Frequently Asked Questions | Less Frequently Asked Questions | Occasionally Asked Questions
Frequently Asked Questions
What is orthodontics?
Orthodontics is the branch of dentistry that specializes in the diagnosis, prevention and treatment of dental and facial irregularities. Removable appliances or braces are used to make these corrections.
When should I first take my child to the orthodontist for a consultation?
It is most important to examine your child's teeth as the permanent teeth grow in. Both the Canadian and American Associations of Orthodontists recommend that a child should ideally visit an orthodontist between the ages of six and seven. At this age the adult teeth are beginning to erupt and the jaw structures still have significant growth remaining. Problems associated with the teeth and jaws are much easier to correct when diagnosed at this early age. Early preventive treatment greatly simplifies any future treatment.
Do I need a dentist to refer me to an orthodontist?
No. Many of our patients have been referred by their friends, family or co-workers, who have been delighted with their own orthodontic results. You can call our office directly to make an appointment.
Will additional jaw growth allow self-correction of crowded teeth visible in a 8 year old?
No. The space available for the front teeth does not increase after the permanent 6 year molars erupt. In most people, the space available for the front teeth decreases with increasing age.
What causes crooked teeth?
Heredity is the main cause although local factors such as finger sucking, high cavity rate, gum disease, trauma and premature loss of baby teeth can also contribute to a bad bite.
Why should I have my teeth straightened?
Poorly arranged teeth can trap food particles resulting in tooth decay and gum disease. They can also lead to poor chewing and digestion, which can be bad for your overall health. Finally, poorly arranged teeth detract from your smile, which is one of the more important features of your face.
How do braces straighten crooked teeth?
Braces use steady, gentle pressure over time to move teeth into their proper positions. They don't look like they're doing much just sitting there, but in fact, every moment of your orthodontic treatment, there's something happening in your mouth. Something good for you. The brackets we place on your teeth and the main archwire that connects them, are the two main components.
The bracket is a piece of specially shaped metal that we affix to each tooth. Then we bend the archwire to reflect your 'ideal" bite-what we want you to look like after treatment. The wire threads through the brackets and, as the wire tries to return to its original shape, it applies pressure to actually move your teeth. Picture your tooth resting in your jaw bone. With pressure on one side from the archwire, the bone on the other side gives way. The tooth moves. New bone grows in behind. It may look like nothing is happening, but we're making a new smile here. Thanks to new materials and procedures, all this happens much more quickly and comfortably than ever before. It's kind of an engineering feat.
What do rubber bands do?
Attached to your braces, elastics exert the energy force that creates the right amount of pressure to move teeth. It's important to wear your elastics all the time and to change them three times per day so that there is a constant force on the teeth.
Will braces correct TMJ or jaw joint problems?
Braces may or may not improve jaw joint problems. More conservative approaches should be tried first. Dr. Janisse would be pleased to discuss any TMJ concerns or problems you may have and to review both orthodontic and non-orthodontic treatment options..
How many people receive orthodontic care?
Approximately 4 million people are in braces in North America at any one time.
Can you be too old for braces?
No. If the bone and gum tissue around the teeth are healthy, age is not a factor. About 30% of orthodontic patients are adults.
Will orthodontics change my lifestyle?
You'll have to give up extremely hard and sticky foods including gum. These foods can get caught on the braces and pull the braces off. And you'll have to spend a few extra minutes cleaning your braces after meals. But, for the most part, you'll find braces don't cramp your style. You'll still have fun. You'll still be able to sing, play your musical instrument, smile and play sports.
Is orthodontic care expensive?
Well-timed orthodontic treatment to correct a problem is often less costly than the additional dental care required to treat the more serious problems that can develop years later. Orthodontic fees have not increased as fast as many other consumer products. Many insurance plans now include orthodontics and the cost of treatment usually is payable over the length of the treatment.
When is the best time to schedule an initial consultation?
Early consultation allows the orthodontist to determine the optimum time for treatment to begin. Seven years old is a good rule of thumb for a child unless you see a noticeable problem earlier. Early examination often permits maximum improvement with the least amount of time and expense.
