Early Orthodontic Treatment for Children...
Early Treatment for Children...  
  
What is the difference between early orthodontic treatment and regular orthodontic treatment, and why might my child need early treatment? How will early treatment benefit my child in the long run?
These are just a few of the questions surrounding the topic of early orthodontic treatment for children. The American Association of Orthodontists recommends that children see an orthodontist as early as age seven. At this point the orthodontist will evaluate whether your child will need orthodontic treatment.

Early treatment (also known as Phase One) typically begins around age eight or nine (Phase Two will begin around age 11 or older). The goal of early treatment is to correct the growth of the jaw and certain bite problems, such as underbite. Early treatment also helps to make room for permanent teeth to come in properly, lessening the chance of extractions in the future.

How to tell if your child may need early orthodontic treatment:
Early or late loss of baby teeth (your child should typically start losing teeth around age five, and will have all permanent teeth around age 13)
Difficulty chewing and/or biting

Mouth breathing

Your child continues sucking his or her thumb after age five

Speech impediments

Protruding teeth (the top teeth and the bottom teeth extend away from each other)

Teeth that don't come together in a normal manner or even at all

Shifting of the jaw when your child opens or closes his or her mouth (crossbites)

Crowded front teeth around age seven or eight

Large spaces between the teeth

What causes orthodontic problems, and how will early treatment benefit my child?
Orthodontic problems such as crowding of the teeth, too much space between the teeth, jaw growth problems, protruding teeth, and bad bites can be inherited or caused by injury to the mouth, early or late loss of baby teeth, or thumb-sucking habits.

Most children lose all their baby teeth by age 13, and by the end of their teen years, the jaw bones will harden and stop growing. Orthodontic procedures for adults often take more time and can involve tooth extraction or oral surgery. Receiving early orthodontic treatment as a child can help prevent the need for orthodontics as an adult, leaving little to no chance of extraction or surgery in the future.

If your child is between the ages of seven and eight and shows signs of needing orthodontic care, or if you have been directed by your family dentist to visit the orthodontist, please contact our practice and schedule an appointment. Our team will provide your child with an initial exam, and discuss with you the best steps to take toward caring for your child's smile.

Two-Phase Treatment

What is the advantage of two-phase orthodontic treatment?
Two-phase orthodontic treatment is a specialized process that combines tooth straightening and physical, facial changes. The purpose of two-phase treatment is to maximize the opportunity to accomplish the ideal healthy, functional, and aesthetic result that will remain stable throughout your child's life.

What if treatment is put off?
Putting off treatment can result in a need for more invasive treatment later in life that may not completely fix your child's smile. Early treatment is most effective for achieving lasting results.

Phase One
The goal of Phase One treatment is to help the jaw develop in a way that will accommodate all of the permanent teeth and improve the way the upper and lower jaws fit together. Children often exhibit early signs of jaw problems as they grow and develop. An upper jaw that is growing too much or is too narrow can be recognized at an early age. If children over the age of six are found to have this jaw discrepancy, they are candidates for early orthodontic treatment. Also, if children around the age of eight have crowded front teeth, early treatment can prevent the need to extract permanent teeth later.

Planning now can save your child's smile later
Children benefit tremendously from early-phase treatment. Receiving early treatment may prevent the removal of permanent teeth later in life, or the need for surgical procedures to realign the jaws.

Making records to determine your child's unique treatment
Orthodontic records will be necessary to determine the type of appliances to be used, the duration of treatment time, and the frequency of visits. Records consist of models of the teeth, X-rays, and photographs. During your child's initial consultation, the doctor will recommend records are taken to determine if early treatment is necessary.

Resting Period
In this phase, the remaining permanent teeth are left alone as they erupt. Retaining devices may not be recommended if they would interfere with eruption. It is best to allow the existing permanent teeth some freedom of movement. A successful first phase will have created room for permanent teeth to find an eruption path. Otherwise, they may become impacted or severely displaced.

Monitoring the teeth's progress
At the end of the first phase of treatment, teeth are not in their final positions. This will be determined and accomplished in the second phase of treatment. Selective removal of certain primary (baby) teeth may be in the best interest of enhancing eruption during this resting phase. Therefore, periodic recall appointments for observation are necessary, usually on a six-month basis.

Phase Two
The goal of the second phase is to make sure each tooth has an exact location in the mouth where it is in harmony with the lips, cheeks, tongue, and other teeth. When this equilibrium is established, the teeth will function together properly. Phase Two usually involves full upper and lower braces.

At the beginning of the first phase, orthodontic records were made and a diagnosis and treatment plan was established. Certain types of appliances were used in the first phase to correct and realign the teeth and jaw. The second phase begins when all permanent teeth have erupted, and usually requires braces on all the teeth for an average of 24 months. Retainers are worn after this phase to ensure your child retains his or her beautiful smile.
Traditional Metal Braces

Traditional metal braces are the most common type of braces and are more comfortable today than ever before. Made of high-grade stainless steel, metal braces straighten your teeth using metal brackets and archwires. With metal braces, you have the option of adding colored elastics (rubber bands) for a more unique and colorful smile.

