Treatment

   braces

Parts of the Braces
An orthodontic appliance (braces) is a very precise, carefully engineered tooth moving machine made of sets of tiny parts. The orthodontist guides the teeth into correct position by regular, incremental adjustments. Parts of the braces:

Band: A stainless steel ring that fits around certain teeth. Each band has a bracket or tube attached to it. The bands are glued to the teeth with a special adhesive.

Bracket: The part that holds the archwire against each tooth. The archwire fits into a slot in the bracket. Brackets may be attached directly to each tooth or to a band.

Ligature: The archwire must be held tightly into each bracket slot. The fine wire or plastic tie that holds the archwire is the ligature.

Archwire: Teeth move from the pressure that is applied by the braces. That pressure comes from the archwire, which guides the direction of the movement.

Headgear: A device with two parts: a soft strap with springs or elastics attached to it and a metal part called a facebow that fits into the molar hands or onto a retainer. A headgear adds extra force to the braces to help move the teeth. It is usually used to help correct overbites.

Elastics: Small rubber bands that hook to the braces between two places in the mouth, helping the teeth move.

Headgear

What it does:

In a growing person, it can help correct an excessive overbite by moving the upper teeth back. It can hold the upper back teeth in place during facial growth while other teeth are moved toward their ideal position.

Parts

A soft strap with elastics or springs and a metal part called a facebow that fits into the braces.

How long will it be worn?

The headgear is usually worn a year or more to correct an excessive overbite. If it is being used to hold the back teeth in place it probably will be worn only for a part of the treatment time.

How often should it be worn?

The more it is worn the faster the teeth move. The orthodontist will recommend the correct number of hours. Usually it is worn 12 hours each day. If it is not worn enough on one day, the time must be made up on the next day.

When is it not to be worn?

The headgear should never be worn during an active sport or activity such as swimming, soccer or dancing. Remove it for eating and cleaning.

Taking care of it:
Do not put it somewhere where it can be stepped on or lost. Brush it with a toothbrush whenever brushing the teeth. The strap can be washed in cold water soap.

Be careful!

Always be very careful placing it or removing it because the wires can be dangerous. There will be clear instructions for this procedure.

If it hurts or breaks:
Call the office to arrange an appointment to adjust or repair it. If it is lost or broken beyond repair there may be a replacement charge.

A final thought:

The patient is in total control of this part of treatment. We have designed the treatment to proceed in a careful manner and we are depending on cooperation from you.
Slip-Cover Retainer

Once the active orthodontic treatment is finally finished, the slip-cover retainer is the best way to stabilize the teeth. Here are some guidelines to you get the most benefit from the retainer:
• Wear the retainer full time for three weeks. You can remove it to eat, but keep it in the protective box.

• After three weeks, wear the retainer at night… that's each and every night

• Clean it with soap, water, and Q-tips if you want it to stay clear and shiny. You can soak it in vinegar now and then, too. Toothpaste dulls the brilliance. Commercial cleaners such as 'Efferdent' or 'Retainer Brite' work well, too.

• If an edge of the retainer rubs your gums, file it smooth with an emery board.

• If you lose it, call us to make a new one (the cost is $125.00).

• If you skip a night, the retainer may feel tight, because your teeth have shifted. Make up the time on the weekend.

• You can put a few drops of fluoride gel in the retainer once a week, and leave it there while you wear it overnight. It will help prevent decay.

Positioner

What is it?

The positioner is an elastic device that looks like a boxer's mouthpiece. The imprints of the teeth are in the positioner, and have been arranged in as perfect a bite as possible. The positioner is used after removal of the braces. It guides the teeth into their final ideal placement.

The most important feature

If it is not worn it does not work.

How long will it take?

Every patient is different, but most people wear the positioner for a few months. It may be followed by retainers.

How much should it be worn?

It is best to wear it at first as much as possible for three days and nights. During the next few weeks it should be worn several hours when you are awake and all night.

Exercise

It works best to intermittently clamp the teeth into it. This makes it flex and move the teeth efficiently. We will demonstrate this exercise.

Taking care of it

Brush it with a toothbrush when it is taken off and before you put it on. Rinse and dry it with a towel before placing it into the protective case. Do not leave it where pets, brothers or sisters can find it. Be sure to keep it away from heat, because it may melt.