Why should you choose an orthodontic specialist?
Teeth and sometimes faces are permanently changed by orthodontic treatment; therefore, it is very important that the treatment be done by a specialist in this area of dentistry.
What kind of infections can occur when wearing braces?
Braces do not cause an infection. Infections are caused by organisms called bacteria and viruses that overwhelm a person's immune system. Poor oral hygiene is the major cause of gum infections and cavities.
Is there more relapse (return to original position) when braces are placed at a young age?
No, teeth actually relapse less if orthodontic treatment is started early. Orthopedic change in the growth of the jaws is more efficient at a younger age, especially if poor muscle function is associated with the problem. Early treatment is usually known as a phase one treatment, which lasts about 12 to 15 months. A second phase of treatment may be required with braces for 18 months to align individual permanent teeth and perfect the bite. Some types of treatment can only be done at a young age and for some patients, early treatment eliminates the need to extract teeth.
How much do braces cost?
The cost of braces is totally dependent upon the type of treatment, the length of treatment, and the difficulty of treatment. There is a payment plan for the cost of braces with a down payment and a monthly payment over the time that the treatment takes.
What can you eat with braces?
A person in braces can eat almost all foods. However, hard foods can break off the braces and bend the wires that move the teeth. Do not chew:
- Ice (drinking hot or cold drinks will not hurt the braces)
- Jawbreakers and other hard candies
- Sticky things such as big hunks, sugar daddies, gummy bears, licorice, etc.
- Corn nuts, Hard thick tortilla chips, hard French bread crust, and other similar items.
Other hard foods such as raw carrots, apples, and hard tacos can also break off the braces and bend wire. You can avoid breaking off brackets and bending the wires by cutting hard vegetables and other foods into small pieces or taking small bites or cooking the food differently. The basic rule is "cut it into small or thin pieces or take small bites."
How often do the braces need to be adjusted?
The teeth move better and faster if adjustments are made approximately every 6 to 8 weeks.
How is brushing your teeth different with braces? Do you need special toothbrushes?
While in braces, you can clean your teeth with your normal toothbrush; however, several things are very important:
- Always use a medium bristle toothbrush.
- Push the bristles past the braces and wires so that the ends touch the surface of the teeth, then vibrate or move the toothbrush in very small circles while softly pushing to make the ends of the toothbrush bristles move on the surface of the teeth, scraping off the plaque.
- Electric toothbrushes are recommended, but are not essential. Two brands to consider are Sonicare and Interplak.
- A water-pik is useful, but it will not remove plaque from the teeth and is a rinsing device.
How do braces really work?
Teeth move very easily with constant light pressure. The wires and elastics provide the pressure to make the teeth move while the braces or brackets allow the wires to apply pressure for tooth movement. Osteoclasts are cells that dissolve bone on the pressure side; osteoblasts are cells that deposit bone on the tension side.
Is anyone too old or too young to get braces? Is there a time when braces work the best?
Braces can be placed at any age. The oldest patient Dr. Janisse has treated was 66 and the youngest was about 6 years old.
How long do you have to wear braces?
The average case takes 18 months, with more difficult cases going slightly longer.
Do braces cut your mouth?
Braces do not cut your mouth unless you get hit in the mouth. When braces are first placed, they rub the inside of your mouth for a few days until the inside of your mouth gets used to them, and then it feels normal.
Is it absolutely necessary to have braces if told you need them?
Anyone can refuse treatment as it is not life threatening, but the quality of life can be greatly affected. Refusing treatment does not avoid the problem. The problem usually gets worse over time and is more difficult to treat later. Once bone and gum are lost around the teeth they cannot be replaced and are gone forever.
What is Invisalign?
Invisalign is a series of clear, virtually invisible custom-molded aligners to straighten your teeth during a one year course of treatment. It is necessary to change these aligners every two weeks to continue the straightening process and Dr. Janisse will see you every 6 to 8 weeks for adjustments and to check progress. The aligners are removed for eating, flossing and tooth brushing.
