How to handle emergencies with braces

Thankfully, there are very few medical emergencies that are associated with wearing braces. There are a number of issues of concern that can arise while you are in braces though, and I will discuss the most common “emergencies” and what to do should they occur.

 

A bracimages (1)ket (or “brace”) has come loose  A bracket that has released from a tooth is the most common concern we see. Brackets are the square metal or ceramic part of braces that are bonded to your teeth with adhesive. This adhesive is designed to release from the tooth if excess force is placed on the braces. This breakage can occur due to a large amount of light “taps” on the braces from chewing (even from foods that might not normally be suspected), or one or two sudden heavy collisions with crunchy, chewy, or tough foods. Patients most often report that they were not eating any chewy or crunchy foods when the braces came off, and we explain that it often takes a day or two before the brace moves and is noticeable. Weakening of the adhesive can accumulate over a period of time before the braces finally releases from an otherwise harmless bite into food (similar to the last “chop” that cuts a tree down). We also explain that the breakage is not necessarily a bad thing, as a stronger adhesive would rip enamel off the tooth with the braces- the release is actually a protective mechanism.

We understand that life happens, and will gladly repair the loose bracket. If we see a pattern of multiple braces coming loose, we will work together with the patient to identify eating habits that are contributing to the breakage. If the bracket is loose, but still attached to the wire, simply use your fingers, a q-tip, or a tooth pick to slide or rotate the brace until it is in a comfortable position. Call our office, and we will help you find the best time to re-attach the bracket.

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A wire is poking your cheek.  Occasionally a wire may deform, or move out of place and start to irritate a patients cheeks or lips. First, try using a q-tip (or the end of the plastic mirror handle that was included in your hygiene kit) to push the wire against your teeth or to a more comfortable location away from the cheek. A nail clipper can also trim many poking wires. If this does not work, use a small pea- sizdownload (1)ed piece of relief wax from your kit, and place it over the irritating piece of wire. If the irritation persists, call our office, and we will likely have to clip or re-position the wire.

 

 

download (3) A wire has broke, or a band is loose.  If an arch wire has broke into two pieces, try to remove the broken part if it is loose. A light wire can often easily be pulled out of the mouth with just a light pull. If this cannot be done, try to keep the pieces in a comfortable part of the mouth, and call our office for a repair as soon as possible. If a band around a back tooth, or an expander has come loose, try lightly pushing it back onto the teeth, and call our office as soon as possible.

 

images (3)A colored or clear tie has come off a bracket.  We call the small rubber rings on your braces ligatures, and occasionally one may come off. If everything else appears in place and you have an appointment soon, we will be able to place a new one at your upcoming appointment. If it will be more than a few weeks until your next appointment, call us and we will replace the tie.

 

images (4)Canker sores.  Canker sores, or aphthous ulcers, can be very painful. They are usually not caused by braces, but the braces can irritate them and exacerbate the discomfort. These sores last about two weeks, and there is no known way to make them go away sooner. The best option is to keep the area as comfortable as possible. Try using over the counter topical anesthetic such as Orabase or Ora-gel, and apply as needed with a q-tip.

 

General tooth and gum pain soon after braces are placed. Discomfort is to be expected the first 4-5 days after braces have been placed. I tell patients to hang in there, they are not alone- this is very common the first week of wearing new braces. For sore teeth, eat a softer diet (mac and cheese, pasta, soup, smoothies…) until things start to feel better. Take Ibuprofen if and as directed by your orthodontist to help with the discomfort. If your lips and cheeks are sore from rubbing on the braces, roll up a small pea sized ball of comfort wax, and press it onto the braces near the area of discomfort.

 

Dr. Dan Rejman is the owner of Meadows Orthodontics in Castle Rock, Colorado. He is a board certified orthodontic specialist, and provides treatment with clear braces, traditional braces, and Invisalign.

