Why an Orthodontist (What is an Orthodontist?)

 

For those who have had braces, most are familiar with who an orthodontist is. But there are still many people who don’t know exactly what an orthodontist is, and how they differ from their general dentist. Ready for an explanation? Here we go…

An orthodontist is a specialist in the diagnosis, prevention and treatment of dental and facial irregularities (straightening teeth, and aligning the jaws). Being a specialist has two components: 1) Attaining a specialized and ADA accredited education, and 2) real world practice where a specialist’s sole focus is on that specialty alone.

All orthodontists are dentists, but only about six percent of dentists are orthodontists. An orthodontist must complete undergraduate college requirements before starting a three-to five-year graduate program at a dental school accredited by the American Dental Association (ADA).  After dental school, at least two or three academic years of advanced specialty education in an ADA-accredited orthodontic residency program are required to be an orthodontist.  Admission to most orthodontic programs is extremely competitive and selective. The training includes advanced education in bio-medical, behavioral and basic sciences.  The orthodontic student learns the complex skills required to manage tooth movement (orthodontics) and guide facial development (dentofacial orthopedics).

It takes many years to become an orthodontist and the educational requirements are demanding. Personally, my residency required classes and clinical training, all day, five days a week, with studying and research in the off hours and weekends. I spent about 65-70 hours a week training, treating patients, studying, and preparing for my research. I received my Masters Degree in Orthodontics at the completion of my residency (This is a bit reversed as opposed to other professions. We receive our doctorate first, and then can receive a masters if we become a specialist).

Only dentists who have successfully completed these advanced specialty education programs (accredited by the ADA) may call themselves orthodontists. General dentists can do orthodontics, but may not call themselves orthodontists or an orthodontic specialist. An orthodontist does not do crowns, implants, cleanings, fillings, sealants or veneers. These are services that general dentists excel at, as they perform these skills daily in their practices.

The American Association of Orthodontics has a web site dedicated to educating the public about our specialty, which can be found here:  https://www.braces.org/. A slogan on the site is,

“Your smile deserves a specialist. And orthodontics is all we do.”

This brings us to the second part of being a specialist. Orthodontics is what I do (and all orthodontists do) exclusively. I have been studying and practicing orthodontics only, for nine and a half years. After graduating from my residency specialty program I was well prepared, but was not even near the orthodontist that I am today. Proficiency and expertise comes from experience (in addition to a great education). Even having treated over 5,000 patients with braces and Invisalign, I learn something as a specialist every day, which further enhances and fine tunes my skills. Doing a proper job aligning the teeth and jaws can be very complex, and then comes the artistic part: noticing and detailing the little and not-so-little nuances that really make things beautiful. Speaking for myself, these qualities have only become exceptionally developed through treating thousands of cases, dedicating myself to continuing education, and being open to examination and criticism through the process of Board Certification (only 40% of orthodontist are Board Certified by the American Board of Orthodontics (see below).

As I tell people, braces and Invislalign are only tools, just as a paintbrush is only a tool for painting. Just as works of art come from the artist who is doing the painting, not the brush, exceptional results come from your choice of professional, not the braces themselves.

So how can you be sure you are seeing an orthodontist for your Braces or clear aligners(Invisalign)? Use these resources and links below.

aao_logoThe American Association of Orthodontists (AAO)  Only dentists who have completed an ADA accredited orthodontic residency program (2-3 years) may call themselves “orthodontists,” and only orthodontists are accepted for membership in the AAO. By choosing an AAO member, the public is assured that the doctor truly is an orthodontist.

To find an AAO member, click here:  https://www.braces.org/

aboThe American Board of Orthodontics (ABO)  Orthodontic specialists can become board-certified by the American Board of Orthodontics(ABO). Board-certified orthodontists are known as Diplomates of the American Board of Orthodontics. The American Board of Orthodontics is the only boarding organization for the orthodontic specialty that is recognized by the American Dental Association (Please note that you can be an orthodontist and not be board certified- this is an optional process).

To find a board certified orthodontist, click here:  https://www.americanboardortho.com/public/

 

Information Courtesy of American Association of Orthodotists (AAO), and the American Board of Orthodontics (ABO)

How to Select an Orthodontist

Posted  Sept. 10, 2012 in Dental Life

How to Select an Orthodontist

Thank you to Mommy DDS.com, who wrote this great article (Posted  Sept. 10, 2012 in Dental Lifeabout selecting the best orthodontist for family. We took the original text, and then added how it pertains to Dr. Dan Rejman and Meadows Orthodontics (in the Blue text!)

