Q: My teeth have been crooked for years, why
should I fix them ?
Q: Is Invisalign the same
as “regular” braces?
Q: Are all aligners the same?
Q: Which is the fastest way to go?
Q: Will braces damage my teeth ?
Q: My teeth have been crooked for years, why should
I fix them ?
Q: Does it hurt?
Q: Am I too old for braces ?
Q: I'm pregnant, do I have to wait for braces
until after the baby comes?
Q: I have gum disease. Can I have
braces?
Q: Should I see a specialist?
Q: Why do I have to get my nose fixed before
I get my braces?
Q: Why do I need extra hygiene visits?
Q: Will I need a retainer and for how long?
Q: My teeth were straight, now they are crooked
again ?
Q: My braces just came off but some of the teeth
are still crooked, why?
Q: Why can’t I get my spaces closed with
braces?
Q: How young should a child be before starting
braces ?
Q: How much will it cost ?
Q: How do I pay for this?
Q: Will insurance cover orthodontics ?
Q:
My teeth have been crooked for years, why should I fix them ?
Let’s forget about the appearance for a minute.
Proper bite, the arrangement of the teeth, prevents premature
breakdown of the teeth and their support. Periodontal (gum) conditions
are often aggravated by bad bites.
Many times a bad bite may be a symptom of a medical disorder (Chirodontics).
Headaches, breathing
problems, grinding the teeth, stiff necks, lower back pain,
may all be symptoms associated with bad bites.
Q: Is Invisalign the same as “regular”
braces?
Invisalign is a technique that uses a series of computer generated
clear plastic aligners to incrementally move the teeth. (see our
Invisalign links)
In general, when case limitations are noted and the patient informed,
patients who wear their aligners are very satisfied with the results
of their aligner treatment.
Being one of the top GP providers of Invisalign we have seen the
benefits and shortcomings of the system.
Slight to moderate orthodontic issues can be treated with Invisalign
adequately.
Is the result the same? Many times it is similar and the differences
not apparent to most. Because the “attachment” of
the aligner is not glue there is some “give” and the
tooth may not always line up exactly the way it is programmed
by the computer.
Cases of Invisalign tend to finish narrower. The use of an expanding
appliance prior to Invisalign treatment will improve the result.
Teeth which are rotated are also a weakness of the system and
sometimes a short course of “braces” is needed to
turn the tooth.
Other types of cases can use a mix of techniques where Invisalign
is the final technique used to finish the case.
Invisalign is an excellent technique to treat previous orthodontic
cases where retainers were not worn and there has been some shifting
of the teeth.
(See: Q: Are all aligners the same?)
Back to the Top
Q:Are
all aligners the same?
Invisalign is a technique that uses a series of computer generated
clear plastic aligners to incrementally move the teeth. (see our
Invisalign links)
The concept behind Invisalign is not new, what is unique is the
use of computers to predict tooth movement and create the aligners.
Occlusoguides, Essix retainers, and others are the predecessors
of the Invisalign system.
In some minor cases of tooth movement, these techniques will give
you similar results at a much reduced cost. The plastics used
in these aligners are not as clear as those with Invisalign, but
you must weigh that against the cost factor, and also consider
that the time involved in these cases is usually 60-100 days or
less.
Likewise, in many cases of minor tooth movement, “braces”
may be the most cost effective and fastest technique available
to you.
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Q:
Which is the fastest way to go?
All we can say is: “It depends”.
Good cases for Invisalign can be finished in about a year. Combined
cases can be finished in about 18 months. Complicated cases can
go to two or more years. Surgically assisted cases, like the Wilkodontics
technique, can be done in 8-10 months.
For minor cases, braces might be the fastest way especially if
you have rotated (twisted) teeth. Minor positional movement using
aligners could be done in about 6 weeks.
The best thing to do in these cases is to come in for a consultation
and let us give you options for your treatment.
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Q:
Will braces damage my teeth ?
When orthodontic care is provided in a moderate and controlled
manner then damage is essentially not a concern. In some people
a remodeling of the root tips may occur. This usually shows up
on x-rays, but to date no studies have shown this to be detrimental.