Our trip to the national AAO convention in San Franciso

Julie and I just returned from four days at the national American Association of Orthodontists (AAO) convention in San Francisco. I wanted to write a quick blog about the latest and greatest that is going on in the world of Orthodontics, Braces, and Invisalign treatment.

I spent the first day teaching the preparatory course for the American Board of Orthodontics (ABO). I taught both the morning and afternoon preparatory classes to about 25 orthodontists and orthodontic residents who are preparing for their Board exams. What a great group of people. It was an honor to meet and help colleagues who are working so hard to prepare for this exam, many of whom came from around the world (Pakistan was the farthest distance a class member traveled from, while several where from right here in the Denver Metro area). As always, I also learned alot preparing to teach the course.

abo_inforgraphic_new_revisedThe American Board of Orthodontics just launched their new web site which is very user friendly, and does a great job explaining to the public and dental professionals the merits of becoming Board Certified (only one in three orthodontists are board certified). You can visit the site at www.americanboardortho.com, and use the orthodontist locator to use your zip code to find nearby Board Certified Orthodontists. The ABO is also addressing the issue of an accepted standard of care for our profession.

I attended a number of continuing education classes, including lectures that reviewed the latest research on early correction of Class II bites (or what the public calls “overbites”, upper teeth that are relatively too far forward compared to the lowers). The research continues to support the rationale for waiting to treat this condition in one phase only, or when most of the permanent teeth have erupted.

On a technological front, the most interesting development is how far optical imaging and impression systems are  coming. At Meadows Orthodontics, we have been using Itero digital impressions to eliminate the goopy impressions that were needed for braces and Invisalign, but they released their newest model at the conference that takes a large leap forward in patient comfort and time needed to capture an image of the patient’s teeth. 3-D printing also continues to proceed forward with many applications in orthodontics that result in higher efficiency and patient comfort.

downloadJulie and I did have time for some fun also. I am a foodie, and there is no better place than San Francisco for eating! We had a great meal in Chinatown (we wished our daughter Nina was with us!), and headed up to Napa and Sonoma for a day and a half. This was my first time in wine country, and it is one of the most beautiful areas I have seen. They really take the quality of food there to another level. As a former farmer, I found it really neat that the area is so rural and agri-based, but so celebrated and world-renowned.

Overall a great educational, fun and filling trip!

Dr. Dan Rejman is orthodontist and owner of Meadows Orthodontics in Castle Rock, Colorado. He was recently named Best-of-the Best, Best Orthodontist in Castle Rock (2014 and 2015), and named a 5280 Top Orthodontist for the 4th year in a row (2012-2015).

Thank you Castle Rock Mothers!

mothers-day-ss-1920All of us at Meadows Orthodontics would like to say happy Mother’s Day to our patient’s moms, and to say thank you for your help in making the task of aligning your children’s teeth possible. Mothers of Castle Rock (and beyond)- here is a partial list of the things you do as a mom that we appreciate at Meadows Orthodontics:

 

  1. You take time out of your busy day to deliver your children to their braces appointments.
  2. You often take responsibility to keep your children’s teeth clean, whether reminding them to brush (over and over… and over again!), or taking the time to do it yourself when needed.
  3. You listen to Dr. Dan’s bad jokes and usually act amused!
  4. (Kids take notice) – Mothers most likely put off getting something that they wanted (A home improvement, a Marc Jacobs purse…) in order to invest in their children’s teeth.
  5. By investing in their children’s smiles they are giving them an amazing gift of health and self-confidence (that kids often don’t appreciate until later!)
  6. Mothers are Dr. Dan’s “eyes and ears”, monitoring if patients are wearing their elastics and retainers at home and in between appointments.
  7. While they wait for their children’s adjustments, they often juggle squirmy siblings that are in tow.
  8. If there is a broken bracket, poking wire, or your child was whacked in the mouth at a sporting event, you bring them in to be fixed up.
  9. And finally, they maintain a great attitude with all of this while fitting the experience of braces into their very busy lives.

I am very aware of all that you do, and as you child’s orthodontist I sincerely thank you.

