Does Your Child Need Jaw Surgery to Correct Their Bite?

One of the more involved things that I do as an orthodontist is to give parents guidance and advice if we have identified something in the cranial facial growth of their child that indicates that they may benefit from a surgical procedure in addition to traditional orthodontics. Some parents are familiar with these procedures if they (or a family member) has had surgery to help correct their own jaw relationships in the past, or can clearly visually recognize that there is a significant jaw imbalance. The purpose of this article is to act as a starting point to help parents and patients understand why they may be a candidate for jaw surgery, how it may benefit them, what the potential risks are.

Hearing that a child’s jaw growth has, or may progress to the point where surgery is needed to achieve an acceptable bite or facial aesthetics is usually a cause of great stress to the parents of the child. Having had this conversation with hundreds of families, and having a daughter of my own that is a possible candidate for a surgical jaw correction, I can empathize with the worry, uncertainty, and parental concern that naturally accompanies such a decision. Here are some of the most common questions about orthognathic (jaw) surgery that I commonly address.

” Why might my child need jaw surgery?”  Jaw surgery (orthognathic surgery) is most often an option when the upper jaw (maxilla) or lower jaw (mandible) has grown disproportionately in size to the other. Other indications for surgery may stem from issues due to jaw asymmetry, congenital defects or syndromes. Most commonly though, I guide people through making decisions about surgery due to a lower jaw that is growing too much, a lower jaw that has not grown enough, or an upper jaw or midface that is not growing enough.

“What are signs that my child’s jaws are not growing in proportion?”  If the lower jaw is not growing enough, there is often the appearance of a “weak chin” that is set far back, or upper teeth that appear excessively forward of the lower teeth. If the lower jaw is growing too much, or the upper jaw not enough, the chin often appears to protrude too far or to be too large. The front teeth will also often be in a crossbite (lower teeth ahead of the upper teeth), even at an early age. An upper jaw that is too narrow will often cause a posterior crossbite (back teeth that are on the wrong side off one another).

“Cant crossbites, overbites, underbites, and jaw issues be corrected by orthodontics?”  Most often these issues can be corrected with orthodontics, but there are two main factors that must be considered. The first is the magnitude of these conditions. If the jaw imbalances are severe enough, no amount of orthodontic treatment will obtain a result that is within normal limits. The second factor is the age that these issues are treated. Certain relatively severe issues, such as crossbites and some underbites can be corrected or greatly improved if treated early enough. It is important for an orthodontist to identify these imbalances early, as there are age appropriate times for these conditions to be treated most effectively (for example, many crossbites cannot be fixed after the maxillary suture fuses during the mid-teen years). However, it is just as important for an orthodontist to have discussions with the family if it appears that orthodontics and braces alone cannot result in a satisfactory outcome. This is when the option of a surgical correction comes into the equation, and the sooner it is discussed, the better prepared the family will be.

In several weeks, I will continue this article with more information regarding surgical orthodontics in the second half of this blog.


Dr. Dan Rejman has two orthodontic specialty offices located in Castle Rock, CO. He is happy to have complementary consultations with families or patients that are looking for advice regarding dental or oral-facial developmental concerns. 

Say “Hi” To Some Of Meadows Orthodontics’ New Technology!

There is so much new and exciting technology available in the field of orthodontics, and I like to share with our patients and the community when we invest in something that makes their treatment more comfortable, more efficient, safer, or increases the quality of their experience or their end result. Below are two pieces of technology that we recently added two our two locations in Castle Rock.

