Frequently Asked Questions

Orthodontics is the branch of dentistry that specializes in the diagnosis, prevention and treatment of dental and facial irregularities. Braces, Aligners and other appliances/devices are used to make these corrections by moving teeth and bones.

Just as there are specialists in medicine (such as cardiologists, gastroenterologists, dermatologists, etc.), there are specialists in dentistry. Orthodontists are dental specialists who dedicate their lives to correcting misaligned teeth and jaws. Teeth and sometimes faces are permanently changed by orthodontic treatment; therefore, it is very important that the treatment be done properly. Only about 6 % of US dentists have the additional education required to be licensed and recognized as an orthodontic specialist. A licensed orthodontic specialist is a expert at moving teeth, helping jaws develop properly and working with you to help make sure the teeth stay in their new positions. Remember that most orthodontic insurance plans pay for braces only once in a lifetime. Have a orthodontic specialist do it right that one time!

What kind of formal orthodontic training have you had beyond dental school? Are you licensed as an orthodontist by the Maryland Board of Dental Examiners? Do you treat all orthodontic cases, even the most complex? Have orthodontists finished orthodontic work that you have started?

No. They are elective but people seldom grow out of the more severe problems. Braces treatment can prevent other unpleasant problems from developing later in life. The newly developed brace-less Clear Aligner Therapies are an alternative to braces for some types of bites.

It is most important to examine your child's teeth as the permanent teeth grow in. Although children mature at different rates, there are some averages for permanent tooth arrival. Some signs that may indicate the need for an early orthodontic examination:

early or late loss of baby teeth difficulty chewing or biting crowding, malpositioned, or blocked out teeth jaws that make sounds biting the cheek or roof of the mouth teeth that do not meet at all jaws and teeth that are out of proportion to the rest of the face finger sucking or pacifier habits continued beyond the age of six top front teeth stick out, protrude or are "bucked" baby teeth that do not grow to full height like their neighbors top front teeth grow in behind the bottom front teeth top front teeth cover more than 25% of the bottom front teeth when the back teeth are biting together weak chin or prominent chin neighboring teeth shifting into bad positions when a tooth between them has been removed centers of the top and bottom front teeth don't line up teeth wearing unevenly jaws that shift off center when the teeth bite together excessive spaces between teeth that persist after the top permanent canine teeth appear embarrassing teeth or smile often hidden by hands

Every child should see an orthodontist at an early age. This could be as young as 2 or 3, but  the American Association of Orthodontists recommends an initial consultation no later than age 7. By age 7, enough permanent teeth have come in and enough jaw growth has occurred, that problems can be identified. Early consultation allows the orthodontist to determine the optimum time for treatment to begin. Many parents and some family dentists assume that they must wait until a child has all of his or her permanent teeth, only to find out that treatment would have been much easier if started earlier. Early treatment can eliminate the need for more drastic measures. In some cases, satisfactory results are unattainable once the face and jaws have finished growing. With proper timing, children may not have to endure years of embarrassment. In addition, girls are beginning puberty at a younger age. The age at which girls begin puberty has fallen in the past two decades, and a new study shows this trend is continuing in some populations in the U.S. The study, “Pubertal Assessment Method and Baseline Characteristics in a Mixed Longitudinal Study of Girls,” published in the September 2010 issue of Pediatrics (published online Aug. 9), assessed the onset of puberty in more than 1,200 girls in three cities. Researchers found that 10.4 percent of white non-Hispanic girls had begun puberty at age 7, measured by breast development, compared to 23.4 percent of black girls and 14.9 percent of Hispanic girls. Among 8-year-olds, puberty had begun in 18.3 percent of white non-Hispanic girls, 42.9 percent of black girls and 30.9 percent of Hispanic girls. The numbers among white non-Hispanic girls represent a significant increase over rates seen in a 1997 study. What causes puberty to begin is thought to be a combination of genetics, environment and individual factors such as weight.