Stuff that matters when choosing an orthodontist:

 

  • Is the orthodontist board certified?  Most people think board certification is required and that all orthodontists are board certified.  Board certification is voluntary in orthodontics and only a small percentage actually go through the rigorous process.  If your orthodontist is not board certified, it doesn’t mean they don’t do a good job.  But, an orthodontist who is board certified is making a concerted effort to better themselves.  For an updated list of board certified orthodontists in your area, please visit americanboardortho.com.  Unfortunately, some orthodontists misrepresent themselves as board certified when they are not.  If your orthodontist claimabos to be board certified, verify it with the American Board of Orthodontics.

 

Dr. Rejman is currently the only Board Certified orthodontist in Castle Rock and Castle Pines.

 

  • Is the doctor an orthodontist or general dentist who does orthodontics? An orthodontist is a specialist, and has attended a 2-3 year residency program.  During this time they are exclusively treating orthodontic patients and studying tooth movement, jaw growth and development.  This person generally has a master’s degree in orthodontics and usually has done extensive research and defended a thesis on the subject.  A general dentist can take courses in orthodontics and is legally permitted to perform orthodontics, but has not been through an orthodontic residency.  If the person offering to do your braces also does cleanings, fillings and crowns, that doctor is a general dentist not an orthodontist.  I often hear people tell me, “My dentist is also an orthodontist”.  It doesn’t work that way.  Orthodontists ONLY do orthodontics.  They never do cleanings and fillings.

 

Dr. Rejman attended four years of dental school at The University of Michigan and completed his residency and Masters degree at Marquette University in Milwaukee, WI.  Dr. Rejman is a Board Certified orthodontist.

 

  • Review the qualifications of the doctor.  In the end, you are choosing an orthodontist – not an office, orthodontic technique or particular bracket.  It takes technical skill to produce an optimal result.  Review the doctor’s education (especially dental school and orthodontic school) and experience.  Not all schools are created the same.  Some are excellent, some are good and some are quite poor.  Some of the top programs in the country include: University of Michigan, University of North Carolina, University of Washington and Baylor University

 

Dr. Rejman attended dental school at The University of Michigan and wumas chosen for his residency and Masters at Marquette University.  He won the award for highest academic standing in his graduating class of 100 at Michigan and has received TOP ORTHODONTIST honors by 5280 magazine in 2012, 2013, and 2014 as voted by his peers. He was recently Best of the Bestvoted Best of the Best “Best Orthodontist in Castle Rock, 2014”. Dr. Dan has also received numerous academic awards throughout his career. 

 

 

  • Is the location convenient to school or home? If your child goes to school 30-45 minutes away from your home, an orthodontist closer to school may be a better choice.  You will be driving to and from the orthodontist every 6-8 weeks, not including emergencies.  It needs to be easily accessible to the places your child spends most of his time – school and home.

 

Meadows Orthodontics is conveniently located across from the Castle Rock Adventist Hospital and next to Einstein Bros. Bagels.  There are over ten schools within two miles of our location.

 

  • What are the hours? Some orthodontists have multiple locations.  Find out the hours that the orthodontist is on-site at the location you are planning on visiting the most.  If the orthodontist is only available one day of the week, that office might not be as convenient as you first thought.  If you need a bracket repaired or have a scheduling conflict, you may need to drive 30 minutes to an alternate location.

 

Meadows Orthodontics is open early mornings (6:30 AM), evenings (until 6:30 PM on Mondays and 8:00 PM on Wednesdays), and is open both day time hours and two Saturdays per month.  Visit www.MeadowsOrthodontics.com for a full listing of our hours. 

 

  • Does the doctor have ownership in the practice?  This may sound like an odd question, but there are more and more orthodontists working out of general and pediatric practices.  They are hired by the general practitioner as an associate.  Because they have no ownership, there is no guarantee that they will be there for the entirety of your treatment. In those situations, it isn’t unheard of to have 3-4 different orthodontists working in an office during a logotwo year period.

 Dr. Rejman is the only orthodontist that you or your child will see.  He is the sole owner of Meadows Orthodontics, and Castle Rock is our only location!

 

  • How accessible is the orthodontist? Dr. Rejman meets with every new family for a one-hour consult.  He also does the majority of in-the-mouth work.
  • Do you like the staff? Every team member in our office is from Castle Rock.  In fact, our staff has lived in Castle Rock a total of 47 years!  Julie, the office manager, is Dr. Rejman’s wife- so Meadows Orthodontics is truly a FAMILY ORTHODONTIC PRACTICE – and our middle name is friendly!  