One of our employees is a full time laboratory technician who makes our retainers in house, which means that we rarely have to order appliances (such as expanders, retainers, space maintainers, etc…) from outside sources. This is a great advantage to our patients, as we can turn around and fabricate retainers within a day, where it often takes up to two weeks when using an outside laboratory. We recently added a Drufomat Scan Pressure Machine to our laboratory. This machine is the same unit that large, professional laboratories use to make custom retainers, and it will largely replace the machines that made our vacuum formed retainers. The Drufomat machine uses very strong positive pressure to evenly and more accurately form plastic retainers to fit your teeth more precisely. Well molded retainers are more comfortable, fit more snugly, and reduce the need to re-make retainers that don’t quite fit perfectly. This technology also uses bar code scanning for the specific type of plastic that is used, and automatically sets the proper heat, time, and pressure to largely eliminate human error and variation that was unavoidable with the traditional machines. Geeky stuff, but our patients are really going to like the new retainers that they receive.

We have been using optical-digital scanning to largely replace the amount of traditional, goopy impressions that are needed in our office. It has been almost one year since we first upgraded our first scanner to the new iTero Element. This scanner uses a hand-held wand with advanced optics to scan our patients teeth, which replaces the goopy impressions that are taken before and after treatment. It is also used as the only record needed to treat our patients with invisalign. We simply scan our patient’s teeth (our technicians can do an entire scan in under 2 minutes!), send the information to invisalign, and the process is immediately started for me to set up the patient’s case for orthodontic correction. No time is lost in the mail, and when touch-ups are needed, it immediately gets the needed information to invisalign for any detailing that I need accomplished for my patient’s teeth. This technology has been a huge time- saver, has greatly increased patient comfort by elimination impressions, and is completely safe (this is optical technology- there is no radiation!).

If you are interested in further details on how the latest technology we utilize can improve your experience with orthodontics, please give us a call at Meadows Orthodontics. I will be glad to give you a tour and explain what is the best option to get a new, amazing smile!


Dr. Dan Rejman is the owner of Meadows Orthodontics in his hometown of Castle Rock, Colorado. Dr. Dan travels extensively for continuing education and seminars throughout the year, and places a priority in keeping his two Castle Rock practices state-of the-art for patient comfort and safety, and to increase treatment quality and efficiency.


We Are So Happy To Welcome Our New Daughter!

As most of our patients and their families are aware, our family has been preparing for the addition of our fourth child this spring. I would like to thank all of you for being flexible the past several weeks as Julie and I have flown to China to meet her and finalize the adoption process!  We like sharing important events with our family of patients and friends in Castle Rock, so as I travel back to the States (I am currently somewhere over the Pacific in the midst of a very long flight!), I will write a bit about our new family member and our adventures this past week.

Julie, my eight year old daughter, Nina, and I arrived in China last Friday, and we were taken to our hotel near downtown Beijing. We had Saturday and Sunday free to explore before we were to meet our new daughter on Monday, and we were excited to see the sights of Beijing. Unlike the glittering cities of Shanghai and Hong Kong, Beijing has a more historic feel to it, with a relatively sprawling, less vertical architecture than these other large cities that have skyscrapers dominating their downtown areas. We were excited for Nina, who we adopted from China as an infant 8 years ago, to see this country for the first time. On the first day we explored the Forbidden City, where dynasties of Chinese Emperors used to reside. We learned an early lesson on how tourists that stick out like a sore thumb can be taken advantage off – we took an unknowingly VERY costly ride on a motorized “rickshaw”. At least Julie was told she was “very, very beautiful” before and after we learned our lesson! The breakfast buffet at our hotel was wonderful, and served a variety of food that was very non-traditional for Western breakfasts. Nina and I loved the station where we filled a metal bowl with noodles, greens and mushrooms, then handed it to a cook who submerged them in boiling water, placed it in a bowl with broth, and we then topped it with red chili, cilantro, tiny salty dehydrated shrimp, and soy sauce! We spent Sunday afternoon wandering an enormous outdoor and tented market, weaving among the 3000 vendors that were selling small sculptures, teapots, beads, jewelry, art work, clothing, books, and hundreds of other items. Those of you who know how social Julie is may find this amusing: At the very FIRST vendor we approached after entering the market, she started talking about where we were from to the vendor who knew little English. As we tried to move on the woman followed Julie with a calculator for 30 minutes trying to get her to buy items. The woman loudly fended of other vendors as they crowded around Julie, as surely this nice lady who had proudly described Colorado and Castle Rock (to someone who didn’t understand her) within seconds upon entering the market must want to buy some goods. Alas, Julie finally succumbed and bought a bracelet that was too large for Nina, and learned not to make eye contact or make small talk unless she wanted to attract a crowd of “friends” listing prices on calculators!