Can anyone have Invisalign?
Invisalign is very case specific and is ideal for correcting minor spacing or crowding situations. Orthodontic braces are still required for the more complex cases or when the jaw structures do not match in length and/or width.
What are invisible braces?
There are three examples of invisible braces – Invisalign's custom-molded aligners, ceramic braces and lingual braces. Although invisible braces are appealing they are all case specific. Dr. Janisse would be pleased to discuss any of these options with you prior to commencing treatment.
Less Frequently Asked Questions
How do braces work? How do braces move the teeth?
Braces consist of brackets (mini-handles) bonded (glued) on to most of the 12 or 14 teeth in each jaw. A thin highly flexible wire is fastened to each bracket on each tooth. Suppose a tooth is incorrectly positioned; let us assume it is a tooth that is depressed inwardly and we want to bring it forward. When we fasten (attach) the wire to all the teeth with brackets the wire flexes in to attach to the depressed tooth. Since the wire is flexible (resilient) it "wants" to "bounce" back to the shape it originally was (straight). So over a long period of time the wire gradually moves the incorrectly positioned tooth in to the desired (corrected) position, that is, in line with the other teeth. As long as the pulling is done gently over a long period of time, the teeth will move through the bone without harm to the tooth, or any other teeth, and gums and bone. It can take between 4 weeks and 3 months to move a tooth 1mm (about 1/32nd -1/16th of an inch) depending on whether the tooth is a lower front incisor which is very small with a single root or a lower six year molar which is much larger and has 2 roots.
Will I need to have any permanent teeth removed when I get braces?
That depends. If your teeth are very crowded and they are protruding far forward (stick out), removing teeth may be an excellent choice for you. Typically, most orthodontists choose to extract two upper side teeth (premolars) and two lower premolars to accomplish the goals of treatment. Other choices may include the removal of only two upper teeth while still other cases may require the removal of only one lower front tooth. Dr. Janisse always discusses the advantages and disadvantages of removing any permanent teeth in considerable detail so that each patient clearly understands the rationale.
If I do need to have teeth removed when do they have to be removed?
In cases where the extraction of teeth is required, Dr. Janisse will refer the patient back to their dentist approximately 10-14 days prior to placing the brackets on the teeth. This timing allows the extraction site to heal but does not provide an opportunity for adverse tooth movement.
How long does it take to glue on (bond) the braces and remove (de-bond) them?
Bonding appointments for brackets are usually 45 minutes. This includes bracket placement, and arch wire insertion. An additional 15-20 minutes are spent on oral hygiene instruction. Removing (debonding) the brackets and wire is much easier and only takes a couple of minutes, after which the residual glue is removed and the teeth polished.
Is it harder to take care of your teeth when you are wearing braces?
Yes. Your gums tend to become more easily swollen because the braces prevent your teeth from getting the stimulation they normally get from the food which contacts them. Furthermore, food particles tend to get stuck in the braces and lodge more easily between the teeth. Dr. Janisse guides his patients with the rule of "33". That is, you should brush your teeth 3 times every day for 3 minutes each time after breakfast, dinner and before bed time. It is also important to remember that braces cause your breath to lose its freshness in half the time it usually takes, because the braces have hidden surfaces where bacteria can flourish. For this reason it is prudent to use an antiseptic mouth rinse to ensure breath freshness.
Do braces harm your teeth or gums?
Braces do not damage your teeth or gums if you follow the correct care and maintenance procedures as discussed at the start of treatment. Lack of regular tooth brushing will rapidly cause the gum tissue to become swollen and result in slower tooth movement. In addition, poor brushing leaves food debris on the tooth surface and eventually causes decalcification (white and brown stains), which result in dental cavities.
What is a retainer?
A retainer is a simple, removable appliance that is fitted to your upper teeth to hold them in their corrected position after the orthodontist removes the fixed (bonded) braces that were used to straighten your crooked teeth. Dr. Janisse uses a lower bonded (glued) lingual retainer behind the six front teeth. This is a permanent retainer and is much more comfortable and less noticeable than a lower removable retainer.
