Thinking About Becoming an Orthodontist?

This week we we were happy to welcome a local high school student who will be working part time in our office. She has shown interest in becoming an orthodontist in the future, and wants to jump right in and see first hand what my day to day life is like at Meadows Orthodontics. I worked as a dental assistant when I was curious about the dental profession, so I think it is really neat that she wants to work with us at such a young age (much younger than when I started thinking about my long term career!) I thought I would write a bit about my profession and experiences as an orthodontist, and hopefully it may help kids who are considering a career as an orthodontist.

I think whatIMG_3643 our new friend is doing is the best way to see if orthodontics is a good fit. A question I am asked frequently is, “How can you work in people’s mouths all day long?” I explain to kids that the majority of health care professions deal with the human body, whether it be the mouth, feet, growths on skin, backs/spines, etc… I think it is important to work part time or as an intern in the field that you are considering, because yes, you may not be comfortable working in these situations. Nothing worse than going to more than 8-12 years of college before finding out that mouths, eyeballs, or rashes skeeve you out! My brother in-law is an ER doc, and although it is a really interesting job, it is not something that I would be comfortable with day in and day out. For me, working with peoples teeth is just the opposite- it is just a natural fit for me.

Another thing to consider is how involved and visible you want to be within your community. When I go to the grocery store, out to eat, or run an errand in Castle Rock, I almost always run into and end up talking with a number of patients or their parents. As an orthodontist you get to know thousands of people- it is not the best job for introverted personalities! I personally like seeing people I know all over town, but if you prefer to be more “anonymous”, this profession may not be a good fit, or you may consider living in another community from where you work.

During the workday itself, I there is rarely a moment when I am not talking to patients, kids, parents, or my staff. It is a job where you are “on” nearly all the time, as far as being in front of people (my wife was a teacher and she says it is similar in this regard). Again, I really like this about my career, while others may find it exhausting. Really think about your personality and if this seems like a fit for you.

Other components of my profession include:

Creativity- there is rarely a day that I am not challenged to figure out a mechanical, physical, aesthetic, or administrative issue that presents itself.

Working with your hands/artistry: I gravitated to orthodontics largely due to the artistic component that is involved with aligning peoples teeth and creating an optimal aesthetic appearance. This is a passion for me personally, and is what makes me love going to work each day!

Entrepreneurship: Most orthodontists own their own businesses, and there is no preparation or training for this part of my job in all the schooling I have done. It is learn as you go, and luckily I have my wife who has helped tremendously with the day -to -day adventures of running a practice. This includes hiring, training and managing a staff of assistants and administrators, doing payroll, taxes, filing and checking insurance claims, advertising, paying bills, keeping up with and enforcing HIPPA and OSHA regulations, maintaining professional and business insurances, licences….it goes on and on! Running a business is hard work (but also rewarding) and having the right people around you to help has been the key for me. If this is really unappealing to you, there are options to become an orthodontist and work for larger, corporate dental chains that allow you to largely not be involved with the administrative or business aspects of dental care.

As always, I welcome anybody young or old who is interested in a career in orthodontics to come in and speak with me. I did not start dental school until I was 29, so it is never too late!

Dr. Dan Rejman is a board certified orthodontist who is the owner of Meadows Orthodontics in Castle Rock, Colorado. He has two offices located within Castle Rock, and is a specialist in braces and invisalign for children, teens and adults.


Our New Broncos Mural Room, and Congratulations Denver for Winning Super Bowl 50!

Meadows Orthodontics second location in Castle Rock is now officially open in the Founders, Terrain, Pradera, and Crystal Valley area of Castle Rock, in the Founders Marketplace! I will post pictures soon of the new office (it is amazing!), but after the Broncos’ Super Bowl win this past Sunday, I wanted to get a picture up of the Mural I have been painting in our new treatment room, as well as some additional pictures of Broncos Spirit from around town. It has been quite an amazing week, and our staff is proud to be from Castle Rock and the Denver area!


This is the new treatment room where we will be placing and removing braces, seeing new patients, and celebrating Denver’s win in Super Bowl 50! What a nice coincidence that I got this far painting the mural just before the big game. I still have a ways to go, but the scene from inside Sports Authority Field is looking better and better!