We woke early Monday morning and met our adoption coordinator, April, and a very nice family from Hawaii that was adopting a son from the same orphanage.  We drove together to the outer suburbs of Beijing where the orphanage was located, and we were unsure exactly how we were going to meet our new daughter for the first time. It had been seven months since we had made the decision to welcome a new family member. Her name is Dang Li, and she is a thirteen year old girl with spina bifida that had been abandoned soon after she was born. We had seen photos and videos of her, and could see that despite her diagnosis, she was full of energy and life. For a time period in China, the name Dang was given to orphans, and through letters she wished to change her name Vivian Li before moving to the States. We had also “met” one another (including Stanley and Mabel- she had never seen dogs before!) using FaceTime and an interpreter several weeks ago.

When our van pulled up to the orphanage grounds and we started to unload, there was no time to wonder as we were met outdoors by the two children and their caregivers in a sea of welcoming greetings, Julie and I received hugs, but Vivian and Nina immediately held hands and headed down the sidewalk towards our meeting area, where we signed documents, gathered Vivian’s belongings (so little), and headed back to central Beijing for more official documentation stops, bonding over McDonalds (Nina was thrilled with Mc Macaroons) and then back to our room.

What a brave little girl. Can you imagine at the age of 13 leaving the home you have known for your entire life, with very foreign looking people that do not speak your language (and are very tall and dress funny)? Then she has to immediately stay with us in a hotel room (her first night ever out of her room she shared with five girls) in close quarters. Julie and I were afraid that if we snored she would be terrified! Luckily the other couple that traveled with us to adopt their son were both language teachers, and the husband, Thomas, is currently an English as a second language teacher at BYU Hawaii. They were so helpful and filled with knowledge about the process of integrating an older child into a family with a new language. They had adopted a 12 year old son from China the year before, and they helped us download an amazing translating program to our iPad that we used to communicate with. She knows so little English! And we know so little Chinese! We jumped right in and we will patiently learn a bit more every day.

We hear all the time, “She is going to be so happy to leave with you and move to Colorado”, and there is a part of that that can be true. But people who are familiar with adoption, especially with older children, know that we hope to see that she is sad as much as she is happy. This means that she has formed bonds with the people in her life and a healthy connection to where she is from, which are just as important as physical well-being. The better she was taken care of, the harder it is for her to leave, but the easier it is to adjust well in her new life ahead of her. We returned to Vivian’s orphanage on Thursday, as her caregivers wanted to have us all for a farewell lunch, and we learned what a best case scenario this orphanage has been for her. Given the hardships that that all the children there have endured, they were nothing but smiles and energy, and the caregivers were laughing with them and treating them as family members. Goodbyes were difficult, but this was encouraging.

Julie will finish with legal work in China this coming week, and will return with Vivian and Nina this Saturday. We cannot wait to share our experiences with you all, and I’m sure Vivian will often be present around our office to say hi!

What is an Orthodontic Technician, and Why are They Special?

We are so lucky at Meadows orthodontics to have such great technicians, which are also called orthodontic assistants. The vast majority of orthodontic offices employ these professionals, who perform a large variety of tasks every day. They wear so many hats in our office, and our patients often become very close and form great relationships with our technicians! Because they are so important to me, and work by my side every day, I thought I would share a bit of what they do during a typical day, and describe what skills are required for their profession.

Before patients arrive in the morning, technicians arrive and open the office, turn on the computers, make sure their stations are fully stocked with all the items that we use during the day (there are hundreds!), sterilize the instruments that we use daily, and check that sterilization is working properly.

