Frequently asked questions about childhood orthodontic treatment
What is preventive orthodontic treatment?
Preventive orthodontic treatment is intended to keep a malocclusion (“bad bite” or crooked teeth) from developing in an otherwise normal mouth. The goal is to provide adequate space for permanent teeth to come in. Treatment may require a space maintainer to hold space for a primary (baby) tooth lost too early or removal of primary teeth that do not come out on their own in order to to create room for permanent teeth.
What is interceptive orthodontic treatment?
Interceptive orthodontic treatment is performed for problems that, if left untreated, could lead to the development of more serious dental problems over time. The goal is to reduce the severity of a developing problem and eliminate the cause. The length of later comprehensive orthodontic treatment may be reduced. Examples of this kind of orthodontic treatment may include correction of thumb- and finger-sucking habits; guiding permanent teeth into desired positions through tooth removal or tooth size adjustment; or gaining or holding space for permanent teeth. Interceptive orthodontic treatment can take place when patients have primary teeth or mixed dentition (baby and permanent teeth). A patient may require more than one phase of interceptive orthodontic treatment.
Comprehensive orthodontic treatment is undertaken for problems that involve alignment of the teeth, how the jaws function and how the top and bottom teeth fit together. The goal of comprehensive orthodontic treatment is to correct the identified problem and restore the occlusion (the bite) to its optimum. Treatment can begin while patients have primary teeth, when they have a mix of primary and permanent teeth, or when all permanent teeth are in. Treatment may consist of one or more phases, depending on the nature of the problem being corrected and the goals for treatment. Orthodontic care may be coordinated with other types of dental treatment that may include oral surgery (tooth extractions or jaw surgery), periodontal (gum) care and restorative (fillings, crowns, bridges, tooth size enhancement, implants) dental care. When finished with comprehensive treatment, the patient must wear retainers to keep teeth in their new positions.
What is a space maintainer?
Baby molar teeth, also known as primary molar teeth, hold needed space for permanent teeth that will come in later. When a baby molar tooth is lost, an orthodontic device with a fixed wire is usually put between teeth to hold the space for the permanent tooth.
Why do baby teeth sometimes need to be removed?
Removing baby teeth may be necessary to allow severely crowded permanent teeth to come in at a normal time in a reasonably normal location. If the teeth are severely crowded, it may be that some unerupted permanent teeth (usually the canine teeth) will either remain impacted (teeth that should come in, but do not) or come in to a highly undesirable position. To allow severely crowded teeth to move on their own into much more desirable positions, sequential removal of baby teeth and permanent teeth (usually first premolars) can dramatically improve a severe crowding problem. This sequential extraction of teeth, called serial extraction, is typically followed by comprehensive orthodontic treatment after eruption of permanent teeth has brought about as much improvement as it can on its own.
After all the permanent teeth have come in, the extraction of selected permanent teeth may be necessary to correct crowding or to make space for necessary tooth movement to correct a bite problem. Proper extraction of teeth during orthodontic treatment should leave the patient with both excellent function and a pleasing look.
How can a child's growth affect orthodontic treatment?
Orthodontic treatment and a child’s growth can complement each other. A common orthodontic problem to treat is protrusion of the upper front teeth. Quite often this problem is due in part to the lower jaw being shorter than the upper jaw. Upper teeth may also be the primary cause of the protrusion if they stick out too far. While the upper and lower jaws are growing, orthodontic appliances can be beneficial in reducing these discrepancies. A severe jaw growth discrepancy may require orthodontics and corrective surgery after jaw growth has been completed, although this is rare. The AAO recommends that all children have a checkup with an orthodontist no later than age 7 so that growth-related problems can be identified and so that treatment can be commenced at the appropriate time for each patient.
What kinds of orthodontic appliances are typically used to reduce the severity of jaw-growth problems?
A process of dentofacial orthopedics (guiding the growth of the face and jaws) with orthodontic appliances may be used to correct jaw-growth problems. The decision about when and which appliances to use for this type of correction is based on each individual patient's problem. Some of the more common orthopedic appliances include:
Fixed functional appliance: The appliance is usually fixed (glued) to the upper and lower molar teeth and may not be removed by the patient. By holding the lower jaw forward, it reduces the protrusion of the teeth while the patient is growing and helps bring the teeth together. The appliance can help correct severe protrusion of the upper teeth.
