Common Problems
Bite Problems
| Upper Front Teeth Protrusion |
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This type of bite impacts the appearance and function of your teeth. It is characterized by the upper teeth extending too far forward or the lower teeth not extending far enough forward. |
| Overbite |
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The upper front teeth extend out over the lower front teeth, sometimes causing the lower front teeth to bite into the roof of the mouth. |
| Crossbite |
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The upper teeth sit inside the lower teeth, which may cause tooth stratification and misaligned jaw growth. |
| Openbite |
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This type of bite, in which the upper and lower front teeth do not overlap, impacts proper chewing. Openbite may cause a number of unwanted habits such as tongue thrusting. |
Other Problems
| Crowding |
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Crowding occurs when teeth have insufficient room to erupt from the gum. Crowding can be due to heredity and/or environment. Heredity determines the tooth and jaw size relationship; larger teeth in a normal or smaller jaw results in crowding. Environment can also be a factor, the premature loss of a tooth can cause a lack of space for the permanent tooth due to unfavorable drifting and prolonged retention of the baby teeth can cause a lack of space due to deflection, or the displaced eruption of the permanent tooth.Crowding can often be corrected by expansion, and many times tooth removal can be avoided. |
| Spacing |
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Spacing: Spacing can be due to heredity and/or environment. Heredity determines the tooth and jaw size relationship; smaller teeth in a normal or larger jaw results in spacing. Environment can play a part in spacing as well. A strong tongue can push the teeth apart and excessive amounts of gum tissue between the teeth and a thumb or finger habit can cause spacing of the teeth.Missing teeth may cause spacing problems, or they may only be a cosmetic or aesthetic issue. |
Types of Bites (Occlusion)
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The ideal occlusion (bite): The points of the upper teeth fit into the grooves of the lower teeth, the defining teeth are the upper and lower first molars. How the first molars fit together is how the bite is classified. The first molars each have two points and one groove, ideally the first point of the upper first molar will fit into the groove of the lower first molar. Also, in an ideal bite the midline, an imaginary line going in-between the upper and lower front teeth, is straight. |
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Class I: The first molars are in a normal relationship. Crowding or spacing may occur. |
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Class II: The lower first molars are too far forward in relation to the first upper molars. |
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Class III: The lower first molars are too far back in relation to the first upper molars. |
Braces: A parts list
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Archwires are thin wires that form a track to guide the teeth as they move.
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Brackets are small squares attached to each tooth through a procedure called bonding. They act as handles to hold the Archwires.
They can be clear, silver or gold.
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Bands are metal rings that fit around the teeth. They hold the brackets and Archwires on the teeth.
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Coil springs pull or push on brackets to open or close space between the teeth.
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Elastics are rubber bands that connect the upper and lower braces. They apply pressure to move upper teeth against lower teeth.
They are used to modify a patients bite. Elastics come in many different sizes.Foods to avoid with braces
Separators or spacers
A week or two before you get your braces, your orthodontist may put separators (spacers) between your molar teeth. These are small elastics, shaped like a small doughnut that fit between the teeth. They help move the teeth slightly apart so that there’s room to fit the bands on the teeth. Spacers will cause some temporary soreness but it goes away in a few days. After a few days your teeth will feel comfortable again as they get accustomed to being slightly apart.
- Don’t floss between any teeth where there’s a spacer. But be sure to floss between all the other teeth.
- Don’t eat anything chewy or sticky that may pull the separators out of place.
- Toothbrush normally.
- If a separator falls out, call us right away. The separator may need to be replaced.
For most situations, common sense will tell you what to avoid. Hard foods, sticky foods and foods high in sugar must be avoided. Hard foods can break or damage wires and brackets. Sticky foods can get caught between brackets and wires. Minimize sugary foods; they cause tooth decay and related problems. Nail biting, pencil and pen chewing, and chewing on foreign objects should be avoided.
Examples of sticky foods to avoid:
- Gum (sugar free or regular)
- Licorice
- Sugar Daddies
- Toffee
- Tootsie Rolls
- Caramels
- Starburst
- Skittles
- Gummy bears
- Now & Laters
Examples of hard foods to avoid:
- Ice
- Nuts
- Hard taco shells
- Bagels
- French bread crust/rolls
- Corn on the cob
- Apples or carrots (unless cut into small pieces)
- Doritos
- Jolly ranchers
- Pizza crust
- Uncooked carrots (unless cut)
Minimize sugary foods like:
- Cake
- Ice Cream
- Cookies
- Pie
- Candy
- Soda
- Sweetened tea
- Gatorade
- Kool-Aid
- Drinks with sugar
Avoid chewing on pens, pencils or fingernails!