At our daily meeting, each tech has differing responsibilities to report on:

  • One tech reports on the list of patients that we will be seeing that day. She checks that we are all prepared for any special procedures that we may be performing during the day, new patients that are visiting, patients that we are placing braces on for the first time, and patients that we will be removing braces for that day.
  • One tech is in charge of keeping track of invisalign cases, and submitting them to the invisalign site after we have taken digital impressions of patients teeth from our iTero scanner. She informs me when the cases are ready for me to work up and “design”, and if there are any complications with delivery dates, etc.
  • One tech is also a laboratory technician, and she makes most of the retainers, expanders, space maintainers and thumb habit guards that we use. She creates these appliances, solders and welds them, and has me check them before we deliver them to our patients.

Once we start seeing patients, their duties include:

  • Greeting the patients, asking them about their day and lives, seating them in the treatment chairs, inquiring if they have any concerns with wearing rubber bands, if there are any loose braces, and making sure that all is comfortable.
  • They untie and remove the wires from the braces, check oral hygiene is acceptable (and give coaching if it is not!), then inform me that the patient is ready.
  • When I arrive to great the patient, they give me a summary of the patient’s progress, then record on the computer all the changes and adjustments that I perform, along with any conversations that I have with the patient or their parents regarding their dental development.
  • They them retie in the wire to the braces, and show the patient how to wear elastics as I have requested, and help them set up their next appointment with us.
  • When braces are first being placed, they clean and prepare the tooth surfaces, and help me place the braces on the teeth. I then place the braces in their final position and light cure (bond) them to the teeth.
  • When the braces are removed, they usually remove the majority of the braces, and remove the cement from the teeth. I then do the final polishing and finishing of the enamel surfaces.
  • They take radiographic images (they are all certified with radiography), take a series of photographs of teeth both before and after treatment.
  • They take impressions of patient’s teeth, using both traditional impression trays, and digital iTero scanning. These impressions are used for diagnosis and creating retainers and expanders.
  • They clean, disinfect, and sterilize the office, including our instruments, chairs, and treatment cabinets/surfaces.
  • Just as importantly, they comfort our patients if they are nervous, and create a caring, fun atmosphere that makes visiting our office a special and positive experience.

As you can see, this is a very hands-on, technical, and very social job. I hope you appreciate all that they do- I sure do!

Dr. Dan Rejman


Dr. Dan Rejman is the owner of Meadows Orthodontics in Castle Rock, Colorado. He currently has five orthodontic technicians on his team, who are all wonderful, dedicated professionals!

Some Statistics on the Benefits of Wearing a Sports Mouth Guard

Youth sports are so popular here in Castle Rock (and around the country), and all of us at Meadows Orthodontics think it is important for kids and their families to be aware of the benefits of wearing a sports mouth guard if they play a contact sport. If your child wishes to have a custom fit, professional quality sports guard, please contact our office – we will happily make one for them! Here are some items of interest and statistics regarding sports injuries.

  • More than 5 million teeth are injured or knocked out every year, resulting in nearly 500 million dollars spent on replacing teeth.
  • Up to 39% of all dental injuries are related to sports
  • Sporting activities account for the greatest percentage of traumatic dental injuries in teens
  • 50% of all children and teens will suffer at least one traumatic injury to a tooth by the time they graduate from high school
  • Broken teeth and other oral related injuries account for more than 600,000 emergency room visits a year
  • Sports related injuries account for 3 times more facial and dental injuries than violence or traffic accident

Now the good news!

  • Athletes are 60 (!!!) times more likely to suffer harm to their teeth when not wearing a mouth guard. Mouth guards work amazingly well when worn!
  • 80% of traumatic dental injuries occur to the top front teeth, which are usually covered by a mouth guard.
  • An estimated 200,000 oral injuries are estimated to be prevented annually in the U.S. by wearing mouth guards
  • Mouth guards help to prevent injuries to the teeth, lips, tongue and cheeks.

