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Dental FAQ's
What's in a dental fee?A dental fee is the cost of a highly trained and skilled professional treating your teeth in a hygienic, comfortable environment. As well, fees represent the costs of the up-to-date equipment and materials, staff, laboratory fees, infection control measures, premises, utilities and furnishings. There are many factors affecting fees for dental treatment. The complexity of the treatment received, and the costs involved in running the dental practice you visit are such factors. The cost of maintaining correct infection control procedures alone can be very high. Dentists also need to pay ancillary staff wages and maintain equipment. The ADA recommends you obtain a written estimate or quote for any major dental work required, so you know how much you are likely to be out of pocket. Is there a recommended dental fee scale and how does this relate to Health Fund rebates?There is no such thing as a 'recommended fee' for any dental treatment. A dentist charges what he or she thinks is appropriate for the service they provide, taking into account all their costs and the particular circumstances of each treatment. The suggestion that some dentists depart from an 'approved' or ‘recommended’ level of fees, thereby creating 'gaps' between the fee and the Health Fund rebates is both false and misleading. In fact, it is against Trade Practices law for dentists to collude in the maintenance of any set fee scale.
Do I have to pay my dental account on the same day as my treatment?Dentists, as anyone who provides a service, are entitled to determine their own terms.
If you are applying for an account, you may be expected to supply enough information to establish your identity and offer some commitment to pay for the treatment. Does the dentist have to itemise my account?Although most dentists charge and invoice on a fee-for-service basis, a dentist is able to issue an account which states the treatment performed with a total cost. However, at the request of a patient, an itemised account must be supplied. Occasionally, problems can arise with dental benefit funds where some dentists establish their fees on a time basis exclusively. The fund then makes an arbitrary division of the total fee between the items nominated. When do teeth appear?Teeth begin to erupt at about six months of age. The tooth appears first and the root begins to develop underneath. When a child's mouth is fully developed there should be 20 teeth -- 10 on the bottom and 10 on the top.
However, the top and bottom teeth erupt at different times. Top Teeth -- The central incisors, or very front teeth, are the first to erupt between 6 to 12 months. The teeth next to them, called the lateral incisors, erupt between 9 to 13 months. The canines erupt between 16 to 22 months. The first molars erupt between 13 to 19 months. And the second molars erupt between 25 to 33 months.
Bottom Teeth -- The central incisors erupt between 6 to 10 months. The lateral incisors erupt between 10 to 16 months. The canines erupt between 17 to 23 months. The first molars erupt between 14 to 18 months. The second molars erupt between 23 to 31 months.
Under all this activity, the 32 adult teeth are forming. In fact, the adult teeth began developing when the baby was three months old. What are the different types of sedation available?Many people are nervous or anxious about visiting and being treated by the dentist. Fortunately there are a number of techniques dentists have at their disposal to help their patients. These include inhalation sedation, intravenous sedation and general anaesthetic. Sedation type 1. - Inhalation sedationThe most common technique is the use of a nitrous oxide and oxygen mix or the so-called 'laughing gas'. The Nitrous Oxide mixture –
Patients will often experience a feeling of well-being and euphoria.
What are the advantages of Inhalation sedation?
The technique has a number of advantages over other techniques:
Sedation type 2. - Intravenous sedationFor people who require a greater degree of sedation, or if the procedure is of a nature that requires the patient to be sedated, intravenous sedation may be suitable. With this technique a sedative is injected into a vein in the arm by a qualified sedationist or anaesthetist.
The advantages are
Sedation type 3. - General AnaestheticThe 'ultimate' technique for the phobic patient is for the patient to be completely anaesthetised by an anaesthetist. Some surgeries offer this technique 'in house' or at their local hospital / day surgery.
At what age should my child visit the dentist?
Children should visit the dentist for the first time between the ages of six months and one year. Do not wait for the child to be in pain to bring him or her to the dentist. Most procedures are pain free, and your child should know that a trip to the dentist can be a comfortable and fun experience.
Regular brushing should become a part of a child's daily routine as soon as he or she can hold a brush. Parents should also swab infant's gums to prevent plaque buildup. Children's teeth should be brushed and flossed as soon as they erupt.
Although the enamel of a child's tooth is stronger than that of an adult, it is also thinner, so cavities develop more quickly. Children's primary teeth require as much care as their permanent teeth. Untreated cavities in primary teeth can adversely affect the development of permanent teeth. Such cavities result in a roughening of adult teeth, or may result in primary teeth that erupt with cavities. Are "baby teeth” important?
Your child's primary teeth are extremely important. Without them your child cannot chew food properly and will have difficulty learning to speak clearly.
Children who lose their primary teeth too soon require a space maintainer until their permanent teeth erupt. Otherwise, the teeth will tilt toward the empty space, causing the permanent teeth to come in crooked. What dental problems can a baby have?
The most important reason for an early dental visit is to create a practical prevention program. A major concern for the dentist is the presence of baby bottle tooth decay, which occurs when your baby continuously nurses from the breast or from a bottle of milk, formula, or juice during naps or at night. The sugars in these liquids pool around teeth, creating acid attacks that destroy the tooth enamel. The result is rampant tooth decay at a very early age.
Also, the earlier the dental visit, the better the chances of preventing dental problems. Children with healthy teeth chew food easily, learn to speak clearly and smile with confidence. It's important to start your child on a lifetime of good dental habits and that's why an early visit to the dentist is crucial. How can I prevent tooth decay from breastfeeding or baby bottles?Protect your child from severe tooth decay by putting them to bed with nothing more than a pacifier or bottle of water. Do not dip the pacifier in any kind of sweetened liquid. When do permanent teeth erupt?The permanent teeth do not erupt until the child is almost 8 years of age. They continue to erupt until the child is about 13 years of age. Girls' teeth tend to erupt a little earlier than boys'. The only teeth to appear after that are third molars, or wisdom teeth. They usually form between the ages of 12 to 16, and do not erupt until 17 to 20 years of age. Why are baby teeth so important?Even though baby teeth eventually fall out, they are very important because they reserve space for permanent teeth when they come in. If a baby tooth is lost too early, new teeth may grow in crooked. How do I prepare my child for the first dental visit?Be low-key about the visit. Your baby has no reason to be afraid of the dental visit but can sense fear from a parent or other relative. However, there is nothing to fear. During a first visit, your child may enjoy a "ride" in the dental chair, play with a mirror, and generally experience the sights and sounds of the dental office. And relax -- dentists who are experienced in dealing with kids do not expect perfect behavior. How do I make my child's diet safe for his or her teeth?
The most important thing you can do is make sure your child has a balanced diet. Also, check how often your child eats foods with sugar or starch in them. Foods with starch include breads, crackers, pasta and snacks such as pretzels and potato chips. Many foods contain sugars, including processed foods such as condiments or salad dressings. A peanut butter and jelly sandwich has sugar not only in the jelly, but probably in the peanut butter too. Limit the number of starches and sugars your child eats and make sure he or she brushes afterwards. Also, watch your child's consumption of soda pop because the sugars erode the enamel on teeth. Most important is that children should limit snacks during the afternoon and when it does occur, snacks should be those that don't contribute to tooth decay. When should I start cleaning my baby's teeth?
At birth! Early care acclimates the baby to a lifetime of good oral care. Begin immediately to clean your baby's gums with a clean, damp washcloth. Use a tiny dab of fluoride toothpaste if your dentist advises fluoride protection. What can I do about teething pain?
When teeth begin erupting, some children may have sore or tender gums. Teething, which may start around 6 months and continue until age 3, can make them irritable. Gently rubbing your baby's gums with a clean finger, a small cool spoon, or a wet gauze pad can be soothing. You also can give the baby a clean teething ring to chew on. Contrary to popular belief, fever is not normal for a teething baby. If your infant has a fever while teething, call your physician. Under no circumstances should a child be given a teething ring dipped in alcohol. This is dangerous to the child and is ineffective in relieving pain. How can I help my child prevent cavities?
Children are the most cavity-prone of all age groups. It is critical that children brush twice each day and floss once each day to remove plaque, the colorless film of bacteria that forms on teeth and leads to decay and gum disease. A well-balanced diet and limited snacking also promote good oral health. Fluoride toothpastes and mouth rinses provide important protection. And, of course, regular dental checkups are important. Why is fluoride so important for my child's teeth?
Fluoride forms mineral crystals in the tooth enamel, which protects teeth from the acid produced by bacteria. Very simply, fluoride keeps the bacteria from being able to attach to teeth. Fluoride is present in the water supply of many communities. It also is found in foods such as tea, fish and vegetables. Many studies show that children who drink fluoridated water have fewer cavities than children who don't. For a nursing infant, a vitamin supplement with fluoride in it is often the best way to provide the infant with the fluoride needed. Even if the mother is drinking fluoridated water, the baby will not get any fluoride. Ask your dentist what is best for your infant. Should I worry about thumb sucking?That depends on the duration and the severity of thumb sucking. In other words, how long and how severely does the child suck his or her thumb? In severe cases, prolonged thumb sucking can create crowded, crooked teeth and bite problems. Thumb sucking is perfectly normal for infants and generally they stop by the age of 2 years old. If your child doesn't stop by the age of 4, consult your dentist. When and how often should my children brush their teeth?Dentists recommend brushing at least twice a day -- after breakfast and before bedtime. How much toothpaste should my child use?Parents should place no more than a pea-sized amount of fluoride toothpaste on the child's brush. Many children cannot adequately spit out the toothpaste after brushing, so they swallow it. Too much fluoride can cause a condition known as fluorosis, or discoloration in tooth enamel. How can I be sure my child is brushing properly?Parents should be brushing the teeth of their children under the age of 6 years, because small kids do not yet have the dexterity, or the desire, to brush their own teeth. Even when they are older, parents should continue to supervise and monitor their children's tooth brushing skills. Ask your dentist to demonstrate appropriate tooth brushing techniques. What kind of toothbrush should my child use?
Most dentists recommend a soft brush with round bristles made of nylon and a flat brushing surface. The toothbrush head should be small enough to reach all of the sides of each tooth. Nylon brushes are most effective in removing the plaque from the teeth without causing gum irritation. The child's brush should be replaced every three months. Also, the brush should carry the American Dental Association's Seal of Approval. What type of toothpaste should my child use?
One which contains fluoride and also carries the ADA Seal. It is not necessarily for children to use whitening toothpaste. When should my child begin flossing?Children should begin flossing as soon as any two teeth touch. This generally occurs when the permanent teeth begin to erupt. Parents generally need to assist with flossing until the early teenage years. Again, check with your dentist to determine the appropriate method of flossing. Why are sealants necessary?
When back teeth are developing, grooves are formed on the chewing surfaces. They are impossible to keep clean because the bristles of a toothbrush cannot reach into them. Therefore, pits and grooves are snug places for plaque and bits of food to hide. Sealants are clear, shaded plastic materials that can be painted onto these decay-prone surfaces of the teeth. By forming a thin covering over the pits and fissures, the sealants keep plaque and food out of the crevices in the teeth, reducing the risk of decay. However, children must continue to brush and visit the dentist. How often should my child visit the dentist?Most children need appointments every six months. However, children who are experiencing cavities or other dental problems may need to see the dentist more frequently. Why will some dentists cover a perfectly good tooth with gold? This is most noticeable on the front teeth. I’m sure you have seen some cases where not only one tooth, but several are covered with gold. Can this process be reversed with success or is it permanent? In addition, this must be extremely expensive. Why would a dentist perform such a procedure to a perfectly normal tooth?The gold around the tooth is actually part of a dental crown or cap used to rebuild a damaged tooth. It only looks like gold around the edges of a “normal” tooth because the rest of the crown is either made of a white material (acrylic), or is all gold and has a window that exposes the middle of the tooth. This type of crown is common in many places, such as Mexico, South America and other parts of the world.
Most of the people with these crowns do not want a dentist to change them. The process involves removing their crown and replacing it with a new one. You should also keep in mind that to these people, gold teeth are a symbol of beauty and status. My tongue feels pasty and burns when I wake up. My dentist has not found anything wrong with my teeth or gums. Do you have any suggestions?
You may be suffering from “burning mouth syndrome,” This disorder can be caused by a deficiency in vitamin B or iron, known as pernicious anemia or iron deficiency anemia; dry mouth, caused by Sjogren’s syndrome or medications; a fungal infection (candidiasis); diabetes; hormonal imbalances; or trauma related to certain dental procedures. I suggest you see an oral surgeon and your family doctor to explore the possibility of this disorder. In some cases, certain blood tests are needed.
If nutritional deficiencies are found, replacing the missing dietary components can sometimes cure burning mouth syndrome. Certain drugs, such as nystatin or clotrimazole can cure a fungal infection. In some cases, the cause has several different components, and multiple types of therapy are needed. If no cure can be found, topical anesthetics like viscous lidocaine or topical steroids may be helpful in reducing the burning sensation. However, please consult a doctor for diagnosis before taking any drugs. What's all the fuss about amalgam fillings?
The ADA policy remains, on the basis of the research available, that the use of dental amalgam produces no harmful effects.
If amalgam is so great, why does my dentist use white or 'tooth-coloured' fillings?
White fillings have been used in front teeth for decades. In recent times, scientists have developed strong white filling materials for back teeth to be used as an alternative to the dark colour of amalgam. The reason for this is the public demand for tooth-coloured fillings in visible areas of the mouth. These materials have not been in use for enough time to test their long-term comparison with amalgam but results are encouraging.
What is an amalgam filling?
Amalgam fillings are used to repair teeth for hundreds of thousands of people each year in Australia. Dental amalgam is a popular choice, as it is strong, relatively inexpensive and can last a lifetime. What makes up an amalgam filling?Is it true that amalgam is dangerous for my baby?
If you already have amalgam fillings, there is no evidence to suggest you or your baby will be harmed because of them. However, general principles of public health during pregnancy suggest that it is prudent to avoid any dental treatment that can be deferred. This includes the removal or placement of amalgam fillings during the pregnancy and during the subsequent period of breastfeeding. The NHMRC Working Party report states: “… general public and environmental health principles dictate that where possible exposure to mercury from dental amalgams be reduced where a safe and practical alternative exists. This becomes more prudent in special populations, including children, women in pregnancy and persons with existing kidney disease. Should I have my amalgam fillings replaced?
Dentists replace amalgam fillings for a variety of reasons including recurring decay, fracture, endodontic treatment and appearance.
What Type of Braces are Best? (ceramic, metal, invisible, etc)
Ceramic braces? Invisalign? Traditional metal? Golden metal? Self-ligating brackets? Viazis Brackets? What about Lingual braces? These days, there are many choices available to adults, and it gets confusing! Which type of braces should you choose? Can you choose, or is it strictly up to your dentist? These questions come up time and again in our Metal Mouth Message Board.
The type of braces you get depends on a number of factors:
This section will try to answer some of your basic questions by presenting the pros and cons of each type of braces. Please remember, your final choice is a combination of your preferences and your orthodontist's technical expertise! How Much Do Braces Co$t?
The short answer is: in 2004, in most parts of the US, two years of full traditional braces costs (on average) about $5,000. Ceramic brackets are about $500 extra. These costs do not include x-rays, extractions, or special appliances. Invisalign treatment (in most cases) costs about the same as traditional braces.
But that varies. Let me explain. If you have a health insurance plan that covers orthodontics, you might pay less, especially if you go to a provider that is in your insurance network. But be careful. Just as you wouldn't choose a medical specialist only because he is on your plan, don't choose an orthodontist soley based on this criteria. Get a consultation (usually free or minimal cost) and see how comfortable you are with that person. No amount of money saved can make up for two years with an orthodontist you don't like or don't have confidence in. Also, remember that most dental plans cover braces only before treatment begins. So if you've already started treatment, you may be out of luck.
OK, that said, let's move on. If you live in Europe or other parts of the world, there may be government health plan that covers your braces. Again, remember to scope out the other professionals in your area. You may pay more for an independent dentist, but it may be worth the extra cost.
If dental insurance isn't an option and you don't want to pay full price, you may consider going to a nearby dental school. Usually orthodontic treatment is done under the watchful eye of an instructor who has many years of professional orthodontic experience. Call your local dental school and ask how much they charge.
The following information has been provided by ArchWired readers over the past few months.In some cases, the cost has been averaged.
United States
US residents can use this handy dental cost calculator, which will give you a general starting point.
Canada
Mexico, and Central and South America
Europe and the UK
Africa and South Africa
New Zealand
Austrialia
Getting Teeth Extracted for Braces
One very common question on our Metal Mouth Forum involves extraction. Often, adults may need teeth extracted to make room so their other teeth can move into their proper positions. It's so easy for someone else to tell you that you need teeth removed. After all, the teeth are not coming from their mouth! And as you know, after teeth are removed, you can't put them back. It's the permanence of the procedure that makes this a very difficult decision for adults.
Let me tell you my story. My teeth were never perfectly straight, and they got more crooked as I got older (despite 4 impacted wisdom teeth being removed in my early 20s). By my early 30s I wanted braces, but every orthodontist that I saw (and I saw plenty) told me that I needed 4 teeth extracted. Well, I didn't like that one bit. In fact, I was totally against it. So I just resolved to live with crooked teeth. Fast forward 10 years. Here I am, at age 43 in braces, with a near-perfect smile, which was only achieved by -- you guessed it -- extracting 4 second bicuspids. Boy, do I wish I'd had this done 10 years ago. Now I feel really silly for being so scared and waiting so long.
The orthodontist who finally treated me tried very hard to fix my teeth without extracting, but it just didn't work. (I applaud his earnest efforts on my behalf). Six months into treatment, it was evident to me (and to him), that the extractions were necessary. At this point I felt better about it because at least we had TRIED the other way.
Was I remorseful about losing those perfectly healthy teeth for the sake of beauty? Yes, of course I was! I felt sick about it! After the extraction, I kept thinking, "Oh God, have I done the right thing?" But soon I got over it. Now that the extraction gaps have closed and my smile looks great, I know I made the right decision. I was worried that extracting teeth would negatively impact my facial aesthetics (which, IMO, didn't need any changing). But you know what? The change is very subtle, and in fact, it is actually good. But that is my experience and it may not be the same as your experience. Sometimes if the mouth and smile are already "small," depending on your facial bone structure, extractions may result in your face looking "sunken in" over time because the underlying structure has been changed. Before you decide on extractions, you should get several opinions, ask how your facial aesthetics may change, and think about it carefully. In some cases, other methods can be used to make space, such as "shaving" the teeth or using Damon-type brackets (whose manufacturer claims that they eliminate the need for extraction in some patients). This orthodontist's web pagetalks a little bit about why he feels Damon brackets help eliminate some extractions. As time goes on, there may be other methods developed which also help to reduce the need for extractions.
If you want to read a detailed account of what my extractions felt like, click here.
If you are hanging on the fence, not sure what to do, then this article will give you some information to help you decide the best course of action.
Why are Extractions Necessary?
By the time we are adults, our jaws have stopped growing. Sometimes our palate can be expanded, but other than that, there is limited room for improvement. If your teeth are crowded, you may need to have some of them taken out to make room for the other teeth to move into better positions. Usually an orthodontist will start with the wisdom teeth. If there still isn't enough room, the back bicuspids are usually chosen next. Because your smile must be symmetrical, the same teeth usually must be taken from the top and the bottom. If two teeth are taken from one side, your midline (the place where your front top and bottom teeth meet) may be thrown off, and you may be stuck with a crooked smile. This is why teeth are often extracted in either 2s or (more commonly) 4s.
Extractions and Children: Be Careful!
What about children? Personally I do not advocate tooth extraction in children because they are still growing. Years ago, extraction for children was common, but this is not the case today. Some orthodontists still routinely extract children's teeth. If you encounter this, please seek several additional opinions before making your decision.
There are many other methods that can be used to meld children's jaws to make room (palate expansion, headgear, or guided growth methodology). Extracting teeth from children can result in less than optimal facial aesthetics. In other words, you child's face may not wind up looking as good as it could have, because it will grow longer and flatter instead of fuller.
One exception involves a Class III malocclusion. Class III cases are technically much more difficult and often involve jaw surgery. If you need more information about Class III malocclusion, read about it in our
FAQ.
Q: Who Performs the Extraction?
A: Usually an oral surgeon extracts teeth. Other types of dental professionals with training in tooth extraction may also perform the procedure.
Q: Does Extraction Hurt?
A: Extraction of wisdom teeth is quite involved, with sedation, stitches, pain, possible bruising, and inconvenience.
Extraction of bicuspids and other teeth is a piece of cake compared to wisdom teeth. There is virtually no pain afterwards (yes, I know that's hard to believe, but it's true). You can either get local anesthetic or get "put out" for the procedure. It takes only about 20 minutes total to extract four bicuspids! There is usually no stitches, very little bleeding, and usually no bruising. [Please do not take any anti-inflammatory or pain medicines beforehand -- they prevent clotting, which could result in more bleeding. So, take no Advil (ibuprofen), no Tylenol (acetaminophen), and no aspirin beforehand! If you take a regular dose of an anti-inflammatory medication for arthritis or other chronic condition, tell your dentist!]
Afterwards, the oral surgeon will give you some strong prescription pain pills such as Vicodin. In my case, I had so little pain that I took only one when I got home (as a precaution), but didn't need any more than that! By the way, I have a relatively low pain threshold -- so you see, it barely hurt at all! You will be told to eat soft food and not to suck on straws for several days. After that, you can do whatever you want.
Q: Can There be Complications?
A: It is rare, but sometimes complications can result from tooth extractions. If the hole doesn't heal properly, you may develop what is known as a dry socket, which may get infected. The following information comes from the website Ask an Oral & Maxillofacial Surgeon.
"A dry socket occurs when the blood clot is lost from an extraction site prematurely. Basically, the blood clot in the socket serves the same two functions as a "scab" on a skin surface cut. First, it assists in the cessation of bleeding and second, it protects underlying structures during the healing process. Like the child who "picks at a scab" the area heals in time but is painful for far longer than if the "scab" had been left alone.
"When the blood clot is lost before the underlying structures have had time to heal, bone is exposed to the oral environment along with fine nerve endings. This is an exquisitely painful but otherwise relatively harmless situation. There are packing materials which the oral surgeon can place to help ease the discomfort both by physically blocking the wound and by the action of the chemicals in the pack on local nerve endings. Generally, patients return to have the pack changed every day or two and most patients do not require more than 2 or three dressing changes. Some patients require no dressing while others may require 4 or 5 changes of packing. Tincture of time and good oral hygiene usually resolve the situation.
"There are some activities which may increase the propensity for dry socket formation...smoking, drinking carbonated beverages in the first 24 hours after surgery, spitting or drinking through a straw in that same time period...but often "dry sockets" occur for no particular reason at all."
Q: When Are The Braces Put On?
A: After an extraction, braces can be put on almost immediately. (I already had braces, so my arch wires were taken off first. After the extractions, the arch wires were replaced the following week).
Q: What About Eating and Talking?
A: Yes, eating with several gaps in your mouth is very strange. Be sure to take small bites and chew slowly and carefully. You will need to change the way you chew for a while, until the gaps begin to close. Food may get stuck in gaps, which is annoying.
As time passes and the gaps close, this will become less of a problem. Just hang in there and deal with it. Also remember that your bite will change as time passes, so your teeth will meet differently, and you will chew differently as you go through the stages of gap closure and teeth straightening.
If frontal teeth have been extracted, you will have to deal with other people noticing your gaps. Yes, this can be a bit embarrassing, but remember that it is only temporary. In a few months, the gaps will be gone (particularly the top gaps, which tend to close more quickly).
Q: How Long Does It Take to Close The Gaps?
A: The length of time to close extraction gaps depends on your unique case. But the short answer is: between 4 months and one year.
The gaps on top often close faster than those on the bottom. My orthodontist said that typically the teeth move about one millimeter per month. Your orthodontist may use power chains or other methods of linking the teeth together to close the gaps.
It took 21 months to completely close all of my extraction gaps (I needed closing loops, as shown in the next section), but I am an exception -- I had a couple of stubborn lower teeth! In fact, the top gaps closed within 9 months.
Each month, your orthodontist can measure the gaps between your teeth with a special ruler. By doing this, you can see solid results from month to month. This is a good idea, because at first it will seem like your teeth aren't moving at all -- when in fact, they are! Here's a photo of my teeth after the gaps on both top and bottom were completely closed. You'd never know that I had two teeth extracted on the bottom, and two on the top!
Q: How Do They Close The Gaps?
