Orthodontic Examination and Orthodontic Records

 

The first step in determining your treatment plan is learning as much about your orthodontic condition as possible. This begins with an orthodontic examination, during which your teeth and jaw alignment will be examined. Your orthodontist will then collect a set of orthodontic records, which may include plaster or virtual imaging models of your teeth, X-rays or 3 dimensional images of your head, teeth and jaw joints, photographs and your medical-dental history.

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Pre-medication

 

If you have a pre-existing medical condition that requires pre-medication, the medical/dental health history will be your orthodontist’s only source of information. Be sure you have completed the health questionnaire completely and correctly as well as provided the office with any medical changes. Your orthodontist, in consultation with your physician(s), will recommend medications. It will remain your responsibility to follow your medical recommendations throughout your orthodontic treatment.

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Allergies

 

Although uncommon, allergies to medicines and treatment-related materials may occur during orthodontic treatment. Please make your orthodontist aware of known allergies so your orthodontist may take steps to minimize your exposure. If your allergies are unknown to you, then it is impossible to predict any reaction. You may be more prone to an allergic reaction during orthodontic treatment if you are allergic to certain foods or have other allergies. If an allergy occurs during your treatment, then medical management, alternative treatment or discontinuation of treatment may be necessary.

 

General Medical Condition

 

General medical conditions including disorders of the bone, hormones, or blood can influence and even prevent successful orthodontic treatment. Many prescription and non –prescription drugs, including bisphosphonates, can affect your treatment. Please inform your orthodontist of any changes in your general medical condition.

 

Dental Checkups and Care

 

Before orthodontic treatment begins, it will be necessary to visit your family dentist for a checkup and any necessary dental work. Once orthodontic therapy begins, and throughout the course of orthodontic treatment, you will be expected to continue to see you family dentist for regular three to six month checkups and routine care. Routine dental care will help ensure the best possible results from your orthodontic therapy.

 

Planning and Consultation

 

Your orthodontist will design a treatment plan, and discuss with you treatment options and alternatives (including no treatment) and any significant risks or limitations to your treatment. You will have an opportunity to discuss the points raised in this booklet with your orthodontist and he/she will request your informed consent to be signed before implementing the treatment plan.

 

Changes in Original Treatment Plan

 

There are some instances when you and your orthodontist may need to change the treatment plan. Poor patient cooperation, periodontal problems, adverse growth and changes in the patient’s or parent’s desires, may necessitate a change in the goals and direction of treatment. Alternatives to orthodontic treatment may vary with the individual’s specific problem, and prosthetic solutions or limited orthodontic treatment may be considerations. These changes may lengthen your treatment time and incur additional fees. Excellent communication with your orthodontist is essential in understanding your treatment progress and ensuring your desires are met.

 

Teeth, Mouth and Jaw Problems

 

Discuss with your orthodontist any potential teeth, mouth or jaw problems before you start orthodontic treatment. Sometimes, oral surgery to remove teeth is necessary with orthodontic treatment, especially to correct severe crowding of teeth or jaw imbalances. As part of your new aesthetic and/or functional occlusion, crowns, bonding, veneers, or implants may be needed to complete your final bite. These would be done by your general dentist and could incur separate charges.

 

Treatment Options

 

In some cases, there are alternate treatment plans with different results. You need to understand the differences. Please ask questions. Your orthodontist will recommend the most suitable treatment he/she feels is best for you and explain the advantages and disadvantages of any treatment options that may meet your needs. Ideal results may be impossible to achieve based on pre-existing conditions. Orthodontics is most often an elective process. You will be asked to make a choice about your treatment. An alternative treatment plan may be a partial treatment with limited treatment results. Another treatment option is to receive no treatment. If you are considering no treatment, ask your orthodontist what the risks are to your teeth and supporting tissue.

 

What can you Expect During Orthodontic Treatment?

 

 

Level of Discomfort

 

Orthodontic therapy uses appliances that apply pressure to move teeth. When braces are placed, or clear removable appliances (aligners) are worn, or when adjustments are made, your teeth and gums may initially feel tender. The amount of discomfort varies from patient to patient, but usually does not last for more than two or three days.