Broncos orange, blue and white were VERY popular the last two weeks as color choices for ties on braces. This is my son showing off his colors (I think he needs to get brushing!).




This is the sculpture heading east on 5th in downtown Castle Rock. I’m not one for messing with sculptures and art, but this orange shirt placed on the cowboy was playful, fun, and showed the spirit we all had this past week!





I’ve been wearing that tie way too much this past week.




My boxer, Stanley, with his Bronco jersey!








Amazingly, we had what is known as a “Broncos Sky” Saturday night before the game, and this proved to be a good omen. Well, it has been a fun several weeks at Meadows Orthodontics and in Broncos Country. I will get pictures up of the new office soon.




Dr. Dan Rejman is one of the few orthodontists that are Board Certified in Douglas County and the Castle Rock, CO area. For a list of orthodontists in your area that are Board Certified, go to


We are Opening Our Second Location in Founders Marketplace Soon!

IMG_3396We are excited to be opening our second office in Castle Rock! In addition to our office in the Meadows, Meadows Orthodontics will be open the first week of February in the Founders Marketplace on Ridge Road (near King Soopers). Why are we opening two locations in Castle Rock? Convenience! Starting orthodontic treatment usually means seeing us every month or two for a year and a half  for adjustment visits for braces and Invisalign. Most all Castle Rock area residents have noticed how increasingly challenging and time consuming it can be to cross I-25 with all the new construction (and soon to be Mall!). We decided to make our offices super convenient for residents of both sides of I-25. Our original West office in the Meadows near Einsteins/Carribou  is really close for residents of the Meadows, Red Hawk, etc…, while the new East office in Founders Marketplace will be close to Terrain, the Founders, Crystal Valley Ranch, Plum Creek, and downtown areas. the East office will also be much closer for our FullSizeRenderIMG_3406patients from Elizabeth, Franktown and Parker.

Construction started several months ago, and is nearing completion (I am
posting several pictures of the progress that is being made). The new office is very similar in size to the Meadows location, but has a slightly different layout and feel. One nice thing about opening this location is that it has inspired me to start painting like crazy again. I am trying to get 4-6 new oil paintings completed and on the walls before the grand opening the first week of February. Here are a couple pictures of the progress of the paintings (the one with the plants is 36″x 36″ and is taking a IMG_3432while- I am having dreams about swiss chard!).

We hope you will enjoy the new location and the convenience it will provide busy families who have kids in braces! I will follow up with more pictures when the office is complete.


Dr. Dan Rejman is a Board Certified Orthodontic specialist who lives and practices in Castle Rock, Colorado. Meadows Orthodontics specializes in Braces, Clear Braces, and Invisalign.

Motivating Your Child to Wear Their Elastics (Rubber Bands) for Braces

Colorful-inter-arch-rubber-band-on-bracesOne of the challenges that parents of of children or teens in braces deal with on a daily basis is getting the child to wear their elastics, or rubber bands, consistently. I commonly hear, “We know they should be wearing their rubber bands all day and night, but when they go to school or to bed, they take them off or don’t remember to put them on.” The situation can get very frustrating for parents, as they feel powerless as their child’s orthodontic treatment extends much longer than was originally planned.  Not wearing rubber bands consistently and as asked by your orthodontist WILL make treatment take longer, which in turn increases the risk of permanent staining of the teeth around the braces (called decalcification), and increases the risk of root shortening and gum disease. What can you do if your child is just not showing interest in cooperating with elastic wear? Here are some tips.