Extraction gaps are usually closed with power chains or other special methods of linking teeth together. White power chain is shown linking my teeth in the photo on the left. Notice the extraction gap between the molar and the bicuspid. The power chain is attached to the hooks on some brackets, and also put directly on the brackets in place of ligatures. (I don't recommend white color power chains, because they show a lot of stains. I've had great success with "smoke" grey color, which is almost invisible. Smoke-colored chains are on the top teeth in the large photo below. Notice that you can barely see them! They "resist" curry stains quite well.)
In some cases, the orthodontist makes a loop in the arch wire to close the gaps. This is sometimes called a "finishing loop" or "closing loop" because it is usually done near the end of treatment to help close stubborn gaps that are not helped by other methods.
Arch Wire Displacement (otherwise know as "a poking wire")
When extraction gaps are closing, the arch wire will often be displaced and the "extra" bit will poke into the end at your cheek. This is very common, and it hurts like hell! If this happens to you, do not wait -- call your orthodontist immediately to get the wire trimmed! You can temporarily remedy the situation by globbing some wax or chewing gum at the end of the wire (but this frankly doesn't work very well). Sometimes, teeth move "all of a sudden" and you find yourself making an emergency trip to your orthodontist to have the wire trimmed. You can purchase a pair of orthodontic pliers for emergency clippings -- but personally my husband was afraid to even try to clip the end of my wires (and you can't really do it on yourself).
Although arch wire displacement is literally a big pain, it is positive. It means that your teeth are moving and the gaps are closing! What is a bridge?
A bridge is an appliance permanently fixed in the mouth to replace missing teeth. It uses remaining teeth to support the new artificial tooth or teeth.
A conventional fixed bridge consists of crowns that are fixed to the teeth on either side of the missing teeth and false teeth rigidly attached to these crowns.
My gynecologist recently prescribed prenatal vitamins for me to take throughout my pregnancy. Do you recommend taking a fluoride supplement as well?
The use of fluoride supplements during pregnancy is a controversial issue. Fluoride is obtained from water and other beverages, foods, prescription drops and tablets, and other sources. A major function of fluoride taken systemically throughout the body is the strengthening of developing teeth, from infancy to adolescence. Fluoride strengthens teeth by the formation of harder enamel (hydroxyapatite crystals are converted to fluorapatite) that is less vulnerable to damage from plaque acids.
Fluoride intake by a pregnant mother may have a positive effect on the unborn child. Several recent studies support the use of prenatal fluoride supplements. In the first study, pregnant women in their second and third trimester would take a daily 2.2 mg tablet of sodium fluoride along with fluoridated water.
The results demonstrated that 97 percent of the offspring of these women had absolutely no cavities for the first 10 years of their lives. These children also had no medical dental side effects from the prenatal fluoride treatment. Another study contained 1200 pregnant women; half were given a fluoride supplement and the other half were not. A five-year follow up of the offspring revealed that the fluoride group had only about half as many cavities as the non-fluoride group, and 96 percent had no cavities at all.
The use of fluoride in the form of supplements, in toothpaste, mouthwash and in drinking water has been clearly established for both children and adults. Recent studies concerning the use of fluoride during pregnancy are encouraging, and may provide a safe and cost-effective way of reducing cavities in children. I recommend that you talk to your gynecologist about the use of fluoride supplements during your second and third trimester of pregnancy. We have a 16-month-old, and she gets upset when we try to brush her teeth. What do we do? Do we try to continue the good habit we have started or should we hold off?
At your daughter's age, it is not uncommon for her to fight tooth brushing, because it is foreign to her and can be abrasive to her gums. What you can do is use a moist washcloth to clean her teeth, especially before bed. Do not allow her go to sleep with a bottle of milk or juice that leads to destructive "baby bottle cavities."
After about two months, re-introduce the brushing with a child-sized toothbrush that has soft bristles. Also, experiment with different child-dosed toothpastes. Your daughter may just not like the taste of the toothpaste you are using. Always use a very small pea-sized quantity of toothpaste because high amounts can be harmful. Even when she does let you brush her teeth expect a little fight -- it’s only natural. You may also want to consider giving her a small reward after each successful brushing. Braces FAQ (Frequently Asked Questions)
Thinking About Getting Braces
Q: Can you be too old for braces?
A: There is no age limit for braces. As long as you have good periodontal health, braces can be used to straighten your teeth and correct your bite. More people over age 30 are getting braces today than ever before. Most ArchWired.com readers are between the ages of 25 to 55! However, if you have been on a Bisphosphonate drug for osteoporosis (such as Fosamax or Boniva) you need to talk to your orthodontist or dentist first. Read this articleto find out why this is very important.
Q: I wore my retainer for a while when I was younger, but then I stopped wearing it and my teeth shifted years later. Is this common?
A: Yes, it is more common than you think. The teeth are actually more dynamic than you'd expect. Sometimes, when wisdom teeth erupt, your bite can change in adulthood. A large percentage of adults in braces are in them for a second time!
Q: My kids just got braces and now I'm thinking of getting them, too.
A: Many adults "finally get their teeth done" when their kids go in for orthodontic treatment. It's more common than you think! Several ArchWired.com readers have an entire family in braces!
Q: What is it like to have braces put on your teeth? Does it hurt?
A: Getting braces put on your teeth does not hurt, and does not require Novocain injections or anything painful. For a full description of the process, read Braces Basics: When the Braces Go On.
Q: How much do braces cost?
A: The average cost for a full set of braces in a typical two-year treatment is about $5,000 US. The cost varies depending on where you live. Major metropolitan areas tend to be slightly higher in cost than rural areas. Generally, metal braces cost less than ceramic ones. Invisalign treatment can be just as costly as traditional braces, and sometimes is even slightly more expensive. Here is a surveywe did on the subject a few years ago.
Q: Does dental insurance cover the cost of braces?
A: Many people in the U.S. have dental insurance through their employers or as individuals/families. This insurance usually cover orthodontic treatment for children up to age 18, but does not cover adult orthodontics -- or only covers it up to a certain dollar amount. If your plan covers adult braces, consider yourself in the lucky minority. I can't speak for dental plans offered overseas, as I know very little about them, and some are government-run (such as the NHS in the United Kingdom).
Remember, most insurance plans and discount dental plans do not cover treatment that is already in progress. So, if you are going to sign up for a dental plan or insurance plan, do it before any treatment begins. Also, beware of any waiting periods your dental plan may enforce. And by the way, jaw surgery or extraction is sometimes covered under your medical plan, so be sure to look into this, too.
Q: How can I find an orthodontist or a discount dental plan?
A: To help find an orthodontist near you, it's best to get personal recommendations. Ask friends who have braces (or whose kids have braces). If your insurance covers orthodontics, see if it is limited to specific dentists/orthodontists. Or, post a query on ArchWired's Metal Mouth Message Board; our readers are all over the US and around the world, and are very helpful!
Dental plans come and go; some are better than others. Please read the fine print carefully before you sign up for anything and check with the Better Business Bureau. If you don't have dental insurance, you can sign up for a discount dental plan. A discount dental plan is not insurance -- it is a cooperative of dental professionals who have contracted with a company to offer their services at a discounted rate. Many are available, offered by different companies. You can search for discount dental plans on Google or DentalPlans.com. Or, ask a trusted insurance agent or your own dentist.
Q: I can't afford dental insurance or a dental plan. What can I do?
A: If you don't have dental insurance and can't afford a a discount dental plan, there is still an alternative. If there is a dental school in your area, call them and ask if they have a clinic. Often orthodontists and dentists in training will practice on patients in the school clinic, under the watchful eye of experienced teachers who are themselves dentists and orthodontists. This service is offered to the public at a minimal cost.
Q: Can I get those invisible braces (Invisalign) instead of traditional ones?
A: That depends on your specific case. Invisalign braces are usually not recommended for very complicated cases, or cases that involve extractions. Only a qualified dental professional who has examined your mouth can decide whether Invisalign is right for you. If you are very concerned about your appearance with braces, another thing to consider is lingual braces, which are behind the teeth (such as iBraces). An orthodontist must take special training to do lingual braces -- not every orthodontist does them.
Q: What is the difference between a dentist and an orthodontist?
A: An orthodontist is a dentist who has taken several years of extra training beyond the basic dental degree. Here is what the American Association of Orthodontists (AAO) says:
"It takes many years to become an orthodontist. As in medicine, the educational requirements are demanding. Next is a three- to four-year graduate program at a dental school in a university or other institution accredited by the American Dental Association (ADA).
Finally, there are at least two or three years of advanced specialty education in an ADA-accredited orthodontic residency program. The program is difficult. It includes advanced knowledge in biomedical, behavioral and basic sciences. The orthodontic resident learns the complex skills required to both manage tooth movement (orthodontics) and guide facial development (dentofacial orthopedics).
Q: Should I get braces done by a dentist or by an orthodontist?
A: My personal opinion leans toward orthodontists. Some dentists incorporate orthodontics into their practices. They have probably completed some extra coursework in tooth movement management and facial development. Some dentists who practice orthodontics have completed more coursework than others. Don't feel shy about asking a dentist about his orthodontic qualifications -- what extra training he has completed, and how many orthodontic patients he has seen. Just because a dentist says he or she "can do braces for you" doesn't mean that they have all the training necessary to successfully handle complicated treatments. Some dentists confer with their their orthodontic colleagues to ensure that they're doing things optimally. If you have minor orthodontic problems, your dentist might be able to handle your case. Complicated cases are probably best handled by an orthodontist who has more training.
If you're considering getting braces, you should probably get at least one opinion from an orthodontist to ensure that you are getting the correct type of treatment.
Q: How many orthodontic consultations should I get?
A: You can get as many orthodontic consultations as you want. In a consultation, an orthodontist looks at the alignment of your teeth and your facial aesthetics and gives you a general opinion of what he or she would do to correct your problems.
Usually the consultations are free or of minimal cost. While an orthodontist can look at your teeth and give you a general opinion, he or she can't put together a comprehensive treatment plan for you until teeth molds and panoramic x-rays have been done.
There is usually no one right way to correct orthodontic problems -- there are many ways, and different orthodontists may give you different opinions. That is why it's a good idea to consult with two or three orthodontist before you start treatment, especially if they recommend extractions, headgear, or jaw surgery.
Q: What are some of the risks of getting braces as an adult?
A: Just like any medical or dental procedure, there are some risks involved in orthodontic treatment, no matter your age. The forces involved in braces can cause some amount of trauma to the dental tissues and structures. However, most adults successfully complete their treatment without any major complications. Orthodontists often give their patients a booklet outlining some of the risks that may be involved and make them sign a waiver that they understand these risks, which include:
Q: What is a "bite" and what is malocclusion?
A: Occlusionis another word for your bite -- how the teeth in your top and bottom jaw meet with each other. Mal comes from the Latin root meaning "bad." So, a malocclusion means a bad bite -- a bite with problems. It means that your top teeth do not line up properly with your bottom teeth.
Q: What are the "classes" of malocclusion?
A: Malocclusion is most often caused by hereditary factors such as an abnormal relationship between the size of the teeth and the size of the jaws. Malocclusion may also result from missing teeth or habits such as thumb sucking or tongue thrusting.
Malocclusions are classified based on the relationship of the maxillary (upper jaw) and mandibular (lower jaw) first permanent molars.
There are three basic classes of malocclusion, Class I, Class II, and Class III: Class I malocclusioninvolves crowding, spacing, or overlapping of the teeth. In this classification the upper jaw is in a normal relationship to the lower jaw; that is, neither jaw protrudes. Class II malocclusionoccurs when the bottom jaw is in a more posterior (backward) position than normal. The top teeth appear to protrude out over the lower teeth. One example of this type of malocclusion is often referred to as "buck" teeth.
Class III malocclusionoccurs when the lower jaw is in a more anterior (forward) position than normal. The lower teeth protrude out beyond the upper teeth. This is often the most difficult type of malocclusion to correct.
Q: What are the "types of bite" and what do they mean?
A: The most common types of bite problems are:
Q: Can I get braces just on the top or bottom?
A: That depends on your case. Orthodontics isn't just about making your teeth straight or making them look better. Most dentists and orthodontists take a lot of things into consideration when recommending treatment, such as:
So you see, it isn't just a matter of making your teeth look pretty. There are lot of other factors to take into consideration. This is why you sometimes need a full set of braces, even if you think that you only need them on top or bottom. Of course, some people are lucky. Their bites are good and perhaps they only need a bit of straightening. People in this position often can get braces only on top or bottom
Q: When will I begin to see changes in my teeth after the braces are put on?
A: According to a recent ArchWired.com poll, most people begin see changes in their teeth in the first 2 to 6 weeks of treatment.
Q: Are people going to think I look geeky or weird with braces on my teeth?
A: Of course you're self-conscious because it is YOUR mouth, but frankly most people don't give a hoot. Your braces are a conversation piece for about 3 minutes; after that, nobody pays much attention. Really. And most people don't think you look geeky. In fact, they probably think you look cute, or applaud that you are doing something positive to improve your appearance and your dental health. Whenever you become self-conscious about your braces, think about how great you'll look after they come off!
FYI, here are the results of a poll of ArchWired.com readers on this very subject, conducted in January, 2004:
Q: What if I move away and change orthodontists or dentists once my orthodontic treatment has begun? What happens?
A: Changing orthodontists mid-treatment can be tricky. Most orthodontists work on a "pay as you go" plan. In other words, you pay a certain amount of money at the outset of treatment (for the molds, consultations, and having the braces installed). Then, each month, you pay a percentage of the rest of your balance. So, if you move away from your orthodontist, be sure to tell him/her ASAP so that you will not be charged extra. You orthodontist will probably "pro-rate" your balance or refund some of your money. You should also request your dental records, or ask your orthodontist to forward them to your new doc.
However, you may wind up paying a few hundred dollars more to your new orthodontist. After all, this new doc has never seen you before, and you are a new patient to him. Hopefully, changing orthodontists mid-treatment won't raise your costs too much.
In any event, this is a good argument for NOT PAYING THE ENTIRE BALANCE UP FRONT. Personally, I think that paying it all up-front is a really bad idea, even if it saves you money. For example, there was a story in the news a few years ago about an unscrupulous dentist who took full payment from his patients -- and then closed his practice! Some of them had to pay the full amount (in excess of $5,000) again to the new orthodontist, and some just couldn't afford the unexpected expense and had to stop their treatment. The odds are that your dentist would not do this to you -- but even under the best circumstances, nobody knows what the future holds, so I think that "pay as you go" is safest option. For more details on this subject, read Braces and Moving.
Q: Should I get teeth extracted as part of my orthodontic treatment?
A: It depends on your specific case. When we are young and our jaws are still growing, dentists/orthodontists can work with our growth to straighten the teeth without extraction.
But once we are adults, dentists are limited to what is already in place. If your orthodontist recommends extraction, it may be wise to get at least one more (if not two more) opinions before going through with the procedure -- once the teeth are gone, they're gone! Your teeth and jaw help to shape your face. Changing the underlying structure will result in some changes in your facial appearance. You should discuss this with your orthodontist. There are newer types of bracket systems that apply lighter forces and may be able to correct your problems without extractions, such as Damon Brackets. You may want to ask your orthodontist about it.
Sometimes however, depending on your unique case, extraction may be the only way to successfully straighten your teeth and correct your bite. For more information about extractions, see Getting Teeth Extracted for Braces.
Q: How long does it take to close gaps between teeth after an extraction?
A: That depends on your body's unique physiology. Gaps in teeth on the lower jaw tend to close slower than on the upper jaw. It can take anywhere from a few months to a year to close extraction gaps.
Q: Do you have to change your diet when you wear braces?
A: Yes, you do, to some extent. At first your teeth will hurt and you won't be able to bite into hard foods, big sandwiches, or anything too chewy or crunchy. It is best to stick to soft foods until your teeth begin to feel better -- usually in a few weeks. Read Soft Food Suggestionsto help you cope.
The Braces: How They Work and How They FeelQ: What is an arch wire?
A: The arch wire is the metal wire that goes across your braces, from one end of your mouth to the other. You have two arch wires; one on top and one on bottom. The pressure from the arch wire is what helps to move your teeth.
Q: What is a ligature?
A: A ligature (also called an "o-ring") is a tiny elastic that holds the arch wire onto each bracket of your braces. Ligatures come in a variety of colors. Some brackets are "self-ligating," which means that they do not need the little elastics to hold the arch wire onto the brackets -- instead they have a "sliding door" system for keeping the arch wire attached to the bracket.
Q: Why do I need to have spacers put in before braces?
A: Sometimes there isn't enough space between certain teeth to insert a metal band or other appliance. Spacers help move the teeth slightly to create space that is needed for your treatment. For more information, read What are Orthodontic Spacers? How do braces work?
In a nutshell, the ligament surrounding the teeth is loosened, allowing the teeth to move. For a more detailed explanation, and illustrations of the parts of braces, read How Do Braces Work?
Q: Is there a big difference between metal and ceramic braces?
A: All the pros and cons are outlined in What Type of Braces are Best?Also, visit ArchWired's Linkspage.
Q: Why are there hooks on my brackets?
A: Hooks are for attaching elastics (rubber bands). At some point in your treatment, your orthodontist may tell you to wear rubber bands that attach from a hook on the top brackets to a hook on the bottom brackets. Elastics help to close up your bite and correct things like midline problems. This all refers to the way your top and bottom teeth meet and align with each other.
Q: Why are there little tubes on my molar brackets?
A: The tubes (often called "buccal tubes") on your molar brackets may be used for attaching an appliance like headgear or a facebow. Don't be alarmed -- just because you have them, it doesn't mean that you are going to get headgear or a facebow! Some molar brackets have the tubes "by default." My molar brackets had tubes but they were never used for anything in the three years I had my braces! Q: How long have braces been around?
A: Braces, in one form or another, have been around since ancient times! For an interesting article about the history of braces, read A Short History of Braces and Orthodontics.
Q: Do braces hurt when they are on your teeth?
A: Yes, at first they do. For me, it felt like I had been hit in the teeth with a baseball -- but everyone's experience is different. Your teeth will ache to some extent and your gums will probably get sore in specific places. This is because your teeth are not used to the pressure, and your cheeks are not used to the metal or ceramic rubbing against them.
After wearing braces for a few weeks, the pain and discomfort begin to diminish. You can use dental wax and topical anesthetic to help create a barrier between the braces and any sores that develop on your gums (the sores usually heal within a few weeks). You can also use a lip protector. In a few months, pain is less of an issue, and it goes away. You sometimes even forget that you're wearing braces! Your teeth may also hurt again for several days after your monthly adjustment, but by then you're used to it and it doesn't bother you as much.
Q: How long will braces cause pain and discomfort?
A: When you first get braces on, your teeth will hurt or you may be in some amount of discomfort for several weeks. After about a month, it is better. In a few months, you may even forget that you are wearing them. Within 3 months you will be able to eat almost anything you like. In six months, you might even be biting into hard cookies, chips, and crusty bread once again. Eat these things in moderation and always be careful. "Forbidden" foods and soft foods are mentioned in the next section.
Q: I just got my braces recently and my teeth feel loose. Why? Is it OK?
A: The periodontal ligament, which helps to hold your teeth in place, is loosening up. Yes, this is perfectly normal, although it is very disconcerting. The teeth should stop feeling loose after a few weeks. If you're very concerned about it, or if the teeth feel loose for months on end, talk to your dentist about it.
Keeping Your Braces Clean and ComfortableQ: Do I need to use a special toothbrush or other gadgets when I have braces?
A: Yes and no. You can use a regular soft toothbrush, but most orthodontists recommend an orthodontic-cut toothbrush, where the bristles in the middle are lower than the bristles on the edges and cut into a "v" shape. You can also use any electric toothbrush, such as a Sonicare
To floss your teeth, you don't necessarily need special floss. You can use any type of floss with a plastic threader needle such as BridgeAid. The plastic threader helps you bring the floss under the arch wire for each bracket.
To make things easier, there are also several types of "threader floss" which is a length of floss that has a built-in stiff threader end. Some popular brands of threader floss are Thornton 3-in-1 Floss, SuperFloss, Crest Glide Threader Floss, and SturdyFloss which was created by a dental hygienist. An enterprising orthodontic patient even invented a tool he calls "FlossFish" to help you floss under your brackets with any type of regular dental floss. Many of these flossing tools can be found at DentaKit.comor many online drugstores.
You might also want to get a small spiral dental brush (sometimes called an "interproximal brush" or a "proxi-brush") or a rubber-tipped stimulator to help clean food debris out from between the brackets before you brush. A WaterPik
And finally, you will need some dental wax, because inevitably, the brackets will irritate the insides of your cheeks at first and you will want some relief from the irritation.
Q: Why do you need to use wax when you have braces?
A: Wax helps to create a barrier between the bracket and the inside of your cheeks and lips. It helps prevent the bracket from irritating your cheeks or gums. At first you will probably use a lot of dental wax, but as your get used to your braces and the insides of your cheeks "toughen up" you may wind up using less.
Q: How do you use orthodontic dental wax on your braces?
A: To use dental wax, break off a tiny bit of wax from the container, smoosh it with your fingers a bit to mold it, then place it directly on the bracket that is causing the irritation, as shown in this photo. Dental wax is non-toxic, so it's ok if you swallow it. Wax tends to break down over time, so you'll probably have to apply more after eating a meal. Take off the wax before you brush your teeth, or it will gunk up your toothbrush.
Dental silicone, such as Ortho-Sil is a little different. It lasts longer than regular dental wax. Your brackets must be extremely dry when you apply dental silicone, or it will not stick to them. Some people love dental silicone and some prefer regular wax. If you have never used OrthoSil, ask your orthodontist for a small packet, or buy just one container to try before buying a large quantity.
Usually your dentist/orthodontist gives you some dental wax after you get your braces put on. Most pharmacies (both online and local) carry dental wax. DentaKit.comalso carries silicone dental wax, as well as several types of lip protectors which are alternatives to wax.
Q: What else can you use to ease irritations inside your mouth in the first weeks of braces?
A: A warm salt water rinse, several times per day, can be very soothing. But if that isn't enough, try a mouth rinse called Rincinol PRN
Q: How do you brush your teeth with braces on?
A: First, rinse with warm water a couple of times to dislodge any food particles. You can also use a rubber-tipped gum massager to dislodge any particularly stubborn particles that are badly stuck in your brackets. Now you can use a small amount of toothpaste and brush your teeth.
It is best to use circular, vibrating motions around the gum line. Angle your toothbrush above and below the brackets. Scrub each surface of every tooth with 10 strokes of the toothbrush. This should take several minutes -- be as thorough as possible. Don't forget to also clean the surfaces of the molars and to also brush your tongue!
Q: Can you use whitening toothpaste when you wear braces?
A: It's probably best not to use a whitening toothpaste until after your braces come off. If you use a whitening toothpaste on a daily basis, the teeth underneath the brackets may not be as white as the rest of your teeth when your braces come off!
Q: How do you floss your teeth with braces on?
A: It's a little tricky at first. You must thread the floss under the arch wire between each tooth, floss under the gumline, then remove it. Repeat for each tooth. At first it will take about 15 minutes to floss all of your teeth, but with practice you will get faster and more efficient at doing it. It is important to floss EVERY NIGHT. Even if you use a Waterpik device, you should still floss. Braces are notorious for hiding tiny pieces of food you could have sworn were rinsed away!
You can use any type of floss that is comfortable. Most people attach the floss to a plastic needle called a Floss Threader, or use floss that has a stiff end, such as SturdyFloss or Glide Threader Floss, as mentioned a few paragraphs earlier.
Q: How can I keep my braces clean after eating at a restaurant or traveling?
A: Most people who have braces carry a little dental kit to help them in such situations. A dental kit should contain a dental pick, some floss and floss threaders, a toothbrush, and some toothpaste. A travel cup is also a good idea. It is easy to put one together yourself.
All these items are compactly offered in a product called DentaKit Braces Survival Kit, which is pictured here on the right. This is a product that I created a few months after getting my braces. I needed a kit like this and couldn't find one anywhere, so I created one! Like most people, I started out by putting some stuff in a baggie, and then a small cosmetic bag. One of the advantages of the DentaKit product is that everything is held securely in the pockets, making it easy and convenient to use. All the tools included in the kit are designed to help you clean your braces. Thousands of orthodontic patients worldwide have bought this kit and tell me that they consider it a valuable tool in helping to keep their teeth and braces clean. It includes everything you need to clean your braces "on the go," including a unique leak-proof pop-up folding cup, and extra pockets to put lip gloss, Chapstick, or hand wipes.