Dr. Dan Rejman

P.S. I would like to thank my mother for all the support and love  she has given to me for years, in addition to passing on to me her beautiful teeth!

Colors for your braces!

After writing so many “serious” articles in a row, it is time to lighten things up a bit. Let’s talk about the color choices for your braces! Once your braces are placed, kids and adults are usually very extremely excited to maketumblr_inline_mo2m7d6mx11rgkf2p their first color selection. After all, it is an extremely important decision- this is what the world is going to first notice when they see you in braces! Colors can also be switched at every appointment with us, so if you are ready for a change, it won’t be long before you create a new look. Dr. Dan is a kid at heart, and he usually get just as excited about patients’ color selections as they do.

colored-bands-for-bracesThe colored part of braces are actually called elastomeric ligatures, and these “ties” are what attaches the removable wire to the metal or clear ceramic brackets that are bonded to your teeth. At Meadows Orthodontics we have over 30 different colors to choose from. From the basic ROYGBIV, black and white, to everything in between, there are literally thousands of color combinations that you can create. We even offer neon colors, and ties that glow in the dark!

Here are some fun and interesting ideas and observations about this all important decision. The colors that we order the most due to their popularity include hot pink, black, lime green and navy blue. Popular color combinations are very dependent on the season. In the fall, Broncos blue, orange and white is very popular. Others seasonal combinations include black and orange at Halloween, green and red for Christmas in December, a mix of greens for St Patrick’s Day in March, and Red White and Blue for the 4th of July.

Clear ties are the most popular for patients who have clear ceramic braces, although they also look great and unique with colors on them also. If you want a bolder look we can use many bright colors to create a “rainbow” appearance, or choose all five neon colors for what we call “Neon Deon”. If you want to earn some brownie points with Dr. Dan, choose maize (yellow) and blue for my team, the Michigan Wolverines, and yell GO BLUE! All year long kids wear the colors for their school or club sports teams, in addition to their favorite college and professional sports teams. CV, DC, Dolphins, Warriors, CRMS, Aspen View, American Academy, Air Force, CU, CSU, Nebraska, Oregon, the Avs., Rockies and Nuggets colors are all choices that we send kids happily away with. Dr Dan and hBLUE_Ligaturesis staff love to help getting your selection just right. The only exception? Absolutely no Scarlet (red) and gray allowed!

Dr. Dan’s favorite? Simple sky/baby blue looks great on metal or clear ceramic braces. Whatever your tastes are with color, let your imagination run wild and have some fun with your time in braces!

 

Dr Dan Rejman is the owner of Meadows Orthodontics in Castle Rock, CO. A resident of Castle Rock, he loves art, design, and making things (especially teeth) look amazing! He has been selected by his peers a 5280 Top Orthodontist in 2012, 2013, 2014 and 2015.

Do wisdom teeth cause your teeth to become crowded?

 

One of the most common things that I hear from my adult patients who come in for an exam is, “I had braces as a teen and my teeth were straight. But then my wisdom teeth came in and caused my front teeth to become crowded.” This belief that wisdom teeth “push” the others forward has existed with patients as long as I have been involved with dentistry, and many patients are encouraged by their dental professionals to have their wisdom teeth (third molars) extracted to prevent future crowding. Is there any validity to this theory?

In short, current research does not support the belief that wisdom teeth cause crowding of the teeth in front of them, or “push” on them enough to cause movement. The vast majority oInmanAligner005f peer reviewed research shows that even if people have their wisdom teeth removed, teeth (especially the lower anteriors or front teeth) continue to crowd as we age. This is the case whether a person has had braces or not. Research has shown that teeth tend to drift forward throughout life, even in the absence of posterior teeth or molars.

