What is orthodontics?
Orthodontics is the branch of dentistry that specializes in the diagnosis, prevention and treatment of dental and facial irregularities. Braces are appliances or devices used to make these corrections.

What is an orthodontist?
An Orthodontist is a highly trained specialist who has completed two to three years of training after graduating from dental school. An orthodontist not only straightens teeth but also is interested in the bite, facial profile, and oral growth.

What is a Board Certified Orthodontist?
A Board Certified Orthodontist is a person who has completed a comprehensive written examination covering all phases of orthodontic and dentofacial orthopedic care. They also demonstrate actual accomplishment in patient care, with detailed reports on the treatment provided for a broad range of patient problems. A Board Certified Orthodontist achieves the title of Diplomate of the American Board of Orthodontics.

Why should I have my teeth straightened?
Orthodontic treatment improves your smile and your health. Your smile is the most striking part of your face. Look in the mirror. Do you like your smile now? Can your smile be improved? Think about how you react to someone with a pretty smile. Do you find them more attractive? Will you be more attractive with an appealing smile? Orthodontic treatment will make your smile look fabulous. The fabulous smile can last for the rest of your life. Think about how a fabulous smile will improve your life. Orthodontic treatment will also make your face look delightful. Wouldn't a delightful face be wonderful?

Your health is also affected by poorly arranged teeth that can break easily and trap food particles that cause tooth decay and gum disease. They can also lead to poor chewing and digestion which can be bad for your overall health such as:

Dental problems. Crooked teeth are hard to clean so that people with crooked teeth tend to have more cavities and gum problems than people who have orthodontic treatment. Crooked teeth wear in ways that they should not. This puts extra stress on your teeth, gums and jaw which can lead to problems later on.

Breathing problems. As you get older the roof your mouth can sometimes partially block the air passages in your nose. If you have orthodontic treatment you may avoid this possibility.

Statistically, people who have had braces as children have lower incidence of cardiovascular disease as adults. Children who get braces learn to take care of themselves, and that translates into a reduced risk for cardiovascular disease. There is also some recent data which indicates that oral bacteria might play a direct role in cardiovascular disease, by dissolving calcium in your mouth and depositing it into your arteries. Orthodontics helps prevent oral infections which may have a direct effect on heart disease.

The American Association Of Orthodontics (AAO) has a new program called a smile bank, which uses computer imaging to show you how much better your face will look after orthodontic treatment. Contact the AAO at 1-800-787-2444

How do braces straighten crooked teeth?
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 of your orthodontic treatment, there's something happening in your mouth. Something good for you. The brackets we place on your teeth and the main 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.

How can I tell if my child needs orthodontic treatment?
It is usually difficult to know if your child will need orthodontic treatment until your child is 7-8 and their permanent teeth start to come in. We recommend that you bring your child into the orthodontist when your child is 7 years old to evaluate whether treatment will be needed. Generally, the orthodontist will evaluate your child, and if your child needs treatment, the orthodontist will take corrective action to avoid costly and uncomfortable treatment later on.

What are the early symptoms of orthodontic problems and how can I look for them?
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. It is always better to consult a professional. Still, there are some warning signs that you can look for to help evaluate whether your child needs orthodontic treatment. The figure above shows what proper occlusion is like. Notice how the top teeth exactly line up with the bottom teeth, and there are no spaces or gaps. If your child teeth look perfect, your child probably will not need orthodontic treatment. On the other hand if your child's teeth look as shown in one of the figures below, your child will need orthodontic treatment.

First ask your child to open their mouth, and let you look at their teeth. Are all of their teeth straight? Do any of the teeth slant to the side? Are there any gaps between your child's teeth? Do any of your child's teeth overlap? If you see any signs of crooked teeth, gaps between your child's teeth or overlapping teeth, your child may need orthodontic treatment.

Next ask your child to bite down. Does the center of the front top teeth line up with the center of the front bottom teeth? Do your child's top teeth protrude out the front of their mouth? Does your child have bucked teeth? Do the top front teeth cover more than 25% of the bottom teeth? Are any of the top teeth behind the bottom teeth? Do the teeth come together smoothly, or are there any gaps? If your child's teeth do not come together smoothly, or if any of your child's teeth do not lining up properly your child may need orthodontic treatment.

Now look at the alignment of your child's jaw. Do all of the teeth come together smoothly, or does your child's jaw shift off center when your child clenches their teeth together? If you see any misalignment or shifting of your child's jaw, your child may need orthodontic treatment.

If you see any of the above symptoms, or if you are not sure, bring your child in for orthodontic treatment. It's best not to wait hoping that the problems will go away.

At what age should I take my child to an orthodontist for an orthodontic screening?
The American Association of Orthodontists recommends a screening at age 7. The most appropriate age varies for each particular problem. We recommend that you have an initial appointment as soon as any problem is evident; we can then monitor the problem if it is too soon to treat. Many orthodontic problems are treated using growth and it is important that we see children before their growing phase. How many permanent teeth they have is not initially important.