Headgear: This appliance applies pressure to the upper teeth and upper jaw to guide the direction of upper jaw growth and tooth eruption. The headgear may be removed by the patient and is usually worn 10 to 12 hours per day.
Palatal expansion appliance: A child’s upper jaw may be too narrow for the upper teeth to fit properly with the lower teeth (a crossbite). When this occurs, a palatal expansion appliance can be fixed to the upper back teeth. This appliance can markedly expand the width of the upper jaw. For some patients, a wider jaw may prevent the need for extraction of permanent teeth.
Can my child play sports while wearing braces?
Yes. But wearing a protective mouth guard is advised while riding a bike, skating,or playing any contact sports, whether organized sports or a neighborhood game. Your orthodontist can recommend a specific mouth guard.
Will braces interfere with playing musical instruments?
Playing wind or brass instruments, such as the trumpet, will clearly require some adaptation to braces. With practice and a period of adjustment, braces typically do not interfere with the playing of musical instruments.
Why does orthodontic treatment time sometimes last longer than anticipated?
Estimates of treatment time can only be that – estimates. Patients grow at different rates and will respond in their own ways to orthodontic treatment. The orthodontist has specific treatment goals in mind and will usually continue treatment until these goals are achieved. Patient cooperation, however, is the single best predictor of staying on time with treatment. Patients who cooperate by wearing rubber bands, headgear or other needed appliances as directed, while taking care not to damage appliances, will most often lead to on-time and excellent treatment results.
What is patient cooperation and how important is it during orthodontic treatment?
Good “patient cooperation” means that the patient not only follows the orthodontist’s instructions on wearing appliances as prescribed and tending to oral hygiene and diet, but is also an active partner in orthodontic treatment. Successful orthodontic treatment is a “two-way street” that requires a consistent, cooperative effort by both the orthodontist and patient. To successfully complete the treatment plan, the patient must carefully clean his or her teeth, wear rubber bands, headgear or other appliances as prescribed by the orthodontist, avoid foods that might damage braces and keep appointments as scheduled. Damaged appliances can lengthen the treatment time and may undesirably affect the outcome of treatment. The teeth and jaws can only move toward their desired positions if the patient consistently wears the forces to the teeth, such as rubber bands, as prescribed. Patients who do their part consistently make themselves look good and their orthodontist look smart.
What is two-phase treatment?
Two-phase treatment simply means that the treatment is carried out in two stages. The first is the interceptive orthodontic phase (see above) and the second is the comprehensive orthodontic phase (see above).
Some of my children’s friends have already started treatment, but our orthodontist says my child should wait a while. Why is there a difference in treatment?
Each treatment plan is specific for that child and his/her specific problem. In some cases, children mature early (e.g.: get their permanent teeth early) and in some cases early treatment is indicated to prevent a more severe problem from occurring. Your orthodontist is the best person to decide the most optimum treatment plan. If you have questions, you should discuss them with your orthodontist.
What do the initials mean after an orthodontist’s name?
The initials after an orthodontist’s name indicate the academic education of the orthodontist. For instance, DMD and DDS indicate that the individual is a graduate dentist.
How can I fit the orthodontist’s fee into my family budget?
Orthodontic costs and payment options can be discussed with your treating orthodontist. Your orthodontist will be able to provide you with information about insurance and other possible funding options.
How do braces feel?
Most people have some discomfort after their braces are first put on or when adjusted during treatment. After the braces are on, teeth may become sore and may be tender to biting pressures for three to five days. Patients can usually manage this discomfort well with whatever pain medication they might commonly take for a headache. The orthodontist will advise patients and/or their parents what, if any, pain relievers to take. The lips, cheeks and tongue may also become irritated for one to two weeks as they toughen and become accustomed to the surface of the braces. Orthodontic wax applied to an offending bracket will help relieve discomfort. Overall, orthodontic discomfort is short-lived and easily managed. Once patients have become accustomed to their braces, they may even forget they have them on.