If you rely heavily on the opinion of others before making treatment commitments, you are encouraged to bring all the decision makers with you to this consultation. They can be taking notes while you listen or act as a sounding board. Your orthodontist doesn't want information lost in translation if decision maker does not come and you have to relay the consultation outcome to them.

The reason that treatment is needed. The optimal time for starting treatment. The treatment approach that will be used. The length of treatment. The expected appearance when treatment is completed. The past success rate of the recommended treatment with other patients. The pros and cons of treatment. The treatment cost and financing options. The possible outcome if nothing is done.

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.

Early treatment provides the opportunity to:

guide the growth of the young jaw bones creating a better environment for those new emerging permanent teeth guide incoming teeth into optimal positions regulate the width of the jaws lower the risk of trauma to prominent front teeth correct harmful sucking habits reduce the likelihood of teeth becoming stuck or impacted under the gums preserve or gain space for arriving permanent teeth allow easier correction if found early

Just as we inherit eye color from our parents, mouth and jaw features are also inherited. Examples of these genetic problems are crowding, spacing, protrusion, extra or missing teeth and some jaw growth problems. Some other bad bites are acquired as local factors such as finger sucking, pacifier sucking, high cavity rate, gum disease, trauma and premature loss of baby teeth can also contribute to a bad bite. One out of every five school age children have a severe bite problem so it is not surprising that you might need braces.

Poorly arranged teeth can break easily and can trap food particles that cause tooth decay and gum disease. Researchers at the Baylor College of Dentistry, found that malocclusions interfere with the chewing ability to break down foods which affects digestion and overall health. Crooked teeth can cause abnormal wear of tooth surfaces, difficulty speaking, and excess stress on supporting bone and gum tissue. Without treatment many problems become worse. Finally, poorly arranged teeth detract from your smile which is one of the more important features contributing to facial beauty. You only have one chance to make that first impression!

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 or your orthodontic treatment, there's something happening in your mouth. Something good for you. The brackets we place on your teeth and the main arch wire that connects them, are the two main components. The bracket is a piece of specially shaped metal or ceramic that we affix to each tooth. Then we bend the arch wire 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 arch wire, 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 quicker than ever before. It's kind of an engineering feat.

Yes, the teeth will move in different directions as the teeth are straightening out. You may see a space between your two front teeth that was never there before or teeth that seemed perfectly straight before the braces were placed may not seem as straight. Be patient and things will start to improve. That space will close and those teeth will line up as treatment continues.

Yes, if you are an adult or a mature teen with only 1 - 6 millimeters of crowding or spacing of your front teeth and no missing or severely tipped teeth. A series of 3-D computer generated invisible aligners may allow creation of a beautiful smile for you without glued on braces. This advanced technology does not correct bites that are due to jaw bone malpositioning. Be aware that in 2002, Invisalign began licensing this technology to dentists who have "no prior orthodontic experience". We urge you to select a provider with orthodontic training and experience to provide your Invisalign treatment.  Many patients will receive a superior result with a combination of  a short period of traditional braces to correct problems that are difficult for clear aligners to correct followed by Invisalign aligners to complete tooth alignment.

Rubber bands or elastics contribute a lot to straighter teeth. They are marvels of physics. Attached to your braces, elastics exert the force that creates the right amount of pressure to move teeth in directions that the braces alone can't. They don't work without you. It's important to wear your elastics as prescribed. Rubber bands get tired and lose their stretch so change them every day so the force is constant which the teeth like. A lack of consistency in wearing rubber bands can bring treatment to a standstill and who wants to do that to themselves. Teeth never fail to move when elastics are worn consistently as directed. As for bouncing an elastic off someone across the room, it will happen (don't worry, your aim will improve). Always carry a few rubber bands with you so if one breaks, you can replace it right away. If your supply is low call us and e can mail you more rubber bands.

If you use makeup, use it to draw attention away from your mouth. Go wild using eye shadow and keep the lips simple with beige or nothing at all. Stay away from lip gloss that makes the metal parts of braces more reflective. Ask for clear braces.