  • Remind them of the biggest benefit of wearing elastics as asked.  The biggest benefit is usually what kids want about half way through their treatment- to get them taken off! I constantly remind kids that wearing the rubber bands is usually the only way to move teeth as we want, and wearing them close to all day and night makes things go really fast. Parents, remind them of this often.
  • Go to google images, download and print out a picture of “braces decalcification”. Tape it to the childs bathroom mirror as a reminder of what may happen if braces are on too long.
  • Similarly, tape a paper saying ‘Remember your elastics” to their mirror, refrigerator, or computer so they are constantly reminded.
  • Try positive reinforcement- bribery works well for encouraging consistent wear (I know- three of my own children are currently in braces!  Reward great elastic wear weekly with a treat from their favorite restaurant, pizzeria, or ice cream. Movies, I tunes points and video games are great rewards to work towards. Every child or teen has specific wants and interests that can be used to your advantage!
  • Keep a calendar that you fill out together every day, coloring the day in with blue for great wear (20-24 hours a day), yellow for so-so wear (14-20), and red to indicate insufficient wear (under 14 hours). Make it clear every red day means an entire extra day in braces!
  • From my own experience, sometimes taking something away may work well if the above ideas do not work. My oldest daughter responds well to several days without her cell phone. Taking away video game or computer time may work well, as could assigning chores or not being able to attend an event (although offering to take them to a movie or an event for great wear usually works better).

Try these tips, and remember that most parents feel similarly and go through some struggles with motivating their children. It is important to remember that most children and teens do not have a fully developed sense of long term consequences and responsibility as most adults do. Give us a call at any time if you feel you need additional help.


Dr. Dan Rejman is an orthodontist in Castle Rock, CO, and currently has three children of his own in braces!

Common Misconceptions about Braces and Invisalign, Part 2.

This is the second part of my article explaining some common misconceptions or myths about braces and Invisalign. These are things that I hear and see on a daily /weekly basis and that patient often misunderstand.

  1. images When patients come to see me for a consult and are interested in Invisalign treatment, there are differences that braces that they need to be aware of. First, there are some tooth movements that Invisalign just is not good at. Often times to approach the same quality that you receive from braces, elastics (rubber bands) must be worn, bumps called attachments may need to be bonded to the face of your teeth, and “ramps” on the back of your upper trays may prevent you from closing your back teeth together. I like patients to be aware if these adjuncts are needed before deciding between braces and Invisalign. The relative advantages of Invisalign (aesthetics, the ability to remove them) can then be weighed against the disadvantages (also the ability to remove them, sometimes  limitations in correcting the bite, and usually an increase in cost). I will be glad to help you decide which option is the best for your smile and your lifestyle.
  2. images (1)“I would like clear braces, but I heard that they can discolor or stain.”  For years now, the clear ceramic braces that I use at Meadows Orthodontics do not stain or discolor! The small clear ties that hold in your arch wire can discolor (especially from coffee, tea, red wine and curry), but these are changed to brand new ties at each visit, so they never really get the chance to be noticeably discolored. It is really nice that the clear ceramic braces have advanced to the point that this is no longer an issue!
  3. “If I double up on the elastics that I was asked to wear, I will get my braces removed faster”  Kids- do not do this! Wearing double the rubber bands will not speed up your treatment, and could likely break the brackets off your teeth, cause pain, and slow down tooth movement! There are many sizes and strengths of elastics, and I choose the most efficient ones for you to wear (if needed) at every visit.
  4. “I heard that Damon (or self-ligating) Braces will speed up my treatment, or are more comfortable.” Damon braces are one of MANY brands of braces, and each manufacturer touts the merits of the product that they are selling. The fact is teeth do not know what brand of braces is on them, and it is mainly the decisions of the orthodontist that determines the quality and length of your treatment. Damon is a really nice system of braces and I offer self-ligating braces as an option to my patients, but I am honest with them and explain that the latest research (and my own clinical experience) do not support the above claims from the manufacturers. Please see my blog article from August 21st, 2014 for more detailed information on this topic.
  5. “Phase 1 (or early) treatment will eliminate the need for braces later on, or reduce the total time in orthodontic treatment.”  In general this is not the case. The majority of children do not need early intervention, but it is very important to identify the children that do.  If I have informed you that your child needs early or Phase 1 treatment, it is because of one of the following: 1). If not treated now, there is a window that will be missed that will negatively affect his/her future outcome,  2). If two phases are done a better or more stable outcome will be attained, or 3). The appearance, function or health of the patient will be improved as an adult if treated in two phases versus one phase.  Because the need for early treatment is very specific, you should have a full understanding of WHY early treatment is needed and why it is not advised to wait until one complete set of braces (which I prefer if possible). Phase 1 treatment is limited treatment before all the permanent teeth have erupted, is very specific in its focus, and the limited braces are are usually removed after 9-12 months.  Because there are so many baby teeth present during phase 1 treatment, full alignment of the teeth is not the intention of this early phase. The term “Phase 1” implies that there will be another second phase of treatment, when a full set of braces is placed  to align the permanent teeth when they have erupted. Usually the time in treatment of Phase 1 and Phase 2 added together is longer than most one phase comprehensive cases, so this should be made clear also.