Will I have to have my wisdom teeth removed for the treatment?
Dr. Janisse will assess each patient at the end of treatment with a panoramic X-ray to determine the position of the wisdom teeth. A decision is then made as to whether extraction(s) is recommended to prevent tooth movement.
Occasionally Asked Questions
Does it hurt when you bond (glue) the braces on or take them off?
There is absolutely no pain when the braces (brackets) are bonded. However, you may experience some pain/discomfort for the next 2-4 days and this can be controlled with aspirin or Tylenol. Removing (debonding) braces causes minimal or no discomfort.
How do I know if I am too old for braces?
You are never too old for braces. Healthy teeth and jaw bones in a person who is 50-60 years young can be moved just as quickly as healthy teeth in healthy bones in a person who is 15-25 years young.
Is it true when the braces are removed the teeth get crooked again?
No, not unless you neglect to wear your retainers. Retainers are appliances that hold the teeth in their straightened position after the fixed braces are removed. Dr. Janisse recommends wearing the retainers for as long as you want the teeth to remain as straight as they were the day the braces were removed. When and if you decide you are going to permanently stop wearing your retainers, genetic forces and forces from the tongue and lips, natural tooth wear, as well as the loss of bone that sometimes occurs with increasing age will begin to dictate how the teeth will move, and in most cases teeth will shift slightly over the years.
Do I need to have surgery on my jaw bones?
In some cases the problem is not with teeth although it may appear that way. The problem lies with jaws that are undersized, oversized, or too narrow. Dr. Janisse will advise you of the extent to which they can improve your appearance (camouflage the skeletal problem) without surgical assistance. When jaw surgery is essential for a successful result, Dr. Janisse will refer you to an oral surgeon so that your problem can be further assessed prior to commencing treatment.
What is TMJ?
The letters TMJ are an acronym that stand for the words Temporo-Mandibular Joint. This is the joint that operates the opening and closing of your mouth. The joint is composed of a part of the skull called the Temporal bone, the lower jaw bone called the Mandible which is connected to the Temporal bone. Lying between the Temporal bone and the Mandible is a disc of cushioning material controlled by muscles and ligaments that help to open the mouth. . You can feel the joint by putting your index fingers just in front of your ears and opening and closing the jaw (mandible). The right and left side together comprise the TMJ. However, doctors often call the pain you feel around the joint when you are under tension and stress "TMJ". They will tell you that "you have TMJ".
There are two basic kinds of TMJ problems: The first kind is related to pain that comes from some disorder of the parts inside the joint. This kind of disorder is much less common than the pain that originates in the muscles just surrounding the joint that help to open and keep the jaw closed. A common example of this kind of pain/disorder occurs when you are under a great deal of stress and you begin to clench and grind (brux) your teeth, not only during the day but at night in your sleep. This extra ordinary (para-functional) chewing puts a great deal of stress on your TMJ. The muscles that hold the mouth closed go into a kind of spasm which can be very painful. The treatment is very simple: allow the jaw to rest, keep to a soft diet for 14-21 days. When the problem is associated with the internal dysfunction of the joint then additional treatment to correct the bite is often required. This may involve not only orthodontic treatment to align the teeth but also jaw surgery to align the jaws and restorative treatment to reshape one or more teeth.
Could I lock braces if I kissed another person with braces?
Not even if you tried with all your might. Those of you who have heard such a story will be hard pressed to prove it with documented information. If you can obtain such a document, send it to Dr. Janisse at this e-mail address: firstname.lastname@example.org.
Will I be able to floss my teeth after the braces are put on?
Yes. There is nothing to prevent you from being able to floss your teeth. However, it does take about 5 minutes longer to do a thorough job because you must first pass the floss under the wire that is attached to the brackets, then floss, then remove the floss and pass the floss back under the wire to floss the next area, etc., etc.