Many parents will ask at their child’s exam, “When is the best time to start orthodontic treatment?” The answer is that it varies from person to person, depending on what the orthodontic problems are. The American Association of Orthodontists recommends that kids be seen for their first orthodontic check up at age 7. This is the age when most kids have their permanent front teeth, incisors, and their first set of adult molars fully grown into place. In most cases, kids don’t need treatment at that age, but Dr Kyger can identify any potential problems that are developing and give you an idea of when the appropriate time to start will be. In general, it is easier on everyone (the patient, orthodontist, and the parents) if treatment starts after all the adult teeth have grown in (usually around the age of 12-13). However, their are some instances where it is advisable to start treatment earlier than that.
Sometimes Dr Kyger will recommend treatment while some of the baby teeth are still present. This is often called interceptive, or Phase One, orthodontic treatment. Some of the indications for this early treatment are significant crowding or bite problems (overbites, underbites, open bites, extreme deep bites where the lower front teeth are digging into the roof of the mouth, and crossbites of the front or back teeth). Some of these bite problems are associated with a current thumb or finger sucking habit that needs to be addressed as well.
Orthodontic Problems to Watch for in 7 Year Olds
One of the goals of Phase One treatment are to harmonize the growth of the upper and lower jaws as much as possible. Another goal is to make enough room through expansion of the dental arches to make enough room for all the adult teeth to fit into place. Our goal is to treat our patients without having to have any teeth pulled whenever possible. By timing an appropriate Phase One treatment we are usually able to straighten all the teeth in Phase Two without any extractions.
You can think of Phase One as treating significant bite problems or correcting a developing skeletal growth problem. Phase Two is the definitive straightening of the teeth. Most people are ready for Phase Two by the time they are 12 to 13 years old. This is usually the age when most people have lost all their baby teeth and the adult second molars all the way in the back have grown into place. Phase Two is usually a shorter treatment time than it would have been without the Phase One treatment (12-18 months vs 18-24 months). On rare occasions we get such a nice result out of Phase One that we don’t need to do a Phase Two treatment. This is the exception to the rule, however. If your child is getting Phase One treatment, plan on needing a Phase Two treatment in a few years.
Orthodontic Retainers, why they are needed. Everyone needs some kind of retainer after they finish up with their braces or Invisalign treatment. Your teeth have memory, and for most people, their teeth want to move back in the direction they came from. The amount of movement varies from person to person. Some people are lucky and their teeth don’t move very much. Others see a more significant amount of movement.
When asked by my adult patients why retainers are needed, I pose them this question. ”Can you name one part of your body that hasn’t changed over the last 30 or 40 years?” Our bodies change as we age, and that includes your teeth. They are not set in stone. You can generate a lot of force when you bite down. These forces are transmitted to the teeth and they can move the teeth around. This is especially true for people that grind their teeth (brux) in their sleep.
The most common reason I see people in their 30′s or 40′s to get their teeth straightened for a second time is because they stopped wearing their retainers and their lower teeth crowded up. It is for this reason I typically use a bonded (fixed) retainer on the inside of the lower front 6 teeth after we are done with treatment. It is not visible to others and after a day or two people really don’t notice them that much. Those bite forces I mentioned earlier have a tendency to make the lower canine teeth collapse inward toward the tongue over time. As the canine teeth drop back, the lower front teeth (incisors) tend to crowd up. With the lower bonded retainer in place this can’t happen. Of course, if someone doesn’t want this type of retainer, I will make them a removable retainer.
For most of our patients, we make a removable upper retainer. This is either a traditional retainer that has the wire that goes across the front teeth, or a clear plastic retainer that is form fitted to the teeth. Both types have their advantages. The nice aspect of a traditional retainer is that the orthodontist can move teeth with it (we can with the clear retainer as well, but on a much more limited basis). If a tooth moves, I can put a bend in the wire and move it back. Having said that, whenever possible, I do like to use the clear retainer. It’s clear! People can’t really see it, and patient compliance is higher with this type of retainer.
When we have a patient that started out with a very large gap between their upper front teeth, in addition to the removable upper retainer, we may also bond the upper two front teeth together to prevent the gap from opening again.
People will often ask, “How long do I have to wear my retainer?”. The answer is “How long do you want your teeth to stay straight?” It is a long term proposition. Now that certainly doesn’t mean you have to wear it all the time forever. We start people off with full time wear (take it out to eat, brush, and for sports). As soon as we can we start to cut back on the number of hours a day it needs to be worn. For most of our patients, we have them wearing it just at night within about six months. Eventually, we like to get to the point where people are just putting it in a night or two a week to keep things straight.
Check out our retainer video on youtube to see images of different kinds of retainers.