Dr. Dan Rejman is an Board Certified orthodontic specialist, and exclusively treats  patients with braces and Invisalign in his Castle Rock Colorado practice. Meadows Orthodontics is located in the Meadows community, and will soon open a second Castle Rock location in the Founders Marketplace (in February 2016)!

Common Misconceptions about Braces and Invisalign (Part 1)

Everyday at Meadows Orthodontics, we explain to our patients how braces and Invisalign work. There are a number of common misconceptions that keep coming up, so I thought I would write an article with a list that addresses these issues.

  1. “As an adult, I am too old to get my teeth straight, or my bite fixed”.  This is not the case! There are a number of skeletal issues that are best treated as child, but most tooth alignment issues can be treated fully, or significantly improved as an adult. In fact, over 20% of our new patients are over 30 years old!
  2. abo logo“All orthodontists are Board Certified, right?”  Absolutely not! In fact, just over one in three are Board Certified by the American Board of Orthodontics (ABO). Dr Rejman is one of the few Orthodontists that are board certified in Douglas County. Finding a board certified orthodontist helps to ensure they are committed to the very highest standards of the profession. To learn more, visit, which includes a list of board certified orthodontists when you enter your zip code.
  3. “Braces are so expensive that I cannot afford them”. We understand the that this may be the thought when considering braces or Invisalign, but we offer fantastic, interest free, in house financing to get that smile you have been wanting. We also participate with most insurances, which combined with flex and HSA plans can reduce fees by over half!
  4. “I had braces, then when my wisdom teeth erupted, they caused misalignment of my front teeth”.  This is one that I hear all the time.  Research has shown that wisdom teeth DO NOT push the teeth in front of them forward and cause crowding. In fact, even if you never had braces, teeth tend to crowd as you age (especially the lower teeth).  Teens also tend to stop wearing retainers around college age as they get out of site from their parents- this coincides with the age that wisdom teeth normally try to erupt. It is the lack of retention that is to blame, not the wisdom teeth erupting! Which leads us to…
  5. ©Blue Moon Studio, Inc.“After several years of retainer wear, my teeth will stay straight and stable“.  Every day we let our patents know that to maintain straight teeth, retainers must be worn for life! The good news is that do not need to be worn during the day, and as you get older several nights a week of routine wear is usually adequate.
  6. “I described to my child what braces felt like when I was a kid/teen. Sorry mom or dad… your child’s treatment will be a much more comfortable and fun experience than when you has orthodontic treatment! Advanced in braces, wires, digital technology that replaces the goopy impressions of old, many fun color choices…the improvements since we were kids goes on and on. The orthodontic version of “When I was a kid, I walked uphill to school both ways!”.

Dr. Dan Rejman and his wonderful staff are setting the standard in quality and fun in Castle Rock and the surrounding areas when it comes to Braces and Invisalign. Please contact us if you have any questions.

A Guide for Halloween Candy and Braces

jack-o-lanternHalloween is such a fun time for children, with costumes and candy. For kids with braces, it can be tough to judge what candy may harm their braces. I tell my patients that for this night, it is OK to enjoy some treats, but to follow some guidelines. Here is a list of common candies that are acceptable and not recommended.

Absolute No- No’s:     Candies on this list are either really hard, extremely chewy, or have a consistency that will likely damage your braces.

  • Jolly Ranchers or hard candy
  • Taffy or hard caramels
  • Starburst
  • Now and Laters
  • Tootsie rolls
  • Sugar Daddies
  • Pay Days (or anything with full nuts)

Acceptable as Treats:     These candies are acceptable (as limited treats only!), especially if they are broken into smaller pieces.