Do teeth with braces need special care?
Yes. Patients with braces must be careful to avoid hard, sticky, chewy and crunchy foods. They must not chew on pens, pencils or fingernails because chewing on hard things can damage the braces. Damaged braces will almost always cause treatment to take longer and will require extra trips to the orthodontist’s office.
Keeping the teeth and braces clean requires more precision and time and must be done every day if the teeth and gums are to be healthy during and after orthodontic treatment. Patients who do not keep their teeth clean may require more frequent visits to the dentist for a professional cleaning. The orthodontist and staff will teach patients how to care for their teeth, gums and braces during treatment. The orthodontist will tell patients (and/or their parents) how often to brush, how often to floss and, if necessary, suggest other cleaning aids that might help the patient maintain good dental health.
A good reason to keep teeth, gums and braces clean during orthodontic treatment is that clean, healthy teeth move more quickly! This will help keep treatment time as short as possible. Patients who are active in contact sports, whether in organized programs or just games in the neighborhood, should wear a mouth guard. Talk with your orthodontist about the kind of mouth guard to use while braces are on.
What is patient cooperation and how important is it during orthodontic treatment?
Good “patient cooperation” means that the patient not only follows the orthodontist’s instructions on oral hygiene and diet, but is also an active partner in orthodontic treatment. Successful orthodontic treatment is a "two-way street" that requires a consistent, cooperative effort by both the orthodontist and patient. To successfully complete the treatment plan, the patient must carefully clean his or her teeth, wear rubber bands, headgear or other appliances as prescribed by the orthodontist, avoid foods that might damage braces and keep appointments as scheduled. Damaged appliances can lengthen the treatment time and may undesirably affect the outcome of treatment. The teeth and jaws can only move toward their desired positions if the patient consistently wears the forces to the teeth, such as rubber bands, as prescribed. Patients who do their part consistently make themselves look good and their orthodontist look smart.
How long does treatment take?
Although every case is different, generally speaking, patients wear braces from one to three years. Treatment times vary with factors that include the severity of the problem, patient growth, gum and bone response to tooth-moving forces and how well the patient follows the orthodontist's instructions on dental hygiene, diet and appliance wear (patient cooperation). Patients who brush and floss thoroughly and regularly; avoid hard, sticky, crunchy and sticky foods; wear their rubber bands and/or headgear as instructed; and keep their appointments usually finish treatment on time with good results. After the braces are removed, most patients wear a retainer for some time to keep or “retain” the teeth in their new positions. The orthodontist will determine how long the retainer needs to be worn. Most patients remain under the orthodontist’s supervision during the retention phase to ensure that the teeth stay properly aligned.
Why are retainers needed after orthodontic treatment?
After braces are removed, the teeth can shift out of position if they are not stabilized. Retainers are designed to hold teeth in their corrected, ideal positions until the bones and gums adapt to the treatment changes. Wearing retainers exactly as instructed is the best insurance that the treatment improvements last longer. It is normal for teeth to change with increasing age.
Will tooth alignment change later?
Studies have shown that as people age, their teeth may shift. This variable pattern of gradual shifting, called maturational change, probably slows down after the early 20s, but still continues to a degree throughout a lifetime for most people. Even children whose teeth developed into ideal alignment and bite without treatment may develop orthodontic problems as adults. The most common maturational change is crowding of the lower incisor (front) teeth. Wearing retainers as instructed after orthodontic treatment will stabilize the correction and can prevent most of this change.
What about the wisdom teeth (third molars) – should they be removed?
Research suggests that wisdom teeth do not necessarily cause teeth to shift. In most cases, removal of wisdom teeth is done for general dental health reasons rather than for orthodontic health. Your orthodontist, in consultation with your family dentist, can provide guidance regarding removal of wisdom teeth.
What happens to teeth and gums if they are not kept clean during orthodontic treatment?