Can wearing a custom mouth guard help reduce the risk of sports related concussions? More peer- reviewed research is needed regarding this question, as some research has shown evidence that it does help, while other research is inconclusive. They certainly do not increase the risk, and if one is being worn to protect teeth, a side benefit may be reduced concussion risk. I will be watching for new, more conclusive research!


Dan Rejman D.D.S, M.S. is a board certified orthodontist in Castle Rock, Colorado. His children play sports in the area, and he has been instrumental with fitting their teams with custom mouth guards for years!

Does your child have an underbite? An effective new treatment option now exists (miniplates)!

I have previous blog entries about the difficulty of treating underbites, which can be the result of the upper jaw (maxilla) not growing enough, the lower jaw growing too much, or a combination of both. It is vital that underbites be identified as early as possible, as successful  treatment of this type of bite is often largely dependent on a patients age. We are often trying to eliminate the need for a surgical correction later in life by identifying the problem and treating it appropriately at the correct age. For decades, the standard of care for treating underbites was the use of a facemask, or reverse pull headgear. miniplatesMost studies have shown that the most successful results occur when treatment is started before the ages of 8 or nine (with the exception of severe cases, which should be identified early as needing surgical intervention at a later age). Some  problems with this treatment option are: 1) If the child is brought in for an exam at a later age, say 12-14 years old, often a window for successful treatment may have been missed. 2) There are issues with children being compliant with wearing the facemask appliance (even if only at night), as there are obvious social concerns, and comfort issues. 3) Due to these social concerns, the realistic hours of using this appliance outside of school hours is inherently limited. 4) The appliance is removable, and can be removed easily even if parents check that it is being worn when they take a look at bedtime.

Recently, devices called miniplates have started to be used as an alternative to facemask therapy. Miniplates are biocompatable, titanium attachments that can be fixed to the upper or lower jaws. An oral surgeon uses very small screws to attach the miniplates to the upper and back areas of the upper jaw (usually at the zygomatic butress), and also to the more forward area of the lower jaw. Of course, this occurs under anesthesia, and this is a relatively non-invasive out patient visit. The orthodontist can then attach elastic rubber bands from the upper miniplate to the lower miniplate. Advantages of this treatment option, as contrasted to facemask treatment, include:  1) Research is supporting the idea that miniplate treatment is ideally started at a later age (around the age of 11-14) than facemask therapy, when the density of the maxillary bone has increased. 2) The social stigma is reduced, as the mini plates are located intraorally, and are quite small as they emerge from the gum tissue. 3) Due to the applaince being located entirely in the mouth, elastics can be worn 24 hours without concern about them being noticeable or looking “out of place”. 4) The miniplates are semi-permanantly fixed until they are removed by the oral surgeon. Largely due to these reasons, recently published research is showing impressive results using this method vs. traditional facemask treatment. In summary, orthodontists have another great option to help achieve more successful cases, and to reduce the number of surgeries needed to treat these cases.

There are some obvious downsides to using this technology that must be considered. Miniplates require two visits to the oral surgeon; one for having them placed, then another for removal after orthodontic treatment is complete. There is also the additional asscoiated cost of having an oral surgeon perform these procedures. As with any treatment, dental or medical, the advantages must be weighed against disadvantages, and risk vs. reward. I have been having these conversations with families of children with underbites, and each conversation is as unique as the child’s unique facial structure. Please g ive me a call if you have any questions regarding underbites, and we will determine if miniplates are an appropriate option for your family member.


Dr. Dan Rejman is the owner of Meadows Orthodontics in castle Rock, Colorado. He is Board Certified by the Amerivcan Board of Orthodontics.


