Ask the Expert

Q: I am caught in the middle of 2 opinions from 2 different orthodontists. One wants to take out 4 teeth and you recommended treatment without taking out any teeth. I have been going to my dentist for 9 years and I really trust his opinion. Does asking him for advice on which way to go put him in a bind with the 2 orthodontists?

A: No. Your dentist will respect your right to self-determination. He realizes that you have the responsibility to evaluate the factors and options presented to you. Your dentist also has an obligation to promote your welfare and communicate truthfully to you. Your dentist can be used to help sort out the
issues involving extractions versus no extractions. While both treatments should be considered acceptable, you must choose the option that you feel is best for you.

Q: I called another orthodontist to see if he uses the Damon System of Braces. His receptionist said they use a "Damon like" bracket and all "self ligating" brackets are the same just different names. Are they all the same?

A: No. His receptionist was misinformed. The Damon System of Braces is a system not a bracket. It is a system that requires extensive training to achieve
maximum performance. Damon users have a set protocol and a research and development team that provides training on new developments every year. The
"Damon like' are just self ligating braces that use the same methods as traditional braces. They require the same amount of extractions and their results are the same as traditional braces. Ask about the number of patients treated. Request before and after photos of patients that have a problem similar to your own. Please make an informed decision. If you visit his office and then my office, you will find out that his receptionist's statement is inaccurate.

Q: During the 80's I wore braces that were big and silver that I had tightened every four weeks.  Those braces kind of hurt. Are braces still like that?

A: At my office the answer would be "no". I use only the Damon System of Braces. Damon Braces are much smaller than most traditional braces. It is rare that I ever use a ring like band for your back teeth. Damon Braces use a passive self ligating brace/wire interface. This means I do not tighten your braces and instead, use low force/low friction mechanics to move your teeth. Pain is greatly diminished by using low force systems. I feel the differences in technology between the Damon System of Braces and traditional braces are as great as the differences between a 1980's cassette player and a 2011 IPOD.

Q: At my consultation with you I had my expectations raised on what you could do to improve my smile. At my husband’s request I went for a consultation with another orthodontist. He told me my expectations were unreasonable. Adding he is no plastic surgeon and that I am no Julia Roberts. Why the different response?

A: I use the Damon System of braces and the other orthodontist uses traditional braces. The Damon System is more about creating a wider smile that enhances the face and traditional braces is more about straitening teeth along existing bone. To raise expectations I show all prospective patients photos of treated patients and educate them on anticipated results. After 7 years of using Damon, I continue to be impressed about what this system can accomplish.

Q: I went to a dentist who said that I should have my wisdom teeth out to reduce the chances of my teeth moving when the wisdom teeth come in. On the x-ray (panorex) it looked like the teeth had room to come in and he said they were not impacted. Do I really need them out to prevent my teeth from moving?

A: No. Some dentists believe this reasoning; however a recent study states" Extraction of wisdom teeth is not necessarily a wise choice". The data clearly showed that taking out wisdom teeth had little to no impact on preventing the shifting of teeth. Removal of wisdom teeth may be appropriate for reasons such as periodontal concerns or impaction, but not to prevent teeth from moving. Clearly and still, the best way to keep your teeth from moving is to wear your retainers.

Q: I am 34 years old. I have had a wired retainer glued on the back of my teeth for over 20 years. If I take it off will my teeth stay in place? Can I finally quit wearing my retainer?

A: A recent long-term study found that over time teeth shift on both people treated with braces and people never treated with braces. Teeth shift more as a teen and less as an adult. The research states that patients and their orthodontists need to recognize that the shifting of teeth is a normal physiologic process. Permanent retainers like your wired retainer, "blocks" this process. If you remove that retainer or stop wearing your removable retainer your teeth will shift. They will shift no matter what your age. No study has really been able to accurately predict if your teeth will shift just a little bit or a lot.

