Frequently Asked Questions

What is orthodontics?

Orthodontics is the branch of dentistry that specializes in the diagnosis, prevention, and treatment of dental and facial irregularities.

What is an orthodontist?

An orthodontist is a specialist who has completed an advanced education program following dental school to learn the special skills required to manage tooth movement and guide facial development.

What are some possible benefits of orthodontics?

• A more attractive smile
• Reduced appearance-consciousness during critical development years
• Better function of the teeth
• Possible increase in self-confidence
• Increased ability to clean the teeth
• Improved force distribution and wear patterns of the teeth
• Better long-term health of teeth and gums
• Guide permanent teeth into more favorable positions
• Reduce the risk of injury to protruded front teeth
• Aids in optimizing other dental treatment

What are some signs that braces may be needed?

• Upper front teeth protrude excessively over the lower teeth, or are bucked
• Upper front teeth cover the majority of the lower teeth when biting together (deep bite)
• Upper front teeth are behind or inside the lower front teeth (underbite)
• The upper and lower front teeth do not touch when biting together (open bite)
• Crowded or overlapped teeth
• The center of the upper and lower teeth do not line up
• Finger- or thumb-sucking habits which continue after six or seven years old
• Difficulty chewing
• Teeth wearing unevenly or excessively
• The lower jaw shifts to one side or the other when biting together
• Spaces between the teeth

At what age should orthodontic treatment occur?

Orthodontic treatment can be started at any age. Many orthodontic problems are easier to correct if detected at an early age before jaw growth has slowed. Early treatment may mean that a patient can avoid surgery and more serious complications. The American Association of Orthodontists recommends that every child first visit an orthodontist by age 7 or earlier if a problem is detected by parents, the family dentist, or the child's physician.

What is Phase I and Phase II treatment?

Phase I, or early interceptive treatment, is limited orthodontic treatment (i.e. expander or partial braces) before all of the permanent teeth have erupted. Such treatment can occur between the ages of six and ten. This treatment is sometimes recommended to make more space for developing teeth, correction of crossbites, overbites, and underbites, or harmful oral habits. Phase II treatment is also called comprehensive treatment because it involves full braces when all of the permanent teeth have erupted, usually between the ages of eleven and thirteen.

Would an adult patient benefit from orthodontics?

Orthodontic treatment can be successful at any age. Everyone wants a beautiful and healthy smile. Twenty to twenty-five percent of orthodontic patients today are adults.

How does orthodontic treatment work?

Braces use steady gentle pressure to gradually move teeth into their proper positions. The brackets that are placed on your teeth and the archwire that connects them are the main components. When the archwire is placed into the brackets, it tries to return to its original shape. As it does so, it applies pressure to move your teeth to their new, more ideal positions.

How long does orthodontic treatment take?

Treatment times vary on a case-by-case basis, but the average time is from one to two years. Actual treatment time can be affected by rate of growth and severity of the correction necessary. Treatment length is also dependent upon patient compliance. Maintaining good oral hygiene and keeping regular appointments are important in keeping treatment time on schedule.

Do braces hurt?

The placement of bands and brackets on your teeth does not hurt. Once your braces are placed and connected with the archwires you may feel some soreness of your teeth for one to four days. Your lips and cheeks may need one to two weeks to get used to the braces on your teeth.

Will braces interfere with playing sports?

No. It is recommended, however, that patients protect their smiles by wearing a mouthguard when participating in any sporting activity. Mouthguards are inexpensive, comfortable, and come in a variety of colors and patterns.

Will braces interfere with playing musical instruments?

No. However, there may be an initial period of adjustment. In addition, brace covers can be provided to prevent discomfort.

Should I see my general dentist while I have braces?

Yes, you should continue to see your general dentist every six months for cleanings and dental checkups.

What is a space maintainer?

Baby molar teeth, also known as primary molar teeth, hold needed space for permanent teeth that will come in later. When a baby molar tooth is lost, an orthodontic device with a fixed wire is usually put between teeth to hold the space for the permanent tooth, which will come in later.

Why do baby teeth sometimes need to be pulled?

Pulling baby teeth may be necessary to allow severely crowded permanent teeth to come in at a normal time in a reasonably normal location. If the teeth are severely crowded, it may be clear that some unerupted permanent teeth (usually the canine teeth) will either remain impacted (teeth that should have come in, but have not), or come in to a highly undesirable position. To allow severely crowded teeth to move on their own into much more desirable positions, sequential removal of baby teeth and permanent teeth (usually first premolars) can dramatically improve a severe crowding problem. This sequential extraction of teeth, called serial extraction, is typically followed by comprehensive orthodontic treatment after tooth eruption has improved as much as it can on its own.