 

Ask who sees patients if there are after hour emergencies.  There are some offices where a staff member is available to take care of your needs.  In other offices, you have access to the doctor and he/she will see you for after-hours care

 

Dr. Rejman sees the majority of emergency patients himself.  He lives right in Castle Rock and is very accessible to is patients. 

 

  • What does the practice charge for additional services? In an effort to make their treatment fees appear lower, some practices will present you with a lower fee and then surprise you with additional fees for required services such as x-rays, models, retainers and emergency appointments.

 

Our office does not charge for additional services.  Dr. Rejman also issues TWO sets of retainers at the end of treatment and these charges are built into the original price.

Top ten things that have improved with braces and orthodontics since I was a kid!

 

Everybody loves a top ten list, so here we go! Many parents of my patients at Meadows Orthodontics had braces themselves in the past. They often wonder how their childrens’ experience with braces will differ from the experience that they had. There have been many positive changes over the years, all of which make braces more comfortable, make treatment more efficient, or increase safety. Here are some of the most significant changes.

  1. The development of advanced arch wires used in braces. There has been a massive increase in comfort and efficiency due to the wires (the part that actually aligns the teeth) that we currently use. Beta- titanium, Nitinol (Nickel- Titanium Naval Ordnance Laboratory- an alloy named after its site of discovery), and heat-activated Nitinol wires are widely used, which allows us start with more gentle forces, and offer a large range of flexibility, adjust-ability, and shape-memory properties.
  2. Clear braces, and more esthetic alternatives. New advances in ceramic braces have Braces for Adultsoffered highly esthetic alternatives that were not available before. These new braces are similar in size and shape to metal braces, but are clear! After years of development they no longer stain or change color as some people remember from years ago. They really look beautiful, and are a great option for adults with concerns about their appearance during treatment, and for teens that just want a different look. Of course, Invisalign is an option that I didn’t have in the 80’s, but I am honest about whether Invisalign will be the best option for your individual smile and goals. It is a great for some, not so great for others!
  3. Bonded braces. Most people take this one for granted, but it was not that long ago wearing braces meant full metal bands that totally surrounded every tooth in the mouth. My wife was actually one of the unfortunate last of our generation to wear these bands as the profession migrated to using bonded braces. Bonding technology allowed brackets (the “square” part of braces) to be “stuck” to the surface of the teeth, instead of being welded to the metal ring that surrounded every tooth. Kids, you may groan when parents say, “When I was a kid…”, followed by some tale of childhood hardship. In this case they mean it – the braces of today are so much more comfortable and smaller than they used to be!
  4. Decreased exposure to radiation. The development of digital radiography, which has replaced traditional film, has reduced exposure to radiation my many multiples.
  5. Better long term retention of straight teeth. This is more due to awareness than to any technological advancement. It is rare that a progressive orthodontist does not recommend retention for life these days, which certainly was not the case when I was younger. Whether you have had braces or not, we now know that most people experience tooth movement as they age. After your orthodontic treatment, we will help you choose the most comfortable retention option for your lifestyle.
  6. Options to help prevent permanent tooth staining. The new adhesives we use to make the braces “stick” contains fluoride to help counteract decalcification (the loss of minerals in the teeth, which causes “spots”). For added protection, we also offer a protective, clear glaze that can be placed for more at risk individuals.
  7. No more headgear! Well, sort off. We now have multiple alternative choices to treat Class II cases (or upper teeth that are located too far ahead of the lower teeth), most of which are hard to see, relatively small, and worn within the mouth. Head gear is still a great treatment option for some kids (some actually prefer it over the other options), but we certainly do not ask for it to be worn in public!
  8. Digital impressions. A recent advancement in the last few years, digital scanners (no radiation) are taking the place of the gooey alginate impressions that most consider an uncomfortable part of treatment. The digital scanners use a low- intensity laser that is fast and completely comfortable. At meadows Orthodontics, we use what is called an iTero scanner, which also sends digital impressions directly to Invisalign if this is the treatment of choice.
  9. More fun colors! For patients who choose traditional braces, we offer over 30 colors to mix and match, including glow in the dark colors. Parents are often shocked at the colors we offer compared to when they had braces! A smart friend of mine figured out that there are 435 different combinations of two colors, and 4060 combinations for three colors!
  10. Evidence for ideal treatment. Dr. Rejman uses peer-reviewed evidence to help make treatment decisions whenever possible. The web alone has been a game changer in the ease that professionals can access research and information from respected journals around the world. Clinical experience is very important in practicing orthodontics and making decisions, but Dr. Rejman balances this with being an evidence based practice for the well-being of his patients and the community.