Day-to-day Living with Braces and OrthodonticsQ: What is an adjustment and how is it done?
A: In a nutshell, the elastic ligatures are changed, and sometimes the arch wire is also changed. For a detailed description of the procedure, read About Tightening/ Adjustment.
Q: seem to be drooling more, now that I have braces. Why?
A: Excess saliva (drool) is actually very common. Apparently your mouth mistakes the feeling of the brackets on the inside of your cheeks for food, and sometimes produces extra saliva to help digest it.
Q: Suddenly I've developed gaps between teeth which never had gaps before. Should I be worried?
A: It is very common for your teeth shift and develop gaps while treatment is underway. Your bite will change many times during your treatment. Remember than any strange gaps or bite problems will be resolved by the time your treatment is finished. If you are really concerned, mention it to your orthodontist.
Q: Do I really need to brush my teeth after every meal when I'm wearing braces? What a pain!
A: Yes and no. Yes, you should, because depending on what you eat, food gets stuck in and around the brackets. Besides looking gross, it causes tooth decay and bad breath. It also feels yucky. Some people can't stand the feeling of food stuck in their brackets. You wouldn't believe how much food can get stuck -- often more than you'd imagine!
However, if you let the brushing slide every so often, it's not the end of the world. Just try to be as diligent as possible on a regular basis. At the very least, swish your mouth with water and try to pick out any food that is stuck in your brackets. It's also a good idea to floss each night, or at least a few times per week. Sometimes food gets stuck between teeth and you don't realize it until you floss it out.
Some dentists also recommend a fluoride mouth rinse, such as ACT, which is available in most supermarkets and pharmacies, and comes in many flavors (including bubblegum
Q: My teeth really hurt! What can I do to ease the pain?
A: In the first weeks after you get your braces on, your mouth will be sore and your teeth will hurt. Most people take ibuprofen (Motrin/Advil) or acetaminophen (Tylenol) to help ease the pain. Cold drinks or cold foods (such as frozen yogurt, milkshakes, ice cream, or just plain ice water) may also help.
Q: What can I eat? Should I really avoid the foods on my orthodontist's "don't eat" list?
A: It is best to eat only soft foods that are easy to chew. Do not take big mouthfuls. Chew carefully and slowly so that you don't gag or choke. Avoid stringy foods like melted cheese that forms big strings, and long stringy pasta -- they will get stuck in your brackets and may cause you to gag. Cut your food into small pieces. No biting into large sandwiches -- use a knife and fork until you get the hang of wearing braces! I ate hamburgers with a knife and fork the entire 3 years I was in braces!
Read our pages of Soft Food Suggestionsto get some insight on what types of foods you can manage. This stage will probably only last for a few weeks, until you get used to your braces and your gums "toughen up."
Your orthodontist may have given you a list of foods that should be avoided. These include gummy sticky foods (like Gummy Bears), and very hard foods (like nuts or hard chips). But it can also include things like ice cream and popcorn. Why? Because many flavors of ice cream can include hard chunks. The unpopped shell of popcorn can get stuck in your brackets. Biting into any hard food might cause your brackets to break or your wires to bend, so you must be careful.
Q: Will my brackets pop off?
A: Sometimes a bracket will spontaneously pop off. There are a number of reasons this can happen. Remember that your brackets are glued on, so if the glue bond is broken, the bracket will come off. If this happens to you, call your orthodontist immediately to get it re-glued. It is normal for a bracket to pop off occasionally. But if a bunch of brackets keep popping off by no fault of your own, speak to your orthodontist about it. Gluing on brackets can be tricky and it may take a few tries to get it exactly right.
Q: I don't want to wear my headgear during the day. Why can't I wear my it only at night?
A: Nobody likes to wear headgear, but it serves a specific purpose in your treatment. If you don't wear it as many hours as your dentist recommends, your treatment won't progress as fast, and you might wind up wearing the headgear additional months. It's best to just go along with what your dentist recommends and get it over with sooner. Read A Few Words About Headgearfor more information.
Q: Why do I need to wear elastics?
A: Elastics help fine-tune the alignment of your teeth and your bite. There are many different ways that you can wear elastics for specific reasons. You should wear the elastics the number of hours that your dentist recommends to help your treatment progress properly. (Wearing them "double time" or "double strength" to make up for time you spent without them is NOT advisable -- that could harm your teeth). Most people take elastics out before a meal, brush, then replace them after a meal.
Q: How can I cope with canker sores when I have braces?
A: There are many ways to cope with canker sores. If the sore is near a bracket, you can put some dental wax or dental silicone on the bracket to create a barrier, then apply some canker sore medication to the sore area. For more detailed information, read Ouch! I Have a Canker Sore!
Q: Do ceramic (non-metal) braces stain?
A: The brackets themselves usually do not stain. It's the elastic ligatures that hold the arch wire to the bracket that stains. These are changed at each adjustment, when you get fresh clean ones. So, if your ligatures or power chains stain, you'll only have to live with it for a short time.
Q: What foods stain the ligatures of your braces the worst?
A: Foods like curry, mustard, black coffee, and red wine create the worst stains. For more details, read Help! Did I Stain My Braces?
Q: What colors of ligatures or power chains resist stains the best?
A: Clear or white ligatures show yellow stains the worst. The best colors, according to ArchWired readers (and my own personal experience) are: smoke, pearlescent, glow-in-the-dark, and any dark vibrant colors. I have also worn light blue, which turn a pleasant teal color when stained by curry (i.e., blue ligatures plus yellow curry make greenish blue ligatures).
Q: Can I change my elastic ligatures ("o rings") myself at home?
A: Unless your orthodontist has given you the go-ahead to do this, it is NOT recommended! Yes, there are places on the web where you can buy elastic ligatures and power chains, but even THEY do not recommend that you change them yourself at home. The reason is: putting extra pressure on your teeth at inappropriate intervals can interfere with your treatment. Read Changing Your Own Ligatures for more information on why it is a bad idea to change your own ligatures.
Q: Can I smoke cigarettes, cigars, or pipes with braces on my teeth?
A: Yes, you can smoke or chew tobacco, but both of these habits will stain your ligatures and may possibly stain ceramic brackets.
Q; Is it OK to have braces if you are pregnant, or plan to become pregnant?
A: Yes, many pregnant women have had orthodontic treatment. Your teeth may be a bit looser than average because of the hormonal changes and the effect on your periodontal ligaments. But as long as you maintain good periodontal health, it shouldn't be a problem to wear braces if you're pregnant. For a reader's perspective on the subject, read Braces and Pregnancy.
Q; Can you wear braces if you snorkel or scuba dive?
A: Yes, you can. It's probably best to have the braces on for a few months before snorkeling or scuba diving, so you can get used to the extra hardware in your mouth. For a reader's perspective on the subject, read Braces and Snorkeling/Scuba.
Q: Can you wear braces if you play a wind instrument?
A: Yes, you can. Several companies make mouth guards and lip protectorsspecifically for this purpose. Ask your orthodontist for one that he/she recommends. Some orthodontists can make a custom lip guard for you.
Q: How can I keep my braces clean after eating at a restaurant or traveling?
A: Most people who have braces carry a little dental kit to help them in such situations. A dental kit should contain a dental pick, some floss and floss threaders, a toothbrush, and some toothpaste. A travel cup is also a good idea. All these items are compactly offered in a product called DentaKit Braces Survival Kit.
Q: A wire at the end of my braces is poking my cheek. What should I do?
A: This is always an annoying and tricky situation. If possible, gob a bunch of dental wax at the end of the wire to stop it from poking you. You can also try a bit of cotton. Call your dentist or orthodontist and ask to come in ASAP so they can clip the wire. Please don't suffer needlessly with a poking wire. After a day or two it can really painfully tear up the inside of your cheek, so don't wait to get it clipped! Some orthodontists let you come in "as needed" for a clipping without an appointment.
By the way, the wire pokes you because your teeth have moved, displacing the end of the arch wire. Although this is annoying, it's a good sign that your treatment is progressing!
Q: What about braces and sports?
A: Depending on the sport, it is probably a good idea to wear some sort of lip protector or mouth guard so the braces don't cut up the insides of your mouth (and also to protect your teeth and braces). Light contact sports will be made safer with a simple lip protector. Many heavy contact sports require a larger mouth guard. If you are not sure what is appropriate for you, ask your orthodontist. Sometimes, orthodontists make custom-fitted mouth guards and lip protectors.
Q: How often should I get my teeth cleaned when I have braces?
A: Most dentists recommend that people get their teeth cleaned twice per year. For people with braces, this is especially important. Even if you brush and floss very well, a professional cleaning will ensure that you don't develop decay. When you have braces, you should consider getting one or two extra cleanings per year. They do not take off your arch wires or brackets to do a cleaning. They usually work around your braces, or use a device called a Cavitron, which is like a high-powered Waterpik.
Retainers
Q: What are the types of retainers?
A: To retain means to keep in place; therefore, an orthodontic retainer is used to keep your teeth in their new positions after your braces come off. Most orthodontists use one of these three types of retainers:
A clear plastic retainer(also called an Essix Retainer) is sometimes placed on the upper teeth one or two days after the braces are removed. It resembles the Invisalign appliance. It is normally worn only at night and lasts an average of 24 months. After it wears out the orthodontist may replace it with a traditional wire retainer. Some people have commented that this type of retainer can be uncomfortable.
A bonded retainer is normally placed behind the lower teeth after the braces are removed. It is a wire "permanently" bonded to the teeth with composite material. Sometimes this type of retainer is used for the upper teeth, but usually this is not possible because it would interfere with your bite. A bonded retainer will remain in place for several years. A wire retainer (also called a Hawley Retainer) is normally placed after discontinuing use of either the clear retainer or bonded retainer. This type of retainer has the added benefit of being adjustable so that minor tooth movement is possible. Sometimes a wire retainer can be worn full time instead of braces to correct mild crowding. As you can see, the plastic part of the retainer can be made in a variety of colors and patterns.
Q: Do I have to wear a retainer after my braces come off?
A: The short answer is: YES, absolutely! The long answer is:It takes many months for your periodontal ligaments and bone to "remember" the new position of your teeth and keep them in place. The retainer helps keep them in their proper new positions. It's important to wear the retainer exactly as your dentist/orthodontist recommends. Otherwise, your teeth may shift, especially if you stop wearing your retainer in the first two years after your braces come off.
Most people wear their retainer 24/7 for at least 6 months to a year after the braces first come off. Of course, you must take your retainer out to eat or to to brush your teeth. Be sure to carry a retainer casewith you to store your retainer when it is not in your mouth. Keep a few handy -- in your car, your purse, at work, etc. Many retainers have been lost in napkins at restaurants or school and thrown in the trash. A new retainer can cost as much as $300! There are also special "Retainer Maintainer" plastic bagswith a "don't throw this out" symbol to use in a pinch. These are easy to stuff in your pocket, purse, or backpack "just in case."
After the initial period is over, your orthodontist will probably tell you that you can switch to wearing your retainer only at night. Be sure to wear it EVERY night for at least 4 to 6 additional months. After that, if everything seems stable, you can probably switch to wearing it only several nights per week (always be sure to ask your orthodontist what he or she recommends).
Q: If you totally stop wearing your retainer, even after a few years, your teeth may begin to move and shift.
A: This is especially true if you have tongue thrust issues or have had extractions. Unless you want crooked teeth again, or want to go back into braces, wear your retainer regularly for the rest of your life -- at least a couple of nights each week! This isn't as bad as it sounds. It just becomes part of your life -- another way to ensure that your smile stays beautiful and healthy!
If your retainer breaks, call your orthodontist immediately to have another one made. If you can't afford a new one, discuss this with your orthodontist and try to set up a payment plan or work out a financial arrangement.
Q: How do I keep my retainer clean?
A: You should clean your retainer each night as directed by your orthodontist. If you are wearing your retainer around the clock, rinse it with warm water after taking it out of your mouth, and also before putting it back in later! This will help prevent bacterial buildup.
You can brush a Hawley retainer with a toothbrush and a tiny bit of toothpaste, but that is not recommended for a clear Essix retainer, as it can get scratched. Brushing also gets tiresome after a while. The most convenient way to keep your retainer clean is to use a product made for this purpose, or to use denture cleaner. Several great specialty products are available to help keep your retainers clean and free of odor. Four such products are SonicBrite, Retainer Brite, DentaSoak, and Cleanse.Freshen.Go. They work great on all types of retainers and even clear Invisalign -type aligners. SonicBrite includes a portable sonic cleaner. Retainer Brite is a tablet which can be used with or without a sonic cleaner (sold separately). In both these products, the sonic cleaner helps the product to reach all the little crevices in your retainer, cleaning out all the bacteria and dissolving all of the white buildup.
DentaSoakworks with cold water and one batch can be used for an entire week. Cleanse.Freshen.Go. makes convenient retainer cleaning wipes and and an instant cleaning spray which you can take with you "on the go." Both DentaSoak and Cleanse.Freshen.Go. do not contain the chemical Persulfate, which causes some people to have an allergic reaction. So, if you're looking for a retainer cleaner which is Persulfate-free, these two would be a good choice.
She ArchWired.com WebsiteWho owns ArchWired.com? ArchWired.com is owned, designed, maintained, edited, and mostly written by me, Lynn S., a 40-something mother of two in Northern California, who recently had braces for almost three years (I now wear Hawley retainers at night).
ArchWired.com is a non-commercial website. It is owned by a person, not by a company or an organization. The website accepts advertising to help cover hosting costs, but that is separate from the editorial content. At this point, I will also admit that ArchWired.com needs a design overhaul, but it's a huge job because this site has hundreds of pages! Sometime in the near future, I plan to hire a crackerjack web designer to help bring our website up to more modern design standards. In the mean time, please bear with us!
I created this website because I thought there was a need for orthodontic information specifically for adults. I felt so alone in the experience when I first had my braces put on and wanted some support. When I first began my Braces Journal,I had no idea that there were thousands of adults who felt the same way I did!
Since the inception of this website in late 2001 (back then it just consisted of my braces journal), I have received dozens of emails and guestbook entries stating how helpful this site is, and how it has eased many an anxious mind. That makes me very happy and proud, because I created this site to help people. As time permits, I continue to add articles and information.
I am not a doctor or a dentist, but I do know a lot about braces from my own personal experience and from reading the comments and questions of members on ArchWired.com's message board. I used to be a technical writer and trainer (software manuals and courses), and before that I worked in corporate communications. I have a college degree in communications and journalism. In my free time (what little there is of it) I write poetry and songs, and do my best to keep my busy household of two kids in order! I also manage the day to day operations of ArchWired's sister website, DentaKit.com (more on that below).
Input to ArchWired.com from dental professionals -- whether they be dentists, hygienists, technicians, assistants, orthodontists, oral surgeons, etc. -- is always welcomed. I like to think of ArchWired.com as an open world-wide internet community where we can exchange patient-oriented orthodontic information and support each other.
Q: Does ArchWired endorse any products, services, or dentists?
A: ArchWired.com has some advertising, but this should not be confused with endorsement. I strive to keep ArchWired.com a non-biased web site. There is only one product that ArchWired.com overtly endorses. That product is DentaKit Braces Survival Kit, which I created six months after getting braces and realizing a need for such a product.
I created the web store DentaKit.comfor selling that Braces Survival Kit. Over time, DentaKit.com has expanded to carry more than 80 helpful products for people with braces and retainers -- some not found in any other stores. And we've sold our products to people in more than 55 countries across the globe!
Q: Does the owner of ArchWired.com have a braces fetish?
A: (Sigh)No, she does not -- never has and never will.
Q: Braces are impressive little gadgets. Over time, they move your teeth. But how do they do it?
A: Braces have four basic parts (more are shown in this photo):
The teeth move when the arch wire puts pressure on the brackets and teeth. Sometimes, springs or rubber bands are used exert more force in a specific direction. Braces exert constant pressure, which over time, move teeth into their proper positions. Occasionally adults may need to wear headgear to keep certain teeth from moving (see A Few Words About Headgearfor more information).
Your teeth are surrounded on top by gum tissue (also called Gingiva). Under the gum tissue, the Periodontal Membrane (sometimes called the Periodontal Ligament or PDL) encases the bottom portion of the tooth. Next to that lies Alveolar Bone.
When braces put pressure on your teeth, the periodontal membrane stretches on one side and is compressed on the other. This loosens the tooth. The bone then grows in to support the tooth in its new position. Technically, this is called bone remodeling.
Teeth Move Through Bone Remodeling
Bone remodeling is a biomechanical process responsible for making bones stronger in response to sustained load-bearing activity and weaker in the absence of carrying a load. Bones are made of cells called osteoclasts and osteoblasts.
Bone remodeling works like this: increase the load on a bone and osteoclasts are created which break it down in response to the load. Remove the load and osteoblasts are created which create new bony cells. Repeat the process through repetitive motion and eventually the bone density increases.
Your teeth are socketed in bone (your maxilla for the upper teeth, and your mandible for your lower teeth). As mentioned, surrounding each tooth is a Periodontal Ligament (PDL) which attaches it to the surrounding bone.
The PDL as a sort of messenger between the teeth and surrounding bony sockets. Pressure between the PDL and bone causes the bone to create osteoclasts and breakdown the bone to restore the normal spacing between the teeth and bone. The corresponding tension on the PDL behind the movement causes the bone to create osteoblasts, effectively building new bone to fill in the difference and restore the normal spacing between teeth and bone. Not a whole lot of force is necessary, only "some" force which is not normally present.
Enter the brackets and arch wire - the artificial force needed to create and sustain the pressure. Arch wires are interesting things in that they tend to want to retain their normal shape. They are also made of materials activated by body heat to increase stiffness. The wire you have presently is what is called a twist wire which is like a small cable. It wants to remain straight. When it is put onto your teeth which as a braces patient are all over the place, and activated by the heat of your mouth which is 20-25 degrees above room temperature, its desire to remain straight provides the forces necessary to get the biomechanical process of bone remodeling to begin and continue.
The solid wires which come later are made of a nickel-titanium alloy and while so flexible that you can tie a knot in it, once activated by body heat becomes quite stiff. The strategic placement of brackets on teeth and tying of those brackets to this wire complete the transmission of forces from the arch wire to the teeth and sustained result in the awesome process of bone remodeling as your teeth are moved to new positions in your mouth.
The osteoclast (breakdown) process takes about 72 hours to get fully going, the osteoblast (rebuild) process about 90 days. Stabilizing the result takes about 10 months (which is why it is important to wear your retainer to avoid a relapse of the original or some intermediate positions). A Brief History of Orthodontics and Braces
If you think the desire for straight teeth is a trapping of modern society, think again! Extreme Makeovers may be new, but "braces" date as far back as ancient man!
Early History
Even ancient people wanted straight teeth! According to the AAO (American Association of Orthodontists), archaeologists have discovered mummified ancients with crude metal bands wrapped around individual teeth. To close gaps, it has been surmised that catgut did the work now done by today's orthodontic wire! Later, in 400-500 BC, Hippocrates and Aristotle both ruminated about ways to straighten teeth and fix various dental conditions. Straight teeth have been on our minds a very long time!
While Greece was in its Golden Age, the Etruscans (the precursors of the Romans) were burying their dead with appliances that were used to maintain space and prevent collapse of the dentition during life. Then in a Roman tomb in Egypt, a researcher found a number of teeth bound with a gold wire -- the first documented ligature wire! At the time of Christ, Aurelius Cornelius Celsus first recorded the treatment of teeth by finger pressure. Despite all this evidence and experimentation, no significant events in orthodontics really occurred until the much later, in around the 1700s (although dentistry as a whole made great advancements in the interim). It should be noted that in Medieval times, specialized barbers often performed dental "operations", extractions, and procedures such as blood-letting. Let's be glad we live in the 21st Century!
Important Breakthroughs
Even before George Washington wore his famous wooden teeth, dentists were thinking about ways to correct bad bites. In 1728, French Dentist Pierre Fauchard published a book called the "The Surgeon Dentist" with an entire chapter on ways to straighten teeth. Fauchard used a device called a "Bandeau," a horseshoe-shaped piece of precious metal which helped expand the arch. French Dentist Ettienne Bourdet followed Fauchard in 1757 with his book "The Dentist's Art", also devoting a chapter to tooth alignment and appliances. Bourdet was the dentist to the King of France. He further perfected the Bandeau, and is also the first dentist (on record) who recommended extraction of premolars to alleviate crowding. He was also the first to scientifically prove jaw growth. Here's a linkto a series of pages with some fascinating illustrations of early expansion devices.
Scottish surgeon John Hunter wrote (among other surgical books) "The Natural History of the Human Teeth" in 1771, clearly describing dental anatomy. Hunter coined the terms bicuspids, cuspids, incisors and molars. His second book, "A Practical Treatise on the Diseases of Teeth", described dental pathology. Although teeth straightening and extraction to improve alignment of remaining teeth has been practiced since early times, orthodontics as a science of its own did not really exist until the mid-1800s.
In 1819 Delabarre introduced the wire crib, which marked the birth of contemporary orthodontics. The term orthodontia was coined by Joachim Lafoulon in 1841. Gum elastics were first employed by Maynard in 1843. Tucker was the first to cut rubber bands from rubber tubing in 1850. And in the late 1800s, Eugene Solomon Talbot was the first person to use X-rays for orthodontic diagnosis. But all this was nothing compared to advances in orthodontics in the 20th Century.
Daddy-O (as inOrthodontic)
Historians claim that several men deserve the title of being called "The Father of Orthodontics." Fauchard certainly took orthodontics out of the dark ages, but these men really put maloclussion on the map. One man was Norman W. Kingsley, a dentist, writer, artist, and sculptor. In 1858, he wrote the first article on orthodontics, and in 1880, his book "Treatise on Oral Deformities" was published. The second man who deserves credit was a dentist named J. N. Farrar who wrote two volumes entitled "A Treatise on the Irregularities of the Teeth and Their Corrections". Farrar was very good at designing brace appliances, and he was the first to suggest the use of mild force at timed intervals to move teeth.
In America in the early 1900s, Edward H. Angle devised the first simple classification system for malocclusions, which is still used today (Class I, Class II, and so on). His classification system was a way for dentists to describe how crooked teeth are, what way teeth are pointing, and how teeth fit together. Angle contributed significantly to the design of orthodontic appliances, incorporating many simplifications. He founded the first school and college of orthodontics, organized the American Society of Orthodontia in 1901 (which became the AAO in the 1930s), and founded the first orthodontic journal in 1907. A journal and website bearing his name still thrive today. His highly praised reference book, "Malocclusion of the Teeth" went through seven editions. In the wake of all these advancements, the field of orthodontics and dentofacial orthopedics eventually became a respected dental specialty in its own right.
Other innovations in orthodontics in the late 1800s and early 1900s included the first textbook on orthodontics for students, published by J.J. Guilford in 1889, and the use of rubber elastics, pioneered by Calvin S. Case (some believe it was H. A. Baker).
The First Metal Mouths
What did braces look like a century ago? In the early 1900s, orthodontists used gold, platinum, silver, steel, gum rubber, vulcanite (and occasionally, wood, ivory, zinc, copper, and brass) to form loops, hooks, spurs, and ligatures. Fourteen- to 18-karat gold was routinely used for wires, bands, clasps, ligatures, and spurs, as were iridium-platinum bands and arch wires, and platinized gold for brackets. Why gold? It is malleable and easy to shape. Gold had its drawbacks, however -- because of its softness it required frequent adjustments, and it was expensive! Anyway, you guessed it -- these bands wrapped entirely around the each tooth -- the original "metal mouth" was real gold or silver! How's that for bling?
In 1929, the first dental specialty board, the American Board of Orthodontics, was born. On a side note, the first synthetic (nylon)-bristle toothbrush was invented in 1938. Around this time, stainless steel became widely available, but using it for braces was considered somewhat controversial. It wasn't generally accepted as a material for orthodontic treatment until the late 1950s/early 1960s! In addition, you may be surprised to learn that x-rays were not routinely used in orthodontic treatment until the 1950s!
Advancements in the 1970s
Braces continued to wrap around the teeth until the mid 1970s, when direct bonding became a reality. Why did it take so long for dentists to invent the modern bonded bracket? The adhesive! The bonded bracket was actually invented earlier, but the formulation for the adhesive wasn't perfected until almost a decade later. At first, bonded brackets were (of course) made of metal. Like any new method, it took a while for the direct bond bracket to catch on -- which is why some people may remember wearing the old "wrap around" metal braces into the late 1970s.
