Early Orthodontic Treatment
You probably know that it’s never too late to begin orthodontic treatment. But when it comes to your youngster’s teeth, did you know that earlier may be better than later? According to the American Association of Orthodontists, kids should have an initial orthodontic screening at age seven.
What makes early evaluation—and potentially, early treatment—so important? There are several ways that kids can benefit from early orthodontic evaluation. But it’s important to recognize that early evaluation isn’t necessarily followed by early treatment; in many cases, if orthodontic work is needed, we simply monitor your child’s growth patterns until we see that it’s time for treatment to begin. This gives us an opportunity to get the best results in the most efficient way, and to help prevent future problems.
Although every child’s development is different, in most kids, the first adult molars have typically started to emerge by around age six. This, along with other developmental markers, lets us get a handle on the basic alignment of the teeth, from front to back and side to side. It may also be possible at this point to determine whether there is adequate room in the mouth for all of the permanent teeth—and, if not, to act.
When Earlier Treatment Is Better
Treatment for common orthodontic problems typically begins around age 9-14, when all of the baby teeth are gone and many of the permanent ones are in place. But there are some conditions that are much easier to treat if they’re caught at an early age, when a child’s natural growth processes are going full speed ahead.
One is severe crossbite, a condition where the upper teeth close inside the lower teeth. To treat this problem, a device called a palatal expander can be used, which gradually and painlessly widens the upper jaw; it’s especially effective when the jaw itself hasn’t fully developed. If we wait too long, a more complicated treatment—or even oral surgery—might be required to correct the problem.
Another condition that may benefit from early treatment is severe crowding. This occurs when the jaws are too small to accommodate all of the permanent teeth. Either palatal expansion or tooth extraction may be recommended at this point to help the adult teeth erupt (emerge from below the gums) properly. Even if braces are required later, the treatment time will likely be shorter and less complicated.
Early intervention may also be helpful in resolving several other problems. Protruding teeth, especially in front, can be prone to chipping and fractures; they may also lead to problems with a child’s self-image. A severe underbite, caused by the lower jaw growing much larger than the upper jaw, can result in serious bite problems. Orthodontic appliances, including braces and headgear, can be successfully used to correct these problems at this stage, when the child’s development is in full swing, thereby increasing the chances that surgery can be avoided.
Correcting Bad Habits
At one time or another, anyone may pick up a bad habit. But there are some situations where a youngster’s parafunctional (detrimental to health) habits can actually influence the development and function of his or her teeth, jaws, and mouth. Some examples of these are persistent thumb sucking, tongue thrusting, and mouth breathing.
The sucking reflex is natural in early childhood; it usually disappears between ages 2 and 4. But if it persists much later, the pressure of the digit on the front teeth and the upper jaw can actually cause the teeth to move apart and the jaws to change shape. This can lead to the orthodontic problem called “open bite” and may impair speech. An open bite can also be caused by the force of the tongue pushing forward against the teeth (tongue thrusting).
Mouth breathing—an abnormal breathing pattern in which the mouth always remains open, passing air directly to the lungs—is related to alterations in the muscular function of the tongue and face. It may cause the upper and lower jaw to grow abnormally, which can lead to serious orthodontic problems. Although mouth breathing may start from a physical difficulty, it can become a habitual action that’s hard to break.
Various orthodontic treatments are available to help correct these parafunctional habits—and the sooner they’re taken care of, the less damage they may cause. But these potential problems aren’t always easy to recognize. That’s one more reason why you should bring your child in for an early orthodontic screening.
Adolescent Orthodontic Care
For many teens, braces are a rite of passage: They’re one more example of the changes adolescents go through at this time, along with growth in stature, edgier tastes in clothes and music, and an increasing degree of self-awareness. But is there any particular reason why orthodontic appliances and teenagers seem to go together? In a word: Yes.
There are several good reasons why adolescence is the optimal time for orthodontic treatment, though occasionally, even earlier intervention is called for. One has to do with the development of the teeth: There’s no set timetable for every kid, but generally by the age of 11-13, the deciduous (baby) teeth have all been lost and the permanent ones have largely come in. This is the time when we can go to work correcting the problems that cause a bad bite (malocclusion), improper tooth spacing, or poor alignment.