If the wisdom teeth are not major contributors to increased dental crowding as we age, where does it come from? Current theories include late mandibular growth, or continued forward growth of the lower jaw as we grow older, and changing pressures from the tongue, lips and cheeks. Also commonly overlooked is the age that people stop wearing their retainers. Many adults remember being told by their orthodontist to wear their retainers for only several years after they had their braces removed.  By the late teen years a large percentage of orthodontic patients are no longer in retention, and this is the age that the wisdom teeth first start to erupt, or become impacted (stuck below the gums). We have learned that without retention, teeth that were previously crowded will start to revert back towards their previous position (see an earlier blog about why teeth do this). Often wisdom tooth issues that arise at this age are mistakenly blamed, or correlated with the crowding that occurs during these years after retention is stopped.

The take home message, and current standard of care, is that wisdom teeth should not be extracted to decrease the chances of future crowding. There are a number of other reasons that may indicate m4_slide18_pericor1the need for extracting these teeth, including the inability to properly clean these teeth, tooth decay, pericoronitis (inflammation of the gingiva around partially erupted third molars), and impacted positions that may cause damage to the surrounding jaw structures. Each person is an individual, and the decision to extract the third molars should be discussed with your dentist, orthodontist, or oral surgeon.

 

Dr. Dan Rejman is the owner of Meadows Orthodontics in Castle Rock, Colorado. He is a Board Certified Diplomate of the American Board of Orthodontics, and is a Councilman on the College of Diplomates of the American Board of Orthodontics, representing the Rocky Mountain and Southwest regions.

Orthodontic Treatment for Underbites (Class III relationships)

This is the second of a two part blog addressing the most current research and options for the treatment of underbites, or what orthodontists and dentists refer to as Class III relatioships. This facial type is one of the most difficult to treat in orthodontics, and the earlier it is identified and diagnosed, the higher the chance of arriving at a succesful outcome.

The first consideration is what age do we start treating anterior crossbites that are skeletal in nature (lower jaw growing too much, upper not enough, or a combination of both)? Most research continues to support treating at an early age for mild and moderate underbites, ideally prior to 8 years old. However, new research indicates that favorable changes can occur with treatment in older children, even well into the adolescent growth spurt. The positive changes appear not to be as dramatic compared to starting treatment earlier, but can still be significant.
reverse-pull-headgear (1)In the early 1980’s a protocol for early treatment of underbites became the standard of care that has remained until this day (with some new modifications and options that I will discuss). Treatment usually consists of upper jaw expansion (using an “expander”), followed by facemask therapy. A facemask is a device that has rests on the patient’s forehead and chin, and elastics attach from this facemask to “arms” on the expander that place a forward directed force on the upper jaw. Studies have shown the correction comes from foreward movement of the upper jaw, usually accompanied by downward growth, which makes the lower jaw rotate downward (resulting in a chin position that is further back). This rotation of the lower jaw can also be a negative side effect, and must be monitored closely by the orthodontist.
It is imperative for parents and the child to understand that the success of treatment is dependent on the number of hours a day that the facemask is worn, and the number of months that it is worn. The highest success rates occur when it is worn all day and night, however, most orthodontists are understanding of the social issues of wearing a facemask to school. We ask that it be worn every hour that the child is not in school or sports, which usually is about 16 hours per day, including while they are sleeping. Studies have shown the greatest sucess rates occur when the facemask is worn upwars of 10-12 months, and an over correction is observed where the upper teeth are a ahead of the lower tclass-iii-elasticseeth by at least several millimeters.
A very important thing to keep in mind with the treatment of Class III cases is that after early treatment is stopped, the patient will continue to grow like a Class III patient until growth is complete. Since the growth of the lower jaw will continue to be more pronounced, a second phase of treatment is almost always needed, with full braces, rubber bands, and possibly more time with the facemask.
miniplatesIn the last several decades studies have increased our knowledge in treating underbites, and there have been several modifications to the basic protocol. First, the use of a palatal expander has been shown to be useful only if needed for other reasons such as gaining space or correcting a crossbite that exists along with the underbite. A large number of underbite patients have a hyposplastic maxilla (smaller upper jaw), so many continue to have an expander included with their treatment. Second, another viable option to the facemask has emerged that has demonstrated excellent, or even improved results. Skeletal anchorage in the form of surgically placed miniplates can now be placed, which allow the patient to wear elastics entirely within the mouth, and 24 hours a day. The downside is an increased cost due to two surgical proceedures needed to place and remove these miniplates after treatment. This option has been shown to be optimally successful between the ages of 10-12 years of age due to the need for higher bone density to hold these devices secure.
For more severe cases where a very pronounced underbite is detected early, and especially if there is a strong lower jaw component, it may be decided early on that jaw surgery will be needed to obtain a succesful result. These more severe cases cannot be corrected enough by orthodontics alone, but your orthodontist will continue to monitor facial growth, and work in conjunction with an oral surgeon to determine the optimal time to start preparing for a surgical correction. Jaw surgery to correct underbites are usually not performed until the patient’s jaws have completed growing. The best way to determine when this has occured is by taking a series of radiographs called serial lateral cephalograms, and measuring the size of the upper and lower jaws over time. Surgery performed prematurely while the jaws are still growingwill usually result in an unstable result with return of the underbite.
After treatment with full braces is completed, retainers are placed like any other case. However, I do monitor patients with Class III patterns for a longer period of time, as the underbite pattern sometimes returns to varying degrees due to small growth changes that occur throughout life. Yet another challenging aspect to this type of facial growth!
A summary of modern treatment for Class III cases (underbites):
1) Timing is important, with higher sucess rates occuring with early treatment prior to the age of eight. However, later treatment (just before or during puberty) has been shown to be more sucessful than previously believed.
2) Treatment with a facemask and elastics remain the most common forms of treatment. New advancements with surgically placed miniplates have provided another effective option.
3) Success with any treatment option is dependent on number of hours the device is activated, and how many months they are worn. Consistency is the key!
4) This facial growth pattern persists and is often accelerates during the adolescent growth spurt. This must be kept in mind regarding the length of treatment, and is the reason two phases of treatment are usually needed for this facial type.
5) Severe cases detected early usually will need a a surgical correction, usually done in the late teen/early 20’s, and no amount of orthodontic treatment alone can achieve an acceptable result. The earlier parents are informed of these cases, the earlier appropriate plans can be set in place to manage this issue.