Around this time, the self-ligating bracket also appeared on the scene. Self-ligating brackets don't need tie wires or elastic ligatures to hold the arch wire onto the bracket -- they are held on by a "trap door" built into each bracket. As early as 1935, the idea of a self-ligating brackets began to take shape. Over the years many designs were patented, but few were commercially available until Ormco created the Edgelock system in 1972. As the 1980s and 1990s progressed, many companies created their own versions of self-ligating brackets and improved upon the idea by offering both passive and active resistance on the arch wire. Nowadays, we have a number of self-ligating choices, such as Orec's Speed Braces, Ormco's Damon System, GAC's In-Ovation, and Adenta's Evolution.
In the 1970s, Earl Bergersen, DDS created the passive Ortho-Tain appliances, which guide jaw growth and help correct orthodontic problems and malocclusions in both children and adults. The Ortho-Tain appliances look like custom plastic mouthguards, and are worn mainly at night, or for only a few hours each day. In many cases, people have been able to correct (or greatly diminish) many types of orthodontic problems with these removable custom-made appliances.
Around 1975, two orthodontists working independently in Japan and the United States started developing their own systems to place braces on the inside surfaces of the teeth -- lingual braces. These "invisible braces" offered people the results of bonded brackets with one big advantage -- they were on the inside of the teeth, so nobody else could see them! In America, the late Dr. Craven Kurz of Beverly Hills California developed the Kurz/Ormco lingual system. In Japan, Professor Kinya Fujita, of Kanagawa Dental University invented his own lingual system, and continues to make great advances in the lingual method.
It takes special training to treat a patient with lingual braces, and many American orthodontists in the 1970s and 1980s were reluctant to use the method -- but orthodontists in other countries readily embraced it, and continued to make advancements with new techniques. Recently, lingual braces have become more popular because technology has made them more comfortable. One example is iBraces, a company which custom-fabricates brackets for a patient's teeth with the aid of digital computer imaging.
Lingual braces were the "invisible" braces of choice until the early 1980s, when "tooth colored" esthetic brackets made from single-crystal sapphire and ceramics came into vogue. Nowadays we also have brackets made from a combination of ceramic and metal -- giving the patient a strength of metal with esthetic look of less noticeable "tooth colored" braces. Recently, a European company even invented a ceramic bracket that is self-ligating!
Invisible Braces via Silicon Valley
As far back as 1945, orthodontists realized that a sequence of removable plastic appliances could move teeth toward a predetermined result. Some orthodontists even made simple plastic "aligner trays" in their offices for minor adjustments. But it took an adult who'd just had braces to take the concept a step further.
Invisalign was the brainchild of Zia Chishti and Kelsey Wirth, graduate students in Stanford University's MBA program. Wirth had traditional braces in high school (she reportedly hated them). Chishti had finished adult treatment with traditional braces and now wore a clear plastic retainer. He noticed that if he didn't wear his retainer for a few days, his teeth shifted slightly -- but the plastic retainer soon moved his teeth back the desired position. In 1997, he and Wirth applied 3-D computer imaging graphics to the field of orthodontics and created Align Technologies and the Invisalign method. With a boost from ample Silicon Valley venture funding, Align soon took the orthodontic industry by storm. Dentists and other dental companies were skeptical at first, because neither Chishti nor Wirth had any professional dental training. Invisalign braces were first made available to the public in May, 2000 and proved extremely popular with patients. Soon similar products began appearing on the market, made by GAC,
The Future: Technology Continues to Advance
NASA developed one of the late 20th century's most dramatic orthodontic breakthroughs: heat-activated nickel-titanium alloy wires. At room temperature, heat-activated nickel-titanium arch wires are very flexible. As they warm to body temperature they become active and gradually move the teeth in the anticipated direction. Because of their high-tech properties, these wires retain their tooth-moving abilities longer than ordinary metal wires and need less frequent attention from the orthodontist. Many orthodontists now employ heat-activated wires in their treatment plans.
What does all this mean for the orthodontic patient of the future? As companies develop more precise, high-tech materials and methods, your braces will be on for a shorter period of time, be smaller and less visible, result in less discomfort, and give great results. We've sure come a long way from the wrap-around "metal mouth" -- and that's something we can all smile about! Wilckodontics/AOO/Accelerated Orthodontics
WilckodonticsTM – also known as Accelerated Osteogenic Orthodontics (AOO)TM – is a relatively new treatment in the orthodontic realm. It promises to radically shorten your time in braces with a dental surgical procedure. This technique has roots in orthopedics, dating back to the early 1900s. Only recently was it modified to assist in straightening teeth and fix bites. This article will help you understand what AOO is, how it is done, and the pros and cons of the procedure. While researching and writing this article, I tried to remain as objective as possible to give you a clear picture of AOO.
Who Developed AOO?
The AOO procedure was developed by Drs. Thomas and William Wilcko, of Erie, PA in 1995. Thomas Wilcko is a Periodontist in practice for 25 years, and his brother, William Wilcko, is an Orthodontist in practice for 18 years. Both were interested in methods of growing bones called Distraction Osteogenesis and Regional Accelerated Phenomenon (RAP), and modified these methods to work orthodontically with limited trauma to the surgical site.
A Brief History of the Technique
Distraction osteogenesiswas first used in orthopedic medicine in the early 1900s, but the method wasn’t widely employed until the 1950s, when Russian orthopedic surgeon Dr. Gabriel Ilizarov perfected the technique. Dr. Ilizarov often did bone surgery to correct deformities and repair defects in arms and legs. While treating a patient with a short amputation stump, Dr. Ilizarov performed an osteotomy – that is, he cut the bone, intending to lengthen it with a bone graft in the middle. He then put a metal frame around the stump, creating a gap (technically called a “distraction gap.” By chance, he discovered that new bone grew in the distraction gap, eliminating the need for the bone graft. Intrigued, Dr. Ilizarov researched the phenomenon and proved that stressing a bone increases metabolic activity and cellular generation, also known in orthopedic science as "bone remodeling," resulting in growth of new bone. The phenomenon was named Distraction Osteogenesis (DO) – growth of new bone by means of surgically "distracting" the bone.
In the early 1960s, craniofacial surgeons began using DO techniques to rapidly expand palates in growing patients. In the 1970s, the technique was introduced to jaw surgery. During the next two decades, interest in craniofacial distraction grew slowly and sporadic experiments were performed, mainly on dogs. In the early 1990s, the technique began to be more widely used on human patients with jaw defects. Meanwhile, distinguished orthopedist Harold Frost realized that there was a direct correlation between the degree of injuring a bone and the intensity of its healing response. He called this the Rapid Acceleratory Phenomenon (RAP). In RAP, there is a temporary burst of localized soft and hard tissue remodeling (i.e., regeneration) which rebuilds the bone back to its normal state.
As early as the 1950s, periodontists began using a corticotomy technique to increase the rate of tooth movement. An oral corticotomy is surgical procedure where cuts are made in the Aveolar bone (the bone surrounds and supports your teeth). In the 1990s, the Drs. Wilcko, using computed tomography, discovered that reduced mineralization of the Alveolar bone was the reason behind the rapid tooth movement following corticotomies. They used their knowledge of corticotomy, and their observations of RAP, to develop their patented AOO technique in 1995.
Q: How Does AOO Work?
A: Unlike a usual corticotomy, AOO doesn’t just cut into the bone, but decorticates it – that is, some of the bone’s external surface is removed. The bone then goes through a phase known as osteopenia, where its mineral content is temporarily decreased. The tissues of the Alveolar bone release rich deposits of calcium, and new bone begins to mineralize in about 20 to 55 days. While your Aveolar bone is in this transient state, braces can move your teeth very quickly, because the bone is softer and there is less resistance to the force of the braces.
Research has shown that after the Aveolar bone heals and the teeth are in their new desired positions, additional Aveolar bone has formed. The Drs. Wilcko, and other researchers have proven that the aftermath of AOO is as stable and long-lasting as conventional orthodontic braces. (A dental student named S.S. Hajji did his Masters thesis at St. Louis University on a comparison of the techniques and found that results were statistically identical between AOO subjects and the conventional orthodontic treatment group). So, after AOO, the Aveolar bone is apparently not only as strong as it was before the procedure (and your teeth held in it just as well), but there is actually more of it-- which is advantageous if your profile needs to be built up to improve your facial aesthetics.
Q: How Long Does Total Treatment Take?
A: Most people who have undergone AOO surgery are in braces from three to nine months. Afterward, they are in retainers for at least six months, or longer.
Q: How Much Does AOO Cost – and Is It Covered by Insurance?
A: AOO is typically about double the cost of a traditional orthodontic treatment. So, if traditional braces cost you $5,000 for two years of treatment, AOO would cost around $10,000 for a three to nine month treatment. Some fees go as high as $15,000. Those costs include the anesthesia, the surgery, and the orthodontic treatment.
Most dental insurance plans don’t cover AOO surgery, because, at the moment, it is viewed as a cosmetic surgery. For example, Delta Dental, one of the largest dental insurers in the US, does not cover AOO. However, you should check with your insurance plan before you make your final decision. Be sure to check your medical plan as well as your dental plan, because some types of dental surgeries or anesthesias are covered under medical health benefits.
If your dental plan covers braces, the orthodontic portion of the procedure (which is roughly half of the total cost) may be covered.
Q: What Type of Doctor Does AOO?
A: AOO surgery can be done by an oral surgeon, a periodontist, an orthodontist, or any dental professional who is versed in oral surgery and has attended the two-day Wilckodontics course. Currently, approximately 300 dental professionals around the world are qualified to do the procedure; about 270 of them are in the US.
Q: How is AOO Surgery Done?
A: AOO is an outpatient procedure done in the office of an oral surgeon or other dental professional trained in the technique. It takes between three and four hours, and is considered a minor periodontic plastic surgery.
Usually, your braces are put on a few days before you undergo the AOO procedure.
After receiving anesthesia, (either general or local, depending on you and the surgeon), the oral surgeon cuts flaps along the surface of your gums and behind your teeth, exposing the bone adjacent to your teeth. Using a surgical bur, the bone is scored. The surgeon then places a bone graft over the bleeding area. The grafting material is mixed with antibiotics to help prevent infection. According to Dr. Thomas Wilcko, who I interviewed as part of my research for this article, the surgery is not difficult for the periodontist or surgeon, but is a bit tedious, as repositioning of the soft tissue can be time-consuming. "(AOO) is not as invasive as taking out teeth," Dr. Wilcko said. "There is some swelling and very little bleeding involved." After the procedure is done, you are usually given a narcotic pain reliever or told to take acetaminophen (i.e., Tylenol). According to Dr. Wilcko, pain relievers like Ibuprofen (i.e., Advil) are not recommended, since they are NSAIDs (Non-Steroid Anti-Inflammatory Drugs). NSAIDs can interfere with the production of prostaglandin hormone in your body and slow down the bone growth process which is vital to AOO. In addition, NSAIDs given during the first 24 hours following trauma (surgical or otherwise) inhibit clotting. Therefore, you should not take NSAIDs on a regular basis before or after undergoing AOO surgery.
After the surgery, you will probably be in no shape to drive, so arrange for someone to pick you up at the surgeon’s office and take you home.
Recovery from AOO Surgery
Total recovery from the procedure takes seven to 10 days. You will probably experience some swelling and need to use ice packs. If you are given a narcotic pain killer, you can take it for up to a week post-surgery. The surgery usually does not result in facial bruising.
During this time, you also use a special prescription mouthwash, because you can’t brush your teeth. Most people get the surgery done on Thursday, and take Friday and the weekend to recover before considering going back to work or school. However, you may want to schedule an entire week off (or do it during vacation time), to ensure that you will be most comfortable. After all, if complications (such as infection) do occur, you probably won’t be able to go to work or classes. And you certainly can’t work, study, or drive if you’re taking a narcotic pain killer.
Orthodontic Adjustments After the Surgery
After you have fully recovered from the procedure, your orthodontist adjusts your braces about every two weeks. Depending on your case, you will wear braces from 3 months up to about 9 months. After the braces are removed, you must wear a retainer for at least six months (although longer is usually recommended).
The same types of braces and retainers are used in AOO as in traditional orthodontics, so you will have your choice of metal or ceramic brackets.
Interestingly, an Austin, TX orthodontist named Albert H. Owen III researched Invisalign treatment in conjunction with AOO surgery. He had some minor crowding in his mouth and had the procedure done on himself (how’s that for dedicated research?!)
After surgery, he used Invisalign appliances to move his teeth. He reported his findings in the Journal of Clinical Orthodontics in June, 2001. Of course, the aligners were changed much more quickly than traditional Invisalign treatment (every 3 to 4 days instead of every two weeks). Dr. Owen was pleased with the result. He concluded that because the aligners had to be worn full-time, this technique required a high degree of patient compliance. He also said that because he didn’t have the AOO surgery done on his entire mouth (only on the areas adjacent to the crowded teeth), the "non-surgery" teeth hurt a lot more than the "surgery" teeth because of the force applied by the aligners. According to officials at Align Technolgies, Dr. Owen is the only dental professional (to their knowledge) that has used Invisalign after AOO surgery.
Patient Qualifications for AOO Treatment
AOO can be done on people of any age, as long as they have a healthy periodontal situation. According to Dr. Wilcko, the technique has been done on children as young as age 11 and on senior citizens as old as 77 (mainly as preparation for dental implants or devices).
You are not a candidate for this procedure if you have dental bone loss, periodontal disease, root damage or poor roots. In addition, if you have a disease such as Rheumatoid Arthritis which requires you to take regular doses of NSAIDs, you may not be a good candidate for AOO.
Dr. Wilcko says that the AOO technique can correct most of the orthodontic problems that are treated with traditional long-term braces. The only exception is a Class III condition, in which the lower jaw is too long relative to the rest of the face, and the chin protrudes. Class III cases have many physical constrains which may not lend themselves to AOO treatment.
Pros and Cons of AOO Surgery
Pros:
Cons:
About the TPA Appliance
The TPA (Trans-Palatal Arch) is a thin wire that goes across the roof of the mouth from first molar to first molar. Most people get a TPA to maintain arch width and aid in molar movement that wires alone can't achieve. In my case, the orthodontist was using the TPA to maintain the width between my first molars and use the immobilized first molars to pull my displaced bicuspid back into line (think of a lever).
The day I got my braces on, the assistant took an impression of my upper arch before the wires were put on. I noticed I had lingual tubes on my first molar bands that would eventually be used to seat the TPA. There are some who have the arch bonded directly to the bands. At my first adjustment, the TPA was sitting in a ceramic mold of my teeth. It looked like someone got bored and started bending one of those heavy gauge paper clips. The orthodontist came over and snapped the ends of the device through the lingual tubes and the assistant used metal ties to secure the arch into place. I was given a slip of paper that instructed me to rinse with salt water if I was in pain and warned me not to play with it because it would only make the soreness wore. I was also told to make sure I chopped long stringy foods (even pasta) into bite sized pieces because trying to unwind something that is wrapped in the roof of your mouth is not attractive or easy. The orthodontist also told me to make sure I brushed my tongue regularly as that is what would help keep my arch clean and odor free.
At first, trying to talk was difficult because this thing was stopping my tongue from hitting the roof of my mouth. The worst for me was probably the "K" sound. However, talking was the least of my problems because the wire presses on your tongue and eventually makes a running U impression (always a hit to show off at family gatherings). The constant pressure caused my tongue to be very sore and swollen. The feeling is like a bad burn. Too bad most numbing gels aren't very tasty because that seemed to be the only thing that gave me some relief while my tongue adjusted to this torture the orthodontist's office put me through.
After a couple weeks the pain went away and I found that no one but me noticed the slight slur of certain sounds. Then, two weeks before my next adjustment, the soreness came back again and I noticed the arch had changed positions just enough to make an impression in a slightly different spot. After that bout of pain went away, it was smooth sailing from there.
Eventually, I did play with it a little just because it was there. I would push on the U portion of the arch with my tongue just to feel the slight pressure on my molars. When I was in the musical mood, I would run my tongue across it just to hear the dull twang.
Sometimes food would get stuck between the arch and the roof of my mouth, especially the sides (thank heaven for proxy brushes). If I wasn't careful, food would also get caught up under the arch and just hang down the back of my throat that lead me to feel like I could choke at any minute.
After four months, the orthodontist hinted that my arch might come out at the next visit if everything looked good. At my next visit, she changed her mind and nothing was mentioned about removing it until I had been wearing the TPA for eight months. I went in for an adjustment the Tuesday before Thanksgiving and the orthodontist looked at my bite up, down, and all around and asked if I would like an early Christmas present. She clipped the wire ties and with a yank on both sides, removed the arch and put it in an envelope for me to keep as a memento of my ordeal.
This is probably one of the few cases where the orthodontist did understand about what I was going through because she had a TPA as an adult as well. Braces and Bisphosphonate Drugs (Fosamax, Boniva, etc.)
If you have osteoporosis or have received cancer treatment, your bone-strengthening medication may put you at risk for a serious dental complication, especially if you need tooth extractions, implants, or other types of dental surgery as part of your orthodontic treatment.
According to the American Dental Association (ADA), a condition called Osteonecrosis of the Jaw (ONJ) has been associated with the intravenous use of bisphosphonate drugs such as Zometa (zolendronic acid), Aredia (pamidronate), Ostac and Bonefos (clodronate). But people taking the drug in oral form as Fosamax (alendronate), Actonel (risedronate), and Boniva (ibandronate sodium), might also be at risk.
In addition, Didronel (etidronate disodium) and Skelid (tiludronate disodium), bisphosphonate drugs used to treat Paget's Disease, have been implicated in causing ONJ.
ONJ Risk Discovered by Oral Surgeons
ONJ is a serious condition in which small areas of bone in the upper or lower jaw become infected or inflamed and die, producing a searing neuralgia-like pain. The condition is irreversible -- there is no cure. Reports about the link between bisphosphonate drugs and "jaw bone death" began to surface in late 2003, when Dr. Robert E. Marx, a maxillofacial surgeon in Florida, wrote a letter to the editor of the Journal of Oral and Maxillofacial Surgery. He realized that he was inexplicably seeing more and more patients with osteonecrosis.
After some investigation, Dr. Marx learned that all the patients had been taking Aredia or Zometa. Eighteen of 36 patients (50%) had multiple myeloma (cancer of the plasma cell). Dr. Marx and others observed that with more than minor dental surgery there was a risk of very poor healing of the jaw. Over time, additional cases have been reported around the world.
Salvatore Ruggiero, Chief of Oral and Maxillofacial Surgery at Long Island Jewish Medical Center in New York had also seen an increase in ONJ among his patients. Most were cancer patients who had received the intravenous bisphosphonates Zometa or Aredia or both for excessive calcium in their blood or bone tumors. But about 10% were osteoporosis patients who had taken an oral bisphosphonate, mainly Fosamax. In May 2004, Ruggiero co-wrote a report on 63 patients with ONJ, which was published in the Journal of Oral and Maxillofacial Surgery. Six had taken Fosamax, and a seventh had taken Actonel. Further study was done and published in the Journal of Clinical Oncology in 2005 and February 2006. The most recent article concluded that "ONJ appears to be time-dependent with higher risk after long-term use of bisphosphonates in older multiple myeloma patients [ages late 50s to early 60s] often after dental extractions. No satisfactory therapy is currently available. Trials addressing the benefits/risks of continuing bisphosphonate therapy are needed."
Most Cases Linked to Intravenous Bisphosphonates Most of the cases of ONJ that have been reported are linked to the intravenous drugs Aredia and Zometa, which are often given to treat such cancers of the breast and prostate, as well as multiple myloma. But there may also be risk for people taking oral doses of bone-strengthening drugs such as Fosamax, Actonel, and Boniva. Some studies have shown that there is very low risk for people taking an oral bisphosphonates. However, lawsuits have been initiated around the country by patients who took Fosamax or Actonel and then developed ONJ or ONJ-like symptoms. Merck, the manufacturer of Fosamax, has said it did not receive any reports of the disease in the more than 17,000 patients who participated in its clinical trials.
Uncommon But Still A Concern
According to a letter in the Journal of Oncology Practice (January 2006),"ONJ is not seen commonly—incidence is estimated at approximately 1% to 10% in patients receiving intravenous bisphosphonates." And apparently there is little evidence that taking oral bisphosphonates such as Fosamax can cause ONJ. However, the evidence was strong enough to force Merck to change its labeling on Fosamax. In January 2005, Merck received a request from the Food and Drug Administration (FDA) to update the label for Fosamax to include bisphosphonate class labeling for ONJ. The new label went into effect in July 2005. Now, all bisphosphonate drugs include a similar warning in their literature. According to the FDA: "If patients on bisphosphonates do require dental procedures, there are no data available on whether stopping the drugs reduces the risk of osteonecrosis of the jaw. The clinical judgment of the physician should guide each patient's management, based on an assessment of benefits and risks."
In a paper published last year in the Journal of the American Dental Association (JADA), a team of dentists and dental researchers speculated that bisphosphonates may inhibit bone growth and decrease the blood flow within oral bone tissue. Bisphosphonates can persist in bone for months and sometimes years after the drug has been discontinued. Presently, no one seems to understand precisely why these drugs cause ONJ. It has been speculated that the risk seems to increase with the length of time a person is on these drugs, and the amount of drug taken.
Symptoms, Risk Factors, and Treatment
If you have been treated with a bisphosphonate drug, the symptoms of ONJ you should look for include:
Some possible factors that may increase the risk of developing ONJ include:
ONJ can be treated with antibiotic therapy, prescription periodontal mouth rinses, and removable mouth appliances (such as mouthguards). Surgery can make the condition worse, although sometimes it is necessary to remove dead tissue. However, at present there is no cure for the condition.
The American Association of Endodontists (AAE) recently issued an official statement on the subject, warning of the risks. AAE President Marc Balson, D.D.S. said, "With this position statement, we hope to ensure the highest quality care and safety for patients taking bisphosphonates.” He went on to say,“Until further information becomes available, the AAE recommends that all patients taking bisphosphonates be considered at some risk for ONJ, recognizing that the magnitude of the risk varies by patient. The AAE also encourages patients taking bisphosphonates to inform their dental care providers and consult with specialists as needed,” he said.
Thanks to the AAE's public education efforts, articles warning the public of the risks associated with bisphosphonates have been published in the Wall Street Journal, the New York Times, the Los Angeles Times, by United Press International, WebMD.com, the Chicago Tribune, the Las Vegas Journal Review, and USA Today, among other publications.
A Risk For Orthodontic Treatment?
What does this mean for the adult orthodontic patient?Simply this: if you have taken or are currently taking a bisphosphonate drug, you should tell your orthodontist and your dentist. This is especially important if you plan to have any type of jaw surgery, implants, or tooth extraction.
So far, no conclusive data have surfaced linking ONJ to "normal" non-surgical orthodontic and dental treatment (where no tooth extractions or jaw surgery is required). One short research project was done jointly by the Medical College of Georgia and the University of Alberta, Canada. Published in March 2005 by the journal of the International Association for Dental Research, the study concluded "...that orthodontic treatment may be contra-indicated when taking [Fosamax or Evista]..." If any new information becomes available, we will publish it on this website.
If your dentist is not familiar with the condition, tell him to go to the website for the American Dental Association or the International Myeloma Foundation, where he can find more information. Or, you can print this article and show it to him. A Few Words About Headgear
Headgear is typically used in growing patients to correct overbites by holding back the growth of the upper jaw, allowing the lower jaw to catch up. Headgear needs to be worn approximately 10-14 hrs to be effective in correcting the overbite, usually anywhere from 6 -18 months depending on the severity of the overbite and how much a patient is growing.
Headgear is also used in adults, but for a different reason. A typical scenario is a case where some teeth are extracted, and front teeth are being retracted (pulled backward). When extraction spaces are being closed, the teeth behind the extraction space slide forward and the teeth in front of the space slide backward. In some situations, to maintain the bite, the orthodontist will not want the back teeth to come forward. The headgear serves to hold them back (maintain anchorage). Orthodontists will want those patients to wear the headgear as much as they can. Realistically for most adults this might only be 8-10 hours per day, but the more the better; even 24 hours would be acceptable.
Soreness of teeth when chewing, or when the teeth touch, is typical. Adults usually feel the soreness 12-24 hours later, but younger patients tend to react sooner, (e.g., 2-6 hours).
The soreness/tenderness may persist for several days. Usually, the second and third days are the most severe, with reduction in soreness over the next couple of days. Ibuprofen and soft diet are helpful. There is also a device called a "bite wafer," which is a soft U-shaped piece of rubber which patients can gently squeeze their teeth into. The bite wafer keeps the blood circulating around the teeth and lessens the time teeth might be sore.