Have a Merry Christmas, from Meadows Orthodontics

fullsizerender-2From all of us here at Meadows Orthodontics, I would like to wish the Castle Rock community a wonderful Christmas season. We really enjoy this time of year in our office, and we have several traditions that we continue to carry on in both our Meadows, and Founders/Terrain locations. The first is that we continue to be a drop off location for the Toys for Tots program, which is very active here in Douglas County. Toys for Tots is a program organized by the U.S. Marine Corps Reserve, which collects and raised funds to purchase new toys for less fortunate children in local communities. It is a very well run program, and I encourage our neighbors to consider dropping off toys in our Meadows location for this cause. We will get your donations to to the program in time help make the holiday season a bit nicer for a number of local families!

We also have a tradition of “decking the office”, where we decorate both offices the weekend after Thanksgiving.  The Christmas tree in the Meadows office is special to me, as it is mostly decorated with MacKenzie- Childs ornaments and ribbons. MacKenzie- Childs is handmade, eclectic artisan pottery and decor company located in Aurora, N.Y. near where I was raised. In 1993, I had a back surgery and was unable to work on our family’s dairy farm due to the physical labor required.  While I  was recovering, I worked at MacKenzie-Childs, where I hand painted plates, bowls, serving platters, and more. Now 23 years later (ugg I’m getting old!), it is a tradition to decorate this tree in the whimsical style of this company that reminds my wife and I of where we grew up. Fell free to stop by and take a look.

Well, Merry Christmas, Castle Rock- we are all merry here, are placing LOTS of red and green colors on kid’s braces, and we look forward to seeing you this season.

Dr. Dan Rejman


Both locations of Meadows Orthodontics are located in Castle Rock, CO. We are open 5 days a week here, including every other Saturday!


Are bonded retainers good for my teeth after braces?

downloadSometimes while I am surfing the web, I will check what is “floating around” the internet regarding orthodontic topics. I talk to my patients often about retainer options when their braces are removed, and I was surprised to see the amount of information and discussions out there regarding bonded retainers – small wires that are bonded to the back side of front teeth (usually lowers) – after braces have been removed. Like most topics, there is a large amount of credible information available, and an equally large amount of…how shall I put this…baloney? If you are wondering about if bonded retainers are right for you, here is my take on the subject.

First a little about my overall orthodontic philosophy. There are many ways to treat patients orthodontically. There are many MANY appliances, manufactures of braces, wires, instruments, elastics, etc… that all claim to be the best.  There are a large number of “systems” that practitioners can choose to follow exclusively, and there are different types of retainers and retention protocols that orthodontists can choose to offer to their patients. Personally, I choose to be educated and aware of all the options that are available to my patients (both cutting edge and traditional tried-and-true), and do my best to make decisions whenever possible according to evidence based practices (from scholarly peer reviewed journals of our profession) mixed with years of clinical experience. Borrowing from Dr. William Proffit’s article about using research to guide clinical decisions:

An orthodontist, like all health care providers, wants to know three things about the treatment he or she is providing: its

  1. effectiveness (how well it works, i.e., how effective it is in dealing with the patient’s problems, taking into account possible negative side effects),
  2. efficiency (how cost-effective it is, with cost in its broader sense to include time and effort for the provider and impact on the patient), and
  3. predictability (the amount of variation in patient response).

Lets look at bonded retainers in light of these three factors.