Our teeth are covered with enamel. Enamel is susceptible to dissolving/softening in acids created when certain bacteria/germs living on a tooth's surface, eat sugar. Soda and sports drinks contain sugar and acid like preservatives. Take a look at the contents label on the drink. Frequent sipping drinks throughout the day is particularly punishing on your teeth. If brushing is not adequate, if a person frequently drinks several of these beverages a day or if super sized drinks are consumed, the enamel dissolves/demineralizes leaving permanent white spots on the teeth. In addition, when enamel is softened by exposure to these drinks, the enamel is at increased danger of being worn away leaving your smile look prematurely aged. Who wants a spotted smile with teeth that look 90 years old? Drink tap water whose fluoride content is carefully monitored and confine eatinghealthy foods to mealtimes without in between meal snacks.

Conventional braces on the left are tied in with elastics, which cause friction and pressure, making treatment slower and less comfortable. Damon braces use a slide mechanism to hold the wire, which allows teeth to move more freely, quickly and comfortably.

Space maintainers are appliances that keep adjacent teeth from shifting when a baby tooth is prematurely lost or removed. They are critical when the baby tooth lost is just in front of the first permanent molar. The space manitainer needs to be placed quickly after the baby tooth loss because most of the harmful shifting of adjacent teeth will occur within the first three months after the baby tooth is lost. The shifting of adjacent teeth can cause permanent teeth to become impacted or stuck under the bone.

Braces may or may not improve jaw joint problems. More conservative approaches should be tried first.

Approximately 4 million people are in braces in the US at any one time.

No. If the bone and gum tissue around the teeth are healthy, age is not a factor. Orthodontic treatment can be successful at almost any age. About one in every five orthodontic patients today is over age 18. Adults who are in the pursuit of a healthier, younger, appearance include straightening their smile as part of their total body improvement plan. The oldest patient we have treated was a very young 83.

If a patient leaves his or her aligner off for as little as 4 hours, the osteoclastic process of breaking down bone material can stop completely. Once this osteoclastic process stops, it can take 48-72 hours to fully get going again. A patient who regularly removes his or her aligner for long periods will be restarting the osteoclastic process over and over again, and probably won't experience good results.

You'll have to give up extremely hard, sticky, and high sugar foods. These foods can get caught on the braces, bend wires, loosen cement and pull the braces off and/or cause cavities and permanent white marks. Soft foodsor foods cut into small pieces are much better. 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, play sports and of course, kiss. You can even make a fashion statement by having your orthodontist add color to your braces. Your friends will be accustomed to you in braces more quickly than you think.

That depends a lot on you and how bad your bite is to begin with. Complex/severe bad bites take longer. The national average is 27 months. The better you are following your orthodontist's instructions and taking care of your braces, the sooner your teeth will improve. Remember that no one else can wear your braces for you!

In most cases, yes. Phase One treatment strives to create a better environment for the permanent teeth. Phase One treatment is often initiated to 1) prevent a problem from developing 2) intercept a developing problem, or 3) guide the growth of the jaws that support the teeth. After the permanent teeth have grown in, treatment is usually necessary to complete the work that was started in the Phase One. This completion of the earlier phase using full braces is often called Phase Two.

This growth/observation period will involve a combination of retaining the correction that has been made in Phase One and guiding the growth of the permanent teeth into more favorable positions. Because treatment timing is critical, a child's growth and development is monitored very carefully during this period.

Baby teeth hold room for the permanent teeth that will come in later. A lower lingual arch space maintainer can be placed when the baby canine and baby molars are getting loose or fall out prematurely. The space maintainer prevents the lower back permanent molar from slipping forward and prevents the lower front permanent incisor teeth  from tipping toward the tongue. This saves or preserves the maximum amount of space for the permanent teeth (canines and bicuspids) that grow between the permanent back molar and the permanent lower incisors.

They use headgear/night brace which applies pressure to the upper teeth and jaw,  lip bumpers which applies pressure to the lower molar teeth and restrains lip pressure away from the lower front teeth, expanders which apply sideways pressure to the teeth to widen the jaws the teeth are imbedded in, springs which move teeth away from one another, Herbst which holds the lower jaw forward encouraging the bone and jaw muscles to support the lower jaw in this new forward position and sophisticated removable "retainer like" appliances. Some of these approaches take advantage the fact that bone is pliable or flexible and can be pushed, pulled and reshaped.

