First visit |
Orthodontic First Visit
The initial Exam:
The initial exam
can be a very helpful way for you to get a clear idea about you or your
child's orthodontic needs. The exam will be done at no charge, as
a service to you and your dentist. Although a referral is not required
to schedule this appointment, we will work closely with your dentist to
assure comprehensive care.
At your first visit,
photographs of you or your child’s teeth will be taken and viewed on the
computer screen. Dr. Chen will examine you or your child's teeth, bite,
TMJ and facial soft tissue. This information will be used to give you a
preliminary idea of the problems that may be present. Dr. Chen will also
present you with possible treatment alternatives, an estimate of the
treatment time, an estimate of the cost, and answer any questions you
may have. If no treatment is required, Dr. Chen may suggest an
observation recall to monitor future growth and development of your
If treatment is
recommended, we will make arrangements with you to schedule an
The impression/records visit:
appointment takes about 60 minutes and usually includes the following:
Impressions or "molds" of
your teeth and bite
Once the records have
been taken, Dr. Chen will be able to develop the final diagnosis and
treatment plan. This will be presented to you at a subsequent
appointment where he will then discuss treatment alternatives,
risks/benefits of treatment, and answer any questions you may have.
appliances can be placed approximately 2 weeks after the
Orthodontic Frequently Asked Questions
What age should
my child have an orthodontic evaluation?
American Association of Orthodontists (AAO) recommends an orthodontic
screening for children by the age of 7 years. At age 7 the teeth and
jaws are developed enough so that the dentist or orthodontist can see if
there will be any serious bite problems in the future. Most of the time
treatment is not necessary at age 7, but it gives the parents and
dentist time to watch the development of the patient and decide on the
best mode of treatment. When you have time on your side you can plan
ahead and prevent the formation of serious problems.
Why is it important to have orthodontic
treatment at a young age?
Research has shown that serious orthodontic problems can be more easily
corrected when the patient’s skeleton is still growing and flexible. By
correcting the skeletal problems at a younger age we can prepare the
mouth for the eventual eruption of the permanent teeth. If the permanent
teeth have adequate space to erupt they will come in fairly straight. If
the teeth erupt fairly straight their tendency to get crooked again
after the braces come off is diminished significantly. After the
permanent teeth have erupted, usually from age 12-14, complete braces
are placed for final alignment and detailing of the bite. Thus the final
stage of treatment is quicker and easier on the patient. This phase of
treatment usually lasts from 12 - 18 month and is not started until all
of the permanent teeth are erupted.
orthodontic treatments in two steps provides excellent results often
allowing the doctor to avoid removal of permanent teeth and jaw surgery.
The treatment done when some of the baby teeth are still present is
called Phase-1. The last part of treatment after all the permanent teeth
have erupted is called Phase-2.
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What causes crooked teeth?
Crowded teeth, thumb sucking, tongue thrusting, premature loss of baby
teeth, a poor breathing airway caused by enlarged adenoids or tonsils
can all contribute to poor tooth positioning. And then there are the
hereditary factors. Extra teeth, large teeth, missing teeth, wide
spacing, small jaws - all can be causes of crowded teeth.
How do teeth move?
movement is a natural response to light pressure over a period of time.
Pressure is applied by using a variety of orthodontic hardware
(appliances), the most common being a brace or bracket attached to the
teeth and connected by an arch wire. Periodic changing of these arch
wires puts pressure on the teeth. At different stages of treatment your
child may wear a headgear, elastics, a positioner or a retainer. Most
orthodontic appointments are scheduled 4 to 6 weeks apart to give the
teeth time to move.
Will it hurt?
teeth are first moved, discomfort may result. This usually lasts about
24 to 72 hours. Patients report a lessening of pain as the treatment
progresses. Pain medicines such as acetaminophen (Tylenol) or ibuprofen
(Advil) usually help relieve the pain.
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part of your braces which actually moves the teeth. The arch wire is
attached to the brackets by small elastic donuts or ligature wires. Arch
Wires are changed throughout the treatment. Each change brings you
closer to the ideal tooth position.
Brackets are the “Braces” or small attachments that are bonded directly
to the tooth surface. The brackets are the part of your braces to which
the dentist or assistant attaches the arch wire.