Typically, soreness from the headgear and elastics will attenuate and disappear after a few days, but it may persist for as long as a couple of weeks. Very few patients complain of having sore teeth essentially the whole time. Once the soreness is gone, it is not uncommon for soreness to flare up again, usually just involving a few teeth. Then the soreness disappears again. Soreness tends to leapfrog among different teeth at different times as a result of tooth movement.
The key to the fastest relief of tenderness is to continue the wear headgear/elastics even though the teeth are sore. If you stop wearing the headgear or elastics, your teeth will feel better temporarily, but as soon as you resume wearing your headgear, the symptoms will start all over again. Adrian Vogt, DDS, MSD; grew up in Hong Kong and eventually moved to Canada, where he attended Western Ontario University. From there, he went on to finish at the top of his class at the University of the Pacific School of Dentistry, concluding his studies there with a Master’s degree from the graduate orthodontic program.
When can my child brush and floss their own teeth?
We recommend that parents brush their children's teeth for the first five to seven years of life, since young children lack the manual dexterity of proper tooth brushing. The toothbrush should be a child's size, with soft nylon rounded bristles. Toothpaste should not be used until the child is able to spit (three to four years of age) to avoid swallowing it. A pea-sized drop should be dispensed by the parent for young children. Flossing should be performed by the parent prior to brushing. Most children lack the proper manual dexterity to floss on their own until the age of 10 and will need a parent's help and supervision. Why are baby teeth important? Don't they fall out?Baby teeth serve the important function of eating, speech and aesthetics (self-image). These teeth not only help form the developing jaws, but they hold space for the permanent teeth so that a normal bite occurs. The last baby tooth falls out at about 12 years of age. A decayed baby tooth can become so badly decayed that it can do damage to the permanent tooth. At times severe infections of the face, head and neck can be caused by infected baby teeth. What are the signs of teething, and what can I do to make my child more comfortable?The signs of teething are drooling, irritability, restlessness and loss of appetite. Fever, illness and diarrhea are not symptoms. If your child presents with the latter signs, they need to be evaluated by his or her pediatrician. The best solution to comfort the child is to have the child chew on a cold or frozen rubber teething ring. Topical anesthetics are not recommended. I have heard that a nursing bottle can cause cavities on toddlers. At what age should I take my child off the bottle?Your child should stop using a bottle when they are old enough to hold a cup. This usually occurs around one year of age. After this age a child should not be placed to sleep with a bottle because this may cause dental decay, increase the incidence of ear infections, and prolong the use of the bottle. If you put your child to sleep with a bottle, the best way to stop this habit is by placing only water in the bottle, or progressively diluting it until it is all water. Then be firm with the child. Juice or milk in a cup will not cause the severe decay that a bottle will. This may cost the parents a bit of sleep, but it is important for future dental health. My child sucks his/her thumb or finger. What effect can it have on the bite, and when should I work on stopping the habit?
Most children stop sucking their fingers between the ages of three to five. Sucking of a finger can have a significant effect on the bite. Flaring of the upper front teeth producing a protrusion, and backward positioning of the lower front teeth are common. Also a crossbite or narrowing of the upper jaw can occur producing an openbite, where the front teeth don't touch. The amount of these bite effects depend on the frequency, how long the child does it each time, and intensity of the finger habit. If your child continues this habit past the time of the eruption of the first permanent tooth, then it can have a permanent effect on the adult bite. The habit should be stopped before these teeth come in. From a preventive point of view, infants should be given pacifiers, as they will do much less harm than finger habits, and most children will discontinue their use earlier. My child's permanent lower front tooth is coming in behind his baby tooth. What should be done?If the baby teeth are moderately to very loose, there is no immediate treatment. Patience is recommended. This is a normal process. The tongue will push the permanent lower front teeth forward. If the teeth are not very loose, your child should be seen to take an X-ray and evaluate the situation. My child is over one year old and has no teeth. Should I worry?
Even though most children that age have a number of teeth, some children may have delayed tooth eruption. There is usually no concern about this. Should I be giving my child fluoride drops or tablets?No, if the water supply in your area is fluoridated. If you are not sure if your water is fluoridated, contact your local health department. When should my child first visit the dentist?How can you prevent dental caries?
If you have a sensible diet, a good flow of saliva, a cleaning routine and your teeth get an appropriate fluoride exposure, you are unlikely to get decay. So, you can prevent decay by:
1. being careful with how often you eat sugary foods or have sugary drinks. How can you prevent dental caries?
If you have a sensible diet, a good flow of saliva, a cleaning routine and your teeth get an appropriate fluoride exposure, you are unlikely to get decay. So, you can prevent decay by:
1. being careful with how often you eat sugary foods or have sugary drinks. What is Cosmetic Dentistry?
In today’s age of technology, your dentist has a range of options to help your teeth look great. Stained teeth, dark teeth, chipped teeth, crooked teeth, and even teeth that are missing altogether, can be repaired or replaced. Cosmetic or aesthetic dentistry is the broad heading under which many dental procedures that improve the appearance of teeth may be described. What are the latest developments in cosmetic dentistry?
The latest developments in dentistry include tooth whitening treatments, micro-abrasion, bonding and veneers. These techniques can whiten and improve the shape and colour of your teeth, even close gaps.
a. Sometimes dentists will 'kick-start' the whitening in the surgery with high-strength bleach gels in the trays.
Home bleaching works in most cases although the result depends on the initial level of staining of the teeth and the type of staining. It is less predictable on teeth that contain some specific discolourations such as those caused by tetracycline intake in childhood. Home bleaching usually takes about two weeks, wearing trays either during sleep or for a few hours a day, depending on the technique. Home bleaching will not whiten fillings, and it may be necessary to have visible tooth coloured fillings replaced with ones that more closely match the final tooth colour after whitening is completed.
Who does cosmetic dentistry?
All general practice dentists use bonding as part of their everyday practice and are trained in and quite skilled at the above procedures.
What is dental caries?
Dental caries, or dental decay, is a common disease, which causes cavities and discoloration of both permanent and "baby" teeth. As the disease progresses in a tooth it becomes weaker and its nerve may be damaged. What causes dental caries?
Dental decay occurs when bacteria in the mouth make acid which then dissolves the tooth. Bacteria only produce this acid when they are exposed to sugar. What causes dental caries?
Dental decay occurs when bacteria in the mouth make acid which then dissolves the tooth. Bacteria only produce this acid when they are exposed to sugar. What is the best way to whiten the teeth?
There are many excellent ways to whiten the teeth and all have advantages and disadvantages. Since each case is different there is no one best way.
On the other hand, when staining is actually in the tooth, below the surface, there are a number of ways to whiten the teeth. Sometimes simply replacing old, worn out fillings that are failing at the edges can produce better looking front teeth. Alternatively, when the enamel is heavily stained, crowns or facings may be the best option. ADA dentists have access to continuing education in the latest dental techniques and they can give advice as to the best choices for you. What is dental caries?
Dental caries, or dental decay, is a common disease, which causes cavities and discoloration of both permanent and "baby" teeth. As the disease progresses in a tooth it becomes weaker and its nerve may be damaged. What is home bleaching?
Home bleaching involves wearing very thin, transparent plastic trays molded to your teeth, which are used to hold a bleaching agent in contact with the tooth surface. They are normally worn for approximately ten days.
What is a bridge?
A bridge is an appliance permanently fixed in the mouth to replace missing teeth. It uses remaining teeth to support the new artificial tooth or teeth.
How effective is home bleaching in whitening the teeth?
Home bleaching does not make the teeth as white as chalk. If it did the teeth would not look natural. Usually the whitening is subtle, but a real difference can usually be noticed between, for instance, upper teeth that have been bleached and lowers that have not. Home bleaching seems to be slightly more effective for younger rather than older people. Why are crowns more expensive than fillings?
A crown is more complicated than a filling. Laboratory fees are incurred in its preparation and the materials used are more expensive than normal filling materials.
Is home bleaching safe?
Yes. Hydrogen peroxide (the whitening agent) is actually produced in the body in small amounts and the effects have been studied for many years. Dentists know that the whitening process should not be abused, because bleaching teeth well beyond the recommended level can lead to damage of the enamel. When bleaching is carried out according to an ADA dentist's instructions, it appears to be a safe, simple procedure.
How long does the bleaching last?
This may vary depending upon the circumstances, however teeth can still become dirty and they will continue to age in a normal way with the passage of time. You should keep the trays and obtain new bleach stocks from your dentist to repeat the whitening periodically (usually once a year). The trays will continue to fit your mouth for many years in most cases. What is a crown?
Dental crowns (also sometimes referred to as ‘dental caps’ or ‘tooth caps’) cover over and encase the tooth on which they are cemented. Dentists use crowns when rebuilding broken or decayed teeth, as a way to strengthen teeth and and as method to improve the cosmetic appearance of a tooth. Crowns are made in a dental laboratory by a dental technician who uses moulds of your teeth made by your dentist. Are whitening toothpastes very effective?
Whitening toothpastes are really aimed at whitening stains that are on the surface of the teeth, not whitening into the tooth surface. Whitening toothpaste needs to be in contact with the teeth for many minutes to have the slightest effect. The active ingredients of bleaching toothpastes are present in much lower concentrations than those in home bleaching kits, and they tend to be quickly washed off the tooth surface by saliva. Many people choose whitening toothpastes because they may get some whitening as well as the benefits of fluoride in the paste. Which dentist can bleach my teeth?
All dentists have the skills to assess your teeth for whitening and advise you on the chances of a good result. It largely depends on how badly your teeth are stained and what colour they are naturally as to whether the treatment will work. It is best to see your dentist and discuss your options. What type of forces cause teeth to crack?
Front teeth usually break due to a knock, an accident or during biting.
Why does a cracked tooth hurt?
The crack will expose the inside of the tooth (the 'dentine') that has very small fluid filled tubes that lead to the nerve ('pulp'). Flexing of the tooth opens the crack and causes movement of the fluid within the tubes. When you let the biting pressure off the crack closes and the fluid pressure simulates the nerve and causes pain. How can I prevent my teeth from fracturing?Most fractures cannot be avoided because they happen when you least expect them. However, you can reduce the risk of breaking teeth by
How does the dentist treat a cracked tooth?
It depends on the direction and severity of the crack. If the crack is small enough, it may be removed by replacing the filling. Bonded white fillings and bonded amalgam fillings will hold the tooth together making it less likely to crack.
The nerve may sometimes be affected so badly that it dies. Root canal treatment will be required if the tooth is to be saved. Will my tooth become better?
Unlike fractures elsewhere in the body, this crack will never heal. There is a small chance that the crack will get worse even with a crown placed. This may lead to the need for root canal treatment, or even removal of the tooth. However, many cracks can be fixed without root canal or tooth removal. Why is saliva important?
Saliva is the best natural defense against decay. The acid from bacteria can be neutralised by saliva. A reduced flow of saliva (dry mouth) can increase your risk of decay. Causes might include: 2. Excessive intake of caffeine. Caffeine is found in coffee, tea, chocolate and cola drinks. It draws fluid from the body and reduces saliva. 3. Working in a dry environment and not rehydrating often enough 4. Some specific diseases or conditions such as Sjogren's syndrome
What happens when my saliva is not adequate?
In the mouth, there is a constant demineralisation (tooth being dissolved by acids) and remineralisation (tooth being re-deposited on the teeth from saliva). If your demineralisation is happening at a greater rate than remineralisation, you get loss of tooth substance. How important is my diet in preventing and treating dental caries?
Being careful about how often you have sugar in your food and drinks is the best way to prevent and treat dental caries.
> Rinse your mouth with water after having sugary food or drink > Have a small amount of cheese after sugary food or drink. This will help to neutralize the acid produced by oral bacteria. > Using sugarless chewing gum may help protect your teeth by stimulating extra saliva. Saliva is very important in protecting your teeth from decay. > Do not put any sugar or other sweeteners in babies' bottles. > Remember the drying effect of excess caffeine. > Remember that smoking changes the saliva to a more harmful consistency. How do dentists treat dental caries?
Early dental caries is reversible. Mineral can be deposited back onto the tooth surface if you can modify your diet and oral hygiene. Your dentist can treat early areas of caries with topical fluoride, and if you are careful with your diet and cleaning no other treatment may be required.
A more advanced area of dental caries will require a "filling". Your dentist will remove the damaged and infected soft tooth structure and repair the tooth. It is important to have this done as early as possible to preserve the strength of the tooth and prevent bacteria damaging the tooth pulp.
What should I do in a dental emergency?
Toothache: Very persistent toothache is always a sign that you need to see a dentist as soon as practicable. In the meantime, you should try to obtain relief by rinsing the mouth with water and trying to clean out debris from any obvious cavities. Use dental floss to remove any food that might be trapped within the cavity (especially between the teeth). If swelling is present, place a cold compress to the outside of the cheek (DO NOT HEAT). Take pain relief if necessary, using pain medicines that you know you are safe with. Remember, no pain relief tablets will work directly on the tooth. They must be swallowed as directed. If placed on the tooth, they can cause more trouble (especially aspirin). If a wire is causing irritation, cover the end of the wire with a small cotton ball or a piece of gauze or soft wax. If a wire is embedded in the cheek, tongue or gum tissue, DO NOT attempt to remove it: Let the dentist do it. If there is a loose or broken appliance, GO TO THE ORTHODONTIST OR DENTIST. Knocked out tooth: If dirty, rinse tooth in milk holding it by the crown (not roots). If not available use water (few seconds only) or have patient suck it clean, then put the tooth back in the socket. If the tooth cannot be replanted, wrap in Glad Wrap or place it in milk or in the patient's mouth inside the cheek. Go to a dentist within 30 minutes if you can. Time is critical for successful replanting.
Broken tooth: Try to clean debris from the injured area with warm water. If caused by a blow, place a cold compress on the face next to the injured tooth to minimize swelling. Try to find all the bits that are missing and bring them to the dentist, keeping them moist. Some broken bits can be bonded back onto the teeth almost invisibly. Go to the dentist as soon as practicable.
Apply direct pressure to bleeding area with a clean cloth. If swelling is present, apply cold compress. If bleeding doesn't stop readily or the bite is severe, go to the dentist or hospital.
Try to remove the object with dental floss. Guide the floss in carefully so as not to cut the gums. If unsuccessful, go to a dentist. Hey, do those whitening toothpastes really work?Over-the-counter whitening toothpastes have only been shown to whiten teeth two shades. In contrast, a dentist-supervised tooth whitening system can whiten teeth 12 to 15 shades. What’s up with these multiple varieties of toothpastes anyway? You’ve got your “tartar control,” your extra whitening, your mint flavor gel, etc. How do I know which toothpaste to buy these days? Help!
That’s a good question. The type of toothpaste you use should be based on the condition of your teeth and gums. Your dentist is the best person to suggest what toothpaste you need based on the condition of your mouth. I would point out, however, that the frequency of brushing, flossing and regular visits to the dentist play a much greater role in improving oral health than which brand of toothpaste you are using. I’ve heard that you aren’t supposed to have your teeth cleaned while pregnant. Is this true? Why?
No, that is not true. In fact, hormonal changes during pregnancy can make the gums more susceptible to irritation and inflammation. You should have your teeth professionally cleaned at least twice during pregnancy. It is recommended that routine checkup X-rays be avoided during pregnancy. If a tooth is infected, however, dental X-rays can safely be taken without any danger to the unborn child. I use mouthwash and it actually hurts my gums when gargling. Is this normal?
Yes, some people do experience discomfort when using mouthwash at full strength. I recommend that you dilute the mouthwash with water by at least 50 percent (half mouthwash, half water). That should solve the problem. I would also recommend that you see your dentist to evaluate your teeth and gums. Is it safe for small children under the age of 8 to use mouthwash?
I would not recommend the routine use of mouthwash unless directed by your dentist. If a mouthwash is recommended, its use should be supervised with small children. What are some alternatives to braces? Also, if my dentist tells me I need them, should I get a second opinion?
If your dentist believes that you need braces, you should go to an orthodontist for his or her opinion. If the teeth need to be straightened, there are some alternatives to braces that your orthodontist can offer. One recent development is that the orthodontist, working with a high-tech lab, can make a series of customized mouthguards (clear acrylic) that can move the teeth and straighten them in some cases. If you are looking for a cosmetic alternative to braces, porcelain veneers can also make teeth appear straight without the use of braces. Good luck! I’m quite a chain smoker and I’m getting my wisdom teeth removed this weekend. My dentist warned me not to smoke for a while after the procedure, but I know I will. Is it really that bad? Will a few cigarettes cause problems?
Yes, smoking after dental extractions can increase the rate of complications. Some of the complications that can occur from smoking after oral surgery include increased bleeding and increased likelihood of a painful infection of the extraction socket (dry socket). If you must smoke and know that you cannot stop for 24 hours, my only suggestion would be to take very light drags of the cigarette and direct the smoke away from the areas where the teeth have been removed. However, it is best to stop smoking for at least 24 hours after the procedure. What can I do if I'm scared about dental treatment?The best way to overcome your fear is to discuss your concerns with your dentist. This will obviously be a team approach between you and your dentist and his/her staff. Communication is the key. You must feel comfortable expressing your fears and concerns and have a sense that you are being listened to. There are various forms of anaesthesia and relaxation that can be used effectively to change your negative thoughts into a positive experience.
Do all dentists use "happy gas"?"Happy gas", "laughing gas", "relative analgesia", "nitrous oxide" are all describe the same form of sedation which can be used for patients who are apprehensive of treatment done with local anaesthesia. Can I have my dental records?
A patient's dental records and x-rays are the property of the dentist.
What are Dentures?
A denture is an appliance that replaces teeth. You remove it to clean it and it may be replacing all the teeth (full denture) or some of them (partial denture). What is the difference between a denture and a crown or bridge?
Removable dentures are those dentures (plates) the wearer can remove and replace at will. These types of dentures can replace one tooth, all your natural teeth, or any number of missing teeth in between. A crown or a bridge is fixed or cemented in place and cannot be removed. What steps are involved in getting a denture?
Before any denture treatment is undertaken, it is recommended that you have a thorough dental check-up. If you are having full dentures, it will involve an examination of the mouth and an assessment of the health of the gums.
How are dentures made?
Many removable dentures rely on some of your remaining natural teeth to help keep them in. Your natural teeth were never designed to help support a denture. In most cases, some minor modification of your natural teeth would be desirable to improve the wearability and life of your denture. Your dentist has the required training to be able to modify your teeth to ensure the highest quality removable denture is constructed around your natural teeth. How long will I have to go without any teeth?
Some removable dentures are made to be inserted immediately after the removal of a tooth or some teeth. These types of removable dentures are commonly termed ‘immediate dentures’. They can be constructed to replace only one tooth or many teeth. Your local dentist can undertake all the required stages involved in immediate dentures. This will mean that one person will oversee the whole treatment, assuring you of the highest possible standards. How often should I have my denture checked?
If you currently wear removable dentures of any kind, it is advisable that you have these checked regularly. It is recommended if you have any remaining natural teeth you should have these and your dentures reviewed every six months or as directed by your dentist. If you have no natural teeth and wear removable full dentures, your dentures should be reviewed at least every two years. Why does my denture need to be relined?
The rapid shrinkage of bone following extractions means the denture will soon need to have the fitting surface relined once that shrinkage has slowed down enough. After a reline, patients report a much better fit. This relining maybe done between three and six months after an immediate denture has been fitted. Your dentist will advise you when an immediate denture is ready to be relined.
How long after fitting can I keep going back to have my new dentures adjusted free of charge?A dentist will be happy to see you and make any necessary adjustments free of charge in the initial stages of fitting your denture. The number of visits you will require is related to the nature of the job and your dentist will be the best person to advise you about this before you proceed. What is a filling?
A filling is a plug of material that is placed into a tooth to replace missing tooth substance and/or structure. Can all teeth with holes or fractures be filled?
Most teeth with small to moderate decay or fractures are easily restored to function with fillings. Where decay is extensive or fractures are large, more complex treatment may be required. Some teeth can be so badly broken down or fractured that they are unable to be saved. Can fillings be repaired rather than replaced?
Some fillings can be repaired when they fracture, or the tooth around them fractures, but only if there is no tooth decay present. How are fillings done?
Tooth preparation, prior to filling placement, is usually done under local anaesthesia (making the tooth numb). Once all the decay is removed and the tooth is washed and dried, the filling is packed into the cavity and it sets.
How do I know if I need a filling?
You may not know if you need fillings in your teeth. Many small to medium holes in teeth are asymptomatic, giving no pain. In fact, decay can sometimes eat out two-thirds of the tooth from the inside and you would have no idea it is happening.
How long do fillings last?
The position, shape, material, and functioning pressure, all influence how long dental fillings will last. Larger fillings that bear a heavy functional load tend to break down more quickly than smaller fillings that bear little force. This is why it is impossible and meaningless to try to state categorically how long fillings should last.
Is it possible to avoid fillings?
With proper attention to diet, oral self-care, regular dental check-ups, and the correct use of mouthguards to prevent injury, the need for fillings can be eliminated, and the frequency of filling re-placement can be extended. Should baby teeth have fillings too?
Yes, baby teeth should be filled to prevent toothaches, to maintain the baby teeth for eating, and to hold the right amount of space for the adult teeth. If the baby teeth are going to be exfoliated (fall out) soon, then it is not always necessary to fill the teeth. This should be discussed with your dentist. What are fillings made of?
Dental amalgams (silver fillings) are made from a silver/tin/copper alloy that is mixed with mercury. The alloy is in powder form prior to mixing with the mercury, which is liquid at room temperature. Are there alternatives to water fluoridation?
There are no other cost-effective preventive schemes that benefit the total community like water fluoridation. Health conscious parents and individuals outside fluoridated areas can use personal fluoride supplements such as tablets and drops. But they do not work as well as fluoride in drinking water, are more expensive, require continuous motivation and compliance, and only reach a small part of the population. There is also the danger of accidental overdose with any tablets or drops. What is fluorosis?
Dental fluorosis is seen as small white flecks in the surface enamel of teeth. In minor cases it is usually not visible to patients but in more advanced cases it appears as large white patches or occasional pits in the tooth surface. After some years, stains may penetrate the white patches and they can appear brown.
Does My Water Filter Remove Fluoride?
Some filters do and it is important to check with the manufacturer or supplier. Common questions about fluoride
Q: What Is Fluoride?
A: Fluoride is the ion that comes from the naturally occurring element, fluorine. Fluorine is never encountered in its free state in nature because it combines with other elements as fluoride compounds in the earth. Water dissolves these compounds, creating fluoride ions that are present in all water sources, including the oceans.
Q: How Does Fluoride Stop Tooth Decay?
A: Fluoride reduces the number of cavities an individual will develop in their life by about half. This is because it makes the enamel of the tooth more resistant to the acid attacks of plaque bacteria. Resistance occurs initially when the fluoride is incorporated into the teeth during their formation and secondly, as fluoridated water washes over the surface of the erupted teeth.
Q: Are Some People Allergic To Fluoride?
A: There has never been a case of an allergy to fluoride. If a person was allergic to fluoride they could not drink present water supplies because all water contains some fluoride. Similarly, because of its natural abundance in nature, fluoride is contained in virtually all food and drinks. People allergic to fluoride would also be allergic to tea, coffee, mineral water and seawater.
A: There are no other cost-effective preventive schemes that benefit the total community like water fluoridation. Health conscious parents and individuals outside fluoridated areas can use personal fluoride supplements such as tablets and drops. But they do not work as well as fluoride in drinking water, are more expensive, require continuous motivation and compliance, and only reach a small part of the population. There is also the danger of accidental overdose with any tablets or drops.
Q: How Much Fluoride Is In Fluoride Toothpaste?
A: Children's toothpaste contains between 400 and 500ppm (parts per million). One part per million is the equivalent of one milligram per litre. Adult's toothpaste contains between 1000 and 1100ppm. Toothpaste should not be used on children under the age of two years. Over two years of age only a 'pea-sized' smear of toothpaste should be used, as young children have not developed an adequate spit-out mechanism.
Dental fluorosis is seen as small white flecks in the surface enamel of teeth. In minor cases it is usually not visible to patients but in more advanced cases it appears as large white patches or occasional pits in the tooth surface. After some years, stains may penetrate the white patches and they can appear brown.
How much fluoride should I give my child?