Orthodontic problems don’t improve with age; they simply become harder to treat. It’s easier to treat many orthodontic problems during adolescence because the body is still growing rapidly at this time. Whether we use standard braces, or appliances like palatal expanders, we can create an improved appearance and function in a short period of time. In later years, when the bones of the face and jaw are fully developed, many conditions become more difficult (and costly) to treat.
There’s even a social element to getting orthodontic treatment in adolescence. If you need braces, you’re not alone! Chances are you’ll see some of your classmates in our office, and you may even make new friends as you go through the process together. When it’s done, you’ll have a smile that you can really be proud of and benefits that will last your whole life.
The Orthodontic Treatment Process
What can you expect when you come in to our office for treatment? It all depends on what kind of treatment you need. The first time you come in, we will take pictures and radiographic (X-ray) images of your mouth and possibly make a model of your bite. Then, we’ll develop a treatment plan. It may involve regular braces, with or without elastics (rubber bands). We might also recommend that you use a specialized appliance for a period of time. Here are some of the most commonly used orthodontic appliances:
- Metal Braces need no introduction. But you might be surprised to find they’re smaller and lighter than ever. They may even offer some customized options, like colored elastic ties on the brackets.
- Clear Braces feature brackets made of ceramic or composite materials which blend in with your teeth, making them harder to notice. They’re suitable in many situations, but they cost a little more.
- Invisalign is a series of removable, clear plastic trays that gradually straighten teeth as they’re worn (for 22 hours per day). Formerly recommended only for adult patients, they now come with special features—like compliance indicators to tell how often you’ve been wearing them—that make them appropriate for teens in some situations. They’re practically invisible but more costly.
- Other orthodontic appliances may be recommended in some cases, where major tooth or jaw movement is needed. They can range from small devices that fit inside the mouth to external headgear. But don’t worry: You’ll get used to them, and they’re temporary—but they provide a long-term benefit in a short time.
How Long Will I Wear Them?
There’s no one answer that fits everyone: It all depends on what we need to do in your individual situation. Generally, however, the active stage of orthodontic treatment lasts 6-30 months. Afterwards, you will wear a retainer for another period of months. When your orthodontic treatment is complete, the new smile we’ve worked together to create will be yours for a lifetime.
Brushing and Flossing with Braces
You know how important it is to brush and floss properly when you’re wearing braces. But what’s the best way to do that? Let’s start with the basic brushing tools: Either a soft-bristle brush or a bi-level brush (one that has shorter bristles in the middle and longer bristles at the edges) can be effective. Used carefully, an electric toothbrush can work just as well. But be sure the electric brush is set to a moderate power level, and don’t let its vibrations cause the back of the brush to hit the braces!
You should brush with a fluoride toothpaste at least two times per day (preferably after meals), for at least two minutes each time. Remember to brush all of the tooth surfaces: the outside, the inside, and the chewing surfaces as well. Be especially careful to clean the areas between wires and teeth, and between brackets and gums—that’s where food particles can easily become trapped.
Here’s a suggested brushing technique: Beginning at the outside surfaces, place the tips of the bristles flat against your teeth, and use small circular motions to gently polish them clean. For areas between braces and gums, tilt the brush toward the gum line (down for the bottom teeth, up for the top) while keeping up the circular motions. Next, move on to the chewing surfaces of the upper and lower teeth, using a firm back-and-forth motion. Finally, finish up by carefully brushing the inside surfaces of the teeth the same way you did the outside surfaces.
Here is a video that reviews all of this with you: DFC Orthodontic Brushing Instructions.
Special Brushing Tools
If you’re having trouble cleaning the areas near brackets and wires, there are some special tools that may help. One is the interdental toothbrush, or proxabrush. It has a small tuft of bristles that stick up all around, like a pipe cleaner. Use it gently and carefully to clean the tiny spaces under wires and around bands and brackets.
Another special cleaning tool is the oral irrigator or “water pick.” This device shoots a small stream of pressurized water at your teeth, which can help dislodge bits of food that become trapped in nooks and crannies. While it’s easy to use, an oral irrigator isn’t a substitute for a toothbrush or dental floss—but when used along with proper brushing and flossing techniques, it can be very effective.