We have seen this in patients 40 or more years after treatment
and they weren’t even aware of it.
Overly rapid movement can cause damage and must be avoided. Using
10 elastics to move a tooth is not a good idea!!!
Poor oral hygiene is perhaps the number one reason why teeth are
damaged during braces. If dental plaque is not removed from around
the braces or food is allowed to pack in between the teeth, then
cavities may form in the teeth and the gums will become infected.
Many people unfortunately carry the “white spots”
from their childhood indiscretions.
For Invisalign users poor hygiene and drinking soda with your
aligners in has been the chief culprits in decay forming under
the aligners. In fact the damage that has been done has surprised
the researchers conducting the study.
BOTTOM LINE: Proper hygiene, proper diet, and proper use of elastics
should allow you to feel confident that when your braces are removed
that they will look their best!!
Back to the Top
Q:
My teeth have been crooked for years, why should I fix them ?
Let’s forget about the appearance for a minute.
Proper bite, the arrangement of the teeth, prevents premature
breakdown of the teeth and their support. Periodontal (gum) conditions
are often aggravated by bad bites.
Many times a bad bite may be a symptom of a medical disorder (Chirodontics).
Headaches, breathing problems (link OSA), grinding the teeth,
stiff necks, lower back pain, may all be symptoms associated with
bad bites.
If you have noticed tooth movement in the last couple of years;
spaces opening, crowding developing, a tooth moving out of place,
or some other type of condition, then it is safe to say that some
new medical or dental condition has occurred and a bite evaluation
is warranted.
Back to the Top
Q:
Does it hurt?
Anytime you move teeth there is discomfort. Some people are not
bothered at all and some are bothered more by it. Most of the
time the discomfort is short-lived and you will accommodate to
it fairly quickly.
Those who are using the Invisalign aligners and are changing them
every two weeks say that the first one was the tightest and that
the tight feeling with each new one seems to be less and less.
A little known fact is that eating is the best way to decrease
the amount of soreness in your teeth. The blood flow that increases
in the ligaments that hold your teeth is responsible for reducing
the inflammation which is the source of the discomfort.
Good hygiene is also important. Pain associated with swollen gums
can be eliminated by practicing proper home care and seeing the
hygienist as recommended.
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Q:
Am I too old for braces ?
So far, after doing this for 20 years, I can say that no one is
too old for braces. Our oldest patients are in their 70’s
and the rate of movement is not that much different than a teenagers.
I guess they still had it after all those years!!
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Q:
I'm pregnant, do I have to wait for braces until after the baby
comes?
A: We love pregnant women! Our experience is that pregnant
women experience tooth movement far faster than anyone else. Our
results have been very good and stable. For those women
who tend to have sensitive and bleeding gums, we have found that
an agressive hygiene protocol manages that problems very well. To
our knowledge, there is no contraindication to having braces during
pregnancy. Since we are a latex-minimal office and do not
use natural rubber latex elastics*, we are more comfortable doing
orthodontic procedures. * studies have shown that 5% or more of
the general population may have reactions to natural rubber latex.
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Q:
I have gum disease. Can I have braces?
We have successfully treated patients with periodontal (gum) disease.
A malocclusion (bad bite) in many cases can be contributing to
the periodontal (gum) disease, and treating with orthodontics
may be of great benefit to the patient. Due to the condition
of the teeth some compromise in results may be necessary, and
in some severe cases orthodontic therapy may not be appropriate.
We would be happy to consult with you if you desire or have questions
about orthodontic treatment.
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Q:
Should I see a specialist?
Many people question whether a general practitioner or orthodontic
specialist is better qualified to treat orthodontic patients.
The fact is that in the United States half of all cases are treated
by general practitioners and in Canada the percentage is closer
to 60%.
The key factor is experience and exposure.
Orthodontic exposure to the dental provider population outside
of specialty training is very basic and limited. Most dentists
have a rudimentary knowledge of growth and development, airway
issues, and knowledge of interceptive orthodontic techniques.