Given at optimal levels, fluoride can strengthen teeth and help prevent tooth decay. The correct amount of fluoride to give your child depends upon his or her age and whether or not the local water contains fluoride. Your dentist is the best person to advise you on the amount of fluoride needed to meet your child’s needs.
Who should use fluoride toothpaste?
Regardless of the presence or absence of water fluoridation, or the taking of fluoride supplements, everyone should be encouraged to brush their natural teeth with fluoride toothpaste. Where can I find more information on fluoridation?
The following website provides extensive information on fluoridation: Common questions about water fluoridation
Q: What Is Water Fluoridation?
If you are not sure whether you water supply is fluoridated, check with a local dentist or your local water supply authority.
0.3 - 0.5 mg/litre 0 0.25mg 0.5 mg More than 0.5 mg/litre 0 0 0
Q: Who Benefits From Water Fluoridation?
A: People of all ages benefit from water fluoridation.
Children benefit from the tooth decay preventive effects of water fluoridation with less tooth decay in their first and second set of teeth. Existing fillings in teeth last longer where water is fluoridated as there is less decay starting again where the filling meets the tooth surface.
A: No. Fluoridation is not mass medication any more than other disease prevention health measures. It is not a 'foreign chemical' in a water supply, but a naturally occurring element that reduces dental disease. Along with pasteurisation, water purification, and immunization, fluoridation is considered one of the four most important and successful public health measures of the twentieth century. Q: Does My Water Filter Remove Fluoride?
Filters That Remove Fluoride: Ion Exchange Filters Reverse Acinous Filters and Distillers
Carbon Filters Ceramic Filters
Q: Are There Any General Health Side Effects?
A: No. Drinking optimally fluoridated water is not harmful to human health.
Q: Has The Issue Been Fully Investigated In Australia?
A: Five major inquiries have addressed the issue of water fluoridation in Australia. Most were prompted by claims that new evidence showed water fluoridation to be either harmful or ineffective. Each investigation took many months to examine all available information. All the inquiries found the allegations to be unproven and fluoridation to be safe, effective and economical.
> Report of the Committee of Inquiry into the Fluoridation of Victorian Water Supplies for 1979-80 (Melbourne, 1980),
> Report by the National Health Medical and Research Council on the Effectiveness of Water Fluoridation (1991). See NHMRC document ‘The Effectiveness of Water Fluoridation’.
Q: Who Supports Fluoridation?
A: Water fluoridation is supported by the World Health Organisation (World Health Assembly, 1978), the Australian Dental Association, the Australian Medical Association and the National Health Medical and Research Council.
Q: How Cost-Effective Is Water Fluoridation?
A: Water fluoridation is the most cost-effective and socially equitable method of tooth decay prevention for all members of a community.
Cost varies with the size of the population fluoridated, but averages about $1 per person per year according to American figures (Garcia, 1989). Therefore it is likely to cost less to provide a lifetime of fluoridation to an individual than it costs for a single dental filling. CONCLUSION: Water fluoridation is a safe, equitable, cost-effective public health initiative that responsible state and local governments should implement to reduce dental pain and disease throughout Australia.
My son hates the fluoride treatment, even though it's supposed to taste good. He's 10 years old and his dentist recommends this treatment for at least another four years. Should we stop any sooner?
No, I do not recommend stopping any sooner. In fact, I recommend continuing fluoride treatments until he's age 18. Professional fluoride treatments are essential for strengthening teeth and helping to prevent cavities in the future.
You might consider asking your dentist for a different flavor of fluoride. Perhaps other people do not like the taste of the brand that he uses as well. I would caution, however, that your son should not swallow the high concentration fluoride used in the fluoride treatment. It can cause upset stomach. I haven't been to the dentist for years and it shows, but I would like to start going. Besides brushing and flossing, can you recommend a good way for me to get them in a little better shape before I visit a dentist? I am embarrassed to go as they are right now.
Aside from brushing and flossing, there is really no other way to improve the overall appearance of your teeth and gums. I think what you are really concerned about is that the dentist will scold you about the condition of your teeth. Every day in my office, people come in with that same fear. I remind them that I've seen teeth in far worse condition than what they have come in with -- from teeth that are all black and broken down to no teeth at all. Your teeth will not shock the dentist, I can assure you. You need to find a dentist who has a reputation for being skilled, caring and compassionate. That should allay any of your fears about coming to the dentist. Good luck! I've been wearing a retainer behind my lower teeth for several years. The retainer was put in after my braces were removed. I've left the retainer in for fear my teeth may separate if removed, but if it's no longer needed, I would like to have it removed.
A permanent retainer is useful in preventing teeth from shifting after braces have been removed. They can present a problem because they collect food and plaque and make cleaning the teeth more difficult. You should ask your family dentist and orthodontist whether they feel that the retainer can be removed at some point. Sometimes, a removable retainer can be made and only worn part time to prevent teeth from shifting. Is drinking a lot of soda bad for the teeth?
Yes, any sugar-containing beverage can increase the risk of tooth decay. Drinking soda with frequent sips throughout the day is more harmful than drinking it all at once in one sitting. The reason is that every time the sugary solution contacts the teeth, bacteria in the mouth can use that sugar to create damaging plaque acids. These acids cause dental cavities. If you drink soda, you should brush your teeth directly afterwards. Can you recommend a dentist to me?
As our members pay to be a part of our Association, it would be unethical of us to recommend one of our members over another. Choosing a dentist is a personal thing, and what works for one person may not work for another. It is most important that you find a dentist that makes you feel comfortable. The Association recommends you talk to family and friends about their dentist. How do I find a good dentist?
10 TIPS ON FINDING A GOOD DENTIST
Look for an ADA (Australian Dental Association) Member.ADA Members- agree to abide by a code of ethics- participate in on-going education.
Ask your friends, neighbors, co-workers, family doctor or previous dentist for their recommendation.
Will your dentist be located near your home or work? Will the surgery be convenient for you? Ask about the availability of after-hours emergency services.
Consider the friendliness and helpfulness of the dentist and his/her staff. Are they willing to answer your questions and readily provide information?
Is the practice clean, tidy and hygienic? If you have questions on infection control are they answered? Are instruments sterilsed? Do staff wear gloves and masks, and offer you protective eyewear?
Does the dentist appreciate that your time is important, allowing, of course, for the unpredictability of some procedures, e.g. emergencies?
Does your dentist take interest in your medical and dental history and listen to your concerns about having dental treatment?
Does the dentist examine all your teeth and your gums thoroughly and regularly?
Does the dentist present you with treatment options and explain them so that you understand? Does the dentist give you pre-treatment cost estimates and inform you of variations as they occur? Does the dentist have a long-term view of your dental health - with a plan that you arrived at together, including seeing you regularly to help maintain optimal health? What is a dental specialist?
Dentists who undergo further training after their initial dentistry degree are called specialists. Dental specialists restrict their practice to a specific area of dentistry. Your local dentist has had extensive training to be an “oral physician”. This training enables your dentist to treat you as a person and understand all your dental requirements. In most cases, your local dentist will be able to undertake most of your treatment needs. In some cases, he or she may elect to have the assistance of specialist dentists to ensure you receive the highest quality treatment. There are many forms of dental specialties, some of which are outlined below.
Oral Pathologists diagnose pathological conditions in the mouth. Dental Radiologists provide specialist diagnosis.of xrays.
Who will treat my disabled child?
Not all dentists have the facilities to treat disabled children. Some children and adults may need general anaesthetic before a dentist can treat them. Contact the Australian Dental Association office in your state for a dentist in your area that may be able to help you. I have a question about dental assisting — can you help me?
ADA has limited information about dental assisting, as we are primarily a professional association for dentists. We are able to answer some queries regarding industrial relations and awards, employment and training. Contact the Dental Assistants Association in your State; they may be better able to answer your questions. Some ADA State Branches also have information on dental assistant employment and training. Are amalgam fillings harmful?
Some people claim that the mercury in dental amalgam can cause or affect a wide range of medical conditions. In providing advice on this matter to its member dentists, the ADA draws its opinion from credible scientific and medical bodies such as the World Health Organisation and the National Health and Medical Research Council (NHMRC) in Australia.
Does a dentist provide a guarantee for workmanship?
No treatment can be "guaranteed", either in terms of its 'cure' or by a length of time.
Gum Disease Introduction
Teeth are meant to last a lifetime. Periodontal disease (previously known as Pyorrhea) is a major cause of tooth loss in our population. Most of the time, periodontal disease is preventable. What is gum disease?"Gum disease" describes a range of conditions that affect the supporting tissues for the teeth. The supporting tissues comprise both the surface tissues that can be seen in the mouth and also the deeper tissues of the bone, root surface and the ligament that connects the teeth to the bone. What causes periodontal disease?
Periodontal disease is caused by bacteria. Bacteria form a ‘plaque’ which is a sticky, colourless film that forms on your teeth, particularly around the gum line. Other bacteria thrive deep in the gap between the gum and the tooth (the ‘pocket’). Some people are much more at risk of developing periodontal disease — smoking is one of the major risk factors. Other conditions such as diabetes, stress, pregnancy and various medications can all be contributing factors. What are the most common forms of periodontal disease?Infection affecting the surface tissues is called Gingivitis. This may progress to affect the deeper supporting tissues and is called Periodontitis (previously called pyorrhea). The effects of gingivitis are largely reversible with appropriate care. Once this has progressed to periodontitis there is permanent damage to the ligament and bone that supports and holds the teeth. Often a space develops between the gum and the tooth called a pocket. The pocket forms a protected environment for more bacteria and the condition progresses. If left untreated periodontitis may cause abscesses and tooth loss. Can gum disease be treated successfully?
Yes. In the vast majority of cases the progression of gum disease can be arrested with appropriate care. Management of gum disease becomes more difficult and less predictable the more advanced the disease. Therefore, the sooner periodontitis is diagnosed and treated the better. Regular dental examinations are important to check for the presence of gum disease.
My gums bleed. Is that OK?
No. Bleeding gums are common but not OK. In a healthy state gums do not bleed. Bleeding is often an indication that the gums are inflamed. The inflammation is generally a response to the bacteria on the surface of the teeth. The surface inflammation is Gingivitis. The bleeding may also arise from Periodontitis or traumatic cleaning. Bleeding gums are sometimes associated with serious medical conditions. My mother lost her teeth when she was pregnant. Will that affect me?
There is no reason why a pregnancy should cause you to lose your teeth unless you ignore them totally.
Who gets periodontitis?
Anyone. Many people will have a small amount of periodontitis, which gradually increases with age. However approximately 15% of the population will have a significant degree of periodontitis. The destruction of the tooth's supporting tissues caused by periodontitis gets worse over time when left untreated, and is often seen more severely in the 45+ age group. However the different types of periodontitis may affect people of all ages.
What are some of the warning signs of periodontal disease?
What can you do?
Visit your dentist, who will examine your gums as part of a normal dental check-up. X-rays are often needed to help diagnose any gum problems.
Implants Introduction
Whether you have lost all your teeth, a few of them, or even just one tooth, dental implants should be considered as an option for your oral rehabilitation program.
What is a dental implant?
A dental implant can be thought of as an artificial tooth root that is submerged into the jawbone. When dental work such as a crown, fixed bridge or a full set of dentures is added, one or more missing teeth can be replaced. A dental implant is fabricated from a very strong, biocompatible material placed in a simple procedure that, generally, is as convenient as a tooth extraction. After an initial healing period, during which the implant is buried in bone and left undisturbed under gum tissue, it is uncovered and connected to a small metal post that secures and supports the artificial tooth.
How long does it take?
It depends on the type of bone, and where the implant is placed into your jaw. It can range from a few months to over 9 months. Generally, implants in the front lower jaw need around 4 months; the back upper jaw needs around 9 months and elsewhere in the mouth around 6 months. These times may need to be lengthened if bone needs to be grown or grafting has taken place. Is everyone suitable?
Some people may not be suitable for this procedure. Conditions such as alcoholism, some psychiatric disorders and uncontrolled diabetes can cause problems. Your dentist will also need to check to see how much bone you have and whether there is enough space for an implant. The adjacent teeth roots will also need to be away from the implant. If you don't have enough bone, it is possible to grow bone or even graft bone from elsewhere in the mouth or places like your hip. What are the advantages of the implant treatment?
The adjacent teeth are not damaged or cut in any way. It helps to prevent bone loss. Implants are also used to stabilise loose dentures or even replace them with fixed bridges What happens if an implant fails?
This means the implant has not attached or integrated to the bone. It usually fails at the second stage surgery. The failed implant is unscrewed, the bone left to heal for a while and a new implant placed. Other options such dentures or bridges are also available What is the procedure for implant treatment?
The gum is folded back and the bone drilled to receive the implant. You may have this done in the chair with local anaesthetic or go into the hospital for a general anaesthetic. The implant is generally covered over and left to heal until the implant is osseointegrated. Your oral surgeon or periodontist may also leave the implant uncovered by the gum at this first stage. A second operation may then be needed to uncover the top of the implant. Your dentist or prosthodontist can usually start construction of your crown or a bridge after a month. What is the success rate?
The success rate depends on where in the jaw the implants are placed. The lower jaw has a very good chance of success (98%). The further back in the mouth you go, the lesser the prognosis, but this is generally over 90%. If you smoke, the chances of success drop by at least 10%. Why is implant treatment expensive?
Because it is a complex process requiring expensive precision components and instruments. Why dental implants?
A dental implant is the closest thing to a natural tooth your dentist can give you. They feel much more natural and secure than traditional removable dentures, especially if these are loose fitting because of extensive bone loss. If several adjacent teeth are missing, a fixed bridge may be attached to dental implants as an alternative to a removable partial denture plate. Dental implants allow for the replacement of a missing tooth without modifying adjacent teeth. Your dentist will be happy to discuss alternatives for restoring your dental function with you. Are implants complicated?
The simple answer is no, if sufficient bone is available to accept the implant. The procedures can all be done in the dental surgery, using only local anaesthesia. In the first stage of surgery, the implant root component is inserted into the bone site.
How long will an implant last?
This is impossible to predict. Though research has demonstrated a long life once the implants have been integrated with bone, each patient is different, and longevity may be affected by overall health, nutrition, oral hygiene and tobacco usage. Individual anatomy, the design and construction of the prosthesis and oral habit s may also have an influence. What is the cost of an implant?
In general, costs are closely comparable to those of other prostheses involving fixed bridgework. The uniqueness of each patient’s restorative needs means this should be discussed with your dentist. Are there any limitations?
Discuss this with your dentist, as there are a few medical reasons preventing the use of implants. Sufficient bone to accept the implant is the major limiting factor. This can be assessed radiographically (x-rays), and bone can even be augmented where it is deficient. Are dental instruments sterilised after each use? AnswerDentists use an autoclave that is a steriliser which uses steam under pressure to achieve a rapid high heat sterilisation of instruments. Do dentists and assistants have to wear gloves during treatment?
Gloves should be worn wherever there is a risk of exposure to blood or body substances, which is almost always the case. Should dentists and patients wear protective eyewear and face shields?
Such protection should be worn during procedures where splashing, splattering or spraying of blood or other body substances may occur. Where can I get more information on infection control in dentistry?
The National Health and Medical Research Council document "Infection Control in the Health Care Setting - Guidelines for the prevention and transmission of infectious disease" is available from "Australian Government Publishing Service", telephone 132 447, at a cost of $12.95 Injuries Introduction
Injuries can occur almost anywhere, not just when playing sport. So, it is important that you know how to deal with an injury to the mouth and teeth. What do I do first?
This is dependent on the severity of the problem. If there is a slight bruise or cut to the lip or tongue there may be no need for treatment. More severe lacerations will require treatment by your doctor of dentist. Any chips or fractures of teeth should be assessed and /or treated by a dentist. Traumatic injuries to the teeth and oral structures must be followed up in order to assess healing of tissues and provide further definitive treatment where indicated. What if a tooth is broken, loose or missing?
It is common for a small chip to break from a tooth, a tooth to fracture, a tooth to be pushed out of position, or a tooth to be completely knocked out. Generally speaking, you should not try to replace a loose baby tooth, but you should always make an appointment with your dentist to have it checked. However, a loose, displaced, or knocked out adult tooth is a different story and requires immediate attention from your Dentist! What can be done?
Small chips broken from teeth do not normally require urgent treatment. Often your dentist will just need to smooth the rough edges, or if the chips are larger, repair them with some tooth coloured resin. Make sure you try to find all the broken bits as some pieces can be re-bonded to the tooth with excellent results.
Teeth that have been displaced are easiest for your dentist to reposition very soon after the injury, so it is best to seek immediate treatment. Will a root canal be necessary?
Your dentist will monitor the vitality of any injured tooth and advise you if endodontic (root filling) treatment is necessary.
Will laser treatment mean I don't have to have the drill?
The ADA is waiting for further research to be conducted before it formulates its policy on the use of laser treatment in dentistry.
I want to find out which dentists use laser treatment — can you help me?
The ADA does not keep a register of the equipment used in each member’s practice. What is a mouthguard?
A mouthguard is a removable rubber or polyvinyl shield worn over your teeth, most commonly the upper teeth, to protect the teeth and jaws from traumatic injury during sporting activities. Are there different types of mouthguards?
There are two basic types of mouthguards available:
Do mouthguards come in different colours?
Custom mouthguards are available in a variety of colours. Popular team colours from AFL, ARL and NBL teams are also available. For which sports is a mouthguard recommended?
Mouthguards should be worn during any sport where there is the chance of a knock to the face.
How do I care for my mouthguard?
After use, mouthguards should be rinsed in cold, soapy water. They can be disinfected occasionally with a mild disinfectant solution or mouth rinse.
How long will my mouthguard last?
For adults, a mouthguard can last several years depending on the frequency of use. If major changes occur to the teeth, such as large restorations or loss of teeth, the mouthguard may not fit as well as originally and may need to be replaced. If the mouthguard material has been bitten through during use it should also be replaced.
How much will a custom fitted mouthguard cost?
The cost of providing a mouthguard will vary from dentist to dentist, but would be no more than the latest pair of sporting shoes. It would be best to contact your local dentist to find out their charges. But remember, whatever the cost, it will be minimal compared with the cost of repairing broken teeth with bonding, root canal treatment or crown and bridge work, not to mention the heartache and inconvenience. Where are mouthguards available?
Most dentists are able to provide custom fitted mouthguards. It requires a brief visit to take impressions of your teeth. Usually, the mouthguard will be ready within a few days. Why do I need a mouthguard?
Teeth are at risk of damage when playing sport and can result in long and potentially expensive treatment to restore them to normal function and appearance.
Will a mouthguard affect my speech or breathing?
A properly fitted custom made mouthguard will not affect breathing and should only minimally affect your ability to talk. What if my child has bands on the teeth?
If the child is in the middle of orthodontic treatment, they may be encouraged to avoid contact or collision sports for the duration because of the potential of lip lacerations. However, there are ways of making mouthguards that still fit reasonably well if sport must continue. What is oral and maxillofacial surgery?
Oral and maxillofacial surgery encompasses the art and science of diagnosis, surgical and related treatment of diseases, injuries, deformities, defects, and aesthetic aspects of the oral and maxillofacial area. The word "maxillofacial" refers to the jaw and face. What does it mean to be board certified?
Your board-certified surgeon has graduated from an accredited dental school and is licensed in the state in which he or she practices. In addition, this individual has completed an oral and maxillofacial surgery residency program approved by the American Dental Association's Commission on Dental Accreditation.
What services do board-certified oral and maxillofacial surgeons provide?
Removal of Diseased and Impacted Teeth -- Oral and maxillofacial surgeons remove impacted, damaged and non-restorable teeth.
What is Oral Pathology?
Oral pathology / oral medicine is a specialty area of dentistry that is concerned with the health of the mouth and the diagnosis and management of diseases of the oral region. It may also include the oral and dental treatment of patients who are medically compromised, that is, those that have serious medical problems. What are the most common types of oral pathology?
Dental decay and periodontal disease are the most common diseases in the oral cavity, but there are other diseases that can affect the mouth and surrounding structures. Some of these conditions may be painful or result in gingival (gum) bleeding or halitosis (bad breath), which may prompt the patient to seek treatment. Other conditions, however, may give no symptoms until late in their course, or may be a manifestation of an underlying systemic disease. It is very important to have regular dental examinations to check on the health of both the teeth and soft tissues of the mouth, as early diagnosis of problems often results in better treatment. What about oral cancer?
Cancer can occur anywhere in the mouth and is often painless in the early stages. The major risk major risk factor in western countries being tobacco smoking. Cancers of the lower lip occur more commonly in people who have a high exposure to UV sunlight, such as outdoor workers. By not smoking and always using sun protection on exposed skin and lips, patients can decrease their risk of developing these cancers. Your dentist will examine and assess any non-healing ulcer or change in the appearance or texture of the skin. In most cases, the earlier the treatment, the better the outcome. Cancer of the mouth is both a preventable and potentially curable disease if it is detected early enough. Why doesn't my toothache go away and what can I do about it?
There are a number of conditions that can cause pain which seem to be associated with a tooth. These conditions are associated with nerve injury and are not tooth-related, although the pain may seem to be in the tooth or gum. Trigeminal neuralgia is the most commonly known condition. It is characterized by sharp electric-like pain that is often confused with a cracked tooth. Another toothache-like pain is atypical odontalgia. The pain of this condition is continuous and aching and is not electric-like. Often the pain will briefly subside when dental work is done in the area, only to return. These conditions cannot be treated with dental procedures or extraction of teeth. The treatment involves taking medications that control nerve activity. What is fibromyalgia and myofascial pain and why is it worse when I am stressed?
These conditions are similar, but Fibromyalgia implies widespread chronic muscle pain, and Myofascial pain is more localized or regional muscle pain. When patients have either problem, the muscle is tender and hard bands of muscle fibers can often be felt in the body of the muscle. This is caused by the shortening of some of the muscle fibers. One on the common signs of myofascial pain is limited range of motion and pain due to the muscle fiber shortening. When an individual reacts to stress, the muscles often tighten, aggravating any areas of myofascial pain. In addition, it is known that stress decreases the body's ability to modulate or filter out pain. Both Fibromyalgia and Myofascial pain is best treated by stretching the painful muscles and employing stress management techniques. Where can I read more about these problems?
Whether you are a patient or a consulting doctor or dentist, the best approach to getting current information about any topic is to conduct your own search of literature at a good biomedical library using medline or a similar service. What is orthodontics?
Orthodontics is the specialty of dentistry that involves the treatment of malocclusion, which is when the upper and lower teeth or jaw do not meet correctly. Individuals may need to be treated by an orthodontist if they have problems with their bite (such as an over or underbite), crooked teeth or overcrowding in the mouth. An orthodontist may move the teeth into position or correct the bite using braces, which are appliances bonded to the teeth and use brackets, wires, rubber bands or other ways of moving the teeth. An orthodontist may also use removable appliances to reposition the teeth. In more serious cases, a patient may need jaw surgery to align the bite. Children and adults can be treated for malocclusion. A dentist or orthodontist can perform an initial evaluation to determine if braces are needed. What if my teeth are not straightened?
Left untreated, an individual may suffer from chewing or jaw (TMJ or temporomandibular joint) problems because the bite is off, increased tooth decay because teeth may be difficult to clean, or gum disease. An individual with crooked teeth and an unattractive smile may suffer from low self-esteem, social problems or even depression. What are the types of problems?
There are three main types of malocclusions, including: Type I -- The upper and lower jaw are proportionally related from front to back, but there are problems with the teeth lining up straight within the jaws. Type II -- The upper jaw is too far forward and/or the lower jaw is too far back resulting in an overbite, and there may also be problems with alignment of teeth. Type III -- The upper jaw is too far back and/or the lower jaw is too far forward resulting in an underbite, and the teeth may also be crooked. When should treatment begin?
It's never too late to correct the teeth and bite. One Chicago area dentist reports successfully treating a 78-year-old woman with braces. Interceptive treatment (first stage) may begin with the baby teeth or later on permanent teeth. A dentist or orthodontist should evaluate a youngster by the age of 6. The dentist will analyze the problem and determine when treatment should be started. Every case is different and there is no blanket rule that applies to the treatment of malocclusion. Treatment depends on the severity of the problem.
As a general rule, however, functional problems -- such as TMJ disorders, tongue thrusting or speech/lip function problems -- are usually corrected at an early age, such as 6 to 9 years old. Skeletal or structural problems, such as when the teeth and jaw don't line up, are generally corrected at a later age when the permanent teeth are available. How long will treatment take?