After all the permanent teeth have come in, the pulling of permanent teeth may be necessary to correct crowding or to make space for necessary tooth movement to correct a bite problem. Proper extraction of teeth during orthodontic treatment should leave the patient with both excellent function and a pleasing look.

How can a child's growth affect orthodontic treatment?

Orthodontic treatment and a child's growth can complement each other. A common orthodontic problem to treat is protrusion of the upper front teeth ahead of the lower front teeth. Quite often this problem is due to the lower jaw being shorter than the upper jaw. While the upper and lower jaws are still growing, orthodontic appliances can be used to help the growth of the lower jaw catch up to the growth of the upper jaw. Abnormal swallowing may be eliminated. A severe jaw length discrepancy, which can be treated quite well in a growing child, might very well require corrective surgery if left untreated until a period of slow or no jaw growth. Children who may have problems with the width or length of their jaws should be evaluated for treatment no later than age 10 for girls and age 12 for boys. The AAO recommends that all children have an orthodontic screening no later than age 7 as growth-related problems may be identified at this time.

What kinds of orthodontic appliances are typically used to correct jaw-growth problems?

Correcting jaw-growth problems is done by the process of dentofacial orthopedics. Some of the more common orthopedic appliances used by orthodontists today that help the length of the upper and lower jaws become more compatible include:

• Headgear: This is the standard against which all appliances are measured when reducing and overbite. The appliance applies pressure to the upper teeth and upper jaw to guide the rate and direction of upper jaw growth and upper tooth eruption. The headgear may be removed by the patient and is usually worn 10 to 12 hours per day.
• Herbst: The Herbst appliance is limited in its application due to occasionally unwanted effects on the teeth. It is usually fixed to the upper and lower molar teeth and may not be removed by the patient. By holding the lower jaw forward and influencing jaw growth and tooth positions, the Herbst appliance can help correct severe protrusion of the upper teeth.
• Palatal Expansion Appliance: A child's upper jaw may also be too narrow for the upper teeth to fit properly with the lower teeth (a crossbite). When this occurs, a palatal expansion appliance can be fixed to the upper back teeth. This appliance can markedly expand the width of the upper jaw.

The decision about when and which of these or other appliances to use for orthopedic correction is based on each individual patient's problem. Usually one of several appliances can be used effectively to treat a given problem. Patient cooperation is critical in the success of dentofacial orthopedic treatment.

Can orthodontic treatment time sometimes last longer than anticipated?

Estimates of treatment time can only be that - estimates. Patients grow at different rates and will respond in their own ways to orthodontic treatment. Dr. Papandreas has specific treatment goals in mind, and will usually continue treatment until these goals are achieved. Patient cooperation, however, is the single best predictor of staying on time with treatment. Patients who cooperate by wearing rubber bands, headgear or other needed appliances as directed, while taking care not to damage appliances, will most often lead to on-time and excellent treatment results. The significant majority of patients will finish on time, and if not, you will know well in advance of any changes in anticipated duration of care.

Why are retainers needed after orthodontic treatment?

After braces are removed, the teeth can shift out of position if they are not stabilized. Retainers provide that stabilization. They are designed to hold teeth in their corrected, ideal positions until the bones and gums adapt to the treatment changes. Wearing retainers exactly as instructed is the best insurance that the treatment improvements last for a lifetime.

Will my child's tooth alignment change later?

Studies have shown that as people age, their teeth may shift. This variable pattern of gradual shifting, called maturational change, probably slows down after the early 20s, but still continues to a degree throughout life for most people. Even children whose teeth developed into ideal alignment and bite without treatment may develop orthodontic problems as adults. The most common maturational change is crowding of the lower incisor (front) teeth. Wearing retainers as instructed after orthodontic treatment will stabilize the correction. Beyond the period of full-time retainer wear, nighttime retainer wear can prevent maturational shifting of the teeth.

What about the wisdom teeth (third molars) - should they be removed?

Wisdom teeth may need to be removed either in conjunction with orthodontics or at some point after. There are many reasons to remove wisdom teeth, but crowding of front teeth is usually not one of them. Careful studies have shown that wisdom teeth do not cause or contribute to the progressive crowding of lower incisor teeth that can develop in the late teen years and beyond. Dr. Papandreas in consultation with your family dentist and local oral surgeon, can determine what is right for you.