Specialists have the advantage of concentrated studies, better
exposure to theory, and more over the shoulder guidance in their
early cases. However, the limitations are the breath of knowledge
of the instructors and limitations imposed by the curriculum.
Many orthodontists coming out of residencies have fewer than 30
cases completed. The number of cases that they actually started
and completed may be fewer.
Orthodontic practices tend to see children at an older age, unless
they are referred earlier to the orthodontist. Many orthodontists
enter a residency right after dental school so their knowledge
of dentistry is limited which might be a factor when orthodontics
is part of an extensive dental treatment plan.
General practitioners who provide orthodontics often have a varied
source of knowledge. They often receive different components from
different teachers. Many times this results in these providers
having a wider scope of knowledge and techniques to choose from.
Being in a general practice, they are examining children at an
earlier age, and are able to intercept orthodontic issues earlier
and healthier. Likewise they tend to see these cases after treatment
much longer than would a specialist, so that they can evaluate
the long term success of their treatment.
This is not to say that all specialists do not have broad knowledge
of dental therapies. I may been mentored by some exceptional ones.
I am saying that in general specialists do have a narrower view
of dental therapies.
In the end, experience makes the difference between the two very
minor, so for the average case any experienced provider can provide
an exceptional service.
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Q:
Why do I have to get my nose fixed before I get my braces?
Airway issues are the most significant factor in dental malocclusions
(bad bite). They may be the direct cause in some cases.
Failure to address this issue is one of the most common reasons
for orthodontic relapse.
We believe that we are treating an individual. Overlying medical
conditions should take priority in one’s journey to wellness.
Improved breathing has a multitude of health benefits. Dentally,
a nasal breather will be far more tolerant of dental procedures
like impressions, and treatment will progress faster as no interferences
will be present.
Most importantly the case will be more stable and the teeth are
less likely to move.
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Q:
Why do I need extra hygiene visits?
The greatest risk in orthodontic therapy is tooth or gum damage
done because dental plaque was not adequately removed from around
the braces or appliances.
The braces and appliances give extra surfaces and opportunities
for plaque to buildup and harmful bacteria to multiply.
The extra visits are cheap insurance to keep these types of problems
to a minimum.
Hygienists will help you isolate problem areas and help coach
you in your attempts at prevention.
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Q:
Will I need a retainer and for how long?
Yes.
You will need to wear a retainer. For those individuals who have
airway problems (asthma, allergies, etc.), retainer wear is without
question mandatory, for as long as you have allergies, etc., which
means forever.
Or….
You can wear your retainer as long as you want the teeth to be
straight.
Since most retainer wear is at night the inconvenience is minimal,
but important.
Teeth will move to where all the forces acting on them push them.
Those forces created your face and caused the original malocclusion.
For many of you, those forces are still present and therefore
your retainer is you best insurance to help prevent adverse movement.
Back to the Top
Q: My teeth
were straight, now they are crooked again ?
Teeth move to where all the forces acting on them are equal. If
retainers are not worn (retainer FAQ)
then something like a tongue thrust, periodontal (gum) disease,
or a worn canine (eye) tooth will cause teeth to start shifting.
Airway issues are a real problem. Develop allergies and mouthbreathing
at night and you have a guarantee that some movement of the teeth
will occur.
Evaluation for braces, especially re-treatment, must include a
medical review and airway/breathing evaluation. Many times our
patients see an ENT (ear nose throat specialist) before starting
treatment.
If you have noticed tooth movement in the last couple of years;
spaces opening, crowding developing, a tooth moving out of place,
or some other type of condition, then it is safe to say that some
new medical or dental condition has occurred and a bite evaluation
is warranted.
Back to the Top
Q:
My braces just came off but some of the teeth are still crooked,
why?
Many times this occurs on the lower but it happens on the upper
as well. When the teeth are crooked the wear pattern on the teeth
is crooked as well. Since everything is crooked the wear and edges
of the teeth may appear “even”.
When the teeth are then moved into proper alignment the wear patterns
will no longer line up and the edges of the teeth may look very
ragged and uneven.