Can you be too old for braces?
No. If the bone and gum tissue around the teeth are healthy, age is not a factor. About 20% of orthodontic patients are adults.

Will additional jaw growth allow self correction of crowded teeth visible in a 8 year old?
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.

If I wait, isn't there a chance that my child's bite will get better on its' own?
Usually it is just the opposite, if you wait orthodontic problems will almost always get worse. If a few teeth are crooked or crowded, the orthodontist can realign the crowded teeth easily. However, if you do not treat the crowding right away, the crooked teeth will encroach onto your child's other teeth and push the other teeth out of alignment too. As a result if you wait, your child's orthodontic problems will usually get worse.

Further, as your child gets older, orthodontic treatment becomes more uncomfortable. As your child ages, fibers grow in to anchor your child's teeth to your child's jaw. It takes more force to move the fibers as your child ages so treatment is more uncomfortable. Also the bones in the roof of their mouth harden as your child ages, which makes treatment even more difficult.

If you avoid needed treatment when your children are teens, the children will usually need more uncomfortable treatment later in life. Isn't it better to take care of the problem when it is first discovered rather than waiting until the problem gets worse?

It is hard to see into the future, to tell how the lack of orthodontic treatment will affect your child. Certainly, a child who needs orthodontic treatment but does not get it will have problems with the teeth for years to come; so much so that many adult patients are now going back for orthodontic treatment. The difficulties with not getting needed orthodontic treatment include:

Teeth that wear unevenly leading to weak enamel and tooth loss
Teeth that are difficult to clean, leading to gum problems and eventual tooth loss
Difficulty chewing
Periodontal (Gum) problems as your child gets older
The health issues, that go well beyond good oral hygiene

Also, chewing is the first step in digestion. If your children cannot chew their food properly, their digestive system will not work as well. Stomach problems are very common in people who skip needed orthodontic treatment since if your child cannot chew their food right, it irritates their stomach, and produces a lifetime problem.

Is treatment more difficult for adults?
Adults can be treated successfully at any time. However, treatment options using growth are no longer available.

What causes crooked teeth?
Just as we inherit eye color from our parents, mouth and jaw features are also inherited. Local factors such as finger sucking, high cavity rate, gum disease, trauma and premature loss of baby teeth can also contribute to a bad bite.

Can I have my teeth straightened without having braces glued to my teeth?
Yes, if you are an adult 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 made by Invisalign may allow creation of a beautiful smile for you without glued on braces. This advanced technology is not for growing children.

What do rubber bands do?
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. It's important to wear your elastics as prescribed and 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. 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).

Can I get colors on my braces?
Colors have gone over very big with countless braces wearers. With colors, patients decide to become involved in their treatment and usually take better care of their braces. Patients won't take time to choose special colors unless they intend to use them and speed their treatment. There are soft pastels that coordinate with wardrobe to bright hues for celebrating holidays or expressing team spirit. These colors can be changed when the wires are changed to add constant variety. Once the braces are off, retainer color choices are only limited by your imagination.

If I don't want to show colors on my braces, what can I do to play down braces?
Give clear tooth colored braces a try or 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.

Will braces correct TMD or jaw joint problems?
Braces may or may not improve jaw joint problems. More conservative approaches should be tried first.

How many people receive orthodontic care?
Approximately 4 million people are in braces in the US at any one time. About 70% of people in the US need orthodontic treatment. The benefits of orthodontic treatment go beyond making your face look wonderful. You will be able to chew your food easier. Chewing is the first step in digestion. If your teeth are crooked, you will not be able to chew your food properly which can lead to recurrent indigestion.

Will orthodontics change my lifestyle?
You'll have to give up extremely hard and sticky foods. These foods can get caught on the braces and pull the braces off. Soft foods 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.

How long do you have to wear braces?
That depends a lot on you and how bad your bite is to begin with. The better you are about wearing and taking care of your braces, the sooner your teeth will improve.

Will any teeth be pulled?
Only if there's not enough room for all your teeth. Don't worry, if you have teeth pulled, the spaces will be closed and no one will even notice.

When is the best time to schedule an initial consultation?
Every child should see an orthodontist at an early age. This could be as young as 2 or 3, but should be no later than age 7. 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. Adults can be treated at any age as long as the gums and bone holding the teeth are healthy.

Why should you choose an orthodontic specialist?
Teeth and sometimes faces are permanently changed by orthodontic treatment; therefore, it is very important that the treatment be done properly. 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. Some advanced techniques such as Invisalign are only available through a specialist.

Do you need a referral from your family dentist to see an orthodontist?
You don't need a referral from your family dentist unless you are in a managed care plan with a "gatekeeper" primary care dentist. 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!

What will happen at the first appointment?
You will be seen for an initial orthodontic exam where they will answer your questions about such issues as; do you/your child need braces, what type of treatment do you/they need and about how long will it take. Information about approximate fees with a sample contract will be drawn up for you to review payment options. They will also answer any other question you have about orthodontic treatment. Normally, this appointment takes about 15-20 minutes.