It's important to check your braces regularly check your braces for bent or loose wires and brackets. In the event of a loose/broken wire or bracket, call our office immediately to arrange an appointment for repair.
Two-Phase Orthodontics
Two-phase orthodontics: A special kind of dentofacial orthodontic/orthopedic treatment.
First-phase treatment (interceptive)
The goals of first phase treatment are:
- To develop both the upper and the lower jaws sufficiently to accommodate all of the permanent teeth.
- To correctly relate the upper and lower jaws to each other.
Children sometimes exhibit early signs of jaw problems as they grow and develop. An upper or lower jaw that is growing too much or not enough, or is too wide, too narrow, or crooked can be recognized at an early age. If children over four years of age have these jaw discrepancies, they are usually candidates for early orthodontic/orthopedic evaluation and treatment.
Because children are growing rapidly, they can benefit enormously from an early (interceptive) phase of orthodontic/orthopedic treatment. Orthodontic appliances can be used to correct the jaw shape and direct the growth toward an ideal relationship between the upper and lower jaws. A good foundation can be established thereby providing adequate room for eruption of all the permanent teeth
Early interceptive treatment can prevent:
- The later removal of permanent teeth to correct overcrowding.
- Surgical procedures to align the upper and lower jaws.
Interceptive treatment can also decrease the time necessary for the second phase of treatment. Leaving a malocclusion untreated until all of the permanent teeth erupt could result in a jaw discrepancy too severe to allow achievement of an ideal result with braces alone.
Orthodontic/Orthopedic records will be necessary to determine the diagnosis, treatment plan, type of appliances needed, duration of the treatment, and frequency of visits. Records consist of models of the mouth, radiographs, photographs, and clinical evaluation.
Intermediate retention period
During this period the remaining permanent teeth are allowed to erupt. Retention and/or tooth guidance appliances may be recommended at the end of the first phase.
Oftentimes retainers may be used, however, usually for only a short period as they may interfere with the eruption of the adult teeth. In this case it is best to allow the existing permanent teeth some freedom of movement while final eruption of the teeth takes place. A successful first phase will have created enough room for the teeth to find an adequate eruption path and prevent possible impaction and displacement problems.
It is important to understand that at the end of the first phase of treatment, teeth are not in their final positions. This will be determined and accomplished in the second phase of treatment. This stage is called the corrective stage.
Selective removal of certain primary (baby) teeth may be in the best interest of enhancing eruption during this resting phase. Should this be necessary you will be consulted and a letter of recommendation will then be sent to your dentist. Periodic recall appointments for observation will continue to be necessary throughout this intermediate phase on a four to six month basis.
Occasionally when a patient is treated with a two-phase treatment program, the permanent teeth erupt more rapidly than anticipated. Should this occur, the parents will be advised and the patient will continue directly into the second phase of treatment without removal of the orthodontic appliances.
Second phase treatment (corrective)
Each tooth has an exact location in the mouth where it is in harmony with the cheeks, tongue, jaws, jaw joints, and other teeth. When this equilibrium is established, the teeth will function together properly. With good home care and retainer wear your teeth should stay healthy, stable, comfortable and look attractive. This is the goal of the second and corrective phase of treatment.
At the beginning of the first phase, orthodontic records were made and a diagnosis and treatment plan established. Certain types of appliances were used in the first phase, as dictated by the problem. The second phase is initiated when most of the permanent teeth have erupted, and usually requires braces on all of the teeth for approximately 12-24 months. Retainers are worn after this phase to hold the teeth in their new corrected positions.
Advantages of two-phase orthodontic/orthopedic treatment
The two-phase orthodontic/orthopedic treatment is a very specialized process that encompasses jaw and facial changes (orthopedics) and tooth straightening (orthodontics). The emphasis today on living longer, staying healthy, and looking attractive requires optimum treatment results. The major advantage of two-phase treatment is to maximize the opportunity to accomplish the ideal healthy, functional, aesthetic, and comfortable result that will remain stable.
The disadvantage if waiting for complete eruption of the permanent teeth and having only one phase of treatment is the possibility of a compromised result that may not be functionally healthy or stable and may require preventable adult tooth extraction or jaw surgery.
We certainly hope this synopsis has helped you to understand our "two-phase philosophy". Please do not hesitate to ask us any questions that may assist you in understanding our treatment concepts.
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