frequently asked questions


Questions about Orthodontics for Children:
This information will help parents recognize and understand the management of their children's orthodontic problems.
Questions about Orthodontics for Adults:
About 20 percent of orthodontic patients are adults. Though similar in many ways to adolescent treatment, adult orthodontic treatment has some special considerations.
General Information about Orthodontics:
This category provides a general overview of orthodontics and what orthodontists do.

Questions about Orthodontics for Children

  1. Why should children have an orthodontic screening before all of the permanent teeth are in?
  2. What are the benefits of early treatment?
  3. What is a space maintainer?
  4. Why do baby teeth sometimes need to be pulled?
  5. How can a child's growth affect orthodontic treatment?
  6. What kinds of orthodontic appliances are typically used to correct jaw-growth problems?
  7. Can my child play sports while wearing braces?
  8. Will my braces interfere with playing musical instruments?
  9. Why does orthodontic treatment time sometimes last longer than anticipated?
  10. Why are retainers needed after orthodontic treatment?
  11. Will my child's tooth alignment change later?
  12. What about the wisdom teeth (third molars) - should they be removed?

Questions about Orthodontics for Adults

  1. Can orthodontic treatment do for me what it does for children?
  2. How does adult treatment differ from that of children and adolescents?
  3. My family dentist said I need to have some missing teeth replaced, but I need orthodontic treatment first - why?
  4. My teeth have been crooked for many years - why should I have orthodontic treatment now?

General Information About Orthodontics

  1. What is orthodontics?
  2. What is an orthodontist?
  3. At what age can people have orthodontic treatment?
  4. What causes orthodontic problems (malocclusions)?
  5. What are the most commonly treated orthodontic problems?
  6. Why is orthodontic treatment important?
  7. What does orthodontic treatment cost?
  8. How long will orthodontic treatment take?
  9. How is treatment accomplished?
  10. Are there less noticeable braces?
  11. How have new "high tech" wires changed orthodontics?
  12. How do braces feel?
  13. Do teeth with braces need special care?
  14. How important is patient cooperation during orthodontic treatment?

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Questions about Orthodontics for Children

1. Why should children have an orthodontic screening before all of the permanent teeth are in?

By age 7, enough permanent teeth have come in and enough jaw growth has occurred that the dentist or orthodontist can identify current problems, anticipate future problems, and alleviate parents' concerns if all seems normal. The first permanent molars and incisors have usually come in by age 7, and crossbites, crowding, and developing injury-prone dental protrusions can be evaluated. Any ongoing finger sucking or other oral habits can be assessed at this time also.

Some signs or habits that may indicate the need for an early orthodontic examination are:

An orthodontic screening at age 7-12 enables the orthodontist to detect and evaluate problems (if any), advise if treatment will be necessary, and determine the best time for that patient to be treated.

2. What are the benefits of early treatment?

For those patients who have clear indications for early orthodontic intervention, early treatment presents an opportunity to:

3. What is a space maintainer?

Baby molar teeth, also known as primary molar teeth, hold needed space for permanent teeth that will come in later. When a baby molar tooth is lost, an orthodontic device with a fixed wire is usually put between teeth to hold the space for the permanent tooth, which will come in later.

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4. Why do baby teeth sometimes need to be pulled?

Pulling baby teeth may be necessary to allow severely crowded permanent teeth to come in at a normal time in a reasonably normal location. If the teeth are severely crowded, it may be clear that some unerupted permanent teeth (usually the canine teeth) will either remain impacted (teeth that should have come in, but have not), or come in to a highly undesirable position. To allow severely crowded teeth to move on their own into much more desirable positions, sequential removal of baby teeth and permanent teeth (usually first premolars) can dramatically improve a severe crowding problem. This sequential extraction of teeth, called serial extraction, is typically followed by comprehensive orthodontic treatment after tooth eruption has improved as much as it can on its own.

After all the permanent teeth have come in, the pulling of permanent teeth may be necessary to correct crowding or to make space for necessary tooth movement to correct a bite problem. Proper extraction of teeth during orthodontic treatment should leave the patient with both excellent function and a pleasing look.

5. How can a child's growth affect orthodontic treatment?

Orthodontic treatment and a child's growth can complement each other. A common orthodontic problem to treat is protrusion of the upper front teeth ahead of the lower front teeth. Quite often this problem is due to the lower jaw being shorter than the upper jaw. While the upper and lower jaws are still growing, orthodontic appliances can be used to help the growth of the lower jaw catch up to the growth of the upper jaw. Abnormal swallowing may be eliminated. A severe jaw length discrepancy, which can be treated quite well in a growing child, might very well require corrective surgery if left untreated until a period of slow or no jaw growth. Children who may have problems with the width or length of their jaws should be evaluated for treatment no later than age 10 for girls and age 12 for boys.