Are braces uncomfortable?
Each person finds braces quite different. Placing braces takes a long time (about an hour). However, it is a relatively painless procedure. The following couple of days the teeth may be uncomfortable however they soon settle down and you get used to the new feeling. Patients generally adjust very quickly to the braces and before you know it is it just another part of everyday life.

Is orthodontic care expensive?
Orthodontic fees have not increased as fast as many other consumer products. In 1952, it cost the ordinary US worker about 432 hours of labor to purchase orthodontic treatment for a child. In 1997, that parent will only work 279 hours to purchase orthodontic treatment. Compare that to a single family home which cost 6,528 hours of work in 1952 and today costs 10,480 hours. Fees for an initial consultation are minimal. Financing is usually available. Many insurance plans now include orthodontics. Well timed orthodontic treatment to correct a problem is often less costly than the additional dental care required to treat the more serious problems that can develop years later.

How much does orthodontic treatment cost?
It matters where you live and how much needs to be done. If you live in a rural area, where rents are low and malpractice attorneys rare, orthodontic treatment can be found for under $3,000. Typically orthodontic treatment costs between $3,000 and $7,000 in the USA. The cost goes up to $18,000 in Tokyo! This may seem like a lot, but think about how much you spend to maintain your car.

Can I negotiate lower fees with my orthodontist?
Generally, orthodontists will not cut their fees to individuals. Orthodontists need to pay for a lot of specialized, expensive equipment and to pay their staff and their rent. The Orthodontists need to pay for all of their materials and the operation of their sterilizers. Then there is the cost of malpractice insurance. Most of an orthodontist's fee goes to paying their fixed cost.

Orthodontic treatment is still costly, is it worth the cost?
Yes! Think about the cost of not getting braces. It is hard to see into the future, to tell how the lack of orthodontic treatment will affect your child. Certainly, a child who needs orthodontic treatment and does not get the treatment will have problems with their teeth for years to come; so much so that many adult patients are now going back for orthodontic treatment. The health issues, go well beyond good oral hygiene. A breathing problem cannot be corrected without major surgery.

Also stomach problems are very common in people who skip needed orthodontic treatment. If you/your child cannot chew their food right, it irritates the stomach, and produces a lifetime problem.

There also is some initial data (unverified) that orthodontic treatment can lower your children's chance of cardiovascular disease.

We cannot predict whether your child will develop a breathing problem or a stomach problem if they do not undergo orthodontic treatment. However, lifetime orthodontic treatment costs no more than the lifetime maintenance on a car. Isn't it worth investing as much time in maintaining your children's teeth as you invest in maintaining your car?

Can I pay for my children's orthodontic treatment in installments?
You need to talk to your orthodontist to be sure, but most orthodontists allow you to pay for your children's treatment in installments. Usually the orthodontist will ask you to make a substantial initial payment, to cover the costs of starting up your case. Then the orthodontist will usually let you make monthly payments for the balance. The orthodontist cannot finance the entire treatment, because the orthodontist incurs considerable costs when he or she first starts a new patient and he needs to recover those initial costs. However, once you pay for those initial costs, the orthodontist will usually let you pay for the rest of the treatment in installments.

Can I get insurance to help pay for orthodontic treatment?
Many dental plans now include orthodontic treatment. Check with your provider before seeking care to determine is orthodontic procedures are covered.

If poor orthodontia causes so many health problems, why didn't evolution/natural selection eliminate orthodontic problems?
According to Alex Duncan of the Anthropology Department at the University of Texas, "with very few exceptions, fossil hominids (cave men) had nearly perfect bites."

Malocclusion (overbites and underbites) developed mainly over the last 10,000 years. As people's diets improved, people got bigger. The average height of an adult male increased from 4 ft (1.3M) 10,000 years ago to about 5 1/2 feet (1.9M) today. Human mouths and human teeth did not grow at the same rate. In many cases your child's teeth will be larger than your child's mouth. If so, your child will need orthodontic treatment.

What is interceptive orthodontic treatment and is it necessary?
The objective of interceptive orthodontic treatment is to make room in your child's mouth for your child's permanent teeth. Your orthodontist may expand your child's palate, and try to start to correct overbites and underbites. As noted above orthodontic problems arise because human teeth do not grow at the same rate as human mouths. Your children's mouth will be growing a lot between ages 8 and 12. It is important to make sure that there is room for your children's permanent teeth.

How long does interceptive orthodontic treatment take?
It varies a lot according to the complexity of the case. Interceptive orthodontic treatment can take anywhere from 4 to 16 months.

Can't I wait on interceptive orthodontic treatment until my child is older than 8?
We do not recommend waiting. If your child gets interceptive orthodontic treatment when they are 8, and their palates are growing rapidly, the treatment will be uncomfortable, but not tremendously painful. By time the child is 12, the bones in the top of the child's mouth will have hardened, so palatial expansion will be much more uncomfortable. If you wait until your child is 20 to do palatal expansion, your child may need major surgery to correct a palatal problem.