Dr. Dan Rejman is the owner of Meadows Orthodontics in his hometown of  Castle Rock, Colorado. Dr. Dan is a Board Certified Diplomate of the American Board of Orthodontics, and is the councilman representing both the Rocky Mountain and Southwest Orthodontic Societies for the College of Diplomates of the American Board of Orthodontics.

Treating Underbites

The treatment of underbites (or anterior crossbites) in orthodontics is in a special category of its own, both in terms of jaw growth, and the challenge and difficulty in treating these cases. It is very important for patients and their parents to be educated as early as possible about the unique pattern of growth that is to be expected, and to set realistic expectations in treating this condition.

underWe are all familiar with the typical appearance of people with underbites (Jay Leno comes to mind for most). This appearance is often first seen at a very young age (often before the age of five), and is usually detected by parents or a dentist noticing that the child’s lower teeth are located ahead of, or even with, the upper teeth (the lower teeth should be located behind the upper teeth). ). In orthodontics we refer to this relationship of the teeth as a Class III relationship, which describes the lower teeth as being too far forward when compared to the upper teeth. The underlying cause of an underbite is most often skeletal in nature, and it is believed that genetics play a prominent role in causing the condition. Parents often recall a grandparent with an underbite, or may even have an underbite themselves. Recent research shows that about 68% of Class III patients have an upper jaw (maxilla) that is deficient, and 70% have a lower jaw (mandible) that is protrusive or growing too much. This means that many have both an upper jaw that is not growing enough, and a lower that is growing too much. The front teeth often, but not always, display a distinctive pattern in which the upper teeth are tipped excessively forward (proclined), while the lower teeth are tipped back (retroclined).