  1. Are bonded retainers effective?  Meaning, do they work well? Bonded retainers can work extremely well, and I have found there are two main factors that will determine how well they work. Fist, the patient must be determined to be an excellent candidate for the responsibility to have a bonded retainer. After carefully observing the patient’s habits (oral hygiene, their tendency to keep braces intact or to break them often, and overall compliance and responsibility with treatment), I usually have a good idea if a bonded retainer will work well for them. If a patient does not have excellent hygiene practices, I personally will not recommend a bonded retainer until they prove otherwise. Poor hygiene around bonded retainers is asking for failure, with periodontal health risk. On the other hand, excellent awareness and hygiene usually leads to favorable long term prognosis. The second factor is how well the bonded retainer is applied to the teeth by the orthodontic office. I think properly bonding a retainer is one of the most technique sensitive things that I do day to day, and therefore I exclusively place all bonded retainers in my practice. I know this is not the norm, and not efficient for my practice in the short (see #2!)term, but I have found massive gains in effectiveness since I started doing the bonding myself.
  2. What about efficiency? As stated above, I spend A LOT of time making sure bonded retainers are placed just right. This not cost efficient for my practice short term, but have found that long term the increase in effectiveness and predictability (see #3!) make this overall very efficient. Much fewer re-treating with braces, much fewer failures, and much happier patients!
  3. Are bonded retainers predictable? In other words, how much variation is expected in how patients respond to the bonded retainers? This is obviously very dependent on the factors that I described above. I find that if I am selective with who are proper candidates for bonded retainers,and treat each patient on an individual basis, bonded retainers are very predictable. Having said that, I can predict that at some point they will fail (break) and will need maintenance. Just like a car, your furnace, or your roof, a retainer needs proper care, maintenance, and sometimes replacement to work properly. Some people will need to wear the bonded retainers for life to maintain aligned teeth, while others may wish to have them removed at some point in favor of removable retainers. It is all individual, and each individual should be treated according to their unique lifestyle, habits, and wishes.

I hear often from patients who come to see me for re-treatment (their teeth have shifted after orthodontic treatment in the past), ” My previous orthodontist never offered me bonded retainers! Why not?” Honestly, I cannot answer that question. Maybe they found that in their practice they were not effective, efficient, or predictable, and never offered then to anyone. Why? Maybe in the past their staff members placed the retainers and they failed often (By the way, some staff members in practices I know are great at placing bonded retainers!). Maybe they did not choose wisely in who are and are not good candidates for bonded retainers, and they failed often. Maybe they did offer bonded retainers in their practice, but choose not to offer one to you based on your hygiene or compliance issues. Or maybe they just liked removable retainers better to avoid the possible negative side effects that some patients can experience with hygiene, maintenance, etc…The important thing is for me to consult with you in the present, and to engage in an honest discussion about the pros and cons of bonded retainers (and the pros and cons of removable retainers), and then determine if they will be effective, efficient, and predictable for you.


Dr. Dan Rejman is the owner of Meadows Orthodontics in Castle Rock, CO. He has been board certified by the American Board of Orthodontics since 2007, and is in his third year serving as the councilman representing the Rocky Mountain and Southwest Orthodontic Societies for the College of Diplomates of the American Board of Orthodontics.

What works best to keep teeth clean while wearing braces?

A questions that I am often asked by patients and their parents is, “What works best to keep teeth clean while wearing braces?”  My reply is “whatever works best for you as an individual”.  Many patients do really well with traditional toothbrushes, while others respond really well with to electric brushes. There are also many adjunct devices that help clean between teeth and reach spaces that may be hard for brushes to contact (especially with braces on). With so many choices available when you walk through the dental section of supermarkets and drug stores, here is a guide to help find what will work best for you.

Traditional manual toothbrushes:  As I stated, many orthodontic patients do a fantastic job of keeping healthy teeth and gums using traditional toothbrushes. After braces are placed, our assistants at Meadows Orthodontics review brushing techniques one on one with our patients, as braces add an additional challenge to the brush reaching the surfaces that need plaque removal. I stress to my patients that the most commonly missed areas are where the teeth and gums meet, both below the braces of the lower teeth, and above the braces on the upper teeth. wire. Try to allocate more time to these areas, starting at the back teeth, then working around the mouth one tooth at a time, making sure not to skip any, until you reach the back teeth of the other side. I describe this to kids as “driving around the race track”, as this ensures no areas are missed. Likewise, try to avoid random movements that jump from one part of the mouth to the other- people often get into patterns where some areas are cleaned really well, while other areas are totally skipped over. What about circular motions vs. up and down, vs. side to side? Just like washing a car, as long as all surfaces are cleaned, I tell my patients that they can use whatever motion is the most effective for them! If you want to use trapezoid movements and are good at it… fine!