What steps are involved in full orthodontic treatment?
The objective of full orthodontic treatment is to correct your child's bite, and to make sure that their teeth are in proper alignment.

First there are a series of appointments where the orthodontist examines your child's mouth and figures out what is needed.

Next the orthodontist installs braces in your child's mouth.

Your child will usually keep their braces in for two to two and a half years. During that time, the orthodontist's assistant will "tighten" your child's braces every three to eight weeks.

The orthodontist may tell your child to wear a facebow or headgear during that time. Then your orthodontist will remove your child's braces and give him or her a retainer.

Your child will need to wear the retainer 24 hours a day for a few weeks, then every night until they stop growing. Then a few nights a week as long as they want their teeth to stay straight.

How can I find an orthodontist?
We usually suggest that you talk to your regular general dentist first who can recommend quality orthodontists in your area for you to consider. Also ask your children's friend's parents. They can recommend quality orthodontists in your area. The American Association Of Orthodontists (AAO) maintains a lists of board certified orthodontists. You can call the AAO at 1-800-787-2444.

What are some of the questions that I should ask?
First ask the orthodontist's assistant about the techniques the orthodontist uses and the orthodontist's general treatment philosophy. Some orthodontists try to make the treatment as short and painless as possible. Others try to make the treatment as inexpensive as possible. The orthodontist's assistant may not be able to tell you about the orthodontist's treatment philosophy but you should ask.

You will need to decide whether the orthodontist's treatment philosophy is right for your children.

Ask the orthodontist's assistant about the sterilization procedures used in the orthodontist's office. Make sure that the orthodontist uses an autoclave or dry heat sterilizer on all of his instruments. The orthodontist's assistant may tell you about how they use a "gluteraldehyde" solution instead. If so try another orthodontist. Also make sure that everyone in the office who works on your child wears gloves and changes the gloves (and not just wash them) before each patient. If they do not use fresh gloves, find another orthodontic office.

Ask the assistant about x-rays. A quality orthodontist will request three sets of x-rays: cephalometric x-rays, panographic x-rays and penapical x-rays. Those x-rays are needed to make sure that the treatment proceeds smoothly, and there are no complications.

Ask the orthodontist's assistant whether the orthodontist offers treatment options. Generally, the best orthodontists will offer braces in a variety of colors to suit your child's taste. Ligatures and wax are available in a variety of colors, flavors, and styles. All of these options will make the orthodontic treatment much less stressful for your children and much easier on you.

What can I expect on the initial visits to the orthodontist?
Generally, it takes four visits to the orthodontist for your child to start their treatment. On your first visit orthodontist's assistant will take a medical history. The orthodontist will then examine your child, and start to explain the orthodontic process.

Next your child will come in for what is called a RECORDS APPOINTMENT. The orthodontist's staff will take x-rays and photographs of your child, and make impressions (castings) of their mouth. Further details of the procedure can be found in the patient's FAQ. However, the idea of the records appointment is to gather as much information about your child's bite as possible.

Once the records appointment is done, the orthodontist will be able to design a treatment plan. The orthodontist will build a model of your child's mouth and study the case. They will then draw on his knowledge and training to design a treatment plan.

Once the orthodontist determines what is needed, the orthodontist will then do a "consultation" with you to discuss his/her treatment approach and his/her fees.

The initial exam and consultation are usually FREE. The records appointment typically costs $200-$400.

Is there anything I should do before the consultation?
Most parents find the consultation visit rather overwhelming. Here is the orthodontist using all of these complicated words, such as Class II Malocclusion, Mandibular Protraction ..., and he is asking for $3,000-$7,000 for your child's treatment. You want to do the best for your child, but how can you tell?

We recommend that you do some reading about orthodontics before you come to the consultation appointment. This FAQ is a good start, and a dictionary of orthodontic terms would also be helpful. I have looked for a good book to help parents through orthodontic treatment, but have not found one yet.

You should also talk to your friends to see what their experiences have been. Also, ask your friends how much they paid. It will help the shock when the orthodontist tells you that your child's treatment will cost $3,000 to $7,000.

The one thing to recognize is that most adolescents really do need orthodontic treatment. Human growth patterns were designed back in the days of the cave men, when nutrition was terrible. Today, most children's teeth are too big for their mouth, and so orthodontics is needed in 70%-90% of all teenagers.

Also reread the section above about the costs of orthodontic treatment. Remember, $3,000 to $7,000 is still less than the lifetime maintenance on your car. Aren't your children more important than your car?

What are the other treatment options that I should consider?
This is a difficult question to answer because only your orthodontist has examined your child's mouth and knows what is required. We generally recommend that you trust your orthodontist and discuss all treatment options with them.

As a parent you will have to decide whether you want your children to have plain old fashioned braces or something modern and stylish. We make both kinds, but recommend the stylish braces whenever possible.