 

Dan Rejman, D.D.S., M.S.

Dr. Dan Rejman is the owner of Meadows Orthodontics in Castle Rock, Colorado. He loves discussing treatment alternatives with his patients, and various artistic ways to get a smile to look “just right”! He has been Board Certified by the ABO for seven years, and was recently voted Best of the Best, “Best Orthodontist in Castle Rock, 2014”.

Murals in the Meadows!

How about a break from Orthodontics and teeth? As our patients know, I am really into painting, sculpting and encouraging the arts. Aside from the artistic side that great orthodontics benefits from, I think having an artistic outlet can add a lot of flavor and beauty to life in general. I thought it might be nice to show the progress I am making with the Mural that the Town of Castle Rock asked me to paint. It is located in the tunnel that leads to the Grange in the Meadows, underneath Meadows Parkway. Officer Seth Morrissey is running the program to deter graffiti, and various artists are photopainting murals along the trails, bridges and underpasses throughout Castle Rock. I actually agreed to painting, thinking that it would be the size of your average wall. When we went to see the site, I was met with a NINETY foot wide wall! I had to shift gears, and planned to break down the wall into five sections measuring 18×12 feet. The overall plan is to use a sepia-like effect to unify the five sections, and to blend with the surroundings.

I started two weekends ago, and was lucky to have two very talented volunteers help, Billy and Lela. We started with a simple tree in the middle section of the wall. By simple, I mean the design- we actually painted many thousands of fine branches in three layers to give it a delicate look. I started with a very light tree in the background that took a full day to paint. Although this layer is the least visible at first glance, it gives the final result an overall lush and warm feeling. We spent hours and hours on those small fine braches! The next day we added a medium tone, and then the darkest tone on top of that. We finished with a white ground with a few areas of sparse grasses coming through to give it a wintery feel. Presto- one section done!

photo 3The next weekend we started the Buffalos drinking at the water hole scene. This was painted similarly, in layers and in sepia tones. I sketched the buffaloes on paper, and used an overhead projector to draw it on the wall. For the sky I used a photo on my phone that I took while mountain biking in Buffalo Creek, but ended up changing a large portion of it while we were painting. Now that I’m looking at it, I need to touch up a few areas, but it came out really nice.photo 1

 

What is next? I think we are going to do something fun with frogs. Stay tuned.

Dan Rejman, D.D.S, M.S.

Dr. Rejman is the owner of Meadows Orthodontics in Castle Rock, CO. He was recently named the “Best Orthodontist in Castle Rock, 2014”, by both “Best of the Best”, and Douglas County Living. Stop by his office to see more of his artwork- both on the walls, and displayed on all his patient’s smiles!

Advice on Relocating when a Family Member is in Braces

Sometimes families need to relocate while one of their family members is in the middle of orthodontic treatment. If the move is a significant distance, they likely will have to find a new orthodontist to continue their treatment. In my experience, the majority of these “transfer” scenarios proceed smoothly. There are times though, that this transition does not go as planned for the family. My goal in writing this article is to educate and inform families about what to expect and what to look for when anticipating a move (whether coming into my practice, or moving away from Castle Rock). These tips can make this transition a much easier process.

skyThere are two areas that I will discuss; 1) What to expect regarding treatment and finding the “right” new orthodontist, and 2) financial concerns and expectations in the transfer. I will tackle the former first. Whether your treatment has just begun, or whether you are close to having your braces removed, make sure to inform your current orthodontist of your move as far in advance as possible. At Meadows Orthodontics (and at most practices), we set up a special final appointment that includes the taking of final records. This includes taking photos, digital impressions, and radiographs as needed. I also prepare a transfer form (created by the American Association of Orthodontists -AAO) to send to your new orthodontist. This informs your new doc of your original concerns, diagnosis, types of braces and appliances used, recommendations for continued care, and an estimate of remaining time left in treatment.
I also assist in finding a new orthodontist if possible. I usually build close relationships with my patients, and I want them to find someone that they can trust, and that provides an exceptional level of care. If I do not know an orthodontist in your new area, the AAO provides a data base of orthodontists with information on their practice preferences, education, years of experience, and Board Certification status. Finally, I want to make sure that your braces are as secure and “trouble-proof” as possible for your move.