To keep your teeth and gums clean and healthy, you need to floss at least once per day. But how do you get floss under the archwire of your braces? It’s not so hard with the help of a floss threader. Using this device is somewhat like threading a needle: You pull one end of floss through the threader and then push the threader—carrying with it the free end of the floss—under the archwire. Now grasp the floss on each end and slide it up and down the sides of both teeth and all the way under the gums until you hear a squeaky sound. Finally, pull it out and use a new section of floss for the next area.
Ever wonder how effective your tooth-cleaning techniques really are? There’s an accurate way to tell, using special vegetable dyes called “disclosing solutions” or “disclosing tablets.” As they dissolve in the mouth, these dyes highlight plaque and food debris that brushing has missed. You can then easily remove the dyed spots—and you’ll know for sure if your oral hygiene methods need a little “brushing up.”
Keeping your teeth and gums healthy now is an investment in your future. It enables you to get the best results from your orthodontic treatment and starts you toward a brighter smile that can last for a lifetime.
At first, having orthodontic treatment may take a little getting used to. It isn’t uncommon to experience a bit of soreness when appliances are first put on or some minor aches as teeth begin moving into new positions. Yet it’s comforting to know that genuine orthodontic emergencies are rare.
Some Minor Troubles
Fortunately, the vast majority of orthodontic problems are minor, but they may still cause discomfort or irritation. In general, it’s best to try and soothe the immediate cause of the discomfort, and then call our office to schedule an appointment; that way, we can allot sufficient time to take care of you. Here are a few of the more common orthodontic problems, along with some tips on what you can do to relieve them at home:
Loose or Broken Brackets, Bands, or Wires
This problem is often caused by eating hard or sticky candy or food, or playing with the braces. If the band or bracket is still attached to the wire, leave it as is—but don’t connect any elastics to it. You can cover it with orthodontic wax if it’s irritating the inside of your mouth. If it has come off, save it. In either case, call our office to let us know what happened, and we will schedule a visit. Be sure to bring any loose parts with you to the appointment!
Misplaced or Poking Archwire, Bracket, or Tie
As the teeth start to move, the wire that connects them (archwire) may begin poking near the back of the mouth or irritating the cheeks. You can try moving the wire into a better position with a pencil eraser or a Q-Tip. If the wire won’t move, you may be able to cut the end off with a nail clipper sterilized in alcohol—but before doing so, please call our office for our guidance or instructions. Often, you can also use tweezers to gently move a misplaced wire or a tie that’s causing problems.
When wires or brackets cause irritation, covering the metal parts with wax will often help ease the discomfort. As with any of these types of problems, call our office, and we’ll schedule a time to see you.
General Tooth Pain or Loosening
It’s normal for teeth to become slightly loosened during orthodontic treatment—that shows they’re moving. Sometimes, this movement may be accompanied by tenderness, especially after braces are placed or adjusted. For minor soreness, you can use your regular over-the-counter pain reliever. A twice-a-day salt-water rinse may also help: Mix one teaspoon of salt in an 8-ounce glass of warm water, and rinse for 30 seconds. A warm washcloth or heating pad placed on the outside of the jaw can also offer some relief.
While actual emergencies are rare, our goal is to make orthodontic treatment as comfortable as possible. If you need additional advice, don’t hesitate to call us.
Invisalign Clear Aligners
When you hear the word “orthodontics,” what comes to mind? Probably a young teenager whose teeth are covered by a latticework of metal. There are indeed many orthodontic patients who fit that description. However, there now exists an increasingly popular alternative to traditional metal braces: Invisalign® clear aligners. Dr. Woland is pleased to offer Invisalign for patients who are interested in ‘invisible braces.’
As the name implies, Invisalign clear aligners are made of almost invisible polyurethane plastic. Rather than being cemented or bonded to the teeth as metal or clear braces are, clear aligners are completely removable—for important social occasions, for eating, and, most importantly, for tooth-brushing and flossing. This advantage can also be a disadvantage: It means you must resist the temptation to take your aligners out more than is advised. Here are some other advantages of the Invisalign system:
Improved Oral Hygiene – With an orthodontic appliance that is removable, you will be able to clean your teeth much more easily than if you were wearing metal braces.
- A Discreet Look – If you consider your orthodontic treatment to be a private matter, or simply feel that metal braces don’t fit with your self-image, a practically invisible form of orthodontic treatment might suit you.
- More Dietary Choices – To protect metal wires and braces, some diet modifications are necessary. With clear aligners, you can still bite into an apple or a crispy pizza crust.