Should I seek a second opinion?
Many parents want to seek a second opinion as reassurance that they are doing the best for their child. Many orthodontists do encourage their patients to seek a second opinion. However, it is often difficult to find a quality orthodontist to do the second opinion. Further, if you do find someone, it is often very expensive to get the second opinion.

One resource that is often overlooked is the child's general dentist. Most general dentists have not been trained to do orthodontia. However, they can look over the case, and see if the orthodontist's recommendations are reasonable.

Dental Schools also offer second opinions at nominal rates if you can provide x-rays and impressions. Contacting a dental school is also a way to confirm your orthodontist's treatment plan.

We recommend that if a parent wants a second opinion, they discuss their concerns with their child's orthodontist. If the orthodontist cannot allay the parents concerns, the parents should ask the orthodontist to allow the parent to borrow their child's study models and x-rays, so they can show them to another dentist for confirmation of the treatment plan.

What are extraction and non-extraction therapy, and what are the advantages and disadvantages of each?
Extraction therapy is an technique where some teeth are removed to make room for the other teeth in your child's mouth. This is in contrast to non-extraction therapy where one expands a patients' jaw and shave down some teeth to make everything fit. Years ago, everyone got extraction therapy. Now, most orthodontists use non-extraction therapy with most adolescent patients. Instead, a gadget called a palatal expander can be used to expand the adolescent's jaw. Adult patients are still treated via extraction therapy, however, because once someone stops growing, it takes surgery to expand the jaw.

What is having braces like for my child?
Generally, most patients do not find braces to be any big deal. Patients' mouths are usually sore for the first week after they get braces. Also, their mouths are sore when the braces are tightened. However, with modern braces, most children get so used to the braces, that the children do not notice the braces, except when the braces are being tightened or if the child is hit in the mouth. Certainly, it is much easier for your child to get braces when they are twelve than to go through life with buck teeth.

My son/daughter does not want to get braces because they are afraid that the braces will make him/her look like a geek. Any ideas?
This is hard because some teens are so worried about their appearance. One thing to try is to point out is that most people who need orthodontic treatment look like a geek even before they get braces. How would you like to go through life with buck teeth and a jaw that is too big or too small? If your child is really concerned about their appearance, then braces will really help them. Your smile is the most striking feature on your face, and at the end of orthodontic treatment you child's smile will look fabulous. Doesn't your child want to look fabulous?

The other thing is that braces have changed a lot since the days when we had braces. Braces now come in a series of styles and colors.

Do braces hurt?
Braces have changed a lot in the last 20 years so they are a lot less uncomfortable than they were 20 years ago. At present, we do not know how to avoid the discomfort when the braces are first put in, or when the braces are being tightened. However, modern, cast, low profile brackets are designed to minimize your children's discomfort between visits to the orthodontist. Most children experience some soreness during their first week in braces and occasional discomfort when their braces are being tightened. However, after the first week, most children hardly notice the braces at all.

What happens if my child's braces continue to hurt?
Talk to your orthodontist. Some patients continue to complain for the sake of complaining. However, if your child continues to hurt, it could be a sign of the start of a problem. If your child is allergic to something in their braces, their gums would be inflamed and sore. Your orthodontist can check for this. Your child's mouth will also be sore if he or she is not thoroughly brushing their teeth. Again, your orthodontist can help. If your child hurts, be sure to tell your orthodontist. He or she can help.

Should my children do anything special during their first week in braces?
We generally recommend that patients be especially careful about what they eat during the first week after getting braces. Usually, patients are advised to only eat softer foods and to be very careful with their mouth.

Will braces cause sores in my child's mouth?
Initially, there will be some sores on your child's lips. If you rinse the sores in warm salt water, the sores will heal within a week or two. Thereafter there will be an occasional sore when, for example your child gets into a fight. However, the sores should heal rather quickly. If your child's lips get too sore during the first week, you can put wax on the braces to prevent the braces from rubbing and hurting your child's lips.

How long do the braces take to put on?
Depending on the case, 30 minutes to a little over 1 hour.

Will it hurt to put the braces on?
Not usually. The orthodontist is usually just attaching the braces to your child's teeth. The discomfort comes later, when the braces first begin to rub up against your child's lips.

What holds the braces on?
Generally, the brackets are bonded directly to your child's teeth using a special FDA registered adhesive.

My son/daughter does not want to get braces because they are afraid that the braces will prevent them from participating in sports. Any suggestions?
Years ago people who wore braces were advised to avoid sports. However, in 1981 people started using orthodontic mouth guards. The mouth guards have allowed patients to continue to participate in sports while they have braces. Therefore, there is nothing for your child to fear.

My child plays the trumpet. Will his ability to play be affected by orthodontic treatment?
Be sure to mention your child's musical abilities to the orthodontist. The orthodontist may give you something called "lip protector" which will make it possible for your child to still play musical instruments. We have had reports of entire bands having orthodontia with no problems.