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Additional Orthodontic Appliances

 

Orthodontic therapy may include additional fixed or removable appliances (auxiliaries) to achieve the best results. These appliances are usually worn for a limited time throughout your treatment. These appliances may include removable aligners and their composite attachments, jaw expanders, elastics, jaw correctors (headgear, overjet correctors, functional appliances), and temporary anchorage devices (TADs). Please consult with your orthodontist regarding the potential need of these additional appliances.

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Additional Records and X-rays

 

X-rays may be needed to monitor the progress of your treatment. In addition, after your treatment is completed, your orthodontist may recommend a final set of records. These may include X-rays or 3 dimensional images, plaster or virtual imaging models, and photographs. These new records will be used to plan your retention program, to check for tooth decay, and to determine the position and/or absence of your wisdom teeth. These records will also be used to gauge what changes might occur in the future due to tooth movement or growth.

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Removal of Teeth

 

As part of the orthodontic treatment, teeth may need to be removed. Your orthodontist will recommend removal of one or more teeth if it improves your prospects for a pleasing result. Missing teeth, on the other hand, can make therapy more difficult. In such cases, treatment compromises may be necessary and an ideal result may be impossible to achieve.

 

Timing of Treatment

 

Starting orthodontic treatment may be appropriate when patients have baby teeth as well as permanent teeth. Your orthodontist will determine the appropriate timing of orthodontic treatment based on your specific needs. Phase 1 “interceptive treatment” may begin while baby teeth are still present. Phase 1 is the first phase of an anticipated two-phase treatment plan. This treatment occurs in a growing individual which corrects harmful conditions or when dental and orthopedic corrections are required. PHASE 1 TREATMENT USUALLY DOES NOT ELIMINATE THE NEED FOR FURTHER TREATMENT AFTER THE PERMANENT TEETH HAVE ERUPTED. In Phase 2 or “comprehensive treatment” full braces are used to adjust the position of the permanent teeth to develop a proper bite and enhance facial esthetics. This phase usually starts after the loss of all baby teeth, and is usually necessary after Phase 1 interceptive treatment.

 

Estimated Length of Treatment

 

Your orthodontist may have estimated the length of treatment based upon the complexity of your orthodontic treatment, timing of treatment, growth estimates, and his/her experience treating similar cases. It is only an estimate. Length of treatment time can be shortened or lengthened by your choice of treatment plan, patient cooperation, favorable or adverse growth, general medical and dental health, and the need for additional care by other health professionals.

 

Retainers

 

When your orthodontic treatment is completed, you will wear a retaining appliance to “hold” your teeth in position. Retainers are just as important as the appliances you wore during your active treatment. There are different types of retainers. Your orthodontist will recommend the right one for you. Minor changes in alignment of the teeth after treatment are not a failure of your orthodontic treatment, but are changes that you can expect as you age. Your teeth will want to adapt to these changes. In some cases, spaces may appear or not fully close. Shifting or settling of teeth following treatment, as well as after retention, will most likely occur in varying degrees. Previously rotated teeth, mouth breathing, or other uncontrolled muscle habits are frequent causes. Some of these changes are desirable while others are not. Rotations, crowding of the lower front teeth, slight spaces in the extraction sites or spaces in the upper front teeth are the most common examples. Wearing your retainer as recommended by your orthodontist is the best way to minimize these changes. Further growth after treatment may influence the alignment of your teeth and jaw. In order to protect the result of your orthodontic treatment, you may require at least part-time war of your retainer for your lifetime. Your orthodontist may recommend, or you may request, a “permanent” or “fixed” retainer. Permanent retainers are not for everyone and they cannot be adjusted to correct alignment problems. Patients must spend extra time cleaning to avoid cavities and gum disease. As with any orthodontic appliance, care must be taken in the types of food eaten to avoid breaking a permanent retainer.