Clear (Ceramic) Braces
Ceramic braces are made of clear materials and are therefore less visible on your teeth than metal braces. For this reason, ceramic braces are used mainly on older teenagers and adult patients who have cosmetic concerns. While they are visually less prominent, they do require more attention to oral hygiene as ceramic braces are larger and are more brittle than their metal counterparts. For these reasons, ceramic braces tend to be used more on upper front teeth than on lower teeth.
Clear Aligners

Clear aligners are a series of invisible, removable, and comfortable acrylic trays that straighten your teeth like braces. Not only are the aligners invisible, they are removable, so you can eat and drink what you want while in treatment, plus brushing and flossing are less of a hassle. The aligners are comfortable and have no metal to cause mouth abrasions during treatment.
  
Temporomandibular Disorder
Millions of Americans suffer from chronic facial and neck pain as well as severe, recurring headaches. In some cases, this pain is due to Temporomandibular Disorder, also known as TMD.

Your temporomandibular joints, or TMJs, connect your lower jawbone to your skull. These joints get a lot of use throughout the day as you speak, chew, swallow, and yawn. Pain in and around these joints can be unpleasant and may even restrict movement.

Symptoms of TMD include:
-  Pain in the jaw area
-  Pain, ringing, or stuffiness in the ears
-  Frequent headaches or neck aches
-  Clicking or popping sound when the jaw moves
-  Muscle spasms in the jaw area
-  A change in the alignment of top and bottom teeth
-  Locked jaw or limited opening of the mouth

If you notice that you are experiencing any of these symptoms, let your doctor know at your next appointment. Your doctor can help determine if you have TMD and create a customized treatment plan to help relieve your symptoms.

Not all jaw pain is associated with TMD.
If you feel that you might have TMD, it is always important to see your dentist and receive an exam. However, not all jaw pain is associated with TMD, and if you do not have TMD there are many different preventive steps you can take to maintain a healthy, strong smile.

-  Relax your face — "Lips together, teeth apart"
-  Avoid grinding your teeth
-  Avoid all gum chewing
-  Don't cradle the phone receiver between your head and shoulder — either use a headset or hold the receiver to your ear
-  Chew food evenly on both sides of your mouth
-  Do not sit with your chin rested on your hand
-  Practice good posture — keep your head up, back straight, and shoulders squared

Many people get TMD. Symptoms usually wax and wane regardless of whether braces are worn. If you are experiencing any of the symptoms listed above and are concerned that you're a candidate for TMD treatment, please contact our office for a consultation.

Life with Braces
Now that you have your braces, how do you take care of them? It's important for you to know how to properly take care of your braces throughout your entire orthodontic treatment.

Eating with Braces
Don't worry, you'll be eating popcorn and snacking on potato chips again in no time! However, before you can start enjoying some of the treats you love, you will need to take special care to avoid any foods that could damage your new appliances.

Foods to avoid with braces:
-  Chewy foods — bagels, licorice
-  Crunchy foods — popcorn, chips, ice
-  Sticky foods — caramel candies, chewing gum
-  Hard foods — nuts, hard candies
-  Foods that require biting into — corn on the cob, apples, carrots

Foods you CAN eat with braces:
Dairy — soft cheese, pudding, milk-based drinks
Breads — soft tortillas, pancakes, muffins without nuts
Grains — pasta, soft cooked rice
Meats/poultry — soft cooked chicken, meatballs, lunch meats
Seafood — tuna, salmon, crab cakes
Vegetables — mashed potatoes, steamed spinach, beans
Fruits — applesauce, bananas, fruit juice
Treats — ice cream without nuts, milkshakes, Jell-O, soft cake

Soreness Caused from Braces and Appliances
When you first get your braces, you may notice that your teeth and mouth feel a little tender or sore. This is perfectly normal and we promise your mouth will not be sore forever! To relieve the pain, we recommend dissolving one teaspoon of salt in eight ounces of lukewarm water. Swish and gargle this solution in your mouth for just a couple of minutes (do not swallow the saltwater).
If the pain is more severe and does not go away after rinsing, you can also try taking a pain reliever. It is also not uncommon for your lips, cheeks, and tongue to become irritated for one to two weeks as they toughen and become used to the braces. We would be happy to give you some wax that you can put over the braces to lessen the tenderness. If you need some wax, please let us know.

Loose Teeth
If your teeth begin feeling a little loose, don't worry; this is normal! Your braces must first loosen your teeth to move them into the right position. Once your teeth have been repositioned, they will no longer be loose.

Loose Wires and Bands
The wires and bands on your braces may come loose. If this happens, please contact us as soon as possible so that we can check and repair your appliance. If any piece of your appliance comes off, be sure to save it and bring it to the office with you.
You can temporarily fix the loose wire by using the back of a spoon or the eraser end of a pencil to carefully and gently push the wire back into place. If the loose wire is causing irritation to your lips or cheeks, put wax or a wet cotton ball over the broken wire to relieve the pain.