Can my child still chew gum with braces?
The sugar in the gum can get trapped behind the braces and cause cavities. Still, you might want to talk to your orthodontist if your child really wants gum. In some cases, it may be possible for your child to chew a sugar free, non stick gum such as Freedent or Wrigley's Extra. A study in the American Journal Of Orthodontics 107(1995)497 indicates that the xylitol in the Freedent or Wrigley's Extra prevents cavities, and the gum does not stick to some styles of braces. It is difficult to know if your child can safely chew Freedent or Wrigley's Extra. Check with your orthodontist to be sure.

Are there other foods that my child should avoid?
We generally recommend that your child avoid hard sticky, gooey or crunchy foods. Caramel and taffy can stick on your child's braces. Crunchy foods like carrots and apples and hard rolls can occasionally knock off a bracket.

What happens if a bracket comes off?
The orthodontist will attach another bracket. However, every time the orthodontist has to replace a bracket, it delays the orthodontic treatment.

What happens if my child swallows a bracket?
It is usually NOT a serious problem if your child swallows a bracket. Bracket are usually made of a medical grade stainless steel which should not have any adverse effects on your child if the bracket is swallowed. The bracket just passes through your child's digestive system and leaves in your child's feces.

Inhaling a bracket is a different matter however. If your child inhales a bracket, and the bracket gets into your child's lungs, it could cause a problem. Therefore, the orthodontist will normally ask an MD to use a bronchoscope to remove the bracket.

Why can't the orthodontist attach the braces strongly enough that the braces don't come off during eating?
The orthodontist needs to remove your child's braces at the end of the orthodontic treatment. If the orthodontist attaches your braces too firmly, the braces will not come off again at the end of your child's orthodontic treatment.

Are there any other activities that my child should avoid when they have braces?
We advise against patients participating in activities where there will be many blows to a patient's mouth. Sports like boxing and wrestling should be avoided. Fighting should also be avoided. Your child should wear an orthodontic mouthguard whenever they participate in any sporting activity.

How often should my child brush their teeth when my child has braces?
We recommend that your child continue to brush and floss their teeth after every meal and before they go to bed. Brushing and flossing is especially important when your children have braces because food can get caught in the braces and cause cavities. Many orthodontists also recommend that your child brush with a fluoride gel in a further attempt to avoid cavities.

How do I convince my child to brush their teeth when the child has braces?
This is hard because teenagers are so rebellious. However, if they do not brush their teeth, food will get caught in their braces and their breath will smell awful. One parent said that she started calling her son Mr. Yuch Mouth. It was amazing how fast her son started to brush his teeth.

I have noticed that some children have rubber bands in their braces. What do the rubber bands do?
The rubber bands are used to move teeth forward or back in your child's mouth. For example, they could be used to move your child's lower teeth forward or back, to move a tooth that is far our of alignment, or to close a space in your child's mouth. The rubber bands are often used in the final stages of the orthodontic treatment.

How often should my child change their rubber bands?
Orthodontic rubber bands break after they have been chewed a few times. Usually, the rubber bands snap when the child opens their mouth, with uncomfortable results. The only way to avoid the discomfort is for your child to change their rubber bands frequently. We recommend that orthodontic patients take off their rubber bands before each meal and put in new ones after they are done eating. It also is helpful for your child to change the rubber bands before the child goes to bed.

What happens if my child leaves off their rubber bands?
The orthodontic treatment will take up to a year longer, be more uncomfortable, and results are compromised.

What happens if my child swallows a rubber band?
Orthodontic rubber bands are made of a medical grade latex rubber which is similar to the grade of rubber used in medical implants. The rubber is thought to be safe for human consumption. If your child swallows an orthodontic rubber band, the rubber band just passes through your child's digestive system and leaves in your child's feces. Your child will get indigestion, and may have a bad allergic reaction if the child swallows a bag of rubber bands. Please make sure that your child does not eat a bag of rubber bands.

What does a retainer do?
The objective of a retainer is to keep your child's teeth in perfect alignment after braces are removed.

Why is a retainer needed? Do teeth move after orthodontic treatment?
Usually, when braces are first removed, your child's teeth will all be in perfect alignment, but your child's gums, bones, etc. will not have completely shifted into their new positions. The retainer holds your child's teeth in position until their gums, bones etc. settle in to their new positions. Also, your child is still growing after your child's braces are removed. Sometimes, your child's mouth will grow unevenly. If so a retainer can be used to make sure the child's teeth stay in perfect alignment as your child grows.

What happens if my child does not use the retainer?
If your child does not wear a retainer, your child's gums and bones will not fully settle into their new positions. Eventually, the incorrectly shaped bones will push your child's teeth causing the teeth to move out of perfect alignment.

How long should my child use a retainer?
Generally, patients are advised to keep wearing a retainer 24 hours a day for at least a week after their braces are removed. Then it is recommended that a child continue to wear a retainer every night until your child stops growing at age 24, then a few nights a week to maintain their position.