Use a toothbrush with soft bristles, and avoid stiff  bristles. This will help reduce the chance of brushing causing gingival recession (where the gum recedes to expose the roots of the teeth). As far as all the different bristle shapes, designs, colors, etc…use what is comfortable for you! The one that you use well, consistently and with the correct technique is the best one. At each return visit to have braces or Invisalign checked and adjusted, we will grade your oral hygiene, and give you tips and encouragement if needed.

imagesElectric toothbrushes:  Having said all the above about manual toothbrushes, electric toothbrushes are also a great option. Two of my own kids were not doing well on their own with traditional manual toothbrushes (my third one does amazing with a manual brush), so I got them an electric model. Bingo! they love to use it, and their was a big difference in keeping their teeth clean. A large part of it for them is using something technological and fun, which they responded to immediately.

The biggest difference with a high quality electric brush is that the “scrubbing” movement is taken care of by the brush itself. Children and the elderly especially may lack the coordination for these fine movements, and electric brushes area great option for them. Patients, especially kids, need to be aware that the bristle head still needs to be placed in the correct locations to get the teeth cleaned. Reaching these places is just as described above for the manual brushes. Which brand should you purchase? I recommend both Oral-B and Sonicare brushes. They each claim the superiority of their product, but they are both amazing and your teeth will be happy with either brand. Also, each brand has several levels of brushes. The mechanism and effectiveness is the same for each model, but the more expensive ones have more gadgets built in such as timers, bluetooth tracking for parents, etc… choose the model that has the extras that interest you the most.

Plastic pics, floss, interdental microbrushes, etc.. : The dental aisle usually has many accessories that can be very helpful in cleaning your teeth )I like plastic dental pics, and use them while I am watching TV). Again, choose what you like and what you are comfortable with. They are usually very inexpensive, can be purchased in bulk, and help to clean in areas that brushes cannot reach (in between teeth, under and around braces if food becomes trapped). Flossing will require the use of “floss threaders”. We review how to use these with every patient after braces have been placed.

Waterpiks:  Waterpiks are a great option to use in conjunction with brushes, as the bursts of water are great for flushing out debris and plaque from hard to reach areas, and from around devices such as expanders. You cant go wrong with the Waterpik brand, which is very popular with my patients.

I hope these suggestions help, and if you ever have questions, feel free to ask me, or call Meadows Orthodontics at 303-660-0112.


Dan Rejman, D.D.S., M.S. is the owner of Meadows Orthodontics. There are two locations in Castle Rock, CO for local families: One in the Meadows, and one in the Founders and Terrain area.


Why is Excellent Oral Hygiene While Wearing Braces Important?

Good oral hygiene has many benefits, whether you’re in braces or not.  Removal of plaque is very important to help prevent tooth decay. Braces provide more surface area for plaque to cling to and hide behind, so it is important to be aware of techniques to clean around these additional surfaces.  Plaque that remains around braces (or anywhere on the tooth) for too long can cause white spot lesions, which is the initial stage of tooth decay.  These spots are the result of demineralization of the tooth surface and are a permanent stain the tooth surface. White spot lesions can then progress to dental caries, or cavities. “Fillings” are required to restore cavitated or demineralized areas that have progressed to the point that tooth structure needs to be replaced.

Plaque that is not removed can also cause gingivitis, which is inflammation of the gum tissue.  Signs of gingivitis include swelling, redness, and bleeding gums.  Gingivitis can progress to periodontal disease with progressive bone and gum tissue loss.  It is important for people to understand that poor oral hygiene is a major cause of bad breathe (halitosis).  Most often, a person’s senses becomes accustom to their own bad breath and they are unaware that it even exists.  However, people in their vicinity are usually well aware of this condition.  When this is explained to teens, it can often be news to improve their oral hygiene.

The good news is that tooth decay, demineralization, gingivitis, and halitosis are easily preventable. In the next blog entry I will review the best tips and techniques to keep these conditions away from your mouth!