Correcting a Recessive Lower Jaw in a growing individual

There are many types of orthopedic (as opposed to orthodontic) appliance s used when the lower jaw has not grown enough, resulting in skeletal and bite discrepancies. Fixed appliances include the herbst, Jasper Vektor, and mara (mandibular anterior repositioning appliance). Removable appliances include the twin block, mono block, and bionator. Orthopedic appliances try to get the lower jaw to grow in a forward direction, providing a better relationship with the upper jaw and improving the facial profile. The bite relationship is also improved because the lower teeth move forward with the lower jaw.

Fixed appliances have the advantage of being attached to the teeth and are not removable , so compliance with appliance wear is not an issue. The down side is that they are fairly bulky and can rub on the cheeks and gums , making them uncomfortable. There is also a tendency for them to break , or, in the case of the herb st appliance, come apart. This can require extra trips to the orthodontist to have them repaired. The other major issue is hygiene. They are difficult to clean around, increasing the potential for damage to the teeth and gums.

Removable appliances tend to be more comfortable to wear than fixed appliances. Learning to talk while wearing them does take a little work, but can be mastered in most cases. They can also be removed for eating, activities like sports, and oral hygiene, which is a major benefit. Compliance can be an issue, however. Removable appliances require at least 20 hours of wear each day, so patient cooperation is essential for them to be effective.

A key factor that is required for any orthopedic appliance to make the desired changes is that the patient must be growing. The ideal age in my opinion is from 8 to 10. I find that this age group tends to be the most compliant if removable appliances are to be used and growth potential is not an issue. Orthopedic appliances have been shown to be effective during adolescent years, as late as 14 or 15 if enough growth potential remains. Orthopedic appliances are not an option once growth is complete. Jaw surgery, know as orthognathic surgery , is required if these patients want to improve their skeletal relationships.

By Gary W. Greer, DDS, MSD

Dealing with Acute TMJ Pain

If you get hit in the jaw, and one or both of your jaw joints (TMJ) start to hurt, it can make life miserable. Here are a few things that can help minimize or eliminate the pain.

Eat a Soft Diet: Only eat softer foods like soups, eggs, apple sauce, baby foods, etc. during the initial phase of healing. A blender can be used to add fruit and/or vegetables to your favorite juice. When the jaw joint starts to get more comfortable you may begin to eat more substantial foods, but cut these into small bite size pieces. Do not open your mouth wider than the thickness of your thumb. Do not eat hard crusts of bread, tough meat, raw vegetables, chew gum, or any other food that requires prolonged chewing.

Use Aspirin: Since aspirin is the drug of choice for inflammation of any joint, take it every four hours following the directions of the container. As symptoms improve, you can reduce thee frequency. If you cannot take aspirin for any reason, take one of the aspirin substitutes or what ever your physician recommends.

Use Moist Heat and Ice: Perform the following procedures three times each day:

  • Fill a wash basin with water as hot as your skin can stand, and soak two towels in it. Take one, wring it out, and apply it to the painful area. When the first towel cools, apply the second towel and put the first one back into the water to warm it up again. Apply moist heat for about ten minutes, making sure that the basin water is kept hot.
  • Immediately after applying the moist heat, rub the area with an ice cube for about thirty seconds.

Relax and Disengage: It is important to keep the teeth apart except when swallowing or eating. Make a conscious effort to separate the teeth and relax the muscles of the face and jaw. The goal is to help the lower jaw assume a more normal position in the joints and help to eliminate pressure on the injured tissues in the TMJ. Continued pressure on the jaw joints can delay healing and may result in further damage.

By Gary W. Greer, DDS, MSD

What Are “Clarity Braces”?

An orthodontist used to be fairly limited in what he could offer his patients who needed full braces. Today the alternatives to traditional metal braces include invisible braces, also known as invisalign or aligners, and clear braces. Clarity bracesTM are one of the many types of clear braces that an orthodontist can choose from.

Clarity bracesTM are ceramic braces with a metal insert that are made by Unitek, one of the many supply companies that an orthodontist can order from. The ceramic material used in Clarity bracesTM is translucent, blending well with teeth and making them much less noticeable than metal braces. The metal insert is used to reduce the friction between the Clarity bracesTM and the arch wires that the orthodontist uses to move teeth to their correct positions. The goal is to make the treatment time using either Clarity bracesTM or metal braces the same.

There are many excellent clear braces an orthodontist choose from. Clarity bracesTM is one of these. If you need full braces to achieve the smile you’ve always wanted, talk to your orthodontist about using clear braces instead of metal braces. They aren’t the best option in every case, but they may be a good choice for you.

By Gary W. Greer, DDS, MSD

Will My Teeth Stay Straight After Braces?

You’ve just gone through a year or two of metal braces, clear braces, or invisible braces. Your teeth look great and you have a beautiful smile. Your done, right? Wrong! In reality, the most important part of your treatment is just beginning. It’s called the retention phase.