Occasionally, a bracket may come loose and become an irritation to your
mouth. You can remove the loose bracket and save it in an envelope to
bring to the office. Call the office as soon as possible and make an
appointment to re-glue the bracket.
Elastics (Rubber Bands)
some time during treatment, it will be necessary to wear elastics to
coordinate the upper and lower teeth and perfect the bite. Once teeth
begin to move in response to elastics, they move rapidly and
comfortably. If elastics (rubber bands) are worn intermittently, they
will continually "shock" the teeth and cause more soreness. When
elastics are worn one day and left off the next, treatment slows to a
standstill or stops. Sore teeth between appointments usually indicate
improper wear of headgear or elastics or inadequate hygiene. Wear your
elastics correctly, attaching them as you were told. Wear elastics all
the time, unless otherwise directed. Take your elastics off while
brushing. Change elastics as directed, usually once or twice a day.
called a “night brace”. The headgear is used to correct a protrusion of
the upper or lower jaw. It works by inhibiting the upper jaw from
growing forward, or the downward growth of the upper jaw or even by
encouraging teeth to move forward, if that is the case.
positioning of the teeth.
A Malocclusion where the bite is OK (the top teeth line up with
the bottom teeth) but the teeth are crooked, crowded or turned.
A Malocclusion where the upper teeth stick out past the lower
A Malocclusion where the lower teeth stick out past the upper
teeth. This is also called an "underbite".
alignment and spacing of your upper jaw and lower teeth when you bite
Anterior opening between upper and lower teeth.
Vertical overlapping of the upper teeth over the lower.
Horizontal projection of the upper teeth beyond the lower.
When top teeth bite inside the lower teeth. It can occur with
the front teeth or back teeth.
rings, also called A-lastics, are little rings used to attach the arch
wire to the brackets. These rings come in standard gray or clear, but
also come in a wide variety of colors to make braces more fun. A-lastics
are changed at every appointment to maintain good attachment of the arch
wire to the bracket, enabling our patients to enjoy many different color
schemes throughout treatment.
plastic or rubber donut piece which the dentist uses to create space
between your teeth for bands.
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Fixed and Removable
Band & Loop (B & L)
A Band & Loop is
routinely used to hold space for a missing primary (baby) posterior
(back) tooth until the permanent tooth can grown in.
designed to encourage the lower jaw to grow forward and “catch up” to
upper jaw growth.
lower lingual arch is a space maintainer for the lower teeth. It
maintains the molars where they are, it does not move them. This is
fabricated by placing bands on the molars and connecting them to a wire
that fits up against the inside of the lower teeth. It keeps the molars
from migrating forward and prevents them from blocking off the space of
teeth that develop later. This is used when you have the early loss of
baby teeth or when you have lower teeth that are slightly crowded in a
growing child and you do not want to remove any permanent teeth to
correct the crowding.
appliance which is placed in the roof of the mouth to widen the upper
dental arch. The maxilla, or upper dental arch, is joined in the center
by a joint, which allows it to be painlessly separated and spread.
Temporarily you may see a space develop between the upper two front
teeth. This will slowly go away in a few days. Once this has occurred,
the two halves knit back together and new bone fills in the space.
appliance provides continual, gradual pressure in as many as four
directions, to move molars, expand or contract arches or assist in
eliminating finger or thumb habits.
appliance used to expand the lower arch without interfering with tongue
posture or movement.
universally used retainer with many applications; to move teeth, close
spaces, maintain alignment during or after treatment.
appliance maintains the position of the maxillary molars without using
any other teeth. The plastic button on the palate provides
the completion of the active phase of orthodontic treatment, braces are
removed and removable appliances called retainers are placed. To retain
means to hold. Teeth must be retained or held in their new positions
while the tissues, meaning the bone, elastic membranes around the roots,
the gums, tongue and lips have adapted themselves to the new tooth
positions. Teeth can move if they are not retained. It is extremely
important to wear your retainers as directed!