 

Facial Growth Pattern

 

Occasionally insufficient or excessive jaw growth can limit your orthodontist’s ability to achieve or maintain desired results. On rare occasions, it may become necessary to recommend a change in the original treatment plan. These changes may include the removal of one or more teeth and/or corrective jaw surgery.

 

What Will Be Expected of You During Treatment

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Your Cooperation is Essential

 

Generally speaking, excellent orthodontic treatment results are attained with cooperative, informed and committed patients and parents. Successful treatment is a team effort: patients, parents, the orthodontist and a specially trained staff working together. The rewards? Your radiant smile, healthy teeth and your glow of new self-confidence!

 

For a most pleasing result in the shortest period of time and the lowest cost you must:

 

Keep regularly scheduled appointment and be on time. Your orthodontic team will make every effort to be on time for you.

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Practice and achieve effective oral hygiene

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Wear your elastics and retainers and all other auxiliary appliances as instructed.

Call the office should you experience loose braces or broken appliances and auxiliaries. D o not wait until your next appointment to do so. Additional time may be needed to repair your appliances.

Eat a well-balanced diet.

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Avoid chewing on hard, crunchy or sticky foods, ice, and other objects that may damage the appliances.

Follow all other instructions provided by the orthodontist and orthodontic staff. Instructions are often based on many years of education and proven experience.

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A failure to follow instructions may require your orthodontist to change the procedures and goals of your treatment. As a last resort, treatment may have to be discontinued. Discontinuation of treatment may lead to problems involving teeth, gums, jaw joints, or severe relapse of tooth positions. This may be worse than no treatment at all. Cooperation throughout treatment is your best way to achieve a pleasing smile and a good bite. Please remember that following directions and recommendations are your responsibility. Your orthodontist will encourage you, but cannot assume responsibility for making sure you follow directions.

 

Habits

 

Uncorrected finger or thumb habits as well as atypical swallowing may cause treatment to be extended longer than anticipated. Uncontrolled muscle habits may also cause undesirable tooth shifting following treatment. Grinding and/or clenching the teeth may promote or aggravate jaw problems (TMD) and may increase the tendency for teeth to shift. If significant, undesirable shifting of teeth occurs (relapse), retreatment may become necessary along with a new treatment fee.

 

Cavities and Decalcification

 

Orthodontic fixed appliances (braces) do not cause cavities or decalcification (white or brown tooth scars). Braces do trap food particles and plaque and increase your likelihood of developing cavities or decalcification if you do not effectively clean your teeth. Most patients are able to prevent these problems with a combination of proper diet, effective tooth brushing habits and regular checkups with a family dentist. You should brush your teeth immediately after eating, using the proper techniques for brushing with braces. If brushing right away is not possible, vigorously rinsing with several mouthfuls of water is helpful. Floss once a day. Effective oral hygiene and plaque removal is essential. Remember to avoid sticky candies and foods and minimize beverages high in sugar and limit snacks.

 

Check for loose bands or brackets daily. If any part of your orthodontic appliance becomes loose, call the office to schedule an appointment. A loose band or bracket greatly increases your chance of getting cavities. When you miss appointments and are not seen regularly by your orthodontist, loose bands can go undetected and may result in tooth and/or gum problems.

 

Swollen Gums and Periodontal Problems

 

Ineffective tooth brushing and flossing may cause your gum tissue to become sore and swollen. The swelling may cause your gums to contact your orthodontic appliances leading to even more soreness. Should this condition become severe, swelling may lead to receding gums and gradual loss of supporting bone around your teeth.

 

If severe gum or periodontal problems occur during orthodontic treatment, and if not controlled or corrected, it may be difficult or impossible to control bone loss and subsequent loss of teeth. Consultation and treatment by a periodontist will be advised. If periodontal problems cannot be controlled, treatment may be discontinued.

 

Gum recession can be common in adult malocclusions (improper bite). Aligning your teeth may leave triangular spaces between the front teeth, contributing to esthetic problems and entrapment of food particles. Most often, these spaces can be reduced or eliminated by slightly narrowing the wider portion of the teeth and closing the spaces by bringing the teeth closer together. Other procedures by your general dentist may be appropriate for providing best esthetic results.