We also want the financial aspect of your move to be as stress free as possible. I like having a specific financial transfer meeting with parents, so that we can explain how we prorate or refund a percentage of your investment (if it was paid in full), or when to stop payments if the treatment was financed. Years ago the AAO provided a formula to help determine the fair amount to reimburse patients that are transferring or moving. This formula is no longer published (likely due to individual case variation and differing financial opinions of individual practitioners), but I still use it as a consistent guideline for what is “fair” for the majority of cases (It is important to be aware of this, especially at the start of treatment if you are paying in full). If there is any “grey area”, I tend to err in the patient’s favor, as maintaining great relationships is more important to my business than “nickel and diming” will ever be.

For patients that are moving to the Castle Rock area, we recommend that, as described above, you complete and resolve any financial issues with your current/former orthodontic office before you move. It is important to understand what percentage remains with your or your child’s treatment, and that you are comfortable with the agreed upon financial arrangement. Most orthodontists will gladly discuss your case details with one another (with proper HIPPA compliance) to ensure a smooth transition, but resolving and closing out your previous financial arrangement (and reimbursements if applicable) upon moving are solely between you and your previous office.

On our part, we will do our best to make your transition as easy as possible. When you arrive at our office after your move, we will perform a full examination, and will base our fees to finish your treatment on several factors. The most important factor is how long it will take to complete your case, but may also be influenced by case difficulty, appliances or braces that may need to be replaced, and how fairly we believe you were financially “sent on your way” at your previous location. With the vast majority of cases there is a very similar estimate of remaining treatment goals, and we are on our way to getting you finished! In the rare case that we believe you have considerable more time remaining than your previous orthodontist estimated, I will explain in depth why this is the case, and may recommend a second or third opinion, just so you feel at ease with the treatment that still remains.
Regarding your insurance benefits, be sure to let your original orthodontist and insurance carrier know when you are moving and when your last appointment will be with your original orthodontist. Without this information, your insurance carrier may continue to send payments to an office where you or your child is no longer at! (The above information is applicable to braces, clear braces, and Invisalign)

As always, if you have any questions, please call us at Meadows Orthodontics and we will be glad to help you!

Dan Rejman, D.D.S., M.S.
Owner, Meadows Orthodontics, Castle Rock, CO.

Dr. Dan Rejman is Board Certified by the American Board of Orthodontists, and was recently voted Best Orthodontist in Castle Rock 2014 (Castle Rock News Press), and Douglas County’s finest Orthodontist 2014 (Douglas County Living).

What are self-ligating braces, and are there advantages in using them?

self-ligationThe last several decades have seen an increase in popularity (and marketing) of what are called self ligating braces (brackets). Not unique to one manufacturer, self ligating braces include Empower (American Orthodontics), Damon (Ormco), Smart Clip (3M Unitek), and In-Ovation (GAC Dentsply) among many others. Basically, self ligating brackets use a permanently installed, moveable component to hold the archwire in place instead of removable elastics or steel ties.

The manufacturers of these braces have made many claims regarding the advantages of using these braces, including increased comfort during treatment, increased efficiency, shorter treatment times, and improved oral hygiene. When presented with products with such heavily marketed claims (and which are inevitably more expensive for the orthodontist and our patients), I have to examine the evidence carefully when deciding if I want to offer them to my patients here at Meadows Orthodontics. For ethical reasons, I personally try to make as many decisions as possible using an evidence-based approach. This approach certainly applies to how these braces are presented.

A recent article in the American Journal of Orthodontics and Dentofacial Orthopedics addressed the major claims to these brackets. The findings by the American Association of Orthodontists’ Council on Scientific Affairs (COSA) are very useful in determining the merits to these claims. First and foremost, the article reviews the tenants for an evidence-based orthodontics practice, and states, “Adherence to the tenants of evidence-based orthodontic practice requires that, for any orthodontic intervention applied to a patient, 3 factors must be integrated: the relevant scientific evidence, the clinicians expertise, and the patient’s needs and preferences.” (Note that manufacturers claims and marketing are not among these factors!).

Let’s take a look at what COSA determined (the complete article can be found here). “ 9 of the 14 claims regarding self ligation bracket systems have some peer-reviewed data, but the evidence does not indicate clear differences at this time for reduced friction between arch wire and bracket, reduced clinical forces, reduced treatment time, faster alignment, faster space closure, different arch dimensions, better alignment and occlusal (bite) outcomes, less patient pain, and more hygienic. Three of the 14 claims- lateral expansion leading to bone growth, lateral expansion is comparable to expansion using RPE (expander) and conventional brackets, and stability of lateral expansion long term- have no supporting peer-reviewed data currently. Only two of the 14 claims- mandibular incisor inclination, and time in “untying” the braces, were found to have significant differences.