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will be shown the proper care of your braces when your orthodontic
treatment begins. Proper cleansing of your mouth is necessary every time
you eat. Teeth with braces are harder to clean, and trap food very
easily. If food is left lodged on the brackets and wires, it can cause
unsightly etching of the enamel on your teeth. Your most important job
is to keep your mouth clean. If food is allowed to collect, the symptoms
of gum disease will show in your mouth. The gums will swell and bleed
and the pressure from the disease will slow down tooth movement.
You should brush your teeth 4-5 times per day.
Brush back and forth across……between the wires and gums on the upper
and lower to loosen any food particles.
Next, brush correctly as if you had no brackets or appliances on.
Start on the outside of the uppers with the bristles at a 45 degree
angle toward the gum and scrub with a circular motion two or three
teeth at a time using ten strokes, then move on.
Next, do the same on the inner surface of the upper teeth.
Then, go to the lower teeth and repeat steps 1 & 2.
in a mirror to see if you have missed any places. Your teeth, brackets
and wires should be free of any food particles and plaque.
If your gums bleed when brushing, do not avoid brushing, but rather
continue stimulating the area with the bristles. Be sure to angle your
toothbrush so that the area under your gum line is cleaned. After 3 or 4
days of proper brushing, the bleeding should stop and your gums should
be healthy again.
Use a special floss threader to floss with your braces on. Be sure to
floss at least once per day.
FLUORIDE RINSE OR GEL:
May be recommended for preventive measures.
the retainer by brushing with toothpaste. If you are wearing a lower
fixed retainer be extra careful to brush the wire and the inside of the
lower teeth. Always bring your retainer to each appointment. Avoid
flipping the retainer with your tongue, this can cause damage to your
teeth. Place the retainer in the plastic case when it is re-moved from
your mouth. Never wrap the retainer in a paper napkin or tissue, someone
may throw it away. Don't put it in your pocket or you may break or lose
it. Excessive heat will warp and ruin the retainer.
elastics (rubber bands) are worn intermittently, they will continually
"shock" the teeth and cause more soreness. Sore teeth between
appointments usually indicate improper wear of headgear or elastics or
inadequate hygiene. Wear your elastics correctly, attaching them as you
were told. Wear elastics all the time, unless otherwise directed. Take
your elastics off while brushing. Change elastics as directed, usually
once or twice a day.
Sticky Foods such as:
Candy bars with caramel
Candy or caramel apples
Hard or Tough Foods Such as:
following foods into small pieces and chew with the back teeth:
Corn on the Cob
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Orthodontic Emergencies or Problems
Please feel free to contact the office if you are experiencing any
discomfort or if you have any questions. Below are a few simple steps
that might help if you are unable to contact us or if you need a “quick
Occasionally, a glued bracket may come loose. You can remove the loose
bracket and save it in an envelope to bring to the office or leave it
where it is, if it is not causing any irritation. Call the office as
soon as possible in order for us to allow time to re-glue the bracket.
wire is poking your gums or cheek there are several things you can try
until you can get to the office for an appointment. First try a ball of
wax on the wire that is causing the irritation. You may also try using a
nail clipper or cuticle cutter to cut the extra piece of wire that is
sticking out. Sometimes, a poking wire can be safely turned down so that
it no longer causes discomfort. To do this you may use a pencil eraser,
or some other smooth object, and tuck the offending wire back out of the
Wire Out of Back
Please be careful to avoid hard or sticky foods that may bend the wire
or cause it to come out of the back brace. If this does happen, you may
use needle nose pliers or tweezers to put the wire back into the hole in
the back brace. If you are unable to do this, you may clip the wire to
ease the discomfort. Please call the office as soon as possible to
schedule an appointment to replace the wire.
Poking Elastic (Rubber Band) Hook
brackets have small hooks on them for elastic wear. These hooks can
occasionally become irritating to the lips or cheeks. If this happens,
you may either use a pencil eraser to carefully push the hook in, or you
can place a ball of wax on the hook to make the area feel smooth.
may be experiencing some discomfort after beginning treatment or at the
change of wires or adjusting of appliances. This is normal and should
diminish within 24-72 hours. A few suggestions to help with the
Rinse with warm water, eat a soft diet, take acetaminophen (Tylenol)
or ibuprofen (Advil) as directed on the bottle.
Chewing on the sore teeth may be sorer in the short term but feel
If pain persists more than a few days, call our office.
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