- Comfort – The soft, flexible material of which Invisalign is made will not irritate the soft tissues of the mouth, as metal wires and braces can.
- Teeth-Grinding Protection – If you have a teeth-grinding or clenching habit, clear aligners can function as thin nightguards that will protect your teeth from excessive wear.
Clear aligner technology has been improving over the years and can correct many malocclusions that once would have been too complicated for this form of treatment. Yet there are still some situations for which traditional braces would still be best. We would be happy to discuss this in detail with you.
How Invisalign Works
Invisalign clear aligners work the same way traditional braces do: by applying carefully controlled forces to teeth to move them into a better position. But they are not made of metal; instead, they are made of clear, flexible plastic.
Here’s how it works: Specialized computer software helps us design a plan for moving your teeth from their current positions into the best possible alignment. This movement will be broken down into perhaps several dozen stages. For each stage, the Invisalign company will manufacture two plastic mouth “trays” or “aligners,” one to fit over your top teeth and one for the bottom. You will wear this first set of trays for two weeks, for a minimum of 20 hours per day. You will then move on to the next set of aligners in your series to accomplish the next stage of gradual movement. You will keep doing this until your teeth are correctly aligned.
In the past several years, two features have been added to make Invisalign a more appropriate orthodontic treatment method for teenagers. Special “eruption tabs” hold the appropriate amount of space open for molars that have not fully grown in. Invisalign for teens also comes with “compliance indicators” built into the aligner material, which fade with wear. This allows parents, dentists, and the teens themselves to make sure the trays are being worn as prescribed. Treatment with Invisalign can only be successful if this is the case.
Caring for Your Teeth During Invisalign Treatment
As mentioned above, one of the main advantages of the Invisalign system is that the trays can be removed for easy cleaning. So please don’t neglect to do this! You’ll need to brush your teeth after every meal or snack so that food and plaque do not get trapped in the aligners, which could promote tooth decay and gum disease. Your aligners, too, will have to be cleaned regularly; you can do this by brushing them and then rinsing them with lukewarm water.
Also, please keep in mind that while wearing clear aligners is very different from wearing braces, the importance of retaining your post-treatment results is exactly the same. You’ll want to be sure to wear your retainer(s) exactly as prescribed after your treatment is completed to protect your investment in a beautiful new smile.
One day in the not-too-distant future, your braces will come off. In a few moments, you’ll be free of bands and brackets, able to eat what you want, and run your tongue over smooth, clean teeth. But, even on this happy occasion, please remember that you’re not quite done with orthodontic treatment yet: The next phase, called retention, is just beginning.
Retention is a critical follow-through stage that typically involves wearing an orthodontic appliance called a retainer. Several different kinds of retainers are available, all of which are custom-made just for you. We will recommend the type (or types) that will work best in your situation, and we’ll tell you exactly when and how long you need to wear them.
But if your teeth are straight now, why do you need a retainer at all? Simply put, it’s because if you don’t wear one, your teeth will start moving right back to where they were!
Teeth aren’t set rigidly in the jawbone—instead, they’re held in place by a network of fibers called the periodontal ligaments. After they have been moved, it takes several months for the periodontal ligament to adjust to the new position. So, if you want to keep that new smile—and not waste all the time, effort, and money it took to get it—it’s essential to wear your retainer as directed.
Being fitted for a retainer usually happens on the same day your braces are removed. After your teeth are thoroughly cleaned, we may take another set of X-rays and/or bite impressions to check how well your braces worked and see how much your wisdom teeth have developed. Then, we’ll discuss your retainer and start getting it ready.
Three Types of Retainers
There are three basic types of retainers available today; each works best in particular situations. The most common is the so-called “Hawley” retainer—a thin, tongue-shaped piece of acrylic molded to fit your mouth, with a wire that holds your teeth in position. The Hawley retainer is simple, durable, and easily removed. It’s even possible to personalize it by choosing different colors and designs for the plastic arch. It can also be adjusted to correct minor tooth movements.
Another popular style of retainer is the clear aligner-type, which looks similar to the Invisalign® tray system. These retainers are custom-made of thin, transparent plastic, which is designed to fit precisely over your teeth. Their main advantage is that they’re invisible, with no wire to show. These retainers are also easy to remove, but they may be somewhat less durable than the Hawley. They aren’t recommended for patients with certain conditions, like teeth grinding.
