New York City Orthodontics

A:Braces today tend to be less uncomfortable and less visible than they used to be, but they still take some getting used to. Food can get caught in the wires, flossing and brushing can take more time, and after the monthly adjustments sometimes the teeth are a little sore. Tooth discomfort can be controlled by taking an analgesic, such as ibuprofen (Advil, Motrin and others) or aspirin if necessary. The use of lighter and more flexible wires has greatly lessened the amount of soreness or discomfort during treatment. Because treatment has become more socially acceptable, social embarrassment may be less of a concern.

A:Whether or not one should seek orthodontic care at an older age is an individual decision. Many people live with crowding, overbites or other types of alignment problems without the motivation to seek orthodontic treatment. However, many people feel more comfortable and self-confident with properly aligned, attractive teeth. Unlike strictly cosmetic procedures, orthodontic care can also benefit your long-term dental health. Straight, properly aligned teeth are easier to maintain with proper oral hygiene, such as flossing and brushing. This can help reduce the risk of cavities as well as gum disease, which occurs more readily as it becomes increasingly more difficult to clean around crowded and rotated teeth. In addition, people with bad bites may chew less efficiently. In severe cases (particularly when the jaws are not aligned correctly), this can result in nutritional deficiencies. Correcting bite irregularities can make it easier to chew and digest foods. Improperly coordinated upper and lower front teeth also can create speech difficulties, which can be corrected through orthodontic treatment. Finally, orthodontic treatment can help to prevent premature wear of back tooth surfaces. As you bite down, your teeth withstand a tremendous amount of force. If your front teeth don’t meet properly, it can cause your back teeth to wear more.

A:While braces are a fairly common and predictable way to close a gap between teeth, it is sometimes necessary to explore other options that would be better suited for one’s needs. Among these options are porcelain veneers (thin pieces of porcelain that are made in a dental lab and then bonded into place to create the illusion of a more perfect smile), and bonding (using tooth-colored, composite resin to fill in the spaces between teeth). Both techniques can fix the gaps in one’s smile fairly quickly (within 2 weeks for the veneers, and within an hour or two for the bonding). Bonding will most likely be the more cost-effective way of achieving your goals, but may require periodic maintenance and may not be as natural looking as the porcelain veneer option.

A:Invisalign® straightens your teeth with a series of clear, virtually invisible custom-molded aligners that are made from impressions taken by your dentist or orthodontist. Unlike braces, Invisalign aligners have no metal bands or wires to irritate your mouth. Since Invisalign is removable, you can take the clear aligner out for meals, brushing and special events, although you will need to wear your trays for at least 21 hour a day for it to be effective. Invisalign also allows you to view your own virtual treatment plan before you start so you can see how straight your teeth will look once your treatment is complete.

A:Braces work by applying continuous pressure to move teeth in a specific direction. Braces are worn for an average of one to three years. As treatment progresses, teeth change position, and the braces must be adjusted. When applying braces, the orthodontist will attach tiny brackets to your teeth with special dental bonding agents. He or she will then place wires called arch wires through the brackets. The arch wires, which usually are made of a variety of alloys, act as tracks to create the “path of movement” that guides the teeth. Wires made of clear or tooth-colored materials are less visible than stainless steel wires but are more expensive. Tiny elastic bands hold the arch wires to the brackets, and patients can choose from a multitude of colors at each visit. Expect to be uncomfortable for the first few days after getting braces. Your teeth may be sore, and the wires, brackets and bands may irritate your tongue, cheeks or lips. Most of the discomfort disappears within a week or two, although you may experience moderate pain when wires are changed or adjusted. Taking ibuprofen (Motrin, Advil) or other over-the-counter painkillers can help to ease any discomfort.

A:You can choose between braces made of metal, ceramic or plastic. However, orthodontic treatment usually is done using stainless steel brackets. Ceramic or plastic brackets often are chosen for cosmetic reasons, but plastic brackets may stain and discolor by the end of treatment. Bands made of plastic or ceramic also have more friction between the wire and brackets, which can increase treatment time. Other options for adults include Invisalign, which is a series of clear retainers designed to move teeth into proper alignment, but may have certain limitations when it comes to more advanced tooth movements.

A:A retainer’s purpose is to maintain tooth positions after corrective orthodontic treatment. Once your bite has been corrected, bone and gums need additional time to stabilize around the teeth. The recommended length of time for wearing a retainer varies from orthodontist to orthodontist. Most children and teenagers wear retainers until their early to mid-20s, but your orthodontist’s recommendation should be followed strictly because he or she knows your treatment best. You can choose from a removable retainer or a fixed wire retainer that gets bonded to the inside surface of your teeth to prevent relapse and movement.

A:If you don’t wear your retainer you will run the risk of your teeth shifting back to their original position. The ligaments around the teeth have memory, and the more rotated your teeth were before, the more likely they will drift back without the proper retention. It is most important to wear your retainer for the first 6 months following orthodontic treatment, so that the bone around the teeth will have a better chance to fully fill in the areas around where the tooth was moved from. After this time it is recommended to continue wearing your retainers, unless you are told otherwise by your dentist or orthodontist. At the very least, you should try in your retainer every few days to make sure that it isn’t fitting too tight, signaling some drifting may be taking place. A permanent metal wire splinted to the inside of your front teeth can eliminate the need for the removable retainer, and help to maintain your straightened teeth if you are prone to being non-compliant.

