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Many parents are surprised to learn that their child might need braces as early as age 7 or 8.  Lots of these parents remember getting braces themselves around age 12 or 13, and their initial reaction is, "That seems really young for braces.  I didn't need them that young.  We're going to wait."  Waiting until 12 or 13 is still the right choice in lots of cases, but there are a few problems that require intervention sooner.  We only recommend early treatment in cases where we know we're likely to get a better long-term result by taking action sooner rather than later.

Today we're going to discuss one of these types of problems, the anterior crossbite or underbite.

Anterior crossbites can be caused by a couple of different problems.  Sometimes they result from disparities in jaw growth between the upper and lower jaws.  This is significant because at age 7 or 8, we have the greatest likelihood of being capable of influencing the patient's jaw growth.  As they get older, it becomes increasingly difficult and the results are less robust.  In severe cases, early intervention may be able to help the child avoid requiring a surgical correction later in life.

Another possible cause of an anterior crossbite is the misalignment of teeth in jawbones that are growing normally.  If upper teeth erupt into the mouth but are tipped too far back or lower teeth erupt that are tipped too far forward, an underbite can result.  Once the teeth have come in with this relationship, they will not self-correct.  In fact, they will only get increasingly "set in their ways" if you will as time goes by. This means that they will become increasingly difficult to correct.  In addition, leaving these teeth in the wrong positions for too long can lead to other unrelated problems.  For example, lower teeth that are trapped in a forward position are more likely to experience recession of the gums or mobility.

If your child is experiencing any of these problems, it's a wise choice to speak with an orthodontist.  In our office, like most offices, consultations are free, and you will at least leave armed with the knowledge you need to know whether you want to proceed with treatment or allow more time.  As always, we welcome your calls and emails if you have any questions!

Spring sports season is in full swing these days, and we get lots of questions about how braces will influence playing sports.  These questions usually surround concerns regarding 1) injury, and 2) time spent wearing elastics and retainers.

In the case of many sports, especially those involving lots of contact like basketball and wrestling, or those involving balls and/or equipment that could accidentally contact a player's face, parents are wise to seek extra protection for their child's teeth.  Generally we advise that any sport that recommends a mouthguard, even if it isn't a requirement, is a sport in which the player should definitely be proactive about protecting his or  her teeth.  Certainly, you want to be cautious even without braces.  Any patient can experience an injury that leads to the loss of or damage to a tooth or teeth.  With braces on, the risk of injury to the lips and gums are also increased because of the extra appliances in the mouth.  Wearing a mouthguard can reduce the risk of teeth being broken or knocked out.  In addition, the plastic from the mouthguard separates the braces from the lips, helping to avoid cuts and soft-tissue injury.

Sometimes wearing a mouthguard can be more challenging with braces.  There are ready-made orthodontic mouthguards available that you can invest in with special grooves where the braces fit.  You can also use a traditional boil-and-bite mouthguard with braces.  The way you fabricate your guard will simply be a little bit different.  Before biting into the warm mouthguard, take a strip of wax and lay it across your braces.  This will prevent the plastic from flowing into the grooves around the braces and wires and becoming difficult to remove.  Finally, there are some appliances that we use in conjunction with braces (like the Forsus appliance, for example) which make it difficult to wear a full-length mouthguard.  We advise, in these cases, that you cut the back portion of the mouthguard off to shorten it slightly and make it possible to fit in with your appliance.

If an injury does occur, your first call should be to your general or pediatric dentist who is the expert in assessing damage to and repairing the teeth.  They may take an x-ray to ensure that no teeth or bones have been broken.  If a tooth has broken or knocked out, they will recommend the proper course of action.  In many cases, the orthodontist may be involved in the recovery as well.  Sometimes if a tooth has loosened due to injury, the braces can be used to stabilize the tooth, and your dentist can advise you if they'd like you to see us to assist with this stabilization.  In addition, once the risks to the teeth, lips, and bones have been addressed with your dentist, you should also evaluate to see if any braces or other appliances are broken or loose.  If so, as with any other broken appliances, you should give our office a call, and we can advise you on whether you need to come in right away or if the breakage is minor enough and can wait until your next visit for an easy repair.