 

Tooth Reshaping and Equilibration

 

Occasionally, your orthodontist may recommend removal of small amounts of enamel tooth structure either between or on top of your teeth to allow for proper alignment, improved dental esthetics, or to improve the fit and function of your teeth. Additionally, your orthodontist may recommend adjustment, tooth reshaping, or equilibration of one or more chewing surfaces of your teeth to allow a better fit and function of your teeth in their new positions. This removal of tooth structure does not endanger the long-term health of your teeth or gums. Your orthodontist will explain these procedures in more detail should it apply to you.

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Root Resorption

 

Root resorption is a shortening of the tooth roots. It can occur with or without orthodontic appliances and it is impossible to predict susceptibility to this condition. Some patients are predisposed to this occurring, while most are not. Slight changes in root length are usually insignificant, but occasionally with severe changes, the longevity of the teeth involved may be jeopardized. The incident may increase with extended orthodontic treatment. Your co-operation during treatment is very important in the prevention of root resorption.

 

Ceramic Braces

 

Ceramic (clear) braces have been designed to improve aesthetics, especially for the adult patient. These modern appliances have helped many adult patients receive the benefits of orthodontic treatment without it being obvious they are in treatment. Due to their brittle nature however, occasionally ceramic brackets have been known to break. Ceramic braces on the lower teeth may cause wear of the opposing teeth if in contact, or if the patient is a heavy tooth grinder.

 

Enamel damage can occur at removal, but is uncommon. Your orthodontist will help you determine which braces will provide the best treatment results with a minimum of potential problems.

 

Loss of Tooth Vitality

 

On rare occasions, teeth that have been previously traumatized have large fillings, or periodontal problems, may experience tooth discoloration and/or nerve degeneration during orthodontic treatment. In such cases, root canal treatment might be necessary to maintain the health of a tooth. Bleaching may also be recommended to restore a more natural tooth color.

 

Impacted Teeth

 

Teeth are ‘impacted’ when they stay partially or completely under the gum. While impaction usually occurs when your teeth are too crowded for a new tooth to emerge, it can also happen for no apparent reason. Treatment depends on the cause and the importance of the impacted tooth to the jaw structure. The most common impacted teeth are the ‘wisdom teeth’. These teeth may not grown into place properly because the jaw does not have sufficient room to accommodate proper eruption. Your orthodontist may recommend their extraction. An oral surgeon may be required to uncover and move an impacted tooth prior to tooth movement. The roots of nearby teeth may be damaged by the presence or movement of an impacted tooth. Not all impacted teeth can be successfully moved, which may necessitate their extraction.

 

Ankylosed Teeth

 

In some instances, teeth will not move because they are attached to the jaw bone (ankylosed). When a tooth is ankylosed, adjacent teeth may be forced to move, which may affect your bite. An ankylosed tooth may require surgery for movement into place or removal.

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Injuries from Appliance

 

A number of orthodontic appliances are used in orthodontic treatment. It is important that you follow closely the orthodontist’s instructions regarding their use. However, there is always some risk of injury in the use of appliances.

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Braces

 

Because your braces may project from your teeth, a blow to the face can scratch of cut the inside or your lips or cheeks. Loose or broken wires and bands can also scratch or irritate your cheeks, gums or lips. If problems develop, call the office for an appointment. Dislodged or broken braces can be swallowed or inhaled. The risk of dislodging your braces is increased when sticky or crunchy foods are eaten. Do not eat hard candy, ice, caramel or similar foods.

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Retainers

 

If your retainer breaks, call your orthodontist as soon as possible so that your retainer can be repaired or replaced.

 

Headgear

 

You must follow your orthodontist’s instructions for safe and effective use of headgear. Do not engage in physical sports or activities while wearing your headgear. You may be seriously injured if another person pulls your headgear off accidentally or intentionally.

 

Headgear that is pulled away from the head can snap back and seriously injure your face and/or eyes. Always remember to release all tension before removing the headgear. We utilize safety strap mechanisms on our headgears to prevent the majority of these issues.