What does this mean for an orthodontic patient of mine? First, most of these self-ligating braces are great products, and I can achieve great results by choosing to use them. But I treat the vast majority of my patients without self ligating braces, due to the fact that 1) the scientific evidence to support the “marketed” advantages of these braces is lacking, 2) I have used these braces extensively, and have found no clinical advantage for my patients (although they did finish equal to traditional braces), and 3) the vast majority of my patients do not prefer these systems, even though they are presented as an option. What it comes down to is two things: 1) Kids and teens love the color ties that are the “ligation”  in traditional braces (and that self ligation braces eliminate), and 2)  these systems are significantly more expensive, and most of my patients prefer not to pay more for a product with no real or perceived  added value. For patients with esthetic concerns, ceramic braces (traditional and self ligating) with clear ties and Invisalign are the treatment of choice for adults and older teens -you don’t need to have bright colors!

I hope this helps clarify questions that you may have had regarding this issue. I will be posting a series of articles that examine a number of orthodontic topics, and how the current scientific evidence shapes my decisions at Meadows Orthodontics.

Dan Rejman, D.D.S., M.S.

Owner, Meadows Orthodontics

How long do I need to wear my retainers?

When you think about it, the ability to move teeth within your jaw bones is an amazing and unique thing. While teeth are being moved by braces or Invisalign, the surrounding bone is remodeling to the new position that the teeth are in. It would seem that after this remodeling is complete, or “set”, that this new aligned position of the teeth would be permanent. Most adults that had braces as teens remember being told by their orthodontist to wear retainers to keep their teeth straight, but usually for only several years after their braces were removed. The belief was that when teeth were  aligned and stable, and retainers have been worn for a few years, they would stay this way for life without continued wear of their retainers. Fast forward 5, 10, 20… years later, and many adults notice that their teeth are starting to shift and are crowding again. What happened?

Removable InvisalignAs a profession in general, most orthodontists now agree that to keep teeth straight for life, retention is needed for life (I often joke that just like the rest of our bodies, teeth “wrinkle” as we age!).  I let my patients know that although this may sound daunting, the benefits are great compared to the effort required to keeping their teeth aligned and healthy. Every bite is unique, but most patients only need to wear their retainers at night while they are sleeping, and are free to go to school, play sports, eat, play and go to work without wearing retainers. This is often a huge relief to patients who expect that they will have to wear retainers 24/7 after their braces are removed!

There are several choices of retainers that I match to patient’s lifestyles and preferences. We offer traditional (Hawley) plastic and wire retainers, clear trays (that look like Invisalign trays), and bonded semi-permanent retainers (small wires bonded to the back of the front teeth). At first, we ask that retainers be worn every evening and night for several years. After this, retainers should continue to be worn (for life!), but how often is unique for each person. Most people can keep their teeth aligned wearing them several nights a week, while others may need to wear them every night (these people may prefer bonded retainers). How often depends on several factors, such as how misaligned the teeth were prior to treatment, facial and soft tissue structure, and whether the patient feels the teeth shifting when the retainers are not in place. To ensure that your teeth remain attractive and healthy as long as possible, I will monitor your teeth long after your braces or Invisalign treatment is complete. You will receive guidance as to the ideal retention protocol for your individual needs!

Written by Dr. Dan Rejman
Meadows Orthodontics
Castle Rock, Colorado

Dr. Rejman has been voted a TOP ORTHODONTIST in 5280 magazine in 2012, 2013, and 2014.  He is a Board Certified Diplomate of the American Board of Orthodontics.  

Everything you need to know about your child’s palatal expander!

One of the most common treatments in orthodontics is the use of a rapid palatal expander, often referred to as an “RPE”. An RPE is used to widen the upper jaw (maxilla), and is usually used to correct crossbites, and to create more space for crowded teeth. The following are the questions that we are asked most frequently by kids and their parents here at Meadows Orthodontics.

“Is the expander going to hurt?”

The most common description by kids is a “tight” or “pressure” feeling. Pain is relatively uncommon, and if sensitivity is reported, it usually only lasts several minutes, or even seconds. We generally have parents activate the expander once or twice a day, which is only 1/4mm to 1/2mm. The vast majority of kids feel very little discomfort and adapt very quickly!

“Am I going to sound different when I talk?”