People who had metal braces or clear braces have a choice of retention devices. The most common are a positioner, Hawley type retainers, vacuum form invisible retainers, and bonded permanent lower retainers. People who had the invisible braces, or aligners, typically use the last aligner as an invisible retainer. Unfortunately, there is not a perfect retention device. Each one has its pros and cons.

The positioner provides three dimensional retention and does the most complete job stabilizing the alignment and bite relationship if it is worn properly. It looks like a football mouth piece, so many people can’t or won’t wear them. The Hawley type retainers are fairly easy to wear, and come in many colors and patterns. They don’t stabilize bite corrections, can be lost or broken if not cared for properly, and can affect speech. The vacuum form invisible retainers are easy to wear and don’t affect speech, but don’t stabilize the bite and are easy to loose or break. They also cover the biting surface of the teeth, so grinding or clenching can damage them fairly quickly. The bonded retainers are glued to the inside of lower front teeth, so they won’t get lost and don’t affect speech. They are difficult to clean properly, so hygiene can be a problem; and if one of the teeth comes loose and shifts, the bonded retainer can’t re-align it.

No matter what retention device you choose, make sure to follow the instructions you get from your orthodontist. If the retention device gets lost or broken, call your orthodontist as soon as possible to get it repaired or replaced. You’ve worked hard and went through a lot to get that beautiful smile. Wearing your retention device properly will make sure it lasts a lifetime.

By Gary W. Greer, DDS, MSD

Why Do Young Kids Get Braces And Orthodontics?

Years ago orthodontists rarely put braces on kids until all of their permanent teeth were in, or at least close to it. Orthodontic treatment for young children was typically limited to retainers or other devices for minor straightening of teeth. Eleven, twelve, or thirteen was the typical age metal braces were placed and the majority of teeth straightening was accomplished. Today we see kids as young as six or seven with braces. A lot of parents want to know why?

I tell the parents of my patients that early orthodontic treatment has allowed me to get more ideal results, better facial aesthetics, and dramatically reduce the need for extracting permanent teeth. The earlier orthodontists can diagnose a problem, the more options we have to correct it. It can be as simple as aligning front teeth to improve aesthetics and hygiene, or it can include head gear to retract prominent upper teeth and minimize the potential for traumatic fracture. I have also found my younger patients are much more cooperative with devices like head gear and more accepting of devices like palatal expanders. Early braces and orthodontics can dramatically reduce the time full braces are worn when kids are in middle and high school. They love that!

I think the ideal age range for orthodontists to see children for the first time is between seven and nine. They are typically mature enough at that point to do what is required of them and the orthodontists have the widest range of options available to treat any given bite problem. Parents of young kids have the option of waiting and doing the needed orthodontic treatment when their child is older, but the benefits make early braces and orthodontics something to at least consider.

By Gary W. Greer, DDS, MSD

Metal Braces vs. Invisible Braces …. Which One Should You Choose?

Braces and orthodontics have become more patient friendly over the years. Metal braces are small and use light-force arch wires that move teeth with less discomfort. Aligners, also called invisible braces, give people a more aesthetic option for straightening teeth using light forces with minimal discomfort. Patients often ask which one is the best choice. I make sure we discuss a couple of factors before a decision is made.

The first is the type of bite problems that exist. There are certain types of bite problems that should not be treated with aligners, so the choice is easy. Examples would be skeletal discrepancies requiring both braces and surgery, cases of severe crowding requiring extractions and substantial tooth movement, and young people who still have baby teeth to loose.

The second are the patients goals for treatment. Some people only want to improve the alignment of their teeth, not necessarily achieve an ideal result. Metal braces or clear braces may provide a more comprehensive correction, but the invisible braces will achieve their goals. In these cases, invisible braces may be the best option. My job is to make sure my patients are making an informed decision and know what the aligners will and won’t accomplish.

It is my opinion that an orthodontists role is to evaluate the problems that exist, decide what options provide a viable way of reaching the patient’s goals, and make sure they understand the pros and cons of each option. I do make recommendations, but I feel that the final decision of metal braces, invisible braces, or any other viable option needs to be made by the patient.

By Gary W. Greer, DDS, MSD

Are all “ORTHODONTISTS” the same?

Braces and orthodontics used to be done by dentists who had special training and limited their practice to straightening teeth. The general dentist did cleaning, fillings, crowns, etc. and referred you to a specialist, or “orthodontist dds”, when you needed teeth straightening. Unfortunately for the public, that is no longer the case.

A general dentist can now legally do metal braces, clear braces, clear ceramic braces, or invisible braces and not have to inform his patients that he has not had the training that a specialist is required to have. If you or a member of your family needs orthodontic treatment, I encourage you to have it done by one of the qualified orthodontists in your area.