The first thing for parents to know is how this growth pattern will progress. All children undergo an adolescent growth spurt,underbite where the body undergoes a rapid increase in the rate of growth, which includes the maxilla and mandible (upper and lower jaws). This spurt usually occurs earlier in girls (ages 9-12) than in boys (ages 10-14), with considerable individual variation. The intensity and duration of growth is on average greater in boys. After this growth spurt, most skeletal growth usually comes to an end in the mid-teens for females, and late teens to early 20’s for males.

When comparing children with Class III patterns with children with Class I (upper and lower jaws growing in harmony) patterns, research has shown that the maxilla (upper jaw) continues to grow less in Class III patients, while the mandible (lower jaw) continues to grow more in relation to the maxilla. What we have learned from the information in these last two paragraphs can be summarized as:

1) Class III patients will continue to be Class III patients as they develop.

2) The appearance of the underbite usually becomes worse with age into the teens, particularly during the growth spurt. This includes the underbite becoming larger, the lower jaw and chin appearing more protrusive, and the profile becoming more concave.

3) A relatively stable relationship occurs when growth stops, which is mid-teens for girls, and late teens to early 20’s for boys. This is why, in general, we treat girls at an earlier age than boys.

4) The earlier we detect an underbite or Class III, the earlier we can put together a plan to tackle this challenging growth pattern, as often there are considerable concerns regarding appearance, social issues, speech patterns, and proper functioning of the jaws.

In the next blog entry, I will discuss the treatment options for Class III patients, and the challenges and potential complications related to this treatment.

Dr. Dan Rejman is a Board Certified Orthodontist with a private practice in Castle Rock, Colorado. He has treated hundreds of Class III cases, ranging from relatively mild cases treated with braces, to severe surgical cases for teens and adults. He has a particular interest in underbites, as his youngest daughter has had a considerable underbite since her first baby teeth erupted!

Wearing Elastics (“rubber bands”) with Your Braces

Orthodontic-Rubber-BandsWe all have seen kids and adults in who are in orthodontic treatment connecting rubber bands (we call them “elastics”) to their braces. In addition to the wire that runs through the braces, these elastics are a way of placing forces on teeth to make them move (see the previous blog: “How do braces and Invisalign make teeth move?”). At Meadows Orthodontics, we are constantly educating patients about the importance of wearing elastics consistently as directed by Dr. Dan. Here are why these elastics are so important.

  • Elastics move teeth in the direction that is needed to correct your bite. Each patient is instructed to wear elastics according to their individual needs, and we will teach you which teeth to attach the elastics to. These patterns will often change as your treatment progresses, and your teeth have changing needs as you get closer to an ideal bite. Forward and back, side to side, and up and down…where we ask you to hook your elastics determines where your teeth go!
  • Wearing your elastics as directed by Dr. Dan makes you finish treatment faster! The number of hours you wear elastics each day is usually the biggest factor in how quickly you get your braces removed. It is currently believed that six hours of constant wear is the minimum time required to initiate the biologic mechanisms that allow teeth to move. But the difference in wearing rubber bands 6 or 12 hours a day vs. 20-24 hours a day could be well over a year extra in braces (or more)! This is so important for patients to understand, and they need to be aware of this from the start. Consistency, consistency, consistency! Also, never “double up” your elastics without being directed to do so- this can damage your teeth or cause unwanted delays.
  • Often later in treatment, the braces (after they have initially aligned and leveled your teeth), themselves are just what their name implies, a brace. They are merely holding your teeth in place while elastics are what causes 100% of the desired movement. Sometimes kids will skip several days or weeks thinking that the braces are continuing to move them closer to the goal of getting the braces taken off. The truth is, when the elastics are removed, everything often comes to a screeching halt, or even worse, starts to reverse itself! Don’t let this happen- be consistent. Notice a theme here?

Now that you know how critical it is to wear your elastics, I’ll give you some tips to make wearing them easier and more successful.