Teeth can develop white spots, called “decalcification,” when an individual’s teeth are susceptible or when oral hygiene has been poor. If plaque is not regularly removed, the patient can develop gum disease. This is why the orthodontist, orthodontic staff, the dentist and dental hygienist stress dental hygiene – for the good of the patient’s dental health.
What can I do to get my braces off sooner?
Follow the instructions your orthodontist gives you with regard to oral hygiene (keeping your teeth and gums clean) and wearing your appliances (e.g.: elastics, headgear, etc.). Your cooperation may help speed up your treatment.
What will I look like with braces on?
Much will depend on the kind of braces used for your treatment. Many patients have silver-colored brackets and wires while others may have tooth-colored brackets or clear plastic aligners. Braces are much less noticeable today than they were when each tooth had a metal band around it.
Do you have any suggestions on what foods I CAN eat?
Choose foods that are softer. Right after you get braces or whenever they are adjusted, you may want foods that require little or no chewing such as soup and macaroni and cheese. Cut or tear sandwiches and pizza rather than biting into them.
What happens if something breaks?
If a portion of the appliance breaks, let your orthodontist know so that arrangements can be made for repairs.
My child wants to get his/her tongue pierced. Will this interfere with orthodontic treatment?
Tongue-piercing jewelry may contribute to breakage of appliances and to tooth and gum damage from contact with the stud.
Can orthodontic treatment do for me what it does for children?
Yes. Healthy teeth can be moved at any age. Many orthodontic problems can be corrected as easily for adults as for children. Orthodontic forces move the teeth in the same way for both adults and children, but adult treatment may take longer due to the maturity of the bone. Complicating factors, such as lack of jaw growth, may create different treatment planning needs for the adult. This is why a consultation with an orthodontist, the dental specialist who aligns teeth and jaws of patients of all ages, is essential.
How does adult treatment differ from that of children and adolescents?
Adults are not growing and may have experienced some breakdown or loss of their teeth and the bone that supports the teeth. Orthodontic treatment may then be only a part of the patient's overall treatment plan. Close coordination may be required among the orthodontist, oral surgeon, periodontist, endodontist and family dentist to ensure that the treatment plan is managed well. Below are the most common characteristics that can cause adult treatment to differ from that of children.
No jaw growth: Jaw discrepancy problems, including both width and length, in the adult patient may require jaw surgery. For example, if an adult’s lower jaw is too short to match properly with the upper jaw, a severe bite problem results. The amount that the teeth can be moved in some cases, with braces alone, may not correct this problem. Establishing a proper bite relationship could require jaw surgery, which would lengthen the lower jaw and bring the lower teeth forward into the proper bite.
Gum or bone loss (periodontal breakdown): Adults are more likely to have experienced damage or loss of the gum and bone supporting their teeth (periodontal disease). Periodontal disease is a chronic bacterial infection that affects the gums and bone supporting the teeth. The word periodontal literally means “around the tooth.” Many people are unaware that they have gum disease because there is usually little or no pain.
Periodontal disease can affect one tooth or many teeth. It begins when the bacteria in plaque (the sticky, colorless film that constantly forms on your teeth) causes inflammation in the gums. The mildest form of the disease is called gingivitis. The gums redden, swell and bleed easily. Gingivitis is often linked to inadequate oral hygiene. Gingivitis is often reversible with professional treatment and good oral home care. Untreated gingivitis can advance to periodontitis, a more severe form of gum disease. With time, plaque can spread and grow below the gum line. Toxins produced by the bacteria in plaque irritate the gums. The toxins stimulate a chronic inflammatory response in which the body, in essence, turns on itself, and the tissues and bone that support the teeth are broken down and destroyed. Gums separate from the teeth, forming pockets (spaces between the teeth and gums) that become infected. As the disease progresses, the pockets deepen and more gum tissue and bone are destroyed. Eventually, teeth can become loose and may have to be removed.
The good news is that teeth that are properly aligned are less prone to gum disease. Special treatment by the patient’s dentist or a periodontist may be necessary before, during and/or after orthodontic treatment. Bone loss can also limit the amount and direction of tooth movement that is advisable. Adults who have a history of or concerns about periodontal disease might also see a periodontist (a dental specialist who treats diseases of the gums and bone) on a regular basis throughout orthodontic treatment.
