though not always, can eliminate the need for future orthodontic
- Braces - Ages 12 to 14
In the second
phase, the doctor will be looking at how your child’s teeth and jaws
fit, and more specifically work, together. Your child’s teeth will be
straightened and their occlusion (bite) is properly aligned. Attention
will be given to the jaw joint, (TMJ), the facial profile and periodontal
(gum) tissues. By undergoing the first phase, we can usually reduce the
amount of time needed for braces.
Facial Development - Seventy-five percent of
12-year-olds need orthodontic treatment. Yet 90% of a child's face has
already developed! By guiding facial development earlier, through the use
of functional appliances, 80% of the treatment can be corrected before the
adult teeth are present!
Cooperation - Younger children between the ages of 8 and 11 are
often much more cooperative than children of ages 12 to 14.
Shorter Treatment Time - Another advantage of early
Phase One treatment is that children will need to wear fixed braces on
their adult teeth for less time.
Underdeveloped or Overdeveloped Jaws - Almost
55% of children who need orthodontic treatment due to a bad bite have
underdeveloped or overdeveloped upper or lower jaws. Functional appliances
and/or limited braces can reposition the jaws, improving the child's
profile and correcting the bite problem - within 7 to 9 months!