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6. What kinds of orthodontic appliances are typically used to correct jaw-growth problems?

Correcting jaw-growth problems is done by the process of dentofacial orthopedics. Some of the more common orthopedic appliances used by orthodontists today that help the length of the upper and lower jaws become more compatible include:

The decision about when and which of these or other appliances to use for orthopedic correction is based on each individual patient's problem. Usually one of several appliances can be used effectively to treat a given problem. Patient cooperation and the experience of the treating orthodontist are critical elements in success of dentofacial orthopedic treatment.

7. Can my child play sports while wearing braces?

Yes. Wearing a protective mouthguard is advised while playing any contact sports. Dr. Hime can recommend a specific mouthguard.

8. Will my braces interfere with playing musical instruments?

Playing wind or brass instruments, such as the trumpet, will clearly require some adaptation to braces. With practice and a period of adjustment, braces typically do not interfere with the playing of musical instruments.

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9. Why does orthodontic treatment time sometimes last longer than anticipated?

Estimates of treatment time can only be that - estimates. Patients grow at different rates and will respond in their own ways to orthodontic treatment. Dr. Hime has specific treatment goals in mind and will usually continue treatment until these goals are achieved. Patient cooperation, however, is the single best predictor of staying on time with treatment. Patients who cooperate by wearing rubber bands, headgear, or other needed appliances as directed, while taking care not to damage appliances, will most often lead to on-time and excellent treatment results.

10. Why are retainers needed after orthodontic treatment?

After braces are removed, the teeth can shift out of position if they are not stabilized. Retainers provide that stabilization. They are designed to hold teeth in their corrected, ideal positions until the bones and gums adapt to the treatment changes. Wearing retainers exactly as instructed is the best insurance that the treatment improvements last for a lifetime.

11. Will my child's tooth alignment change later?

Studies have shown that as people age, their teeth may shift. This variable pattern of gradual shifting, called maturational change, probably slows down after the early 20s, but still continues to a degree throughout life for most people. Even children whose teeth developed into ideal alignment and bite without treatment may develop orthodontic problems as adults. The most common maturational change is crowding of the lower incisor (front) teeth. Wearing retainers as instructed after orthodontic treatment will stabilize the correction. Beyond the period of full-time retainer wear, nighttime retainer wear can prevent maturational shifting of the teeth.

12. What about the wisdom teeth (third molars) - should they be removed?

In about three out of four cases where teeth have not been removed during orthodontic treatment, there are good reasons to have the wisdom teeth removed, usually when a person reaches his or her mid- to late-teen years. Careful studies have shown, however, that wisdom teeth do not cause or contribute to the progressive crowding of lower incisor teeth that can develop in the late teen years and beyond. Dr. Hime, in consultation with your family dentist, can determine what is right for you.

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Questions about Orthodontics for Adults

1. Can orthodontic treatment do for me what it does for children?

Healthy teeth can be moved at almost any age. Many orthodontic problems can be corrected as easily and as well for adults as children. Orthodontic forces move the teeth in the same way for both a 75-year-old adult and a 12-year-old child. Complicating factors, such as lack of jaw growth, may create special treatment planning needs for the adult.

One in five orthodontic patients is an adult. The AAO estimates that nearly 1,000,000 adults in the United States and Canada are receiving treatment from an orthodontist.

2. How does adult treatment differ from that of children and adolescents?

Adults are not growing and may have experienced some breakdown or loss of their teeth and bone that supports the teeth. Orthodontic treatment may then be only a part of the patient's overall treatment plan. Close coordination may be required between Dr. Hime, an oral surgeon, a periodontist, an endodontist, and the family dentist to assure that a complicated adult orthodontic problem is managed well and complements all other areas of the patient's treatment needs. Below are the most common characteristics that can cause adult treatment to differ from treatment for children.

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3. My family dentist said I need to have some missing teeth replaced, but I need orthodontic treatment first - why?

Your dentist is probably recommending orthodontics so that he or she might treat you in the best manner possible to bring you to optimal dental health. Many complicated tooth restorations, such as crowns, bridges, and implants can be best accomplished when the remaining teeth are properly aligned and the bite is correct.

When permanent teeth are lost, it is common for the remaining teeth to drift, tip, or shift. This movement can create a poor bite and uneven spacing that cannot be restored properly unless the missing teeth are replaced. Tipped teeth usually need to be straightened so they can stand up to normal biting pressures in the future.