As I mentioned, another concern that often arises during sports seasons is finding time to wear things like elastics and retainers.  If a mouthguard is required for your sport, then this takes precedence over the use of any special appliances!  We always give permission to leave rubber bands and retainers out while you're engaged in playing your sport.  (If you play a non-contact sport (like track and field) and feel comfortable wearing your rubber bands or retainers, it's ok to go ahead and keep them in, but we do not require it.)  Often, especially for serious athletes, there can be many hours spent each day on practices, games, and meets.  It's can be challenging to find enough time to wear your appliances, but rest assured that it can be done!  We suggest keeping extra bags of rubber bands around at all times and putting a fresh pair in every time you have an opportunity.  At a tournament all weekend?  Make sure the rubber bands are in between games.  Even if you only have half an hour, it's important to put them back in and let them keep working.  By making the effort, you can still make progress during your sports season, or at least avoid taking a step backwards!

Keep smiling, friends!

One of the challenges we deal with during orthodontic treatment is maintaining excellent oral hygiene.  This is a challenge for a couple of reasons.  First, many of our patients are young and still struggle with the necessary motor skills necessary to be truly effective at achieving great hygiene.  And second, whether using braces or aligners, while in orthodontic treatment, there are often more places for plaque and bacteria to hide out which means that getting a good result from brushing might take a little more time and effort than usual.  Why is this so important?  Poor hygiene can lead to cavities and gum disease, or white spot lesions.  Not familiar?  Here's a picture of white spots that were seen on someone's teeth after braces were removed:

So what should we do about this?  Well, the best defense is a good offense!  In other words, I'm saying that prevention is key.  White spots are difficult to treat once they've occurred, so avoiding them in the first place is your best bet.  Here are some tips for avoiding white spots!

1. Parents should help, especially for very young patients. I meet lots of parents who are eager to put all the responsibility for brushing in their child's hands.  In some cases, however, the child isn't interested in being compliant, or doesn't yet have the necessary skills to do a good job.  In these cases, it's important to remember that as the parent, it will be your responsibility to monitor their brushing and flossing routines and help them if needed.
2. Avoid excessive sugary foods and drinks. Sugar contributes to plaque and bacteria formation on the surface of the teeth.  It's ok to enjoy as a treat here and there, but you should avoid consuming sugar continuously throughout the day, and you should always brush (or rinse with water if you can't brush right away) after enjoying sugary treats.
3. Try using the special toothbrush we offer when you start braces! We use a special toothbrush when starting treatment with braces.  It's specially designed to make it easier to brush under the wires and around the brackets so that you can be more effective at removing plaque.
4. Watch for bleeding or puffy gums. These can be indications of inflammation which often means that brushing and flossing aren't being done effectively enough.  If you're trying your hardest and still seeing results like this, please let us know.  We'd be happy to review instructions as many times as you need us to!
5. A Waterpik might be your new best friend. Waterpiks are gaining increasing popularity for good reason.  They're fun for kids, and they do a great job of irrigating in hard to reach places!
6. Feel free to ask for feedback on your brushing. We are here to help you.  If you aren't sure how you're doing, let us know!  We'll be happy to check and point out areas for improvement!

With a little effort, you can finish your braces treatment with beautiful stain-free teeth!!  As always, you can find more information on our website at www.sciotobraces.com.  Keep smiling, friends! :)

The popularity of at-home, do-it-yourself orthodontic treatment has increased dramatically in the past year, and we can imagine you might have lots of questions about this method of treatment!  You hear advertisements on TV describing how easy and inexpensive mail-order orthodontic treatment is.  (Saving you all those "pesky" visits to a dental professional's office... )  And you may also hear dentists and orthodontists warning against the risks of DIY orthodontics, but perhaps it isn't clear what the risks are?