  • Chocolate, Hershey’s Kisses
  • Most soft candy bars (Milky Ways, Three Musketeers, and Snickers and Twix in small pieces)
  • Fun dips
  • Lolly Pops- just don’t bite into them!
  • Reese’s Peanut Butter Cups

In general, break things into small pieces, chew lightly, and consume sugar in moderation!


Dr. Dan Rejman is a Board Certified Orthodontic specialist, and is the owner of meadows Orthodontics in castle Rock, CO.

Deciding what Type of Retainer to Wear

When the time has come to where you have almost completed treatment with  braces (or Invisalign), Dr. Dan will help you decide which retainers will be best for you and your bite. There are three main types of retainers that we offer (four including Invisilign Vivera retainers), and each has distinct advantages that different people prefer. Her is a description of each type to help you decide which retainer is best for you!

  • essix-header1Vacuum formed retainers:  Vacuum formed retainers are what is referred to as  “essix”clear retainers”, or “clear trays” by most patients. This retainer is made by vacuum forming clear plastic over a stone model of your teeth. Besides being comfortable, the advantage of this type of retainer is its clear appearance. Both upper and lower trays can be worn without them being seen (unless people are REALLY up close!). Kids and teens seem to really like wearing this type of retainer because of the way they look, and how easy they are placed. A relative downside compared to other retainer types is that longevity is usually less than the ones listed below.
  • A subset of vacuum formed retainers are Vivera Retainers, which are made by the Invisalign company. These are clear vacuum formed trays, but they come in a package with 4 sets of retainers, which addresses the longevity issue. When one set wears out, you move right to the next one. Vivera can be a nice option for people that grind their teeth at night, as there is full coverage over the biting surface.
  • Hawley retainers:  This type of retainer is the traditional type that usually comes to mind when picturing a retainer. Hawley retainers are Hawleymade of acrylic that is custom formed to the palate and inside of the upper teeth, and along the inside surface of the lower teeth. There is usually a metal “bow” that is formed to the outside surface of the upper and lower teeth. Hawley retainers have several advantages. They can be modified to stay in your mouth really well if this is an issue with the vacuum formed retainers, and they are very durable (they should last for years id well cared for). Depending on personal preference, some people like the feeling of their teeth being more “free”, as Hawley retainers do not fully cover the teeth like vacuum formed retainers. The acrylic can also be customized in any color, design, with glitter… the choices are endless! Relative downsides of this retainers is the visible metal bar across the front of the teeth, and a fuller feeling on the tongue side of the teeth.
  • BLR Intra oralBonded retainers:  Bonded lingual (which means tongue side of the tooth) retainers are tiny wires that bond permanently to the inside surface of the front teeth. Bonded retainers can almost always be used on the lower teeth, but due to the way teeth fit together, often they cannot be used on the upper teeth (Dr Dan will let you know where they will work for you). The main advantage of this type of retainer is that it is always on, and stays for years. Lower front teeth are notorious for crowding as people age whether they have had orthodontics or not, and bonded retainers will prevent this from happening. The disadvantage to bonded retainers is also that they are permanent and bonded to the back of the teeth- and this makes it more difficult to clean and floss around them. Because of this, I only recommend them for teens and adults who have great oral hygiene.

I hope this helps with the decision of choosing a retainer!


Dr. Dan Rejman is one of the few orthodontists that are Board Certified in Douglas County, Colorado. Meadows Orthodontics is located in the Meadows in Castle Rock, and will soon be opening another location in the Founders Marketplace in East Castle Rock.

What to expect with Early (Phase 1) Orthodontic Treatment

In the last blog, I addressed why early treatment (often called Phase 1 treatment) may be recommended, and the conditions that often require early intervention. As a summary, early treatment has been recommended by Dr. Rejman only if a window of opportunity will be missed pinterest-child-need-braces(due to age and skeletal growth patterns) that will negatively affect a child’s facial structure, bite, esthetics, or periodontal support (tooth stability).  Orthodontists undergo years of study focused on craniofacial growth and development, and there is considerable variation in age regarding dental and skeletal maturity between children.  Dr. Rejman will inform you when we can best take advantage of this growth, and will let you know when the optimal time is to begin treatment. Orthodontic treatment and a child’s growth
should complement each other if it is timed properly.