4. My teeth have been crooked for many years - why should I have orthodontic treatment now?

Orthodontic treatment, when indicated, is a positive step - especially for adults who have endured a long-standing problem. Orthodontic treatment can restore good function. Teeth that work better usually look better, too. And a healthy, beautiful smile can improve self-esteem, no matter the age.

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General Information About Orthodontics

1. What is orthodontics?

Orthodontics is the branch of dentistry that specializes in the diagnosis, prevention, and treatment of dental and facial irregularities. The technical term for these problems is "malocclusion," which means "bad bite." The practice of orthodontics requires professional skill in the design, application, and control of corrective appliances, such as braces, to bring teeth, lips, and jaws into proper alignment and to achieve facial balance.

2. What is an orthodontist?

All orthodontists are dentists, but only about 6 percent of dentists are orthodontists. An orthodontist is a specialist in the diagnosis, prevention, and treatment of dental and facial irregularities. Orthodontists must first attend college and then complete a four-year dental graduate program at a university dental school or other institution accredited by the Commission on Dental Accreditation of the American Dental Association (ADA). They must then successfully complete an additional two- to three-year residency program of advanced education in orthodontics. This residency program must also be accredited by the ADA. Through this training, the orthodontist learns the skills required to manage tooth movement (orthodontics) and guide facial development (dentofacial orthopedics).

Only dentists who have successfully completed this advanced specialty education may call themselves orthodontists.

3. At what age can people have orthodontic treatment?

Children and adults can both benefit from orthodontics, because healthy teeth can be moved at almost any age. Because monitoring growth and development is crucial to managing some orthodontic problems well, the American Association of Orthodontists recommends that all children have an orthodontic screening no later than age 7. Some orthodontic problems may be easier to correct if treated early. Waiting until all the permanent teeth have come in, or until facial growth is nearly complete, may make correction of some problems more difficult.

An orthodontic evaluation at any age is advisable if a parent, family dentist, or the patient's physician has noted a problem.

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4. What causes orthodontic problems (malocclusions)?

Most malocclusions are inherited, but some are acquired. Inherited problems include crowding of teeth, too much space between teeth, extra or missing teeth, and a wide variety of other irregularities of the jaws, teeth, and face.

Acquired malocclusions can be caused by trauma (accidents), thumb, finger, or dummy (pacifier) sucking, airway obstruction by tonsils and adenoids, dental disease, or premature loss of primary (baby) or permanent teeth. Whether inherited or acquired, many of these problems affect not only alignment of the teeth but also facial development and appearance as well.

5. What are the most commonly treated orthodontic problems?

6. Why is orthodontic treatment important?

Crooked and crowded teeth are hard to clean and maintain. This may contribute to conditions that cause not only tooth decay but also eventual gum disease and tooth loss. Other orthodontic problems can contribute to abnormal wear of tooth surfaces, inefficient chewing function, excessive stress on gum tissue and the bone that supports the teeth, or misalignment of the jaw joints, which can result in chronic headaches or pain in the face or neck.

When left untreated, many orthodontic problems become worse. Treatment by a specialist to correct the original problem is often less costly than the additional dental care required to treat more serious problems that can develop in later years.

The value of an attractive smile should not be underestimated. A pleasing appearance is a vital asset to one's self-confidence. A person's self-esteem often improves as treatment brings teeth, lips, and face into proportion. In this way, orthodontic treatment can benefit social and career success, as well as improve one's general attitude toward life.

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7. What does orthodontic treatment cost?

The actual cost of treatment depends on several factors, including the severity of the patient's problem and the treatment approach selected. You will be able to thoroughly discuss fees and payment options before any treatment begins. Most orthodontists offer convenient payment plans to patients. Generally, treatment fees may be paid over the course of active treatment. Arrangements commonly offered in orthodontic offices may include an initial down payment with monthly installments, credit card payment, finance company agreements, and other innovative ways to make treatment affordable. Insurance plans or other employer-sponsored payment programs, such as direct reimbursement plans, may be helpful.

8. How long will orthodontic treatment take?

In general, active treatment time with orthodontic appliances (braces) ranges from one to three years. Interceptive, or early treatment procedures, may take only a few months. The actual time depends on the growth of the patient's mouth and face, the cooperation of the patient, and the severity of the problem. Mild problems usually require less time, and some individuals respond faster to treatment than others. Use of rubber bands and/or headgear, if prescribed by the orthodontist, contributes to completing treatment as scheduled.