I notice that some braces have little colored rings around the brackets. What do the colored rings do?
The colored rings are called ligating modules. They hold the wires into the brackets.

What happens if my child swallows a ligating module?
Orthodontic ligating modules are made of a medical grade polyurethane which is similar to the grade of polyurethane used in medical implants. The polyurethane is thought to be safe for human consumption. If your child swallows a ligating module, it just passes through your child's digestive system and leaves in your child's feces.

Is there any chance that the sharp edges at the ends of the braces will hurt the insides of my child's cheeks?
This is a hard question. In the beginning part of orthodontic treatment, your child's teeth will move a lot. Sometimes the end of the wire will stick out past the end of the tube, and create a sharp edge. We recommend that you ask the orthodontist to trim the sharp edge before the edge cuts your child.

What is the purpose of a facebow?
A facebow is used to push your child's molars distally (back) creating room for the teeth in the front of your child's mouth.

How does my child use a facebow?
Generally, your child should wear the facebow for about 12 hours a day. The face bow should be inserted into the two holes on the buccal tubes at the back of your child's mouth. The facebow should then be connected to the breakaways, and on to the neckpad or other headgear.

Are there any dangers with a facebow?
A facebow uses headgear to provide the force needed to move your child's jaw. There is also high pull headgear, which has straps over the top of a child's head, and around his neck, and cervical headgear which only have straps around a child's neck. Many manufacturers do not sell high pull headgear because we consider high pull headgear risky. High pull headgear has been known to snap a facebow. In rare cases, the parts from the facebow have been known to go into a child's eye. Sometimes, high pull headgear is the only alternative to surgery, and so an orthodontist will prescribe it. Still, we recommend that parents and children be very cautious around high pull headgear. Be sure that the facebow is inserted properly. Be sure your child wears a safety strap. Be very cautious to make sure that the facebow does not come loose and hurt your child.

If your child finds their facebow coming loose at night be sure to tell your orthodontist about it immediately. If the facebow comes loose in the middle of the night, it could cause a face or eye injury. Ask the orthodontist to adjust your child's safety strap. The safety strap needs to be tight enough that the facebow cannot come out. Make sure your child uses the tightest hole possible. Try out the facebow to make sure that it cannot come loose and hurt your child. Cervical headgear is less risky than high pull headgear but still not 100% safe. Children often try to bend their facebows to make them more comfortable. They can weaken the facebow as they bend it which can cause the facebow to snap. Therefore, you need to be cautious around a standard facebow. We recommend that you insist that the orthodontist give your child a facebow with breakaway modules and/or a safety strap. Ask the orthodontist's assistant to carefully instruct you on the use of the facebow. Make sure that your child does not bend the facebow, and uses the break away modules or safety strap whenever he or she is wearing the facebow.

What causes the facebow to snap?
Something called "metal fatigue." When you bend a wire enough times, the wire will break. You can see this with a solid copper wire like the wires in the wall in your house. If you take a piece of solid (unstranded) copper wire and bend it several times, the wire will break. Facebows are made of a special stainless steel wire which is resistant to breakage. However, all wire will break if the wire is bent enough times.

Are there any other dangers in orthodontics?
There are some concerns about sterilization of orthodontic materials, taking orthodontic materials out of one patient's mouth and "recycling" them to a second patient's mouth, and allergic reactions to orthodontic materials. The braces used in our office come directly from the manufacturer in tamper evident packaging to ensure single use.

My child has Spina Bifida. Is there anything to fear?
Spina Bifida patients are especially vulnerable to class I latex allergy. Be sure to inform your orthodontist that your child has Spina Bifida before your child starts orthodontic treatment.

I have heard that some orthodontists take orthodontic materials out of one patients mouth and then "recycle" the orthodontic materials to another patient's mouth. How prevalent is "recycling" of orthodontic materials and is it dangerous?
Reuse of orthodontic products is a continuing problem. It has been estimated that as many as one US orthodontist in three "recycles" some of their materials from one patient's mouth to the next patient's mouth. Brackets are removed from one patient's mouth, sent out for cleaning and then bonded in another patient's mouth. At present there are no standards for the sterilization of brackets and no data to indicate whether "recycled" brackets are safe; a recent study of other dental materials and instruments indicates that some common sterilization procedures do not kill the AIDS virus. Further a study from the University of Iowa indicates that "recycled" brackets do not meet the manufacture's original specifications. Still, there are no governmental guidelines which prevent the use of "recycled" orthodontic materials in the US. European standards precludes the use of "recycled" orthodontic materials in Europe. The braces in our office come directly from the manufacturer in tamper resistant packaging to ensure single use.

What can I do to prevent my child from getting orthodontic materials which have been previously in someone else's mouth?
Talk to your orthodontist about your concerns. Most orthodontists will not use "recycled" materials (materials that have already been used in a previous patient's mouth) without your consent. Read carefully any consent forms that your orthodontist asks you to sign. If your orthodontist discloses that he uses "recycled" materials, he is usually not saying that he is recycling paper. Instead he is probably "recycling" orthodontic materials from one patient's mouth to the next. In such a case, you need to be especially sure that your child is getting materials that are fresh and clean.