I always inform my patients that “S” sounds will be a bit slurred at first due to the positioning of the tongue on the palate and the new obstacle for the air producing this sound. Most patients overcome this and adapt within a couple days, returning to normal enunciation. I tell kids to practice reading a book or magazine out loud after the expander is placed to help speech return to normal the fastest.

“My child has a hard time breathing through his/her nose, and snores. Will the expander help with this?”

Studies hace shown that there is a reduction in nasal resistance after expansion, and it has been shown to help with obstructive sleep apnea in some children. However, I do not use expansion for the sole purpose of treating these problems, as treatment for airway obstruction should be interdisciplinary (treated along with your physician, who may precribe medications, or recomend proceedures such as an adenotonsillectomy). Personally, my son had his tonsils and adenoids removed, which helped with his airway and snoring for several years before returning recently (he is 10). I started treatment for his crossbite and crowding with an RPE recently, and within 2 weeks his LOUD snoring (I think all of Castle Rock could hear him!) has disappeared. So, yes, it can help, but every patient is an individual and has different results with airway issues.

“My child has a gap forming between her front teeth!! Is this normal?”

Yes, this is to be expected! The gap is the result of widening of the mid palatal suture of the maxilla. Sutural expansion is usually the goal of expansion treatment, as opposed to mearly tipping the back teeth outward towards the cheeks (which usually occurs also, but we try to minimize this tipping). After active expansion has stopped, you may notice the gap narrowing  spontaneously. The suture not closing, rather the fibers in the gums have been “stretched”, and sometimes pull the teeth back together a bit after expansion. Again, this is usually a good thing.

“How long does the expander need to stay in?”

I usually keep the expander in place 6-9 months after the last turns were completed. Removing the expander too early without retention often results in the teeth relapsing back towards the original width. Have patience! Keeping the expander in while your upper jaw remodels will be worth it, so you wont have to wear one again in the future!

“I was told that I was to old for an expander to fix my crossbite. Is this true?”

The answer to this depends on the individual. As a person ages, the mid-palatal suture fuses into one, solid piece of bone. At this point the maxilla cannot be expanded without a surgical procedure. There is significant individual variation as to when this happens, but generally fusion can happen from 11-12 years old to mid teens for females, and mid-teens to late teens for males. On the other hand, I don’t like expanding children at too young of an age (eg: 6 or 7 years old) if there is no downside to waiting for one comprehensive phase of treatment when they are ready for their full braces. Again, there are individual exceptions for severe early problems.

“Does my diet need to change with the expander in?”

We will discuss avoiding very sticky foods and candy, but unless braces are on your teeth also, your meals do not need to change significantly!

 

I hope this helps! If you have further questions, I am always available to discuss them.

Dr. Dan Rejman

Castle Rock, Colorado

How to navigate an orthodontic consult:

If you’re getting ready to call an orthodontist, you might have some questions about how the process works.  Here is a step-by-step guide for you from Meadows Orthodontics in Castle Rock, Colorado (located next to Einstein Bagels):

1.  RESEARCH FIRST!  Before calling an orthodontist that you’re interested in, be sure and research them online.

– Do they have the hours you want?

-Are they Board Certified?  (www.americanboardortho.com)

-Are they located in a convenient location (appointments are generally spaced out every 5-7 weeks, however, don’t forget about emergency appointments or extra appointments if your child is in need of an appliance, such as an expander)?

-Did the doctor specialize in orthodontics for 2-3 years after dental school?

These are just a few of the important questions to ask yourself before calling.

PROBABLY MOST IMPORTANTLY, IF YOU HAVE ORTHODONTIC INSURANCE, find out if the orthodontist you’re interested in PARTICIPATES in your dental plan.  This means that the price will be capped on the top IN ADDITION to getting a benefit!  This could save your thousands of dollars!  Most everyone will “take” your insurance, but few actually participate.  

2.  WHEN YOU CALL be sure and find a good time for BOTH parents to attend, if at all possible.  An investment in your or your child’s smile is FOREVER, and you are truly paying for the expertise of the orthodontist.  It is virtually impossible to recreate a conversation when you return home and show your spouse an estimate, but having both parents at the consultation can help prevent confusion and help with the decision process.  Most offices have things for your younger children to do, so do not hesitate to bring them alone!

ALSO – confirm that the appointment is complimentary and whether or not your child will need a panoramic x-ray.  In addition, it is VERY important to give the office your dental insurance information because the office can call and confirm what your benefits are prior to you arriving.  THIS IS CRITICAL IN RECEIVING AN ACCURATE ESTIMATE DURING YOUR VISIT.  If you do not have orthodontic coverage, take heart… only about 35% of families do!