Worn, damaged or missing teeth: Worn, damaged or missing teeth can make orthodontic treatment more difficult. Teeth may gradually wear and move into positions where they can be restored only after precise orthodontic movement. Damaged or broken teeth may not look good or function well even after orthodontic treatment unless they are carefully restored by the patient's dentist. Extra space resulting from missing teeth that are not replaced may cause progressive tipping and drifting of other teeth, which worsens the bite, increases the potential for periodontal problems and makes any treatment more difficult.
I have painful jaw muscles and jaw joints – can an orthodontist help?
One of the problems commonly associated with jaw muscle and jaw joint discomfort is bruxing, that is, habitual grinding or clenching of the teeth, particularly at night. Bruxism is a muscle habit pattern that can cause severe wearing of the teeth and overloading and trauma to the jaw joint structures. Chronically or acutely sore and painful jaw muscles may accompany the bruxing habit. An orthodontist can help diagnose this problem. Your family dentist or orthodontist may place a bite splint or nightguard appliance that can protect the teeth and help jaw muscles relax, substantially reducing the original pain symptoms. Sometimes structural damage can require joint surgery and/or restoration of damaged teeth. Referral to a TMJ specialist may be suggested for some of these problems.
My family dentist said I need to have some missing teeth replaced, but I need orthodontic treatment first – why?
Your dentist is probably recommending orthodontics so that he or she might treat you in the best manner possible to bring you to optimal dental health. Many complicated tooth restorations, such as crowns, bridges and implants, can be best accomplished when the remaining teeth are properly aligned and the bite is correct. When permanent teeth are lost, it is common for the remaining teeth to drift, tip or shift. This movement can create a poor bite and uneven spacing that cannot be restored properly unless the missing teeth are replaced. Tipped teeth usually need to be straightened so they can withstand normal biting pressures in the future.
My teeth have been crooked for many years – why should I have orthodontic treatment now?
It’s never too late! Orthodontic treatment, when indicated, is a positive step – especially for adults who have endured a long-standing problem. Orthodontic treatment can restore good function. And teeth that work better usually look better, too. A healthy, beautiful smile can improve self-esteem, no matter your age.
Is orthodontic treatment affordable?
Patients are finding that braces are more affordable today than ever. The cost of orthodontic treatment will depend on many factors, including the severity of the problem, its complexity and the length of treatment. Your orthodontist will be glad to discuss the cost with you before treatment begins. Most orthodontists have a variety of convenient payment plans. Often there are combined plans available for parents and children who have treatment at the same time. In addition, many dental insurance plans now include orthodontic benefits. Dollar for dollar, when you consider the lifetime benefits of orthodontics, it is truly a great value.
I am pregnant and want to begin orthodontic treatment. Is this OK?
Pregnancy brings on bodily changes that can affect the mouth. Soft tissues such as gums become much more susceptible to infection. The possible need for X-rays during the pregnancy is not advised. Discuss this question with your medical practitioner/physician and orthodontist before you start orthodontic treatment.
My orthodontist wants to do something called enamel stripping to make my teeth smaller. I have never heard of this. Is this something new? Is it safe?
This procedure goes by many names: enamel stripping; interproximal reduction; slenderizing; reproximation and selective reduction. The goal is to remove some of the outer tooth surface (enamel) to acquire more space for your teeth. The procedure has been used in orthodontic treatment since the 1940s and has been shown to be safe and effective. Some studies among patients who have had this procedure show that it neither makes teeth more susceptible to tooth decay nor does it predispose patients to gum disease.
I see ads for perfect teeth in only one or two visits to the dentist. Will that give me straight teeth?
Crooked teeth should be evaluated by an orthodontist so that the most appropriate treatment plan can be suggested.
To schedule an appointment, please call our office nearest you: in Clearwater at 727-441-8963; in Plant City at 813-752-3555; and in New Port Richey at 727-845-0933. Or use our online Request an Appointment form. For additional information on any condition, treatment or procedure, please visit our Dental Library.