A:Most retainers are removable, meaning that you take them out when eating, brushing and flossing. For this reason, they are easy to misplace. Many people wrap their retainers in a napkin when eating, then forget about them afterwards and have to spend hundreds of dollars on a new retainer. A good solution is to always carry your retainer case with you and to use it whenever you’re not wearing your retainer. For added protection, never leave the case on a table or a bench — always put it immediately in your backpack, purse or pocket.
Your dentist can give you information on how to clean and care for your specific type of retainer. Regardless of the type, you need to make sure you don’t sit on, step on or otherwise damage this delicate and expensive piece of equipment.

A:Braces, bands or the wires that are affixed to each tooth occasionally will break or fall off completely, but usually what happens is that one of the parts will loosen, which may cause minor discomfort. Here are a few problems that can occur:
• Loose bracket — Brackets are the metal or ceramic pieces that are bonded (glued) to the teeth. If the bond weakens or breaks, which can happen after you chew something hard or sticky, the bracket can dislodge and may poke at the gum tissue or other soft tissues in the mouth, such as your tongue or cheek. You can temporarily reattach loose brackets with a small piece of orthodontic wax, or place wax over the bracket to provide a cushion so it doesn’t poke you. This should provide some comfort until you can see your orthodontist.
• Loose band — Orthodontic bands are the metal rings cemented with dental bonding agents or cement around back teeth. If an orthodontic band becomes loose, call for an appointment to have it re-cemented or replaced. If the band comes off the tooth or the wire completely, do not replace it yourself. Save the band and call to schedule an appointment for repair.
• Protruding or broken wire — This is a common problem. If a wire sticks out of the bracket or band or breaks, it may poke or damage your cheek, tongue or gum. The easiest solution is to use the eraser end of a pencil to push the wire into a less bothersome position. If you can’t bend it out of the way, put a small piece of orthodontic wax over the end that is sticking out. You should not cut the orthodontic wire. A cut wire can be accidentally swallowed or inhaled into your lungs. If the damaged wire has caused a painful sore, rinse your mouth with warm salt water or an antiseptic rinse. This will keep the area clean and help reduce the discomfort. You can also apply an over-the-counter dental anesthetic (pain reliever), which will temporarily numb the area. If the pain doesn’t get better or the sore seems to be getting worse, call your orthodontist.
• Loose spacer — Spacers or separators are rubber circular pieces that are put between your teeth. They are left in place for a brief period of time, usually for several days. They open a small space between your teeth so that the orthodontic band will slip into place easily. Sometimes, they can slip out of position or fall out entirely. If this happens you should make an appointment with your orthodontist to have them replaced.

A:Yes, a lot of extra care is needed during orthodontics. The brackets and wires have many nooks and crannies that can trap food and plaque. This means your risk of tooth decay and gum problems may be higher while you are wearing braces. You need to pay special attention to cleaning your teeth everyday and to your diet (try to avoid acidic foods and beverages like soda). Permanent damage to tooth enamel can occur if the teeth and brackets are not kept clean, such as unsightly white spots due to the enamel becoming demineralized. Most of us are well aware that sugary foods and drinks can lead to tooth decay, but starchy foods, such as potato chips, and foods like nuts and raisins can also stick to teeth for long periods of time and cause tooth decay. Avoid hard foods such as nuts and hard cookies. There are foods that can loosen, break or bend wires and bands when you are wearing braces. Foods such as apples and carrots should be chopped into small pieces before eating to reduce the stress on your braces. Avoid sticky foods such as caramels, toffees, or fruit bars. No chewing gum! No chewing ice! Drink plenty of water, and use fluoride tooth pastes and rinses as recommended by your orthodontist. Additionally, try to avoid giving in to bad habits such as nail biting, unnatural tongue thrusting, pencil chewing and picking at your wires, which can also break your braces. Consider using special electric brush tips or orthodontic brushes, along with a water pik and floss threaders to clean more efficiently. While you are having orthodontic treatment, you need to continue to have regular check-ups with your dental professional to ensure little problems don’t become big ones.

A:If your mouth is destined to become crowded, or to develop large gaps or rotations, then braces are most likely in your future. However, there are ways to limit the duration of the treatment, or make it less involved. If you are seen early enough to do some interceptive orthodontics to correct conditions such as a constricted palate or cross bite, the treatment when you are older would be less complicated and much less time consuming. Additionally, wearing your retainers will prevent the need for braces again in the future. Some individuals, who are candidates, may also choose to wear Invisalign trays (clear, plastic orthodontic trays) to straighten teeth instead of opting for the bracket, band and wire option of traditional braces.

A:Whether or not one should seek orthodontic care at an older age is an individual decision. Many people live with crowding, overbites or other types of alignment problems without the motivation to seek orthodontic treatment. However, many people feel more comfortable and self-confident with properly aligned, attractive teeth. Unlike strictly cosmetic procedures, orthodontic care can also benefit your long-term dental health. Straight, properly aligned teeth are easier to maintain with proper oral hygiene, such as flossing and brushing. This can help reduce the risk of cavities as well as gum disease, which occurs more readily as it becomes increasingly more difficult to clean around crowded and rotated teeth. In addition, people with bad bites may chew less efficiently. In severe cases (particularly when the jaws are not aligned correctly), this can result in nutritional deficiencies. Correcting bite irregularities can make it easier to chew and digest foods. Improperly coordinated upper and lower front teeth also can create speech difficulties, which can be corrected through orthodontic treatment.
Finally, orthodontic treatment can help to prevent premature wear of back tooth surfaces. As you bite down, your teeth withstand a tremendous amount of force. If your front teeth don’t meet properly, it can cause your back teeth to wear more.