3.  THE FORMS ARE ONLINE!  If you want to save time, most offices have forms that you can print and fill out prior to arriving.  If you don’t have the time to do this, the paperwork you’ll need to fill out at the time your arrive is minimal (less than 10 minutes).

4.  ONCE YOU ARRIVE, your child will most likely have a panoramic x-ray unless you’ve arranged to have your dentist send a recent panoramic film to the orthodontist.  The x-ray takes about 2 minutes to complete and you should go home with a copy at the end of the visit.  Your child will also have pictures taken that assist the orthodontist in creating a treatment plan.  You will get to take these home as well.

After the x-ray and pictures are taken, the exam with the orthodontist takes place.  Take special note of how much time the orthodontist is willing to give you.  Does he or she examine your child’s mouth for 5 minutes and then leave, or does he or she spend time with you?  This is an important note to take when deciding how much personal attention you need throughout the treatment process.

Dr. Rejman makes it a priority to spend a great deal of time with a family so that your questions can be answered and the full treatment plan can be explained in great detail.  He gives his personal cell phone to patients, and families are always welcome to call with post-consult questions as well.

5.  Finally, the FINANCES are discussed with the Treatment Coordinator.  This is your opportunity to hear what the cost of the treatment will be, what your insurance discounts or benefits will be, and what your payment options are.  Meadows Orthodontics offers interest free financing and many payment options that will make your life easier over the next 12-24 months!

There!  It’s that simple!  To schedule a complimentary consultation today, call us at 303-660-0112.  We are open from 8:45 AM – 5:00 PM every single day of the week AND we offer before school, evening and Saturday appointments!

Dr. Daniel Rejman is a Board Certified Orthodontic Specialist and treats children, teenagers and adults with traditional braces, Ceramic braces, Invisalign Teen and Adult Invisalign.  He owns Meadows Orthodontics in Castle Rock, Colorado and is the only orthodontist at this practice.  As a Castle Rock resident, he is very accessible for not only appointments, but for emergency appointments in the evening and on the weekends.  Dr. Rejman was voted a TOP ORTHODONTIST by his dental peers as seen in 5280 magazine and has multiple awards and honors that can be seen at our website (www.meadowsorthodontics.c0m).  Most importantly, we offer a warm and fun place for you and your children to receive orthodontic treatment!  WELCOME!

 

Avoiding Staining on Teeth While in Braces

The big day has finally arrived!  Both you and your orthodontist have worked hard to make a beautiful smile, with perfectly straight teeth.  It’s time to have your braces removed!  This is usually an extremely happy day with a reason to celebrate!

When some people have their braces removed, however, white spots that look like a “picture frame” from around the outside of the braces remain.  These white stains can form along the border of the teeth near the gum line.  After all of that beautiful work, the appearance of these stains, which are often permanent, is not something that we at Meadows Orthodontics are happy to see.  These permanent white stains are called decalcification, which is a loss of calcium from the enamel.  Decalcification most often occurs due to the poor removal of dental plaque from the teeth, whether the gum lines, around the braces, or if there are no braces at all!  The bacteria in plaque produce acids that damage tooth enamel by leaching away calcium.  This leads to the often permanent white spots, which is the beginning of a more extensive cavity if habits do not change.

What can be done to prevent these unsightly white spots?  First, the removal of dental plaque, by brushing, flossing or waterpik is vital.  An excellent brusher will rarely aquire stains.  Second, avoid or limit the amount of processed sugars in your diet.  Bacteria in plaque actually feed on sugars, and release acids as a waste product onto your teeth.  Yuck!  Soda and sports drinks are the biggest culprits, as the additional acidity compounds the effect on teeth.  Finally, fluoride rinses can help remineralize teeth, but only to a point.  The public water in and around Castle Rock if fluoridated, so this helps in the development of the enamel but this is not enough to counter the effects of poor plaque removal and high sugar levels.

So, protect that beautiful smile while you are in braces (and after!).  Dr. Rejman will always take the time to educate you and your child about proper dental care and a healthy diet.

 

Dan Rejman is an orthodontist in private practice located in Castle Rock, Colorado.  Meadows Orthodontics provides braces and Invisalign for children, teens and adults and offers before school, day time, evening and Saturday appointments.  Dr. Rejman is a Board Certified orthodontist and has been voted a TOP ORTHODONTIST in 2012 and 2013.  Please go to www.meadowsorthodontics.com to learn more.