So today, I'm going to break down a few of the unanswered questions based on my current understanding.  First of all, let's define what we're talking about.  What is DIY orthodontic treatment?  Thirty or forty years ago, DIY orthodontics may have consisted of a dentist telling Mom to save her money on braces and have her son or daughter hold a popsicle stick in their mouth while watching TV at night to correct a crossbite.  So DIY orthodontics isn't a new idea, but it has at least gotten a little more advanced!  In this case, I'm referring specifically to mail-order clear aligners.  These are marketed as invisable aligner treatment without the need to visit a doctor's office.  You fill out a form online and pay a nominal fee to request some materials from the company.  They send you a kit that you use to take an impression of your teeth at home.  You send the impressions back, and they propose a treatment plan.  You then have the option to view a video animation of how they expect your teeth to move and pay for the aligners if you want to.  They are reportedly reviewed by a licensed dental professional, but you will monitor your own treatment at home.  I don't have any first-hand experience with these companies, but I'm guessing (and hoping) that they remain available for questions throughout your treatment.

So, what are the advantages that they advertise?

• Convenience - The company advertises that you can skip trips to the orthodontist's office.  Is this true?  Perhaps.  If you take an excellent impression of your teeth on your own and your treatment goes seemlessly, you may avoid trips to an office!  Here are a couple things to keep in mind.  Taking impressions is something that does not have a 100% success rate even for orthodontic techs and doctors who have done it many times before.  If you end up needing help or a digital scan (rather than an impression), you may end up visiting an office or a shop or kiosk to have this part of the work performed.  Also, keep in mind that during clear aligner treatment in most orthodontic offices, you only need to visit about every 8 weeks and likely for no longer than half an hour or so.
• Cost - The company also advertises that you'll save lots of money compared to traditional orthodontic treatment.  Is this true?  Perhaps.  You are essentially eliminating a middle-man.  But is this a good choice?  Eliminating the middle-man when you buy airline tickets or books online is great because you get the same product either way.  With orthodontic treatment, when you eliminate the middle-man, you also eliminate a person who can give you customized personalized advice, guidance, and help getting the results you want.  You may save money, but it's hard to guess whether you'll get the same value out of your treatment.  There are likely cases where equal success is achieved, but more often than not, aligner treatment does not go precisely as planned, and the in-person help of a professional can help get you back on track.

And what are the disadvantages we've been talking about?

• Limited options - Companies such as the one I'm referring to advertise that they will use aligners to correct your "smile."  This does not necessarily include making improvements to the way your teeth bite together.  Orthodontists are trained to address all aspects of treatment.  In some cases, aligning your teeth could put them in a position where they will be subject to problems later.  Which leads me to my next point...
• Worsening of dental health - Before beginning orthodontic treatment, an orthodontist should perform an exam and/or consult with your general dentist to be sure that your teeth and jawbones are healthy enough for tooth movement.  If they are not, moving your teeth could lead to tooth loss, recession (gum problems), or mobility of teeth.  In addition, orthodontists monitor your treatment throughout the process to be sure that your teeth are moving to a healthy position.  If they aren't biting properly, adjustments need to be made, and sometimes treatment plans need to be revised in order to prevent bite problems.
• Cost - Yes, I mentioned cost as both an advantage AND a disadvantage.  It's great if your treatment goes smoothly - you will probably save money!  However, if you complete treatment and aren't satisfied with the results, as has been the case for many patients, you may find yourself in an orthodontist's office anyways, looking for another treatment option and facing the possibility of paying for treatment all over again.

So, should you try it?  We are obviously fans of treatment that is supervised by an orthodontist, but most importantly, we just want you to be aware of the risks and benefits before you make the decision to try this type of treatment!  And if you decide against it or if you've already tried it and you're not satisfied with the results, we are still here for you!

Keep smiling, friends!