A good rule of thumb, if in doubt, is to ask. Orthodontists who are “specialists” have at least one year of comprehensive full-time training and those with a masters, signified by MSD, have had two years. If your general dentist wants to do metal braces, clear braces, or clear ceramic braces, and does not have an “MSD” after his or her name, ask what additional training they’ve had. If it’s anything less than one year of comprehensive full-time training, they are not a specialist and should not be listed as one of the qualified orthodontists in your area. Even if you still want them to do your teeth straightening, you should get a second opinion from one of the orthodontists in your area. Most orthodontists do complementary consultations and the information they provide will help you make an informed decision.

By Gary W. Greer, DDS, MSD

Another Alternative to Metal Braces

Do you want straight teeth? Have you been told that invisible braces like Invisalign won’t properly correct your bite problems, but you don’t want traditional metal braces? There is a great alternative to consider called clear braces.

Clear braces look similar to metal braces, but are made of a clear or tooth colored material so they are much less visible. They do tend to be a little larger than metal braces to help provide the strength needed to withstand the forces placed on them. They blend in with most teeth, so the additional size has minimal impact on aesthetics. Clear or tooth colored elastic ties are also used with these braces to keep them as inconspicuous as possible.

The aesthetic appearance of clear braces is fairly easy to maintain. An important step is to watch what you eat and drink. Things like coffee, red wine, pasta sauces, curry, and berries can stain the adhesive used to attach the braces to teeth, the elastic ties, and some types of clear braces. The staining makes them more noticeable. Brushing immediately after eating or drinking these will help a lot. I also recommend an electric toothbrush. The Philips Sonicare or Oral-B’s Professional Care Smart Series 5000 are my top picks. Use a straw when you can and make sure your elastic ties are changed at each visit, and your clear braces will look their best throughout your treatment.

Clear braces work the same way metal braces do, but it can take longer to reach the same result. One reason is the materials used to make the clear braces aren’t as strong as metal. I use the analogy of a ceramic plate versus a metal plate. Drop them and which one is going to break? It is typically necessary to use lighter forces over a longer period of time to get the desired tooth movement. Another reason is these materials don’t slide along the arch wires used in orthodontic treatment as well as metal does. The increased friction reduces the speed of tooth movement. Some clear braces have small metal inserts built into the slots that the arch wire fits into. These inserts increase strength and reduce friction to some extent.

People who need more correction than aligners will provide, but don’t want the look of metal, will find that clear braces are a wonderful option. They will give you the beautiful smile you want, as well as the healthy bite you need.

By Gary W. Greer, DDS, MSD

Invisible Braces

Is one tooth ruining your smile? Have several shifted as you’ve gotten older? Did you have braces, but your teeth aren’t straight anymore? People, both young and old, want to improve their smile but don’t want braces. Today there is an excellent alternative called aligners, or invisible braces. Some people call them “invisalign“, which is actually an aligner made by Align Technologies. It’s like asking for a Kleenex when you really want a facial tissue. There are a lot of fine companies fabricating aligners. No matter who makes them, the use of aligners to straighten teeth is one reason many people are deciding to get the smile they’ve always wanted.

Surprisingly enough, this concept is not a new one. It was originally introduced around 1940. Computers and space-age plastics have brought aligner treatment into the 21st century, making it a viable alternative to braces in many cases. The aligners we use today are made of thin clear plastic, which is both durable and flexible. When clean and properly positioned, they are very difficult for others to see and are much less irritating than metal or clear braces.

Aligner treatment is fairly simple for the patient. Models, X-rays, and photographs are taken, as they would be for any orthodontic procedure. These records, along with the doctors treatment prescription form, are sent to a lab. The lab does a computer analysis using a virtual model to determine the best way to make the desired changes. This computer-aided design and computer-aided manufacturing (CAD/CAM) technology allows the lab to fabricate a series of custom made aligners that provide consistent and reliable results. Once the first set of aligners arrives at the doctors office the patient is on their way to a beautiful smile.

Aligners work by moving teeth incrementally, with certain teeth used as anchors to apply force to the teeth that need to be moved. Each aligner is designed to make .25 to .33 millimeters of change over a three week period. Even with this minimal movement, they do put pressure on the teeth and there can be some discomfort as a result. Most of my patients tell me any discomfort goes away fairly quickly, sometimes in as little as a few hours. Total treatment time can be a couple of months to a year or more, depending on the amount of correction that the patient wants to make. In very simple cases, two aligners will do the trick. In complex cases, it can take thirty or more. In every case the procedure is the same. The patient wears the aligner for at least 20 hours each day, removing them only when eating and cleaning their teeth. Every three weeks the patient is given new aligners, and this process continues until the desired result is obtained.

One aspect of aligner treatment that can surprise people is the cost. How can those clear little plastic things be so expensive? One reason is that making aligners is very labor intensive. The lab bill that the doctor pays can be very high, and this cost is passed on to the patient. Another is that some companies advertize to the public for name recognition and pass these costs on in the form of higher lab fees. The three companies I use market to doctors, not the public, and they focus on different treatment needs. This allows me to reduce my lab costs in even the most complex cases, and offer patients quality aligner treatment at more reasonable fees.

By Gary W. Greer, DDS, MSD