-When you first start wearing elastics, your teeth often become sore for a day or two. Your instinct will be to take them off to give your teeth a break, but don’t do this! If they are off too long, all the work you have started can be reversed, and the discomfort will start up again when they are put back on. Instead, keep the elastics on, take Ibuprophen as directed by your orthodontist, and the sensitivity will go away within a day or two. Taking long breaks can cause a cycle of discomfort that never goes away- you are essentially hitting the reset button all the time.

-Keep elastics with you at all times. Place a bag in your backpack for school, have them in your purse or pocket, and have a backup at home or with your parents. Dr. Rejman will gladly provide enough to keep all your bases covered. And if you lose them or run out, call us that day or stop by Meadows Orthodontics and we will give you more!

 

Dr. Dan Rejman is the owner of Meadows Orthodontics in Castle Rock, Colorado. Dr. Dan is a Board Certified Diplomate of the American Board of Orthodontics, and is the councilman representing the Rocky Mountain and Southwest Orthodontic Societies for the College of Diplomates of the American Board of Orthodontics.

Do Braces Hurt?

When the time comes to get your braces put on, and the big day is getting closer, many kids (and adults!) get nervous about what it will feel like. Concerns that I hear often at Meadows Orthodontics include:

Will it hurt getting braces put on? Once they are on, what will it feel like? Will it hurt when I come in for adjustments? And, what is it like to get braces removed?  I will take you through each of these questions, and I think that most children and adults will be relieved… braces have come a long way since I was a teen (the 80’s, yes I am old!).

First of all, there are NO SHOTS involved with getting braces! Things just never hurt to the point that an injection of anesthetic is needed. If there ever is an abnormally sensitive area, I have a very strong topical anesthetics jelly to rub on your gums.

Will it hurt getting braces put on?  Believe it or not, placing the braces put on (bonded) is one of the more gentle parts of your treatment. It literally feels like gently touching the back of your hand with your finger. Now, there are other sensations going on at the same time: Using suction “Mr. Thirsty” to keep your teeth dry can be a bit noisy, and we have to rinse your teeth with water to help prepare them for the braces. We also use a bright blue light that makes the braces stick to your teeth. Sometimes we fit bands around back teeth, and this often feels tight, like there is food caught in between your teeth.

Other than these sensations, there is absolutely nothing to worry about. In fact, what used to be considered the most uncomfortable or annoying part of getting braces – having goopy impressions taken – has been largely eliminated. Digital impressions using our iTero scanner have taken the place of traditional impressions, eliminating that gooey, hard to breath sensation.

©Blue Moon Studio, Inc.Once braces are on, what will it feel like?  This is where I do not mislead my patients. On average, there will be about four days of soreness. I tell patients that the teeth will feel like your muscles feel the day after exercising hard. Most people describe it as a dull soreness, not a sharp pain. Then after several days, things go back to normal! Usually, there is also several days where the cheeks and lips get used to the feeling of having braces on the teeth. Ninety nine percent of the time, getting used to braces is so much better than what they are imagining or have heard about. The new materials and technologies that we use have come a long way to greatly improve comfort!

Will it hurt when I come in for adjustments?  A common misconception is that an orthodontist “tightens” braces, where patients usually imagine us cranking or twisting at the back of the wires. Things often do feel “tighter” after your adjustment visits, but this is usually from getting a new, often larger, wire placed in your braces. A tight feeling can come from me placed new curves or small bends in the wire to move teeth, or from starting new elastics (or “rubber bands”) for the first time. The good news is that this new sensation goes away quickly, and is usually only a fraction of what was felt the first couple days after your braces were first placed.

What is it like to get braces removed?  Getting your braces taken off is usually a very quick experience- usually one minute or less! We use a special tool that squeezes the braces one by one, and you may hear a little “pop” as they release from your teeth. After the braces are off, it usually takes longer to completely remove the adhesive that may still be attached to your teeth. We use a hand piece that sounds like a drill, but is actually a gentle polisher that makes the teeth nice and shiny. This polishing is usually not painful at all (most patients think it tickles!), it may just be the sound that causes some nervousness.