It's impossible for an orthodontist to project the actual treatment time. In most cases, however, treatment will range from 15 to 48 months for those with severe problems. In calculating total treatment time, the "resting stages" between multi-stage treatment periods (when the teeth are not actually being moved), should not be included. If a patient does not follow instructions from the dentist (e.g., to wear rubber bands or appliances), treatment may take longer. If the interceptive stage is a success, subsequent stages may be avoided. An orthodontist develops a tailored treatment plan for each patient. How effective is treatment on adults?
More and more adults are getting braces. There is an array of treatment options for adults on the market -- including ceramic braces and removable appliances -- but they may have limited applicability and effectiveness. Many dentists report that metal braces are still the most effective and least expensive option. What is orthodontics?
Orthodontics is the branch of dentistry that specialises in the diagnosis, prevention and treatment of dental and facial irregularities (malocclusion). It generally involves the use of such things as braces, removable appliances, functional appliances or headgear to move the teeth or jaws into an ideal relationship. What is a malocclusion?
Malocclusion is a technical term for crooked, crowded or protruding teeth that do not fit together properly. These problems may be inherited or acquired. Common malocclusions include crowding of teeth, prominent teeth, too much space between teeth, extra or missing teeth and a variety of irregularities of the jaws and face. Thumb sucking, tongue thrusting, dental disease, premature loss of primary or permanent teeth, or accidents can cause malocclusions. What are the benefits of orthodontic treatment?
Orthodontic treatment is frequently performed to improve a person’s appearance by straightening the teeth. However, an attractive smile is just one of the benefits. Crowded and overlapping teeth are harder to clean and can increase the risk of tooth decay, gum disease and eventual tooth loss. Having your teeth straightened will make it easier for you to look after them.
Who can benefit from orthodontics?
At one time, most people believed braces were only for children. However, teeth can be moved at any age as long as the gum and bone is healthy. Because the basic process involved in moving teeth is the same in adults as in children, orthodontic treatment can usually be successful at any age. However, because an adult's facial bones are no longer growing, some severe malocclusions cannot be corrected with braces alone. In such cases, orthodontic treatment combined with jaw surgery can achieve dramatic improvements. When should orthodontic treatment begin?
It is usually wise to have an orthodontic consultation around nine years of age. Some orthodontic problems are easier to correct if detected early, rather than waiting until jaw growth has slowed. Early examination allows the orthodontist to detect and evaluate problems and plan appropriate treatment. Early treatment may prevent more serious problems from developing or make treatment at a later age shorter and less complicated. However, in other cases, treatment will not commence until all the baby teeth have been lost. What are ‘braces’?
Braces are the most efficient and accurate way of moving teeth. Brackets are adhered to each tooth with special dental glue and are usually made of stainless steel or a clear plastic material. These brackets act like a handle on the tooth so that it can be moved into its correct position using wires. The brackets remain on the teeth for the entire duration of treatment. Generally adjustments are made to the braces every four to six weeks.
How long will I need to wear braces?
On average, orthodontic treatment is approximately eighteen to twenty-four months in duration. However, the length of treatment will depend on the severity of the original malocclusion as well as the type of treatment carried out, and the co-operation of the patient.
Are there any risks involved in orthodontic treatment?
Yes. Successful orthodontic treatment depends on the understanding and cooperation of the patient. Although there are many benefits to be gained from orthodontic treatment, there are also potential risks associated with this type of treatment. Although these risks are generally not serious, they still should be considered when making the decision to undergo orthodontic treatment.
Who does Orthodontics?
Any dentist may carry out orthodontic treatment, but the vast majority of cases are handled by specialist orthodontists who have restricted their practice to orthodontics exclusively.
Can anyone have orthodontic treatment
Generally orthodontic treatment is best carried out in children, but many adults have orthodontic treatment too.
Orthodontic treatment involves a full examination of your teeth, which includes taking x-rays and making plaster models of your teeth from impressions, and possibly taking photographs. Where may I obtain more information on Orthodontics?For more information on orthodontic treatment, talk to your dentist or make an appointment with an orthodontist. What are Orthodontic Spacers?
Your orthodontist may have told you that you need to have spacers before your braces go on. What does this mean?
Some of your teeth may need brackets that are attached to metal bands that go all the way around the tooth.* Usually, the bands are used only on molars. If the space between your molars is very tight, it will be difficult for the orthodontist to put the bands on the teeth. Therefore, space must be opened up to fit the bands in. This is where spacers come in.
Spacers are little rubber nodules that fit between the teeth. In some cases, your orthodontist may use a metal spacer, which looks like a tiny metal hinge. The spacers stay between your teeth for several days and move the teeth apart slightly. You wear the spacers 24/7 until your orthodontist removes them. Do not floss teeth that have spacers between them (it will be impossible)!
Are spacers uncomfortable? Yes, they usually are. It feels like you have something stuck between your teeth -- and you do! In some cases it may be more than just uncomfortable; it may ache. If so, take pain reliever (such as ibuprofen) as needed.
Spacers usually stay between your teeth for several days; sometimes for as long as 10 days. The spacers are taken out before your braces are put on. The braces don't hurt like the spacers; in fact, when the spacers are removed, it feels so much better, even after the braces are put on!
Many people on Metal Mouth Forum have remarked that spacers were the worst part of the entire process. Perhaps that's not very encouraging, but remember, they're only in your mouth for a short period of time. You can deal with it. They'll be in, then they'll be out, and you'll be done with it. Hang in there, you're on your way to a better smile!
*Why do some teeth need metal bands instead of regular brackets? Fillings. If you have a filling that protrudes to the outside of your tooth, brackets cannot be glued to these fillings. Therefore, a metal band must be wrapped around the tooth instead. The bracket is attached to the metal band. About Tightening/Adjustment
Every 4 to 6 weeks, you go to your orthodontist to get your braces "tightened" or "adjusted." Sounds awful, doesn't it? Well, cast aside your visions of Medieval torture devices. Nothing is really "tightened." It's really very simple.
This is usually what happens during an orthodontic adjustment:
That's it! Do your teeth hurt? Take some pain reliever to help you deal with it. The discomfort will probably last a few days, then dissipate. You may need to eat only soft foods for a few days. Protein shakes, such as the Atkins or Slim Fast shakes, made ideal meal replacements if chewing even soft food is uncomfortable. Within a week, most people an usually eat normal food again. After a few months, adjustments won't hurt as much (really!)
After you have had braces for more than 6 months, your teeth get used to the extra pressure. At this point, an adjustment might not hurt at all, but your teeth usually feel sore for about a week afterwards. For some people, the teeth don't feel sore again until the next adjustment. But for others, the pain dissipates for a week or two, and then a week before the next adjustment, the teeth are sore again. Why is this?
The cell regeneration process occurs after an adjustment. Your teeth are under force and move and causes some cells (bone, tissue) to break down and new cells to regenerate. After the regeneration happens the teeth and supporting structures begin giving and moving again and the cycle continues. This is why most orthodontists see patients every 4-5 weeks. The cell regeneration process typically takes about 3 weeks and that gives patients enough time after an adjustment to be ready for another one.
Because today's wires move teeth slowly over a long period of time, the whole cell regeneration doesn't stop/go/stop/go as it used to with older style wires, now it just moves your teeth continually. Movement continues until the wire is fully back to the original size and shape, at which time you are ready for a stiffer and larger arch wire. Can I Change My Own Ligatures? (o-rings)
Here's a topic that comes up frequently on our Metal Mouth Message Board: changing your own ligatures (or powerchains).
Let's say you ate some curry and now your ligatures ("o-rings") are stained. They look yucky. You really want them to look nice again. Hey, maybe you could go online and buy some ligatures to change them yourself! After all, who wants to walk around with yucky looking ligatures for weeks on end until the next ortho appointment? How hard can it be? Well, it's not so simple and it's not a good idea, according to several orthodontists as well as a website that sells ligatures!
Dr. Christopher Jernigan, DMD of Columbia, South Carolina says, "Changing ligatures yourself seems harmless but you could be adversely affecting your treatment. When a ligature is used it begins to stretch and "decay" (as well as discolor). At this point the force applied to your teeth is "deactivating". This is normal and healthy. Many times at an adjustment, all we do is re-tie your ligatures. In effect, doing this at home is actually reapplying new forces to your teeth not under the supervision of an orthodontist. If things were moving poorly at first then one could be making it worse by re-ties at home.
Dr. Jeffrey S. Genecov, DDS, MSD, FICD, FACD of Dallas, Texas adds, "Any damage that's done to the braces, having them come loose, accidental injury, etc from unpracticed hands could slow down and extend treatment times. While all of these skills are learned and learnable, this what we do every day all day. That's why in my office we encourage patients to come in and have their ligatures changed whenever they need to -- and also one reason why we're almost 75% using self-ligating brackets."
Several other orthodontists and dentists were asked the same question and all agreed that changing your own ligs is not a good idea. In addition, the owners of JawProducts.com, a website that sells ligatures stated, "We do not recommend you changing your ties yourself. Please follow the advice of your orthodontist." Help! Did I Stain My Braces?
One of the most common questions we get involves ceramic brackets stained from foods, particularly curry. Well relax, your brackets are NOT stained. The brackets themselves are still white, but the elastic ligatures have become stained. The ligatures are those little rubber bands on each bracket that hold the arch wire in place.
Yes the brackets will look stained. But believe me, in most cases, it's only the elastic ligatures. And those get changed by your orthodontist every 4-6 weeks. So the next time you have an adjustment, the stained ligatures will be replaced with fresh new ones and your braces will look white and perfect again.
But what if it will be weeks until your next adjustment? How can you get rid of stains from curry, mustard, coffee, tea, or smoking? Well, here's the bad news: it's very difficult. You can try brushing with whitening toothpaste, but that has very limited results. The yellowish tinge will probably still be visible to some degree. If you have an important engagement and need your braces to look white again, you must visit your orthodontist and get your ligatures changed.
Here are some suggestions to help you avoid this problem in the future:
Soft Food Suggestions
The first weeks or months in braces can be frustrating because you can't eat some of the normal food you enjoy. And once your teeth stop hurting, the pain may return for a few days when you get an adjustment, putting you back on a soft food diet. Some of the suggestions on this page will help you deal with those painful days.
Remember that whatever you eat, cut it into small pieces and chew carefully and slowly. To get more protein into your diet, try adding protein powder or tofu to some of your meals or drinks. All About Power Chains
Your orthodontist may have told you that you need to have power chains on your braces. What does this mean?
Power chains are made of the same type of elastic material as the elastic ligatures (the o-shaped elastics that hold your arch wire to each bracket). In essence, power chains are like a bunch of ligatures linked together. Placed on your teeth, they form a continuous band, from one tooth to the next. Usually, you wear power chains instead of ligatures. Sometimes, your orthodontist can put both a ligature (or tie wire) and power chains on your teeth. It depends on what is attempting to be accomplished. Occasionally, some orthodontists decide to give you "power chains" made of wire (where a continuous piece of wire is twisted around each bracket).
Why would you need power chains? The most common reason is to close a gap between your teeth. Power chains apply extra force and help move your teeth faster. If your treatment includes extractions, then power chains will probably be in your future. Sometimes your orthodontist may keep the power chains on, even after the gap has closed. This is to ensure that the gap remains closed for the balance of your orthodontic treatment.
Power chains are changed just like elastic ligatures -- at each orthodontic adjustment. Like elastic ligatures, they come in a variety of colors, and yes, they DO stain from coffee, tea, red wine, and most notably, curry. From trial and error, I have found that the best colors for power chains are silver or smoke. You can also try light blue (the ones in the above photo). Light blue will stain bright green with curry, but after a few brushings, will turn a pleasant dull light teal. (Like ligatures, the "tooth-colored" chains will stain bright yellow if you eat curry; I don't recommend them unless you do not eat curry at all).
Power chains come in three different types. The best way to describe them is with a simple illustration:
000000000000000 0-0-0-0-0-0-0-0 0--0--0--0--0--0
Your orthodontist will determine which type of power chain best fits your needs.
Now here comes the most important question: how do they feel? Do they hurt? When you first get them put on, yes, they do make your teeth ache. You may need to go back on a soft food diet for a few days. But if you've already had braces for a few months, the pain should subside quickly -- within a week at the most.
How long does it take for the power chains and braces to close extraction gaps? Each person is different. Some people see dramatic changes in a few weeks. For others, it can take 6 months or more. Your orthodontist can measure (in millimeters) the width of your gaps at each appointment. You may be surprised to realize that the gaps are indeed closing, even if you don't see progress yourself!
Is it harder to clean your braces with power chains? Only slightly harder. You get used to it. A little more food debris gets trapped, but it's rather inconsequential. Ouch, I Have a Canker Sore!
Canker sores. Everybody hates them. When you have braces, you hate them even more. Before we go into ways of treating canker sores, let's explore the reason we get them in the first place.
Canker sores are the most common type of mouth ulcer. It is a misconception that they are a form of herpes virus. This is not true, and canker sores cannot be passed between people.
Nobody knows for sure what causes canker sores, but there are many theories. For example, it is believed that toothpastes and mouthwashes containing sodium lauryl sulfatecan dry the mouth tissues and encourage canker sores. Stress, immune system reactions, family history, and mouth trauma may cause them. Women may sometimes get them at certain points in their menstrual cycle from hormonal changes and fluctuations. Some food allergies or intolerances (such an intolerance to gluten or Celiac Disease) may be responsible. In addition, deficiencies of vitamin B-12, zinc, folic acid or iron may play a part.
The presence of other ulcerative diseases, such as Crohn's Disease, IBS, or digestive ulcers may have an effect as well. Doctors now believe that some of these ulcerative diseases may be caused by H. pylori and other bacteria. A simple blood test will tell you if you have H. pylori bacterium, which is treated with oral antibiotics. If you get frequent mouth sores that do not heal well, especially if you also have other ulcerative or digestive problems, you should talk not only to your dentist about it, but your medical doctor, because it could be a symptom of a larger problem.
But no matter the cause, canker sores are bothersome and painful, especially if they occur inside your lip near a bracket.
Most canker sores last 10 to 14 days and can be treated with over-the-counter remedies. If you get frequent canker sores, talk to your dentist about it, because there are some prescription-strength products that he/she might recommend instead, such as Amlexanox (Aphthasol)or Debacterol®. Doctors also use steroids such as dexamethasone (Decadron)mouth rinse or prednisone (Orasone)tablets. Antibiotics, such as tetracycline (Sumycin) mouthwash, are also sometimes prescribed.
If you get a canker sore only occasionally, you can treat it with many products readily available without a prescription at your local pharmacy or on the Web. There are many options. The following list isn't meant to endorse any of these products, it's just to inform you about what's currently on the market:
Try several remedies and see what works best for you. If the canker sore is irritated by a nearby bracket, you can also ease the pain by applying plenty of dental wax or dental silicone on the offending bracket. This forms a barrier between your the bracket and the sore. Doing this, in combination with the remedy of your choice, will help heal the sore. Changing Orthodontists During Treatment (Moving)
It happens sometimes: we begin orthodontic treatment, and life takes us to a new destination. Changing orthodontists mid-treatment can be tricky. You have all this stuff in your mouth, and somebody has to take care of it!Here are a few suggestions to make things easier for everyone.
Most orthodontists work on a "pay as you go" plan. In other words, you pay a certain amount of money at the outset of treatment (for the molds, consultations, and having the braces installed). Then, each month, you pay a percentage of the rest of your balance. So, if you move away from your orthodontist, be sure to tell him/her ASAP so that you will not be charged extra. You orthodontist will probably "pro-rate" your balance or refund some of your money. Be sure to ask what your doc's policy is in this situation!
2. Get your records. Request your dental records and x-rays, or ask your orthodontist to forward them to your new orthodontist once you arrive at your new location.
3. Try to identify a new orthodontist before you move, if possible.
Your current orthodontist may know of a colleague in your new area. If you have friends or relatives in your new area, that's a good resource, too. Other ways to identify a new orthodontist include:
4. Get them talking to each other.
Orthodontists vary in their treatment approaches. Ask your "former" ortho to call your "new" ortho and talk about your treatment plan. This way, you know that your "new" ortho is continuing your original treatment plan -- or not.
5. Don't be surprised if you need to spend more money.
You may wind up paying a few hundred dollars more to your new orthodontist. After all, this new doc has never seen you before, and you are a new patient to him. Hopefully, changing orthodontists mid-treatment won't raise your treatment costs too much.
6. Ask questions!
Know all the facts about your new orthodontist and treatment before committing. Some of the questions you need to ask include:
7. A note on dental insurance
Here's a great scenario: you take a new job and move. Your new job offers orthodontic benefits! But wait -- did you know that most orthodontic benefits are for new treatment, not for existing treatment? So, no matter how wonderful those orthodontic benefits are, chances are you won't be able to use them. Be sure to look into this!
Also, if you're on a dental plan that offers a list, call and ask if they have any orthodontists in your new area. Maybe they do!
8. A note on payment plans
It's not a good idea to pay for your entire treatment up-front. Most orthodontists have a "make a deposit, then pay-as-you-go" plan. Why don't you want to pay up-front? Several reasons: what if you move again? What if you decide to change orthodontists again?
And....unlikely, but....what if your orthodontist is unscrupulous? Yes, there are true stories about dentists who took full payment from their patients -- and then closed their practices! Some of their patients had to pay the full amount (in excess of $5,000) again to the new orthodontist, and some just couldn't afford the unexpected expense and had to stop their treatment. Don't let this happen to you! Braces and Romance
The question comes up time and again on the Metal Mouth Forum: will the gals (or guys) find my braces to be a turn-off? Will I be destined to spend the next few years in a dateless wasteland?
If you're single and getting braces, this is a serious question. Whether you are 18 or 48, you don't want to be alone just because you have some brackets on your teeth for a few years.
Before you head to the nearest rooftop and scream, "So I have braces, what's the big friggen deal?" read on...
I've seen this question asked many times, and the answer is always the same: the men worry that they look like geeks, and the woman re-assure them that if they are nice guys and are attractive in other ways, it does NOT affect the way others see them. Generally, men seem to have a harder time with braces than women. Perhaps this is because women have other factors at work -- and that teenage cheerleader look isn't always a bad thing when it comes to attracting men.
In reality, how the object of your affection reacts to you has little to do with what's in your mouth, and a lot to do with other things. Like your image, your self-confidence, and your willingness to work just a little harder to win over the person you want. I've never known anyone to say, "Ewww, he/she has braces, I'd never consider dating him/her." And if anyone DOES say or think that, just tattoo a big L on their foreheads, because they are shallow losers -- and you wouldn't want to date them anyway!
Sure, braces are a stereotype. The little girl in Finding Nemo is the perfect example -- slightly ugly, nerdy and mean. On the other side of the spectrum, in real life, there is Tom Cruise. Would any woman kick him out of bed because of his ceramic brackets? (well, ok, Nicole Kidman kicked him out of bed, but I don't think his braces had anything to do with it...)
For that matter, would any man have kicked Gwen Stefani or Nikki Taylor out of bed for their metal mouths? OK, I rest my case. (Photo to the right here is Tom Cruise in his Clarity ceramic brackets).
Also keep in mind the some people have a fetish for braces. So if someone who didn't pay attention to you previously suddenly gets very interested after you get braces, that may be the reason.
You are spending major bucks to get your teeth straightened. When you are done, your teeth will look great. What about the rest of you? Use this time as an opportunity to improve other things about yourself, especially if you weren't a dating champion before the braces went on. Think of this as your "transformation time."
Here's the main idea: if you look better, you'll feel better; if you feel better, you'll be more confident. And if you look good and are confident, you are sexy and attractive to other people. (Photo to the left here is Gwen Stefani in metal brackets).
Ideas for Women
This is a great time to spend a few extra bucks and have a professional make-over. Take a good look at yourself. What could be changed? Your makeup? Your hair? Your wardrobe?
Many day spas and salons offer hair and make-up consultations for reasonable prices. Get yourself out of any rut you may be in and splurge on a new or updated look. If your make-up looks better, they'll be looking at your beautiful eyes and that great hair, and won't notice your teeth.
Color consultants were big in the 1980s, and they're still around today. A color or image consultant can help you update your wardrobe and dress you in colors compatible with your complexion. If you want to do it without professional help, take a trusted fashion-savvy girlfriend or relative (NOT your mother) on a trip to the mall. Take a good look at what's out there and buy yourself a few great new outfits that accentuate your coloring and your figure.
Are you in shape or near your ideal weight? If not, start an exercise and sensible eating plan and try to stick to it. I know, easier said than done, but it's worth it.
Ideas for Men
Have you seen the show "Queer Eye for the Straight Guy"? If not, the premise is: five gay guys invade the life of a hopelessly fashion-blind straight guy and turn him into an enthusiastic and well-groomed metrosexual, often to the drooling delight of their significant other.
I'm not implying that you are fashion blind, but everyone can use a little look-over now and again, just to get out of a fashion rut. You don't necessarily need five gay guys with TV cameras to do this for you -- you can do some of it yourself.
The pages of GQ or Details are a good place to start, but if that's too daunting, go to a high-quality (and/or trendy) men's store in your area and ask a salesperson for ideas. I know it sounds perilous, but you don't have to actually buy anything, just see what somebody else thinks would look good on you, and think about it. If you are friends with a fashion-savvy guy, or a trusted woman with hip good taste (sister, aunt, cousin -- NOT your mother) see if they'll come along to help you. Go out on a limb and buy an outfit or two that looks great on you. Women appreciate a well-dressed guy.
Next, don't be shy about heading over to a day spa for a skin consultation. You'd be surprised how many men get skin treatments these days. Have you ever had a facial? If not, you're missing something really nice! The idea here is: improve your skin, if necessary.
Then, there's the haircut. Have you had the exact same haircut for more than 5 years? If so, maybe it's time for something a bit updated. You don't need to look like you just stepped out of an artsy-fartsy hairstyle catalogue -- you just need a style that looks good on you and is appropriate for your age and in step with today's styles.
Finally, consider getting to your ideal weight and improving your physical appearance and strength overall. If a good-looking, in-shape man in nice clothes approached me for a date, I wouldn't give a hoot about a little bit of metal in his mouth -- I'd be looking at the rest of him, and listening to what words were coming out of his mouth!
Ideas for Anyone
Aside from this, you might want to take a few hours -- or even days -- to assess your life as a whole. Are you happy? What do you want to change? What do you want to get out of your life? What type of partner would fit into your ideal life? Put it down on paper or type it into your word processor! Don't be restrained by reality -- dream a little bit.
Seeing it there in black and white can be very helpful. I did this years ago, and when I met my future husband, I looked at that sheet of paper and realized that he had all the qualities I was looking for, and even more. Right then and there, I knew he was worth seriously considering as a life partner. And so he has been, 18 years and two kids later...and he's the one who really pushed me to get braces a few years ago! In fact, nowadays I thank him for marrying me, despite my crooked teeth!
Sometimes finding the right person means knowing who you are and what you want. I've heard it said before, and I've seen it work: "Know and love yourself, and others will find you." Braces in the Bedroom (adult content, over 18 only)
Here's a rather cloistered topic that many adults think about but rarely bring into the open: how does having braces affect your sex life? This topic recently arose in the Metal Mouth Forum and received a large number of responses -- so after much debating, I decided to create a web page devoted to this delicate topic. After all, we are adults!
There's no easy answer to this question, because it depends on the individual or the parties involved. Aside from your partner having a braces fetish, it really depends on each person's tastes and prejudices -- not to mention, the type of braces you have (regular or lingual) -- and any appliances you may wear (Nance device, bite plate, palate expander, headgear, tongue thrust spikes, etc). I suppose the rule of thumb is: if it's sharp, then Houston, there may be a problem.
Season three of the HBO series Sex and the City ended with Miranda getting metal braces (to fix her TMJ headaches). She found dating disastrous with braces, and her date made an off-hand joke about oral sex being "out of the question." Humiliated, Miranda had her braces removed (I suppose her TMJ headaches just cured themselves). Well, that may work in TV Land, but in real life, it just isn't an option. This page exists to tell the Mirandas of the world (and their dates or significant others) that yes, there is sex after braces. So have no fear, fix your teeth, and continue to enjoy yourself in the bedroom.
Your Kiss is On My List...
After an initial adjustment period of, say, a month or two, you will probably be able to kiss normally with braces on your teeth. Braces don't have much of an affect on your pucker power unless you have other hardware in your mouth, such as an expander or such.
Regular 'ol kissing is usually fine -- the real challenge may lie in what happens when you open your mouth. Some people don't want to feel brackets on their partner's teeth, or may be afraid that their tongue will get cut or stuck. Depending on your hardware, this is a possibility. If your tongue gets cut up from your brackets, chances are your partner's will, too.