If early treatment has been recommended for your child, here is what to expect:

• Because early treatment occurs during the mixed dentition (when both “baby” and “adult” teeth are present), treatment does not involve a full set of braces. We often use a limited number of braces to achieve the desired correction, in conjunction with other devices such as an expander and appliances designed to improve the relationship the child’s upper and lower jaws. It is sometimes advantageous to have several baby teeth removed if there is a severe issue with spacing or improper tooth eruption.

200265569-001 Because Phase 1 is problem focused, we like to be as efficient as possible, and remove the appliances and limited braces once the problem has been addressed. Phase 1 treatment can be as short as 6 months (for dental based interceptive issues), to more than a year for more difficult skeletal issues (such as underbites).

• Retainers will be fit to maintain the correction that has been achieved while we wait for the permanent teeth to erupt. We use a number of different retainers to maintain the correction of different problems. The nice thing for kids is that retainers are usually only worn at night while they are sleeping.

• Often retainers will stop fitting correctly as more permanent teeth continue to erupt, and retainers after Phase 1 are relatively temporary for this reason. Dr. Dan checks the patient’s bite every four to six months during this period and will let you know when it is time to stop wearing this retainer (this is usually when they are ready for the full set of braces).

• Early treatment is very problem focused, and Phase 1 is only meant to address a specific concern that needs immediate attention, not align the entire dentition.  We use the name “Phase 1”, because it implies that there will usually be a “Phase 2” when a full set of braces is used to align the full set of adult teeth when they have erupted. This usually occurs between the ages of 10-14 years old (there is considerable variation in physical and dental maturity and development in children!).
I hope this answers many of the questions that you may have regarding your child’s development, and early treatment if it has been recommended.


Dr. Dan Rejman is a Board Certified Orthodontic Specialist, and is the owner of Meadows Orthodontics in Castle Rock, Colorado.


About Phase 1 Orthodontic Treatment

A while back I wrote an article titled, “Why do I see so many eight year-olds in braces these days?” I believe it is imperative that a parent knows why early treatment has been recommended by an orthodontist, as there should be a clearly defined reason that treatment cannot wait for one comprehensive phase when the majority of the permanent teeth have erupted.

The questions I ask myself when evaluating a younger child’s facial and dental development before all of their permanent teeth have erupted are:

  • If I do not treat this patient now, will a window of opportunity be missed that will negatively affect their facial structure, bite, or esthetics in the future?
  • If we do two phases of braces, will I achieve a better or more stable result than if we treated with one phase?
  • Will the patient look or function differently as an adult if we treated in one phase versus two?

If the answer to any of these questions is “yes”, then early, or phase 1 treatment may be indicated. Whenever possible, I prefer to treat patients in a single phase of treatment (this is not always the case with all orthodontists), because a second phase is usually needed to fully align the teeth when the child is older. When early treatment is recommended, I like parents to know exactly why. Here are the most common reasons (it important to note that I see many of these cases, but they are not the most common types of jaw/dental orthodontic problems- more about that later!)