Impacted Maxillary Canine Diagram. This is a patient educational hand-out from the American Association of Orthodontists. It shows from start to finish how an impacted canine in the palate is moved down into it’s proper position. The way this technique works is we send the patient over to the oral surgeon. The surgeon numbs up the area and then exposes the tooth. An attachment is bonded on to the tooth and this attachment has a tiny chain coming off of it. We see you in our office about once a month tie tie a fresh rubber band onto this chain. Over time, this slowly moves the impacted canine down into it’s proper position. The time it takes to bring the canine down into place varies from person to person and it is also dependent on where the canine is initially positioned. The farther away it is from it’s ideal spot, the longer it will take to bring into place. We have more patient information at our website. Check it out!
Dental Trauma- Knocked Out Permanent Tooth Education Flier. This is a publication by the American Association of Orthodontists to help educate you on what to do in case a permanent tooth is knocked out.
Orthodontic Problems to Watch out for in 7 Year Olds
The American Association of Orthodontists recommends that children get their first orthodontic check up at age 7. Here is a publication by the AAO showing some examples of orthodontic problems to watch out for in 7 year olds. As they say, a picture is worth a thousand words. It is a lot easier to look at these pictures to understand what an orthodontic problem looks like than to read a description. These photos show examples of an anterior crossbite, posterior crossbite, crowding, open bite, protrusion of the upper front teeth, ectopic eruption of a first molar, an underbite, spacing, and a finger habit. If you feel you need an exam please contact our office:
Orthodontic braces work by using brackets that are glued onto you teeth. These brackets have small slots in the front surfaces of them and it is into these slots that the orthodontic wires fit into place. These wires are held in place by small elastic ties that fit around the brackets. Over time, these wires put pressure on your teeth and this moves your teeth into their proper positions.
The brackets (braces) that most orthodontists use these days are not all the same. Each of your teeth has a different size and shape to them. The brackets do as well. So, for instance, a bracket that is made for an upper front tooth (incisor) would not fit correctly on a lower side tooth (bicuspid). Each of these brackets is custom made for the particular tooth it is supposed to fit on. They have different thicknesses, and the slots that the wire fits into are made at just the right angle for that particular tooth.
This system of making the braces to fit individual teeth and to have the slots made at just the right angle to move the teeth to their ideal final positions was developed by an orthodontist named Lawrence (Larry) Andrews in the 1970′s. He is a really smart guy, and very nice by the way. Anyway, this is the type of system that most orthodontists use these days. Before Dr. Andrews developed this system, all of the brackets had the same sized slot cut into them. That meant that the orthodontist had to put individual bends into the wires for every individual tooth in the mouth. That system worked, but it was a total pain for both the orthodontist and the patient. It takes a long time to put all those bends into the wires, and it hurts when one of these wires with all these bend on it is pushed into the brackets.
The other aspect to how braces move your teeth is the wires that are used. Back in the day, orthodontists had stainless steel wires and that was about it. These days, orthodontists have a number of different high-tech wires to use that move your teeth faster and more comfortably. The first wire or two that an orthodontist will use on your teeth are very flexible. They almost feel like rubber. This is beneficial in a number of ways. These flexible wires put a more regulated and constant force on your teeth. This means they are not only more comfortable, but they also move your teeth faster and you don’t need to get them adjusted as often. As the teeth straighten out, the orthodontist is able to put in progressively thicker and stiffer wires until you get to those stainless steel wires mentioned earlier.
Most people that have braces will need to wear elastics or rubber bands. These typically go from one or more of the upper braces to one or more of the lower braces. These elastics pull on your teeth and move them in the direction that the need to move.
I’ve mentioned several times in this post about how the braces/wires/elastic put pressure on your teeth. This pressure is transmitted from the teeth to the bone that surrounds them. The bone responds to this pressure and ‘remodels’ around the tooth. Some bone is taken away in some areas and added in other areas around the tooth, depending on the direction it is being pushed.
That is pretty much how braces move teeth. If you are interested, you can check out our website for more information.
Evidence does not support routine use of antibiotics for dental patients with joint replacements
Historically, the American Academy of Orthopaedic Surgeons and the American Dental Association have advised that people that have a prosthetic joint replacement (knee, hip, etc) take antibiotics before dental procedures. This was due to concerns of getting a bacterial infection around the prosthetic joints. The theory was that bacterial from your mouth would be introduced into your bloodstream during a dental procedure and then infect the tissue around the prosthetic joint. Taking antibiotics before going to the dentist was intended to decrease the risk of an infection.
The American Academy of Orthopaedic Surgeons and the American Dental Association have done a study and release a joint statement that antibiotics for patients with prosthetic joints is not indicated in most cases. The title of the joint statement by the AAOS and the ADA is called ‘Prevention of Orthopaedic Implant Infection in Patients Undergoing Dental Procedures’.
Of course, this is something you want to discuss with your physician and dentist before you stop taking any antibiotics you have taken in the past.