Take Care of Your Appliances
Damaged appliances can increase the length of your treatment process, so be sure to take care of all your appliances. Your teeth and jaw can only move into their correct positions if you consistently wear the rubber bands, headgear, retainer, or other appliances prescribed by your doctor.

Playing Sports with Braces
Game, Set, Match — we have great news for athletes! You can still play sports even while undergoing orthodontic treatment! If you do play sports, it's recommended that you wear a mouthguard to protect your teeth and your appliance. Let your doctor know if you need help finding the right mouthguard for the best protection.

In case of a sports emergency, be sure to immediately check your mouth and appliance for damage. If you notice any loose teeth or appliance damage, please contact our office right away. You can temporarily relieve the discomfort by applying wax or rinsing your mouth with warm saltwater.
  
Brushing and Flossing

Brushing Your Teeth with Braces
When you have braces, it's very important to brush and floss after every meal in order to keep your teeth and gums healthy throughout your treatment. If you need help choosing the right toothbrush, toothpaste, and dental floss, please ask us and we can help you choose the right products for your teeth and your appliance.

Retainer Instructions
Wear your retainer at all times, until the doctor instructs otherwise.
Take your retainer out when eating, and always put it back in its case! [MOST appliances are lost in school lunchrooms or restaurants.]
Clean the retainer thoroughly once a day with a toothbrush and toothpaste. Use warm but not hot water. Brushing retainers removes the plaque, and eliminates odors. Efferdent® or other orthodontic appliance cleaners can be used but do not take the place of brushing.
When your retainer is not in your mouth, it should ALWAYS be in its case. Pets love to chew on them!
Initially, you may find it difficult to speak. Practice speaking, reading, or singing out loud to get used to it faster.
Retainers are breakable, so treat yours with care. If your retainer gets lost or broken, call us immediately.
If you have any questions or concerns about your retainer, or you believe it needs adjusting, call us. Do not try to adjust it yourself.
Always bring your retainer to your appointments.
Retainer replacements are expensive, but with proper care they will last for years!
Remove your retainer when you go swimming.
Keep retainers away from hot water, hot car dashboards, pockets, the washing machine, and napkins.

Emergency Care
True orthodontic emergencies are rare, but when they occur we are available to you. As a general rule, you should call our office when you experience severe pain or have a painful appliance problem you can't take care of yourself. We'll be able to schedule an appointment to resolve the problem.

You might be surprised to learn that you may be able to solve many problems yourself temporarily until you can get to our office. If there is a loose piece that you can remove, put it in a plastic bag or envelope and bring it with you to your next appointment. If your braces are poking you, put soft wax on the piece that's sticking out. If the wire has slid to one side, you can pull it back to the other side with needle-nosed pliers, replacing it in the tube on the back tooth.


After alleviating your discomfort, it is very important that you still call our office as soon as possible to schedule a time to repair the problem. Allowing your appliance to remain damaged for an extended period of time may result in disruptions to your treatment plan.

General soreness
When you get your braces on, you may feel general soreness in your mouth, and teeth may be tender to biting pressures for three to five days. Stick to a soft diet until your teeth do not hurt to chew. Irritated gums and other sore spots can be relieved by rinsing your mouth with a warm salt-water mouthwash. Dissolve one teaspoonful of salt in eight ounces of warm water, and rinse your mouth vigorously. An alternative (better tasting) mouthwash is the Healthy Gums Rinse by The Natural Dentist. Placing Orabase on the affected area may also help relieve discomfort; Orabase can be found in a pharmacy. If the tenderness is severe, take Acetaminophen (Tylenol) or whatever you normally take for headache or similar pain. Aspirin, Ibuprofen (Motrin, Advil) and Naproxen Sodium (Naprosyn, Anaprox) actually slow the tooth movement, so it is not advisable to use them frequently while wearing braces.

The lips, cheeks, and tongue may become irritated for one to two weeks as they learn a new posture and become accustomed to the surface of the braces. You can put wax on the braces to lessen this. We'll show you how!
Loose Appliance
If your appliance is poking you, place wax on the offending part.  
Loose Bracket
If your bracket or band is still attached to the wire, you should leave it in place and put wax on it if needed for comfort. If the bracket or band can be removed easily, place it in an envelope and save it to bring to your next appointment.
Loose Wire
Using a pair of tweezers or needle-nosed pliers, try to put your wire back into place. It is okay to use a piece of floss to tie the wire into place: tie the floss around the bracket in place of the missing colored o-ring. If you cannot put the wire into a comfortable position, and covering the end with wax doesn't help, as a last resort use a small fingernail clipper to clip the wire behind the last tooth to which it is securely fastened. If the end of the wire is still sharp place wax on it.
Poking Wire
Using a pencil eraser, push the poking wire down or place wax on it so that it is no longer poking.