What age should my child have an orthodontic evaluation?
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 problems.
Why is it important to have orthodontic treatment at a young age?
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 erupted.
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.
What causes crooked teeth?
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.
How do teeth move?
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.
Will it hurt?
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 pain.
Orthodontic Terms
Arch Wire
The part of your braces which actually moves the teeth. The arch wire is attached to the brackets by small
elastic donuts or ligature wires. Arch Wires are changed throughout the treatment. Each change brings you closer
to the ideal tooth position.
Brackets
Brackets are the “Braces” or small attachments that are bonded directly to the tooth surface. The brackets are
the part of your braces to which the dentist or assistant attaches the arch wire.
Occasionally, a bracket may come loose and become an irritation to your mouth. You can remove the loose bracket
and save it in an envelope to bring to the office. Call the office as soon as possible and make an appointment
to re-glue the bracket.
Elastics (Rubber Bands)
At some time during treatment, it will be necessary to wear elastics to coordinate the upper and lower teeth and
perfect the bite. Once teeth begin to move in response to elastics, they move rapidly and comfortably. If
elastics (rubber bands) are worn intermittently, they will continually "shock" the teeth and cause more
soreness. When elastics are worn one day and left off the next, treatment slows to a standstill or stops. 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.
Headgear
Often called a “night brace”. The headgear is used to correct a protrusion of the upper or lower jaw. It works
by inhibiting the upper jaw from growing forward, or the downward growth of the upper jaw or even by encouraging
teeth to move forward, if that is the case.
Malocclusion
Poor positioning of the teeth.
Types of Malocclusion
Class I
A Malocclusion where the bite is OK (the top teeth line up with the bottom teeth) but the teeth
are crooked, crowded or turned.
Class II
A Malocclusion where the upper teeth stick out past the lower teeth.
Class III
A Malocclusion where the lower teeth stick out past the upper teeth. This is also called an
"underbite".
Occlusion
The alignment and spacing of your upper jaw and lower teeth when you bite down.
Types of Occlusion:
Openbite
Anterior opening between upper and lower teeth.
Overbite
Vertical overlapping of the upper teeth over the lower.
Overjet
Horizontal projection of the upper teeth beyond the lower.
Crossbite
When top teeth bite inside the lower teeth. It can occur with the front teeth or back teeth.
O Rings
O rings, also called A-lastics, are little rings used to attach the arch wire to the brackets. These rings come
in standard gray or clear, but also come in a wide variety of colors to make braces more fun. A-lastics are
changed at every appointment to maintain good attachment of the arch wire to the bracket, enabling our patients
to enjoy many different color schemes throughout treatment.
Separator
A plastic or rubber donut piece which the dentist uses to create space between your teeth for bands.
Fixed and Removable Appliances
Band & Loop (B & L)
A Band & Loop is routinely used to hold space for a missing primary (baby) posterior (back) tooth until the
permanent tooth can grown in.
Herbst
An appliance designed to encourage the lower jaw to grow forward and “catch up” to upper jaw growth.
Lower Lingual Arch (LLA)
A lower lingual arch is a space maintainer for the lower teeth. It maintains the molars where they are, it does
not move them. This is fabricated by placing bands on the molars and connecting them to a wire that fits up
against the inside of the lower teeth. It keeps the molars from migrating forward and prevents them from
blocking off the space of teeth that develop later. This is used when you have the early loss of baby teeth or
when you have lower teeth that are slightly crowded in a growing child and you do not want to remove any
permanent teeth to correct the crowding.
Palatal Expander
An appliance which is placed in the roof of the mouth to widen the upper dental arch. The maxilla, or upper
dental arch, is joined in the center by a joint, which allows it to be painlessly separated and spread.
Temporarily you may see a space develop between the upper two front teeth. This will slowly go away in a few
days. Once this has occurred, the two halves knit back together and new bone fills in the space.
Quad Helix
This appliance provides continual, gradual pressure in as many as four directions, to move molars, expand or
contract arches or assist in eliminating finger or thumb habits.
Bi Helix
An appliance used to expand the lower arch without interfering with tongue posture or movement.
Hawley
A universally used retainer with many applications; to move teeth, close spaces, maintain alignment during or
after treatment.
Nance
This appliance maintains the position of the maxillary molars without using any other teeth. The plastic
button on the palate provides stability.
Retainers
At the completion of the active phase of orthodontic treatment, braces are removed and removable appliances
called retainers are placed. To retain means to hold. Teeth must be retained or held in their new positions
while the tissues, meaning the bone, elastic membranes around the roots, the gums, tongue and lips have adapted
themselves to the new tooth positions. Teeth can move if they are not retained. It is extremely important to
wear your retainers as directed!
Orthodontic Care
Braces Care
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 1 & 2.
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 again.
FLOSSING:
Use a special floss threader to floss with your braces on. Be sure to floss at least once per day.
FLUORIDE RINSE OR GEL:
May be recommended for preventive measures.
Appliance Care
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.
Elastics Care
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.
Proper Diet
Avoid Sticky Foods such as:
Caramels
Candy bars with caramel
Fruit Roll-Ups
Gum
Candy or caramel apples
Skittles
Starbursts
Toffee
Gummy Bears
Cut the following foods into small pieces and chew with the back teeth:
Apples
Carrots
Corn on the Cob
Pizza
Pears
Celery
Chicken Wings
Spare Ribs
Orthodontic Emergencies/Problems
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”.
Loose Bracket
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.
Poking Wire
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.
Wire Out of Back Brace
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 wire.
Poking Elastic (Rubber Band) Hook
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.
Sore Teeth
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 better faster.
If pain persists more than a few days, call our office.
Early Orthodontics
The American 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)
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.
Treatment initiated in this phase of development is often very successful and some times, though not always, can
eliminate the need for future orthodontic treatment.
Phase Two
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.
Facts: Early Treatment Is Important to Consider!
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.
To Correct 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!