Run your tongue over your brackets and use copious amounts of dental wax or dental silicone on the rough spots. (If that doesn't work, perhaps your orthodontist can smooth the rough spots with a special tool). Be careful kissing areas with short body hairs. Take it slowly, and soon you'll be smooching away to your heart's content.
Members Only...
One female wrote, "my husband is afraid for me to go down on him with these braces on my teeth." Indeed, it's probably not for everyone. Some couples just put a moratorium on this activity until the braces are off. If both parties agree, then of course there's nothing wrong with abstaining from oral sex for a year or two. Men are quite serious about their "members" and the thought of "Mr. Johnson" getting poked by a wire or a bracket...well let's just say...ouch!
Again, dental wax may help alleviate his fears, along with good and caring technique (being sure to cover all the brackets with your lips). One ArchWired reader wrote that "lots of lubrication (lube, water, etc.) is essential". However, if you have lingual (behind-the-teeth) brackets, appliances with rough posts/hooks, tongue-thrust spikes, or a palate expander, there may not be much you can safely do. Unless your partner is into kinky risk, and unless you are extremely careful, it might not have the best....outcome.
You must be careful not only for him, but for yourself -- so you don't knock anything loose or hurt your gums or the inside of your mouth with all the friction. Here's a great suggestion from another reader: "If you're at all worried, try your technique on a hot dog or popsicle... if anything is cut/torn/chipped/broken then I would say it is definitely a no no."
Another suggestion would be to wear a silicone or plastic guard that covers your brackets, such as the Morgan Bumper. One reader, however, didn't think it would stay securely in place, so as they say here in cyberspace, your mileage may vary.
Also, if he is wearing a condom, be sure your brackets haven't made microscopic tears in it. It might be good practice to use a new one for intercourse to ensure protection from pregnancy or STDs.
If this is something that your partner wants you to do, and you are apprehensive, just take it slowly. Remember that good technique includes not only your mouth, but your tongue and also your hands. Creativity -- not to mention a sense of humor -- can make up for lack of classic technique. Who knows, you might discover a new pleasure that will carry over when the braces are removed.
Down In the Valley...
The challenge for braced males (or females with female partners) is probably not quite as risky, but, as one male wrote, "I'm afraid to get her hair caught in my brackets." Ouch again!
The obvious solution here would be for the female (receiving) partner to take a trip to South America. Go "Brazilian" and have a close shave or wax in your nether regions. If there isn't any (or much) hair -- or if the hair is trimmed really short, the chances of a hair getting caught will be greatly reduced.
If your significant female other is a bush supporter (sorry, couldn't resist the political pun there), then you obviously must be more careful. It's doubtful that you'd get anything more than a hair caught in a bracket. But if you tend to have a more aggressive technique, just remember to be careful -- not only down in the valley, but up in the hills and dales, too.
AfterGlow
In conclusion, having braces doesn't have to mean the end of certain sexual pleasures. It might mean tweaking your technique...or just plain being more careful. In the words of one enlightened reader, "practice makes perfect." And if you decide to abstain...well, as they say, absence...or maybe in this case abstinence...will make it all the fonder until the braces are off. Can babies get tooth decay?
Parents and would-be-parents beware; tooth decay can still be a common problem in infancy and childhood. Over the past few decades, despite the general reduction in dental tooth decay, early childhood tooth decay is still common. Are baby teeth essential?
The approach that baby teeth are not essential is a fallacy. We would not be born with them otherwise. Baby (milk) teeth are necessary not only for appearance, eating and smiling, but also serve to hold spaces for developing permanent (adult) teeth. In addition, baby teeth play a role in the development of speech. What are the most common dental decay problems seen in preschool children?
The most common dental decay problem seen in infants and younger children is nursing decay. Dental decay can affect baby teeth extensively. Teeth normally affected are the top front teeth. The back teeth in top and bottom may also be affected. Bottle and breast-fed babies are both susceptible. Babies left with a bottle as a pacifier and those who are frequently nursed, especially at night, run the danger of bottle or nursing decay due to the prolonged exposure to milk (human milk is no exception) or juice. At what age should I schedule my child’s first visit to the dentist?
Early visits can prevent minor problems from becoming major ones. Your dentist will be able to detect early decay. Teach good habits early, as good habits start young for a lifetime of healthy teeth and gums. Brush frequently to keep plaque levels low, reduce snacking and begin dental visits early. Should dental treatment be postponed while pregnant?
If your cavities are minor, you may want to wait to have them filled. However, if you have a substantially sizable cavity, the risks of getting a filling placed are offset by the risks of bacteria from your cavity in your system! Another potential risk you would face is that of the anesthetic in your blood stream during treatment, so if you can complete the filling without anesthetic you are also better off. Sometimes, we can also place a less invasive temporary filling until you are out of any risk. Your dentist will be able to assess the risks vs. needs for you. Is it safe to get an extraction while pregnant?
Women are often safer having an infected tooth extracted than leaving the bacteria in the tooth and risking the chance of an infection, which could compromise the health of you and your baby. Your dentist can assess the extent of risk for you and I recommend that you inform him or her before your appointment of your pregnancy. Ordinarily, however, if your oral health is not at risk, such procedures are delayed until postpartem. Is it safe to bleach your teeth while you’re pregnant?
That is an excellent question. Unfortunately, the effects of bleaching during pregnancy are not well studied and are essentially unknown. I strongly recommend waiting until after your child is born before risking any effects that bleaching materials might have on the fetus. Many dentists do provide an in-office bleaching procedure in which the teeth to be bleached are completely isolated using a rubber dam, reducing, but not eliminating, the risk of bleaching materials entering your system. However, small the risk might be, any elective medical procedures should be postponed. What should I do if I notice my top teeth rotting away?
You may be experiencing the results of pregnancy gingivitis. This condition arises in many expectant mothers and consists of inflamed and puffy gums during pregnancy. This inflammation can be controlled with dedicated cleaning of the teeth. During these bouts of gingivitis, it is quite common for cavities to form in the pockets underneath the gums. As the gingivitis later improves, the gums then recede to a more normal level, exposing the cavities. I strongly recommend visiting a dentist as soon as possible to have your cavities treated. Can I see the dentist if I’m taking blood pressure medication?
Yes, you may certainly see the dentist while on high blood pressure medication, as long as you inform him or her of your condition. What does root canal treatment really mean?
Root canal or endodontic treatment is a process whereby inflamed or dead pulp is removed from the inside of the tooth, enabling a tooth that was causing pain to be retained.
Why do I need root canal treatment?
If you have a damaged tooth, root canal treatment may help to save it. Inside your tooth is soft tissue containing nerves, and blood and lymph vessels, known as the tooth pulp. When the pulp cannot repair itself from disease or injury, it dies. A fracture in a tooth or a deep cavity commonly cause pulp death, as the pulp is exposed to bacteria found in your saliva.
What is root canal treatment?
Your dentist may perform root canal treatment to find the cause of your tooth’s problems. It is a safe way to save teeth. The diseased pulp is removed, while you keep your tooth. What is the dental pulp?
As outlined above, the pulp is the soft tissue inside your tooth that carries the vessels (blood and lymph), nerves and connective tissue. It extends from the crown of the tooth right to the tip of the root (in the bone of the jaw). What happens if the pulp is injured?
If the pulp cannot repair itself from disease or injury, it will die. A cracked tooth or deep cavity can allow bacteria to enter the pulp and cause pulp death. If the infection is not treated, an abscess can form in the root tip. This can eventually cause damage to the bone around the teeth. Why does the pulp need to be removed?
Initially, you may experience pain and swelling from an infection. Damage to the bone surrounding your tooth can also result. Without root canal treatment, your entire tooth may have to be extracted. What does treatment involve?
Root canal treatment may involve one to three visits to the dentist. A general dentist or an Endodontist (a specialist in pulp problems) will remove the pulp of the tooth. They will then clean and seal the pulp chamber and root canal/s.
How long will the restored teeth last?
If you look after your teeth and gums, your root canal treated tooth may last a lifetime. However, you must have regular checkups to ensure that the tissues around it are nourishing the root of your treated tooth. Can I protect my mouth if I smoke?
No. However, there are two things that a smoker should do to help protect his or her oral health. 2. Give up smoking. If smoking is stopped in time it is often possible to maintain a healthy mouth and keep the teeth for a lifetime. In 3-5 years after stopping smoking the chance of getting oral cancer is halved and gets less and less with time.
Does smoking affect the teeth, gums or mouth?
Yes. Most people are becoming aware that smoking poses a problem to general health. It contributes to heart disease, stroke, and to a third of all cancer deaths, to name just a few conditions. In 1992 it was estimated that almost five thousand deaths in Victoria resulted from smoking.
Does smoking always lead to gum disease?
No, but it increases your chance of getting it by about six times and increases the severity by the same factor. However, it can hide the signs of periodontal disease which can take years to progress. The condition can be very advanced before a person actually notices the damage. Gum disease is normally coupled with plaque and calculus that collects at the base of the tooth, which leads to bacteria infecting the gums. Smoking reduces the body's ability to combat this condition.
Does smoking lead to oral cancer?
Yes, smoking is a major cause of cancers in the mouth. It is the single biggest risk factor.
Does smoking make the teeth loose?
Yes. Smokers are six times more likely to have serious gum (periodontal) disease. Periodontal disease is a deep-seated form of gum disease. It involves not just the pink gum, but also the supporting bone and the membrane that holds the teeth in place. When gum disease damages these supports, the teeth become less stable and move too easily. Eventually they can become painful and loose, and need to be extracted. Does smoking stain the teeth?
Yes. Tobacco staining on the teeth is often superficial in the first few years of smoking and your dentist can usually readily remove it. Unfortunately, as the years pass, the staining tends to spread into microscopic cracks in the enamel (the outer layer of teeth) and this is far more difficult to remove. Teeth can become permanently stained. How will a smoker know if their gums are being damaged?
Attend your dentist for regular checkups because a major problem of smoking is that it tends to disguise the damage taking place. At a glance the gums of smokers look as if they are healthy.
What technique should I use?
When brushing your teeth it is best to place your toothbrush at a 45-degree angle to your teeth, aiming the bristles of your brush toward the gum line. The join between the teeth and the gum is a nice niche for bacteria and plaque to accumulate, so it is important to get to this area.
How long should I brush?How often should I brush?
You should brush your teeth at least twice a day. Remember it is important to have the right brushing technique as poor brushing techniques can cause harm to the teeth and gums. Is brushing alone enough?
NO. Good brushing is very important to help prevent dental decay and periodontal disease, however brushing alone is not enough. It is also very important to clean between your teeth. This is why flossing is so important. How often should I floss?What is the correct way to floss?
Holding floss is the key. You should have a decent length and make sure it is tightly wrapped around and locked onto the middle finger of each hand. Some companies also make small flossing aids. You should floss using a gentle sawing motion, against the sides of your teeth. If you find this tricky — speak to your dentist. They will be able to advise you on the best oral hygiene aids for you, and show you exactly how to use them. Remember — prevention is the aim!! What should I do if brushing or flossing makes my gums bleed?
If your gums bleed or become sore after flossing, do not panic. If you have not been flossing regularly then the gums will be inflamed and will bleed more easily. If the bleeding persists — see your dentist. Choosing a toothbrush
The best toothbrush is one with a small head and soft bristles. Electric toothbrushes can also be very good, particularly for people who find proper brushing techniques difficult to master. Choosing a toothpaste
Always use a toothpaste containing fluoride. Fluoride combines with minerals in your saliva to toughen your tooth enamel and help stop decay. What is the ADA's position on tongue and lip piercing?
The Australian Dental Association has warned the public on a number of occasions of the dangers of tongue piercing.
Tongue Piercing
Body piercing is becoming more popular these days. As people run out of body parts to impale, many are turning to cheeks, lips and, most commonly, the tongue.
Is tongue and lip piercing safe?
If you have your tongue pierced and have inserted a stud (or other adornment), you are risking painful damage to your teeth — like the eighteen year-old who needed repairs to six fractured teeth.
What are the most common problems?
Piercing can result in serious problems, such as trauma to teeth (due to constant hitting with a metal object), interference with chewing and speaking, hypersensitivity to metals, foreign debris in the pierced site leading to infection, and difficulty in breathing from airway obstruction due to swelling from infection.
Horror stories have also been reported of studs dislodging and pins becoming "lost" inside the tongue, requiring oral surgery to retrieve them. Who is qualified to do tongue or lip piercing?
People thinking about tongue and lip piercing are urged not to presume that the person performing the piercing procedure has been trained and that the levels of infection control expected in dentistry are practised. Whilst local Government inspectors regulate body and skin piercing premises, there are no regulations restricting the practice of body piercing to licensed operators. The operators are not currently licensed, and there is no guarantee that they know what they are doing. Where people are considering having their tongues pierced, they must ensure that the practitioner providing the piercing is aware of their oral anatomy.
Should teeth be white?
Teeth in adults contain a mixture of yellow, red and grey colours, and between individuals there is a wide range of tooth shades that are normal. There is no one “correct” colour that teeth are supposed to be. It is normal for healthy unfilled teeth to darken and yellow with advancing age. Moreover, because of natural aging process within teeth, the effects of tooth whitening can not last forever, and in several years there may be a need for a "touch up" whitening treatment.
Which dentist can bleach my teeth?
All dentists have the skills to assess your teeth for whitening and advise you on the chances of a good result. It largely depends on how badly your teeth are stained and what colour they are naturally as to whether the treatment will work. It is best to see your dentist and discuss your options. What are the likely causes of tooth discolouration?
Surface stains (also known as extrinsic stains) are superficial stains located on the surface of the tooth. Common surface stains are dental plaque and calculus, tars (in tobacco), tannins (in tea or coffee), coloured foods such as soy sauce, cola drinks, and the ingredients in some dental mouthrinses when these rinses are used very often.
• Severe illnesses and fevers in childhood • Antibiotics such as tetracyclines taken in childhood • Uncommon genetic conditions where there is a pattern of inheritance • Medical conditions affecting the blood system or liver in childhood • Excessive levels of fluoride intake in early childhood because of swallowing toothpaste, which can result in areas of whiteness (opacity).
• Corrosion products from amalgam restorations, which can give grey stains • Tooth decay • Problems with the dental pulp (“nerve”), after decay, root canal work, or damage to the tooth in an injury. Why is it important to know the likely causes of tooth discolouration?
Reaching an accurate diagnosis of the cause of dental discolouration allows your dentist to select the most appropriate treatment options. Over-the-counter products may not be effective against some types of discolouration, and your dentist can advise you whether the problem can be managed by various professional lightening or whitening treatments, or whether more extensive cosmetic procedures (such as veneers or crowns) are needed. Some patterns of tooth shade change such as whiteness from fluoride intake can be treated using methods other than whitening to return tooth enamel to its normal colour. They can also provide advice on the type of improvement expected and the duration of treatment. Documenting the tooth shade using a dental shade guide (or taking photographs) is normally undertaken before starting a whitening treatment. How are surface stains treated?
There are at least 3 options to consider.
What are “conventional” whitening toothpastes and how do they work?
Conventional toothpastes marketed for whitening contain ingredients that help remove external stains by a gentle abrasive or polishing action, however they will not be able to change the natural tooth colour. Conventional whitening toothpastes use abrasive particles such as modified silica, titanium dioxide, alumina, dicalcium phosphate, sodium bicarbonate, calcium carbonate, or similar particulate substances.
• Macleans Advanced Whitening Ice (silica) • Pearl Drops Electric (silica, alumina); Pearl Drops ToothPolish Advanced Whitening (silica, pyrophosphate, dicalcium phosphate) • Cedel Whitening Plus Tartar Control (silica, dicalcium phosphate, pyrophosphate) • Coles Persona Whitening (silica); Coles Persona Total Care Plus Whitening (silica, dicalcium phosphate, pyrophosphate) • WhiteGlo Whitening Toothpaste (silica, calcium carbonate) • Sensodyne Gentle Whitening (silica) What is tooth lightening?
Removal of surface stains and professional polishing of the tooth surfaces by a dentist or hygienist is a physical treatment makes them reflect more light and thus appear lighter. It does not use peroxide or other bleaching chemicals. Special polishing pastes can be used in sequence to give a high surface polish to the natural teeth and to any fillings which may also be present. How are internal stains treated?
Internal stains are normally treated using oxygen-releasing chemicals such as peroxides (typically hydrogen peroxide, carbamide peroxide, or sodium percarbonate peroxide) or chlorites which can penetrate into the tooth and give a bleaching effect. A level of 10% carbamide peroxide in the presence of water releases 3.5%, so this numerical relationship must be taken into account if comparing products with carbamide peroxide with similar products containing hydrogen peroxide. • In an advanced whitening formula toothpaste where special activators are included to enhance the action of peroxides within the toothpaste • As a paint-on treatment where liquid is applied to the teeth as an at-home treatment • As a professional treatment in the dental surgery in which a gel is applied to the teeth and then activated using high intensity lights, lasers or ozone. This is called “power bleaching”.
Are there issues with oxygen-based bleaching methods?
They do not change the colour of dental fillings. After a whitening treatment, it may be necessary to have fillings resurfaced or replaced to match the new shade of the natural tooth structure.
• They elevate the level of oxygen in the outer (enamel) surface of the tooth, and because this can affect dental adhesives used for bonding, any procedures on the same teeth which require bonding must be delayed for at least 2 weeks after the end of the bleaching treatment. Are peroxides safe to use?
Hydrogen peroxide (the active agent of whitening systems) is actually produced in the body in small amounts, and its effects have been studied for many years. When bleaching is supervised and is carried out according to the dentist's instructions, it appears to be a safe, simple procedure.
What are advanced formula whitening toothpastes and how do they work?
These use activators to maximize the effect of the peroxide which they contain. A typical product will contain hydrogen peroxide, a catalyst (such as manganese gluconate) to facilitate its breakdown, together with silica and pyrophosphates, to gain an effect on both internal and external stains. Used under normal conditions (brushed twice daily for 2 minutes each) these toothpastes can physically remove external stains, bleach external stains, and reduce internal stains.
http://www.ada.org.au/oralHealth/sealofApp.aspxfor other suitable products. Paint-on whitening treatments
This consumer-level treatment can be applied selectively to just a single darkened tooth, or to many teeth to achieve an overall whitening action. They are not suitable for handling intense internal stains, but can give a useful effect where the discolouration is age-related and mild. They typically contain either hydrogen peroxide (6%) or carbamide peroxide, and are applied once daily for up to 14 days. • Colgate Simply White ™ and Colgate Simply White Advanced ™ whitening gel • Macleans Brilliant White ™ whitening treatment gel Adhesive strips
These use a thin flexible strip made from polyethylene or a similar plastic material to deliver a hydrogen peroxide bleaching gel to the front teeth. Once in position, the strips are pressed into place to gain the greatest contact with the tooth surface. This "trayless" delivery system provides for extended contact of peroxide (released from the undersurface of the strip) with the outer surface of the tooth. There are different shapes of strips to fit the upper and lower front teeth.
“Home tray vital bleaching”
With this treatment, a gel containing typically 5% hydrogen peroxide or 10% carbamide peroxide is applied to the teeth for several hours, or overnight, using a tray. When the applicator tray is of the “stock” design (“one size fits all”), more gel is needed and there is greater contact of gel with the gums, which can result in irritation. Stock trays are also bulky and uncomfortable. A custom-made tray is vacuum-formed onto a model of the individual mouth, and allows the dentist to determine the amount of gel which contacts the teeth. The design of the tray insures that there is close contact between the bleaching gel and the surface of the teeth, without the tray impinging on the gums and causing discomfort. The tray also prevents contact between the gel and the saliva. Custom-made trays are more comfortable to wear, and less visible to others as they can be made of a clear material. Irritation of the gums can occur because of chemical irritation from the peroxide, or from physical contact of the tray. Both of these are more likely to occur with stock trays because of their poor fit. With custom-made trays, all of the excess gel can be removed easily by wiping it away from the edges of the tray as soon as the tray has been inserted into the mouth and pushed home into position over the teeth.
“Power bleaching”
During this treatment, which is undertaken in the dental surgery, eye protection is first put on, and then a retractor is placed to hold the cheeks and lips away from the teeth. A material such as a flowable white resin is placed to protect the gums and any exposed root surfaces from chemical irritation from the gel, and from accidental heating if a high intensity light source is to be used. This material is simply peeled away from the teeth at the end of the appointment. The whitening gel is then mixed from powder and refrigerated hydrogen peroxide solution, typically resulting in a final hydrogen peroxide concentration of 35%. The gel is then activated, and left in place for some time to allow the oxygen products to penetrate into the teeth. The gel is then washed off and the fresh gel applied. Any leakage of the whitening gel onto the gums can cause irritation, and vitamin E may be applied to neutralize the peroxide and prevent any long term damage to the gums.
Because of rapid penetration and greater levels of oxygen products within the teeth, some patients will experience sensitivity in the teeth during “power bleaching”, particularly when the energy source (light or laser) is applied. The dentist may reduce the exposure level of the tooth to the light source to reduce any discomfort. Sensitivity after the visit may be due to dehydration of the teeth or the body’s natural defense system which neutralizes the peroxide. Sensitivity is self-limiting and will resolve within several days. The dentist may recommend a desensitizing agent or an analgesic medication depending on the nature and severity of the symptoms experienced.
• Opalescence Xtra Boost ™ (with halogen resin curing light) • Zoom ™ (with mercury vapour halide light) • LaserSmile ™ (with diode laser) • OpusWhite ™ (with diode laser) • Rembrandt ™ (with blue/green plasma arc lamp) • BriteSmile ™ (with blue/green plasma arc lamp) • Smartbleach ™ (with blue/green argon ion laser or KTP laser) Is home bleaching safe?Yes. Hydrogen peroxide (the whitening agent) is actually produced in the body in small amounts and the effects have been studied for many years. Dentists know that the whitening process should not be abused, because teeth being bleached repeatedly past the recommended level can damage the enamel. When bleaching is carried out according to an ADA dentist's instructions, it appears to be a safe, simple procedure. What is home bleaching?
Home bleaching involves wearing a very thin, transparent plastic tray molded to your teeth, which is used to hold a bleaching agent in contact with the tooth surface. It is normally worn for approximately ten days.
Are bleaching toothpastes very effective?
No. The active ingredients of bleaching toothpastes are present in much lower concentrations than those in home bleaching kits, and they tend to be immediately washed off the tooth surface by saliva. How long does the bleaching last?
The bleaching is permanent, however teeth can still become dirty and they will continue to age in a normal way with the passage of time How effective is home bleaching in whitening the teeth?
Home bleaching does not make the teeth as white as chalk. If it did the teeth would not look natural. Usually the whitening is subtle, but a real difference can usually be noticed between, for instance, upper teeth that have been bleached and lowers that have not. Home bleaching seems to be slightly more effective for younger rather than older people. What are wisdom teeth?
Wisdom teeth, or third molars, are a set of four teeth that erupt into the back four corners of the mouth, behind the 12 year old molars. This usually occurs between the ages of 17 to 21. Does everyone have wisdom teeth?What is impaction?
Your dentist may advise you your wisdom teeth (or third molars) are impacted and that they need to be removed. What this means is that your wisdom teeth will not grow or erupt into a position that allows them to be functional teeth.
My wisdom teeth are impacted. So what?
The common problems that can arise with impacted teeth are infections of the gum around the teeth, decay and resorption of adjacent functioning teeth, and gum disease around the molar teeth.
My wisdom teeth don't bother me now. Why not wait until they cause me problems?
Some people do elect to wait until they are having trouble with their wisdom teeth. The only trouble is, sometimes the damage is done without any warning. Some people leave their wisdom teeth until they are older than sixty or seventy years. Often they have other health problems at this age and are much slower to recover than teenagers who have the same operation.
Who can remove my wisdom teeth?
All dentists are trained in removal of teeth, however sometimes you may need to be referred to a specialist Oral and Maxillofacial Surgeon who can remove your wisdom teeth for you. Can there be problems with extraction of wisdom teeth?
Yes, as with any surgery, post operative pain, swelling, bruising and infection can occur. Other consequences of wisdom tooth removal may include, difficulty in opening the mouth, sore lips, and bleeding.
Does everyone need to have his or her wisdom teeth out?
No. When there is adequate room the wisdom teeth can erupt into the mouth in the correct position and function as a valuable asset or they may remain unerupted and cause no problems. However, this is usually not the case. |
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