Q: I want to get my 11 year old son started in braces. His teeth are a mess. He is ok with getting braces but I don't think he really sees the need. Should I wait until he is asking me for braces?

A: Maybe, but age 11 is usually a great age to start treatment. It is partially my responsibility to help your son recognize the positive side of getting straight teeth and getting it done in Jr. High. I will obtain this by involving him in the treatment planning process. I will show him before and after photos of a patient with similar problems, similar age, same gender and same race. During the treatment I would routinely show him his before photo and compare that to how he looks now. Showing positive progress would add to helping him feel motivated towards treatment and hopefully improve compliance with his treatment responsibilities.

Q: I called an orthodontic office and I was told the orthodontist takes out permanent teeth to make time in treatment shorter. Really? I would think that taking out teeth would make treatment longer. What is your take on this statement?

A: I agree with you it makes little sense. It usually would add 6 months to a patient's time in treatment. I would state that in cases of moderate to severe crowding it makes it easier on the orthodontist to treat you by taking out teeth. Having treated patients both extraction and non extraction, I know it takes a greater level of skill to treat a patient with moderate to severe crowding without taking out teeth. In addition, I also am aware that patients, no matter what age, dislike having huge spaces for several months as the extraction spaces are closed. It is socially embarrassing to have large spaces while undergoing treatment.

Q: My son is a patient of yours. A couple of years ago my other son went to another orthodontist. Today, I watched you use a horseshoe shaped piece of wax to record the size of the bone holding my son’s teeth. The wire you used to move his teeth was made to fit this mold. The other orthodontist did not do this. He just took a wire from a package and put it in my other son’s mouth. Why do you do it differently?

A: The Damon System of Braces is based on a treatment plan customized for each patient. The research clearly shows that a customized “arch from” (the wax form) is better than a “one size fits all” approach. I customize all of my final or finishing arch wires to each patient. This makes a smile that is specific for each patients face.

Q: How are braces glued onto teeth and what makes them sometimes come off?

A: Braces are glued on using a bonding material (glue) that is very similar to the white, tooth colored material your dentist uses for fillings. The teeth are etched to roughen up the surface and then using a very small brush a liquid resin is painted into the tiny, rough areas caused by the etching. Lastly a thin paste is put on the brace (bracket). You want just enough paste to cover the bracket but you don't want paste (called flash) around the outside of the bracket. By far the main reason for a bracket coming off is biting into some food or candy right on the bracket and popping it off. Other reasons may be due to your bite being very deep or having a tooth that is really rotated.

Q: I want the new Damon Clear braces. Are they in yet?

A: Yes! We are one of the first offices in the U.S. to receive these highly sought after new braces. Now you can get the benefits of the Damon® System of braces: fewer extractions + less pain +shorter time in treatment + longer times between appointments, and now less noticeable! Make an appointment today and discover how you can now get the confident looking smile that you always wanted with the most high tech clear braces available. Call for details on our special promotion on the "Damon Clear" braces.

Q: My dentist said I have to lose all my baby teeth before you start my braces. Is that true?

A: It is possible. There is an optimum time to start orthodontic treatment depending on your individual problems and your stage of growth. That is why I offer a complimentary consultation to evaluate you or your dentist’s concerns. This way I can determine if we should begin treatment now or wait. If it is best to start your treatment later, I put my patients on our growth recall program until it is the right time to start. This way I can monitor all the important orthodontic issues and start treatment at the right time. Thus you will have the perfect bite and smile when we finish.

Q: I went to an orthodontist that my dentist recommended in the same building as he is in. He said I needed four teeth removed to do braces. I really liked your office when I came to you for a consultation. You said I did not have to have teeth removed. Will I make my dentist mad at me because I want to go to you instead of the guy he recommended?