This is a minor restorative/cosmetic issue. If the overall wear
is minimal but uneven a cosmetic recontouring of the edges may
be all that is necessary. If the wear is more significant then
crowns or veneers may be indicated. In deep bite cases where there
is a lot of wear, our finished orthodontic position may actually
have a gap between the upper and lower front teeth. This is to
allow the crowns/veneers to be made longer and restore the original
proportions of the teeth.
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Q:
Why can’t I get my spaces closed with braces?
One of the common problems that we encounter are teeth which are
too small. If we simply close the spaces, the proportions may
not be esthetic, but more importantly the new positions may intrude
into the tongue’s “space”. When that happens,
the tongue will push the teeth out and the spaces will reappear.
Orthodontically, we position the teeth into the right area and
then close the spaces with cosmetic bonding of some type. The
esthetics can actually be better, but more importantly the case
will be more stable.
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Q:
How young should a child be before starting braces ?
Orthodontic problems can be detected in children as young as two.
Pretty teeth with no spaces between them will be a problem when
the permanent teeth start to come in.
One of the common concerns is when the lower permanent teeth come
in behind the baby teeth (treatment is usually just to wait, these
problems usually “straighten” out in a couple of months).
“Buck” teeth are another concern.
See
our article on the 7 warning signs.
The key factor for treatment is timing. Expansion of the upper
arch usually takes place around the age of 7-9. Space maintainers
on the lower usually are placed around the age of 9-11. Trimming
of a long frenum may occur as soon as the child can tolerate the
procedure. Speech and swallowing problems might be related to
this. Check out our frenum presentation.
Your child should be examined for proper growth and development
from the time of their first dental visit. Dental arch development,
airway issues, swallowing problems are among the items that should
be monitored.
The reality is that many general practitioners and more than a
few orthodontists are not very knowledgeable in this area. (specialist
FAQ) This is a function of the training that is given in the
professional schools, not your doctor. If you have concerns ask
for a referral or ask a friend whose child is being monitored
early elsewhere.
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Q:
How much will it cost ?
Orthodontic costs depend on several factors; length of treatment,
laboratory and supply costs, computer CAD-CAM costs, and total
hours spent during treatment.
Because of these factors the same case may differ in price by
several thousand dollars.
Invisalign cases for minor orthodontic movement are the most expensive
due to the computer costs, yet for longer, more average cases
they could even be less expensive.
Traditional braces may be faster in some cases, but less palatable
to some, who will opt for more expensive but more esthetic methods.
As of January, 2004, average cases in our area run from about
$5500-6800, again taking some of the above factors into consideration.
Minor cases can run under $2000.
The best thing to do is to get a consultation and examine your
options. Call us at 703 820-CARE for a consultation.
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Q:
How do I pay for this?
Many insurance plans have a fixed benefit available for orthodontics
separate from regular dental care. Check with your benefits advisor
at your place of employment.
Flex spending accounts are a very good way to pay for your treatment
with discounted dollars. Working with our financial coordinator
will allow you do use several years of benefits if possible keeping
your out of pocket costs to a minimum.
We offer cash discounts for prepayment. We can offer approved
financing packages such as one year same as cash and up to four
years for major dental expenses. We can give you more information
if you are interested.
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Q:
Will insurance cover orthodontics ?
Orthodontic costs may be a covered expense with your dental insurance.
You need to contact your benefits specialist or your plan brochure
may address this question. Orthodontic coverage in the last decade
has expanded to cover adults as well.
If you have coverage, it is separate from your dental benefit.
The amount is usually a single life-time benefit paid out over
the length of the case. Amounts of this benefit range from $1000-3500.
Interceptive orthodontic procedures on children such as space
maintainers and expanders may be covered under the dental benefits
portion of your insurance and will not count against your orthodontic
benefit.
Flex plan programs, also known by names such as 125b, MSA, cafeteria,
etc., use pre-tax dollar contributions to pay for your dental
benefits. This allows you to pay with pre-tax dollars giving you
a substantial effective discount on your dental treatment.