While orthodontic treatment requires a time commitment, patients are rewarded with healthy teeth, proper jaw alignment, and a beautiful smile that lasts a lifetime. Teeth and jaws in proper alignment look better, work better, contribute to general physical health, and can improve self-confidence.

9. How is treatment accomplished?

Custom-made appliances, or braces, are prescribed and designed by Dr. Hime according to the problem being treated. They may be removable or fixed (cemented and/or bonded to the teeth). They may be made of metal, ceramic, or plastic. By placing a constant, gentle force in a carefully controlled direction, braces can slowly move teeth through their supporting bone to a new desirable position.

Orthopedic appliances, such as headgear, Herbst, and maxillary expansion appliances, use carefully directed forces to guide the growth and development of jaws in children and/or teenagers. For example, an upper jaw expansion appliance can dramatically widen a narrow upper jaw in a matter of months. Over the course of orthodontic treatment, headgear can dramatically reduce the protrusion of upper incisor teeth (the top four front teeth) or retrusion of the lower jaw (a lower jaw that is too far behind the upper jaw), while making upper and lower jaw lengths more compatible.

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10. Are there less noticeable braces?

Today's braces are generally less noticeable than those of the past when a metal band with a bracket (the part of the braces that hold the wire) was placed around each tooth. Now the front teeth typically have only the bracket bonded directly to the tooth, minimizing the "tin grin." Brackets can be metal, tooth-colored, or colored, depending on the patient's preference. Modern wires are also less noticeable than earlier ones. Some of today's wires are made of "space age" materials that exert a steady, gentle pressure on the teeth, so that the tooth-moving process may be faster and more comfortable for patients. We use SPEED braces, which are smaller and more efficient than traditional metal braces.

11. How have new "high tech" wires changed orthodontics?

In recent years, many advances in orthodontic materials have taken place. Braces are smaller and more efficient. The wires now being used are no longer just stainless steel. They are made of alloys of nickel, titanium, copper, and cobalt, and some of the wires are heat-activated. (The nickel-titanium alloy was originally engineered by NASA to automatically activate antennae or solar panels of spacecraft orbiting into the sun's rays.) These new kinds of wires cause the teeth to continue to move during certain phases of treatment, which may reduce the number of appointments needed to make adjustments to the wires.

12. How do braces feel?

Most people have some discomfort after their braces are first put on or adjusted during treatment. After the braces are on, teeth may become sore and may be tender to biting pressures for three to five days. Patients can usually manage this discomfort well with whatever pain medication they might commonly take for a headache. The orthodontist will advise patients and/or their parents what, if any, pain relievers to take. The lips, cheeks, and tongue may also become irritated for one to two weeks as they toughen and become accustomed to the surface of the braces. Overall, orthodontic discomfort is short-lived and easily managed.

13. Do teeth with braces need special care?

Patients with braces must be careful to avoid hard and sticky foods. They must not chew on pens, pencils, or fingernails because chewing on hard things can damage the braces. Damaged braces will almost always cause treatment to take longer and will require extra trips to the orthodontist's office.

Keeping the teeth and braces clean requires more precision and time and must be done every day if the teeth and gums are to be healthy during and after orthodontic treatment. Patients who do not keep their teeth clean may require more frequent visits to the dentist for a professional cleaning.

Dr. Hime and our staff will teach patients how to best care for their teeth, gums, and braces during treatment. The orthodontist will tell patients (and/or their parents) how often to brush, how often to floss, and, if necessary, suggest other cleaning aids that might help the patient maintain good dental health.

14. How important is patient cooperation during orthodontic treatment?

Successful orthodontic treatment is a "two-way street" that requires a consistent, cooperative effort by both Dr. Hime and patient. To successfully complete the treatment plan, the patient must carefully clean his or her teeth, wear rubber bands, headgear, or other appliances as prescribed by the orthodontist, and keep appointments as scheduled. Damaged appliances can lengthen the treatment time and may undesirably affect the outcome of treatment. The teeth and jaws can only move toward their desired positions if the patient consistently wears the forces to the teeth, such as rubber bands, as prescribed. Patients who do their part consistently make themselves look good and their orthodontist look smart.

To keep teeth and gums healthy, regular visits to the family dentist must continue during orthodontic treatment. Adults who have a history of or concerns about periodontal (gum) disease might also see a periodontist (specialist in treating diseases of the gums and bone) on a regular basis throughout orthodontic treatment.

We wish to express our gratitude to the American Association of Orthodontists which was the source for the answers to these commonly asked questions. Please visit their website for more information relating to orthodontics.

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