A: Hmmm. Good question. While you might think your dentist may “get mad at you.” I guarantee that this will not happen. Dentists refer their patients to certain specialists for many reasons; the specialist might practice close-by, or he could even be a personal friend that the dentist trusts. Whatever the reason, I would always get a second opinion regarding your orthodontic treatment. Your dentist will respect your right regarding your choice to make decisions for yourself. You may want to discuss both orthodontic treatment options with your dentist so that he can give you his input as well. In fact, I am sure he would respect you highly for seeking his opinion whether you choose to go to his recommended orthodontist or not.

Q: I need an expander and I am a little scared to get one. All my friends are telling me that it will hurt. Do expanders hurt?

A: Expanders are actually not bad when made properly. Our expanders are smooth and fit high up in your palate to prevent interferences with your tongue. A recent study in our orthodontic journal looked at the influence of an expander on oral comfort, speech, and chewing and found that most patients had slight problems but only for the first week. After that things pretty much return to normal. Don’t worry, almost everyone says it isn’t as bad as they thought it would be!

Q: My jaw pops now that I have had braces. Did my orthodontist do something wrong?

A: Not necessarily. Jaw “popping” is one specific condition in the broad category we call temporomandibular disorders (TMDs). The popping probably has nothing to do with your history of orthodontic treatment. Almost every study of TMD in relation to orthodontics does not show an association. In fact, the general consensus is that orthodontic treatment neither causes nor prevents TMD. I would see your dentist or orthodontist for an evaluation to determine if your jaw popping is a problem or not.

Q: Every time I go to the orthodontist, he finds one of my braces is broken. I know it’s not my fault. Can’t he use stronger glue?

A: Braces are attached using a composite material (“glue”) that is similar to the tooth-colored filling material your dentist uses. First we treat the tooth to microscopically roughen it and then a thin resin is painted onto the rough areas. Lastly, the glue is put on the bottom of the brace (bracket) and the bracket is accurately positioned on the surface of the tooth. You want just enough glue to attach the bracket without any excess that would hinder cleaning the bracket. I’m sorry, but by far the main reason for a broken bracket is biting into something hard, crunchy, sticky, or chewy, and not because the glue is not strong enough. Other reasons a brace may break may be due to your bite being deep or having a crooked tooth so that you bite on the brace. Call your orthodontist whenever a bracket breaks to decide how to fix it best. Never wait until your next appointment!

Q: My dentist says I need to start braces right now and when I came to you for a consultation; you said you would like to wait a bit before starting treatment. I really trust my dentist. Who should I believe?

A: When you go to your regular dentist for a checkup, he or she is on the lookout for dental problems that usually need correction as soon as possible- like a cavity, root canal, or a cracked tooth. Sometimes however, this “we need to fix it now” thinking also carries over when your dentist sees an orthodontic problem like an overbite or crooked teeth. Orthodontic treatment however, is a process that will take place over time. Growth can often help an orthodontist correct many common orthodontic problems. That is why I like to coordinate your orthodontic treatment process with an active growth spurt so we can ultimately shorten the amount of time you are in treatment and increase the chance for a successful result. So in your case, even though you have an orthodontic problem and probably will need braces, NOW may not be the proper time to start treatment depending on your individual stage of growth. I was a regular dentist for four years before I went back to school to become an orthodontist and I thought the same way as your dentist at one time. Your dentist is only trying to look out for you but is not trained to think like a specialist.

Q: My dentist said I needed an expander and you said I don’t. Who do I believe?

A: An expander is an orthopedic (bone-changing) appliance that can permanently change your facial bone structure. There are many reasons why an orthodontist might use an expander to widen your upper jaw. The main reason I use an expander is to correct a “cross bite” due to a narrow jaw. You see, the upper teeth and jaw drapes over the lower teeth and jaw sort of like a lid fits on a box. A cross bite exists when the upper “lid” fits inside the “box.” An expander corrects a cross bite very nicely while the upper jawbone is growing. As you age and the upper jawbone sets however, it is unpredictable to permanently widen the upper jaw using an expander by itself. To make a long story short, I would trust the orthodontist who is actually a specialist trained in dentofacial orthopedics.