Also, be very careful with "managed care" plans. Many "managed care" plans are priced low assuming that the orthodontist will not have to buy any new orthodontic materials for your child. Instead, it is assumed that the orthodontist will reuse materials that he has taken out of another patient's mouth. If you have a "managed care" dental plan, talk very carefully with the plan administrator to make sure that the plan specify that the orthodontist use only fresh materials in your child's mouth.

If you cannot convince your plan administrator to pay for fresh materials for your child, then talk to your orthodontist about you paying for your orthodontic materials yourself. Some orthodontists will allow you to do that. As a worst case, ask your orthodontist if he would be willing to order new materials and charge them to your credit card.

I have heard about latex allergy? How common is it, and do I have anything to fear?
There are two kinds of latex allergies, a so called Class IV allergy, which is not very serious, and a so called Class I allergy, which can be life threatening. The Class VI allergy causes a slight inflammation of the patient's mouth, but it goes away after the latex is removed. Class IV latex allergy is fairly common, affecting perhaps 1% of the orthodontic patients. The Class I allergy is much more insidious. Class I latex allergy is quite similar to penicillin allergy. A person might be exposed to latex and have no symptoms for years. Then the person might break out in a rash. Thereafter, the patient is permanently sensitive to latex. He or she might break into hives when exposed to a rubber glove or a condom. We have even heard of a case develop a severe case of latex allergy where a patient cannot walk into a hospital or doctor's office without having a severe anaphylactic reaction.

Further information about latex allergy can be found at the University of Chicago medical information site (http://imr.bsd.uchicago.edu/pcg). The estimates of how common Class I latex allergies are varies considerably. We have seen estimates as high as a Class I latex reaction in one thousand patients, with about one in 40,000 have a life threatening reaction. Other workers have given much lower estimates. Some orthodontists have reported that they have never seen a case of Class I latex allergy in 20 years of practice. Our best estimate is that latex allergy is very rare in orthodontic patients. However, there is a slim possibility that your child will have a Class I allergic reaction to the latex in orthodontic rubber bands.

What are the symptoms of Class I latex allergy?
There can be several different symptoms. Some patients with Class I latex allergy develop hives and/or swelling in their face and hands perhaps 20 to 50 minutes after being exposed to latex. Other patients have difficulty breathing. Occasionally, there are no visible symptoms. IF YOUR CHILD BREAKS OUT INTO HIVES SOON AFTER CHANGING THEIR ORTHODONTIC RUBBER BANDS, OR IF THE CHILD DEVELOPS SWELLING IN THEIR HANDS OR FACE, OR IF THE CHILD HAS DIFFICULTY BREATHING, TAKE THE CHILD DIRECTLY TO AN URGENT CARE FACILITY OR A HOSPITAL EMERGENCY ROOM. DO NOT WAIT HOPING THAT THE SYMPTOMS WILL GO AWAY.

What can I do to avoid latex allergy?
Ask your orthodontist to use only latex free materials.

Are there any concerns about sterilization of orthodontic materials?
Orthodontic materials can be sterilized in dry heat sterilizers, autoclaves, or a solution called "glutaraldehyde." A recent study shows that when used properly, dry heat sterilizers and autoclaves kill all known infectious agents. However, the glutaraldehyde solution does not always kill the AIDS virus. The chances of your child catching AIDS in the orthodontist's office are slim. Still, we recommend that you make sure that your orthodontist is using a dry heat sterilizer or autoclave on all of the orthodontist's instruments and orthodontic materials.

You do also have to be concerned whether the orthodontist is following the correct infection control protocols. The orthodontist should change gloves before examining every patient. The orthodontist's assistant should change their gloves too. Washing gloves is not good enough.

It seems like my child is getting a lot of x-rays during their treatment. Are all of those x-rays needed?
Well, we think so. Your orthodontist does x-rays to make sure that his treatment plan is going to work properly and that you child will not develop any jaw or gum problems later on. The panoramic x-ray and the cephalometric x-rays allow to look for weaknesses in the jaw or any shallow roots, so that you child can avoid a painful TMJ problem or other difficulty later on. The bite-wing x-rays look for caries (cavities). If your child has a cavity under his or her braces, the cavity will grow during orthodontic treatment, and your child may get a toothache. We would never have our treatment done by an orthodontist who does not do the x-rays. It is just looking for trouble to avoid them.

Is there anything which can be done to minimize the x-ray exposure?
X-ray shields are available to help minimize the x-ray exposure. The precision x-ray shield attaches to the orthodontists x-ray machine, and collimates the x-rays so the x-rays shine on your child's teeth gums and cheeks and not elsewhere on their face. If you are concerned about this, talk to your orthodontist about using a x-ray shield.