What do I do if I get a sore spot during braces? All mouths are shaped different, and I use different treatments for different people. Some people go through their entire treatment without getting sore areas, while others develop areas that bother them a bit.  Please read the next Blog that I post, in which I will give tips on addressing this issue.

 

Written by Dan Rejman, D.D.S., M.S. Dr. Dan is a Board Certified Orthodontic Specialist, who is the owner of Meadows Orthodontics in Castle Rock, Colorado.

How do braces and Invisalign make teeth move?

A question that I am often asked by my patients is, “How are braces able to move my teeth?” A very simple answer is that when gentle forces are placed on teeth, the bone around the teeth remodels, or “reshapes” to let the teeth move to a new position. In reality, the physiology of tooth movement is much more complicated, but also more interesting to those who are curious about science and the human body. So for those curious types, here is a more in depth (but still simplified!) explanation as to why teeth are able to be moved by braces.

pdlLet’s start with the players involved. The tooth itself is made of different materials. The part that can be seen in the mouth is covered by a material called enamel, while the root of the tooth (below the gums) is covered with a material called cementum. The cementum of the root is connected to the surrounding bony tooth socket by what is called the periodontal ligament (PDL). The periodontal ligament is made of many bundles of fibers, which in turn are made of a protein called collagen. Many types of cells also reside within the PDL, each with specific functions (more on that below). The main purpose of the PDL is to anchor the teeth to the bone socket (so your teeth do not fall out!), while also allowing slight movement, or “bounce”, to cushion the forces from chewing.

Normal chewing places forces on the teeth, PDL, and bone, and there is constant remodeling (tissue loss and rebuilding) taking place. Under normal conditions, this remodeling is usually in balance, and the teeth do not move. However, if additional forces (or pressure) are placed on teeth (such as with braces), something very interesting happens to the cells that reside within the periodontal ligament. On the side where the PDL is being compressed, or “squished”, cells called osteoclasts start removing, or “eating away” bone. Thus the tooth moves into this new space. On the back side, where the PDL is under tension, or is being “stretched”, cells called osteoblasts start producing bone. Thus bone is added where the tooth root once was. When the forces produced by braces or Invisalign are removed, the osteoclasts and osteoblasts return to their less active roles of maintaining the teeth when they are stationary.

Now that you know the basics of teeth movement, I’ll go over some other questions you might have.

Can I speed up tooth movement by wearing double the rubber bands?  Wearing more rubber bands than asked by Dr. Rejman will likely make your treatment take longer!  In fact, it is thought that the ideal force for orthodontic tooth movement is very light, slightly higher than capillary blood pressure. Excessive pressure can lead to areas around the tooth where cells are not present (hyalanized areas), which results in reduced tooth movement. The take home lesson: wear your rubber bands as directed!

When braces or Invisalign are removed, are the teeth permanently set in place?   No!!! Even though the bony socket has remodeled, and the body finds relative equilibrium (as described above), the PDL fibers are now “stretched”, and want to pull the tooth back towards its original position. Retainers must be worn to keep the teeth in place. Everyone is different, and Dr. Rejman will instruct each patient how long to wear their retainers each day, and which type of retainer will be best for each individual.

So, if placing a light force on a tooth can cause it to move, can I move my teeth with my tongue or my finger? Absolutely! Teeth do not know what is placing a force on it, all it knows is “How much force, and how long does it last?” This is why we are concerned with thumb sucking, which can dramatically tip teeth upwards and outwards. The pressure that the tongue places on a tooth is normally balanced nicely by the opposing pressure the cheeks and lips, and the tooth finds a happy space in the middle of these forces. However, I have seen patients with abnormally large tongues that place a larger outward force on the teeth, which moves them to a non-ideal “wide” position, often causing an open bite. They key is that the force must remain long enough to activate the cells that are responsible to remodel the tissues, as described above.