Only if your orthodontist cannot save or make enough room for all your teeth. Don't worry, if you have teeth pulled, recovery is about 2 days for most patients. Your orthodontist will close the spaces and no one will even notice.

If your permanent front teeth do not have enough room to grow in properly, it is sometimes advisable to remove certain baby teeth in sequence. Removing/extracting baby teeth is like robbing Peter to pay Paul. Room is gained for the front permanent teeth by borrowing room from the teeth along the sides. Eventually the borrowed/loaned space must be repaid, by using orthodontic appliances to increase the space or by taking permanent teeth out. Why do serial extraction at all? Because carefully timed early extractions may prevent unfavorable positioning of permanent teeth and damage to the roots of adjacent teeth.

Patients grow at different rates and speed of the biological process that allows teeth to move can vary between patients. Slower than normal tooth growth, multiple problems often occurring together as in a "syndrome" and poor patient cooperation are the two things that lengthen treatment the most and both are out of the direct control of the orthodontist.

Studies show that people's teeth may shift as they age. This maturational shift continues to some degree throughout life. The most common change is crowding of the bottom front teeth. Surprisingly, careful studies have shown that third molars or wisdom teeth, do not cause or contribute to this crowding. Wearing retainers can minimize tooth position changes of this type.

First, ask your child "Why?" If your child has misconceptions, have your orthodontist address them. If a reasonable explanation to all of your child's objections does not change your child's mind, then don't push or force them into braces. Consider the newly developed brace-less Invisalign teen as an alternative to braces. Everybody loses when a child begins treatment against their will. Circumstances may change over time and your child may become more receptive even if that takes growing into adulthood. You can lead a horse to water, but you can't make it drink.

Referral from your family dentist is not mandatory unless you are in a managed care plan with a "gatekeeper" primary care dentist. Bringing a referral form from your family dentist helps communicate your dentist's concerns more clearly. Word of mouth recommendations from friends and families of existing patients is often the primary way orthodontists meet new patients. Spread the word if you like your orthodontist!

Instant Orthodontics is not orthodontics at all in you define orthodontics as moving teeth to straighten them. Instant Orthodontics is performed by non orthodontists. They leave the roots of crooked teeth crooked and place crowns or veneers on the top half of the teeth to make them look straight.

In the December 2006 Journal of the American Dental Association, renown dental researcher Dr. Gordon Christensen indicated that he was not in favor of instant orthodontics when he wrote: "Even the most conservative ceramic veneer placement procedures remove some tooth structure, during either initial tooth preparation or finishing procedures. Ceramic veneers have a finite life expectancy. Veneers placed on a young adult will require replacement several times during life, each time requiring the removal of more tooth structure and potentially causing damage to pulp and/or supporting structures.....the orthodontically treated patient retains his or her own tooth structure and tooth anatomy, which can serve for as long as a lifetime." In the April 2008 Journal of the American Dental Association, Dr Nancy Jacobson and Dr. Charles Frank studied "instant orthodontics" and concurred with Dr. Christensen. They concluded that "aligning a healthy tooth with veneers(PVR) is not a conservative procedure and more conservative treatment options such as orthodontics....should be offered to the patient." "The cost of orthodontic treatment is more than compensated for by the reduction in the number  of teeth that need to be restored and in the number of times a tooth must be restored throughout a patient's lifetime, as well as by the reduction in pulpal and periodontal complications of treatment." Aligning teeth with veneers(PVR) may create ethical dilemmas"

Short Term Orthodontics is straightening the front teeth for appearances while leaving the malocclusion or bad bite of the rear teeth untouched. Proponents of this approach are recruiting dentists with ads stating "No previous ortho experience needed (Perfect for general dentists)". Many orthodontists would say this type of treatment borders on unethical and does meet the traditional standard of orthodontic care.