Finally, fixed retainers may be an option for some people, especially on the lower front teeth. As their name implies, they aren’t removable by the wearer—but they aren’t visible either. Like lingual braces, this system uses a wire that is bonded to the tongue side of the teeth. It may remain in place for months or longer. This type of retainer is sometimes recommended when there’s a high risk that teeth could revert to their former position.
A Period of Adjustment
After a short time, most people adjust quite well to wearing a retainer. Some may find that they produce more saliva than usual for a day or so after first wearing any type of retainer—a normal reaction to a foreign object in the mouth. You may also find it a little harder to talk normally at first, but that problem will soon disappear. Of course, removable retainers should always be taken out when you eat or brush your teeth—a big change from braces!
At first, you will probably be told to wear your removable retainer all day, every day. This period of 24/7 retainer use generally lasts from several months to a year. Later, we may say that it’s OK to wear it only at night. Finally, you’ll probably need to put it on just a few nights a week.
Maintaining & Retaining Your Retainer
To stay fresh and germ-free, all retainers need proper cleaning. A Hawley-type retainer can be brushed gently with a regular toothbrush—but a brush may scratch the clear aligner types. Denture cleaners, in powder or tablet form, as well as special retainer cleaners, can be used to clean most removable retainers. Fixed retainers are cleaned by brushing and flossing; a floss threader or interproximal brush can also be a helpful cleaning tool when needed.
Finally, remember to always carry—and use—a retainer case. You’d be surprised how many retainers end up folded in a napkin and accidentally discarded! Also, don’t expose your retainer to excess heat by washing it in very hot water or leaving it on a heater: That can cause the retainer to warp and make it unusable. With proper care and conscientious use, a retainer can help you transition from braces to a permanent, healthy smile.
A major benefit of receiving orthodontic treatment in childhood is that it’s possible to take full advantage of a youngster’s own natural growth process to treat or even prevent malocclusions (“bad bites”). A palatal expander is a device designed to help us do that.
Palatal expanders create more space in a child’s mouth by gradually widening the upper jaw. Although this may sound scary, it’s really quite easy—both to do and to tolerate. That’s because the upper jaw actually develops as two separate halves that don’t completely fuse together until sometime after puberty. Before that happens, the two bones can gently be separated and stabilized over a period of several months.
The three situations that most commonly call for maxillary expansion are:
- Crossbite – When a child’s upper jaw is too narrow to fit correctly with the lower jaw, the back-top teeth will bite inside of the lower teeth instead of outside. This can be corrected by expanding the upper jaw.
- Crowding – Even before all of a child’s permanent (adult) teeth come in, we can tell when there will not be enough room to accommodate them. Widening the upper jaw can create the necessary space without the need for tooth extractions.
- Impacted Teeth – When a tooth that hasn’t come in (erupted) yet and is blocked by other teeth, widening the upper jaw can allow it to erupt into a proper position on its own. This most often happens with canine or eye teeth—the pointier ones located directly under the eyes.
Expanding the upper jaw has other benefits: It can broaden the smile in an aesthetically pleasing way, can limit the number of teeth that need to be removed to create space and can also improve breathing. And it can shorten overall orthodontic treatment time (the amount of time your child will need to wear braces).
How Expanders Work
An expander is custom-made for each individual and fits over several top teeth in the back of the mouth. The appliance has two halves that are connected in the middle with a screw. To activate the device, you simply turn the screw a very small amount each day with a special key. This induces tension at the junction of the two palatal bones, causing them to gradually move apart. Once the desired expansion is achieved, we will leave the appliance in for a few more months to allow new bone to form in the gap and stabilize the expansion. Generally, expanders are worn for 3-6 months altogether.
What To Expect
There can be some soreness or a feeling of pressure for a few minutes after the key is turned, but activating an expander actually causes less discomfort than having braces tightened. Your child may find that speaking and eating feel different at first as the tongue adjusts to the presence of the appliance. It is also completely normal to see a gap develop between the front teeth. This shows that the expander is having the desired effect. When all is said and done, your child’s permanent teeth will be beautifully aligned with neither too much nor too little space between them.
We proudly serve families in Weymouth, MA, as well as those throughout the South Shore.