If it hurts or is damaged

Phone the office for an appointment to adjust or repair it. If it is lost or damaged beyond repair there is a replacement charge.

The final step

Orthodontic treatment takes time, care and cooperation. The final success depends on correct use of the positioner.

Rubber Bands

We may ask you to wear elastics on your braces. It is an essential part of the treatment and success depends entirely on your cooperation.

Why are they used?

They add an extra force to the braces to help move the teeth. For example, if the upper teeth are too far forward and the lower teeth are too far back, rubber bands may be stretched from the upper front teeth to the lower back teeth.

When are they worn?

They are worn usually at all times except when eating or brushing. Sometimes we'll recommend part time wear. We'll recommend a specific schedule for you. It is important to be consistent; the elastics will not work as well if they are not in place each day.

When are they changed?

Elastics are replaced at least once each day or they will lose their snap. Be sure to pick up plenty at the office. A few days without them can cause a serious set back.

Are there different sizes?

There are many sizes, each designed for a specific purpose. Wear only the size we ask you to.

What can be expected?

The teeth may become sore when elastics are first used. This soreness will be gone in a few days. The teeth may become loose; that is a normal reaction to the elastic force. Expect to see progress; look for it carefully.

Why are they important?

They have to be worn if the treatment is to be successful. You must help with this part of the treatment in a substantial way if there is to be progress. It requires hard work, even though elastics are not comfortable.

Brushing

Permanent stains, cavities and gum diseases are all caused by bacteria that live on teeth in a colorless sticky substance called plaque. Plaque must be removed every day. Braces make it harder to remove plaque. Brackets, bands and archwires create nooks and crannies that are hard to reach, therefore your brushing technique must be different.

Place the brush against the teeth at an angle. Push the bristles under the wire and between the teeth.

Vibrate and move the brush in small circles in each area of the mouth, from above and below the archwire. Scrub all over the braces, teeth, and gums in a circular motion and do not forget the tongue side and the chewing surfaces. When the brushing is finished, the braces and teeth should be free of food particles and plaque. The braces should be shiny, the gum margin should be distinct and gum tissue should be firm and a light pink color.

A careful brushing of a set of braces takes about 2 minutes and should be done within 10 minutes after eating. Always brush before bedtime. A folding toothbrush is handy at places away from home. A few minutes each day is a small price to pay for fresh breath, and clean, healthy teeth and gums.

The Gum Disease Process

Healthy gums have a salmon pink color and an orange peel (or stippled) surface and distinct margins. They do not bleed easily and are firmly attached to the teeth.

Gingivitis:

Without careful brushing, flossing or diet control, gums develop gingivitis (red swollen gum tissue). The gum may have a reddish color at the gum margin, and bleed when brushed or flossed, but may not hurt.

Periodontitis:

At the gingivitis stage, the gum tissue can still return to a normal condition. But with continued neglect, the condition proceeds to periodontitis, where damage to the gum can occur.

In a condition of periodontitis, the gums may have a color in shades of pink, red and purple, but still may not hurt. The skin surface is smooth and shiny (not stippled). The infection is still limited to the gums. The gum tissue edges may appear ragged and even become detached from the teeth.

Periodontal disease:

In this phase the infection spreads to the bone around the teeth.

Oddly the orange peel surface may return. Gums might recede. It may not be painful. There is permanent damage to the hone and tooth loss may result.

Flossing

Flossing during orthodontic treatment is tricky and time consuming, but with practice it can become an easy routine. Flossing with braces is more important than flossing without them, because plaque collects around the appliance. Plaque is the major cause of gum disease and must be removed daily. Only floss can reach between the teeth to remove plaque.

Use waxed floss or tape; unwaxed floss will shred on the metal edges of the bands and brackets. Use a piece about 18" long. The orthodontist or an assistant will show you how. The floss must be threaded under the archwire before it is passed between the teeth.

Be very careful not to snap it as it is moved between the teeth. Steady pressure works best. Rub the floss up and down against each tooth surface; avoid using a shoe shine motion.

Do not force the floss hard into the gums, but be sure to clean the tooth surface under the loose collar of the gum tissue. The floss must be re-threaded for each contact area. Do not forget the back side of the last tooth.

We will provide a floss threading device to help pass the floss under the archwire. It is difficult at first for all patients to learn to floss with braces. After a few weeks it will be easy and fast to floss all the teeth once a day.