 

Injuries During Treatment Procedures

 

Although your orthodontist will use great care in applying and removing your braces and other bonded attachments, damage may occur to teeth previously weakened by cracks in the enamel, undetected cavities or weak fillings.

 

Jaw Joint Pain and/or Clicking

 

Occasionally problems may occur in the jaw joints, i.e. clicking. Earaches and headaches are sometimes related complaints. Multiple factors are usually responsible for these signs and symptoms, including some which are controlled by the central nervous system. Some of the most common causes of TM disorders (TMD) are chronic muscle tension associated with clenching or grinding of the teeth, or habits such as gum chewing or stressed jaw posture at work or during sleep. The symptoms may originate with a joint disease, such as arthritis or result after a previous trauma, such as a blow to the face or sometimes from a whiplash type injury. The severity of the symptoms may be affected by tension, mood, and emotional distress. Neck and shoulder muscle tension may be a major contributor by referring pain and tightness to the jaws and face. Severity of symptoms may be exaggerated by faulty function of the pain suppression system at various levels of the nervous system. In the past, it was believed that an imperfect bite (dental malocclusion) or a mal-positioned lower jaw was the cause of TMD problems. However, occlusion as a cause of TMD has not been well demonstrated, despite many investigations seeking to test this relationship. ‘Bite problems’ that occur with TMD are most often the result of the problem rather than the cause of the problems. TMJ disorders are musculoskeletal problems similar to aches and pains on other joints of the body. A TM disorder is most often treated as a medical problem and not necessarily a dental problem. Any TMD signs or symptoms should be reported promptly to your orthodontist.

 

Tooth Attrition and Enamel Loss

 

The biting surfaces of adult teeth are frequently worn down by tooth grinding or jaw clenching behavior. Tooth interferences during jaw movements can also contribute to tooth wear. As your teeth move during orthodontic treatment, your bite will steadily change and new interferences may arise. Halting enamel loss is not easy. It is difficult for orthodontics alone to establish a bite completely free from interference during jaw movement. Psychological stress or conditioned habits may be the cause of grinding or clenching. The biting surface of the teeth may need reshaping by special dental procedures. In some cases, an appliance to control the rate of enamel wear may be considered. Such procedures are beyond the scope of usual orthodontic therapy.

 

Orthognathic Surgery

 

You may need both orthodontic treatment and surgery to modify the size, shape, or position of your jaw. As with all surgical procedures, the risk of complications with oral surgery is a possibility. Discuss these risks thoroughly with your oral surgeon if your orthodontist recommends surgery.

 

Relapse Tendencies

 

‘Relapse’ refers to the movement of the teeth back toward their original positions after your braces have been removed. Ideally, your teeth should remain stable after retention. However, teeth can move at any time, whether or not they have had orthodontic treatment. The most vulnerable teeth are those in the lower front. Periodontal disease, mouth breathing, and harmful tongue or oral habits can cause teeth to move. For these reasons, and many others beyond the control of your orthodontist, it cannot be guaranteed that your teeth will remain in a perfect position for the rest of your life. With the use of fixed retainers, relapse long term is significantly reduced. Your orthodontist cannot assume responsibility for undesirable tooth movement. Make sure you keep appointments for retention adjustment as scheduled.

 

Discontinuation of treatment

 

In some instances, your orthodontic treatment may need to be discontinued before optimal results are obtained. The reasons could include poor cooperation with oral hygiene, lack of compliance with elastics, headgear or other auxiliary appliances, not completing dental procedures necessary to continue orthodontic progress, excessive appliance breakage, and missed appointments. It could also be your desire to discontinue treatment prior to completion. Further, inability to meet your financial obligation to your orthodontist can be reason for early termination.

 

Additional Risk and Benefits

 

For all other dental treatment procedures, such as corrective jaw surgery, removal of teeth, root canal treatment, gum surgery, fillings, crowns, (or) cosmetic bonding, dental implants, temporary anchorage devices (TADs) or administering local anesthetics, the doctor performing the procedure(s) will be responsible for discussing related risks and benefits.