  • Posterior-Crossbite3Posterior crossbites with a functional shift.  Posterior crossbites are when the back teeth are biting on the wrong side of one another, usually due to an upper jaw that is too narrow compared to the lower jaw. Why is early treatment recommended?  Early treatment is recommended if the lower jaw is shifting to one side for the child to find a comfortable bite. If left untreated, this can result in permanent asymmetric lower jaw growth to one side. If your child has a posterior crossbite without a shift, I will discuss the magnitude of the problem with your family- not all posterior crossbites require early treatment!
  • underbite-beforeAnterior crossbites due to skeletal growth issues.  Anterior crossbites are when the lower front teeth are located in front of, or edge to edge with the lower teeth. If this is caused by the lower jaw growing too much or the upper jaw not enough, early treatment is almost always recommended for these cases (unless it is so severe that facial surgery is the only option). Teeth will often tip to try to compensate for this growth, and it is possible to not have full crossbites, but have the skeletal pattern detected early (my youngest daughter has this  skeletal pattern).This type of bite is one of the most complicated and difficult types of treatment, and is distinctly different than teeth that have merely erupted in the wrong place. Why is early treatment recommended?  Underbites that are skeletal in nature usually become more severe as children enter their adolescent growth spurt. We try to reduce or eliminate the need for a surgical correction, or identify surgical cases as early as possible.(Please ask about previous articles that I have written about the complications with this type of skeletal pattern).
  • crowding 4Severe crowding that leads to impacted teeth, severe misplacement, or compromises the periodontal (gum) structures hold the teeth stable.  Crowding and misaligned teeth are the most common reasons that patients seek orthodontic treatment, but only a minority need early or phase 1 treatment. This is where it is up to the ethics and integrity of the orthodontist to properly guide the family, and not to treat early because it is good for the practice’s bottom line. But at times, teeth cannot even enter the mouth due to crowding, and treatment is indicated. Why is early treatment recommended? If teeth cannot enter the mouth, or are in extreme positions, Phase 1 treatment may be needed. Examples include canines that are becoming impacted (an would need a future surgery to correct without intervention), incisors and premolars that cannot enter the mouth properly, loss attachment (gums and bone) on the lower front teeth, or severely protruding upper teeth (often from thumb sucking) that is a clear trauma risk. Other reasons can include severe deep bites where the lower teeth are biting against the top of the mouth, severe open bites or permanent teeth that are becoming excessively worn at an early age. I will show parents the specific problems present, and relate them to the three Phase 1 criteria listed above if I believe that phase 1 treatment is needed for these reasons.

Now, just as importantly, things that should not require early, or Phase 1 treatment:

  • crowding 3 Most crowding, spacing and misalignment of teeth at an early age. As stated above, these are the most common reasons children are brought in for an exam, and the vast majority do not need early treatment for this reason. Why not?  Simply put, most crowding, spacing and misalignment is most efficiently, and just as effectively treated when the majority of permanent teeth have erupted (usually ages 10-13 for girls, and slightly later for boys). If possible, less time in braces is healthier for the teeth and gums, reduces family stress (retainers are needed to hold phase 1 corrections until kids are ready for full braces), and reduces “burnout” from being in treatment too long. Also, space can be gained from skeletal maxillary expansion anytime before the maxillary suture fuses, near the end of the adolescent growth spurt (early teens for girls, mid-teens for boys). Again, proper, well informed guidance is needed to not treat too early, or at times too late– once the maxillary suture fuses expansion is no longer possible.
  • overjet 2Excessive overbites (Orthodontists and dentists refer to this as “Overjet”).  Overjet is actually the term for how far the upper teeth stick out forward from the lower teeth, and this is the second most common concern I see for young kids in my practice. The vast majority of kids with this issue do not need phase 1 treatment. Why not? Vast amounts of research have shown that correction of this issue is most efficiently treated in one phase of treatment, usually during the adolescent growth spurt, and when most of the permanent teeth have erupted. Now, I do see a number of kids each year where the overjet is severe and they are having social problems, and there is a clear risk of trauma to the upper teeth and lips. In these relatively few cases, early treatment is certainly indicated.
  • opgggUpper canines (and other teeth) that are erupting at an angle when seen on a radiograph.  I often hear parents say this was the reason their kids received early treatment, but this is usually not an indication for phase 1 treatment. Why not?  Early treatment should only be started for this reason when the canines have started to actually cross over the roots of the neighboring incisor teeth, or are otherwise severely off course. Canines that are erupting at an angle is usually age appropriate.

My next article will explain what to expect from Phase 1 treatment if it is needed, what to expect immediately after the treatment (retainers), and how early treatment is related to full braces when your child is older.

Dr. Dan Rejman is the owner of Meadows Orthodontics, a private specialty practice in Castle Rock, Colorado. He has treated over 6,000 patients with braces and Invisalign, and has been Board Certified since 2007.