Here’s a link to the article on the American Dental Association Website:
The first step to starting Invisalign treatment is to get an exam at our office. The exam is free. At the exam we will determine whether or not you are a good candidate for Invisalign treatment. Invisalign is really good at what it does, but there are certain situations where Invisalign will not work very effectively. A key to remember is that Invisalign works for teens and adults. Kids that still have baby teeth, or adult teeth that still have to grow in a lot do not qualify.
Once we determine you are a good candidate for Invisalign, we take records. The records include photographs of your teeth and face, dental impressions of your teeth, and two x-rays. We send those records off to Invisalign with detailed instructions on how I want the teeth to be moved. Invisalign then scans your impressions, so that they have a 3D model of your teeth in their computer. Their technicians will move the teeth step by step in the computer model to their final positions. I then log on and review the movements of the teeth. Typically, they get it pretty close, but I have to instruct them on some fine point details of how I want the teeth to be moved. They make the changes, and then I review them again. I usually need to do this a couple of times to get the teeth exactly where I want them. Once I am satisfied, I ask Invisalign to go ahead and make the trays and mail them to our office. It usually takes about 4 weeks from the time of the impressions until we get the trays back to our office. Then you are ready to start straightening your teeth!
The way the system works is you wear a set of Invisalign trays (called aligners) for two weeks at a time. Each tray is manufactured so that the teeth are slightly straighter than the previous tray. The teeth will typically move 1/10mm per tray. So when you put a new tray in, the teeth in the tray are slightly straighter than your teeth are. This puts pressure on your teeth, and over the course of two weeks your teeth will move so that they match the tray.
Most people that get Invisalign treatment have crowded front teeth. So if you think about crowding, there is not enough room for the teeth to fit. We need to make more room somehow and we do this in several ways. On most people, I will have the trays do some expansion of the back teeth. This does several beneficial things. One, it makes more room to correct the crowding in the front. Two, it makes for a broader smile, which also looks better. For a lot of people, we will also bring the front teeth forward slightly. A third way we make more room to correct the crowding is to make some of the teeth slightly skinnier. This process is called interproximal reduction (a fancy way of saying we do a little bit of sanding or filing in between some of the teeth to make a little bit more room). This is not something that you can readily see and it stays well within the enamel of the tooth so that you don’t get sensitivity later.
On a lot of people we also need to use something called ‘attachments’ on the teeth. Attachments are small, tooth colored, bumps of plastic material (composite) that we need to put on some of the teeth. Basically, what they do is to give a handle or gripping point for the aligner to click into place around. They help the aligner stay on better and they also can put pressure on the teeth in the direction we need to straighten them out. Not everyone needs these, but a lot of people do.
Sometimes we will also ask people to wear rubberbands with their aligners. This is very similar to what we would ask a patient to do with traditional braces. We will use these to rotate a particular tooth, or if they are worn from the upper aligner to the lower aligner, they are used to help correct the bite.
I will ask most people to wear their aligners close to full time. A major advantage of the Invisalign system is that you can take them out to eat. We also ask you to take them out to brush and floss and you clean the aligners with a toothbrush at the time you are brushing. Typically, this means you will have your aligners in for about 20 hours a day. If you do not wear your aligners this much, the teeth will not have moved to their final position for that particular tray. When you go on to the next set of trays, they will not fit quite as well. This has a cumulative effect and by the time you get 3 or 4 trays down the line, they will not be fitting well at all.
Most of the time (I would estimate about 70%) we will get finished with your last tray and there will be a few teeth that are still slightly out of position. I tell people this ahead of time, because it is pretty normal. If that is the case, we take a new set of impressions and I have Invisalign make us some more trays to detail things. The process for this is identical to what I described earlier. The new trays will come back in 3-4 weeks and we will continue with straightening your teeth. Invisalign refers to these as refinement trays. There is not an additional fee for this, it is part of the process. Most people need to get 1 set of refinement trays. Invisalign allows us to do this up to 3 times, but in my experience that is very rare.
Once we are done with your final trays, it is time for retainers. Most Invisalign patients chose clear plastic retainers that look like Invisalign trays. Some people choose to get a fixed (permanent) retainer on the inside of their lower front teeth. This is a wire that goes across the inside of your lower front 6 teeth. The choice will be yours as to what kind of retainer we use. I ask most people to wear their retainers full time for 2 months and then we cut back to just while sleeping. Eventually, we get to the point where you are just wearing it a night or two a week. People often ask why we need to use retainers. The simple fact is that nothing about your body remains constant. It all changes as we age and that includes your teeth. Biting and chewing can put a lot of pressure on your teeth, and over time, these forces can move your teeth around.
Well, that just about does it. If you have any questions please feel free to call our office (579-0903) and we can set you up for an exam and get you that winning smile you have always wanted!