Appliance Care
Find out here what patients should expect to happen before ortho treatment starts. What the braces procedure involves and the collaboration expected from each patient, potential risks and problems that may occur during orthodontic treatment.
Care of your removable or fixed appliance and fixed and removable retainers is also explained.
Watch this video to get a better idea of what it all means.
Before treatment starts
Records
Before treatment can begin, Dr Dearing must determine the nature of the problem and develop a treatment plan. A set of records will be prepared which may include x-rays of the head, jaws and teeth, plaster models and intraoral and facial photographs.
Diagnosis, Treatment Plan and Fees
Dr Dearing will then provide a written diagnosis, treatment plan and suggest a fee structure. Any significant risks or limitations to your treatment will be outlined. You will have an opportunity to ask any questions. Your written consent will be obtained before any treatment commences.
Extraction of teeth
In some cases, the removal of teeth is recommended. This is a highly specialised judgement made on individual case analysis. The extraction of teeth is only recommended when it improves the prospect of successful treatment and the longevity of the result. Please discuss any concerns you have about extractions personally with Dr Dearing.
Treatment Time
The length of treatment depends on the severity of the problem, the patient’s growth and the level of patient co-operation. Our average treatment time is 18 months across all types of cases. More severe problems take longer and require more co-operation. Poor co-operation or unfavourable growth may lengthen the treatment time and affect the quality of the treatment result.
Patient responsibilities
Successful orthodontic treatment is a team effort between patient and orthodontist. To achieve the best result possible patients must:
- Keep all appointments as scheduled
- Maintain excellent oral hygiene
- Wear all appliances, elastics, headgears, retainers, etc as instructed
- Avoid activities and foods that could damage or dislodge the appliance
- Report all problems or broken appliances immediately
- Attend their dentist or school dental therapist regularly during treatment.
Treatment may have to be discontinued if patient co-operation is not adequate. If treatment is discontinued prior its completion there may be severe adverse effects for the patient.
Potential risks & problems
As with all medical and dental treatment, orthodontic treatment has limitations and potential risks. Fortunately complications are infrequent and when they do occur are usually only of a minor consequence. Nevertheless, they should be considered when making the decision to undergo orthodontic treatment. Problems may be catagorised as common, relatively rare, and very rare.
Common problems
Oral hygiene
Excellent oral hygiene is essential during orthodontic treatment. Braces do not cause tooth decay. However, if you consume a high sugar diet or do not brush your teeth regularly and correctly then permanent white marks (decalcification), decay and gum disease will occur.
Injuries from braces
The mouth is very sensitive to changes and the introduction of any appliance means that a period of adjustment must be expected When first placed, appliances may cause minor irritation to the lips, gums and cheeks. Broken appliances or a blow to the mouth may also cause trauma to the lips and cheeks. Post adjustment tenderness is normal and the period of tenderness will vary with each patient and the nature of the adjustment.
Tooth movement after treatment relapse
It is normal for teeth to move as we age. This natural process can be controlled by the proper wear of a retaining appliance. It is essential that all retainers be worn as directed. Failure to do so may result in significant unfavourable movement of the teeth. The most likely teeth to move are the lower incisors. Gum disease, mouth-breathing and harmful oral habits can also cause teeth to move. For these reasons and others beyond the orthodontist’s control, it cannot be guaranteed that your teeth will remain in a perfect position for the rest of your life. Surveys have shown that an “average” patient can expect to retain 70% of the treatment result ten years after they have stopped wearing their retainers. Thus, orthodontic treatment is exceptionally effective when compared to other medical treatments.
Wisdom teeth
The development of third molars (“wisdom teeth”) may change the alignment of the teeth. They should be checked regularly by your dentist or your orthodontist after active treatment has been completed.
Other dentistry
If your teeth vary in number, size or shape, the achievement of an ideal result may require restorative treatment such as cosmetic bonding, crowns, partial dentures, bridges or implants. The cost of this treatment is additional to the cost of orthodontic treatment. At the end of treatment, there may be some minor imperfections in the way the teeth meet. This is due to irregularities in the shape of certain teeth and uneven wear of the teeth prior to treatment. “Fine tuning” the bite by grinding away minor amounts of enamel which are “high” when you bite or by removing a slight amount of enamel between the teeth improves the stability of the end result.
Relatively rare problems
Root shortening
Some patients are susceptible to root shortening during orthodontic treatment. It is difficult to predict who is likely to develop this condition. Changes in root length will be monitored by x-rays taken during treatment. Usually the changes in the root length are insignificant. Rarely the resorption may be severe enough to become a threat to the longevity of the tooth.
Periodontal problems
The health of the bone and gums which support the teeth may be affected by orthodontic treatment if gum disease already exists. Excellent oral hygiene is required to prevent the accumulation of bacterial plaque which will cause gum disease.
Jaw joint problems
Temporomandibular Joint (TMJ) problems may develop before, during or after orthodontic treatment. These may present as joint pain, headaches or ear problems. Many factors including stress contribute to jaw joint problems and some patients are more susceptible than others. All symptoms should be reported to your orthodontist. If this problem persists during orthodontic treatment additional specialist care may be necessary.
Very rare problems
Ankylosis
In rare instances a tooth will not move because it has become “fused” (ankylosed) to the jaw bone. Such teeth may need to be surgically moved into place or extracted.
Tooth vitality
During orthodontic treatment a tooth may show discolouration or loss of vitality. This occurs more commonly in teeth previously damaged by trauma or extensive decay. Such teeth may require root canal treatment and other dental procedures to restore the colour of the tooth.
Headgear
If incorrectly handled, headgear may cause injury to the face and/or eyes. Horseplay, physical sports and activities are forbidden while wearing a headgear.
Broken braces
Dislodged or broken braces can be inhaled or swallowed. Breakages must be reported immediately.
Abnormal growth
Patients who have not grown normally and have severe jaw problems may require a combination of orthodontic treatment and jaw surgery. You will be referred to an appropriate specialist if this surgery is necessary. There are additional risks associated with surgery which should be discussed with the surgeon prior to treatment. If growth becomes disproportionate during orthodontic treatment, treatment may be prolonged and jaw surgery may be required.
Slow tooth-movement
Tooth-movement occurs at different rates in different individuals and can sometimes even vary during the course of treatment. Isolated cases in which the teeth could not be moved have been reported. It is known that high doses of some non-steroidal anti-inflammatory drugs such as Ibuprofen can slow and even stop tooth-movement. Most recently Imigran, a drug used to treat migraine has been identified as possibly interfering with tooth-movement. It is important that you advise Dr Dearing or his staff if your doctor prescribes you medicine while you are wearing braces.
Allergic reactions
Allergic reaction to Nickel contained in most orthodontic alloys, to latex in surgical gloves or to the starch used to lubricate surgical gloves has been reported. Fortunately, such instances are extremely rare and alternative materials are available when required. If you develop a rash of mouth ulcers after a visit, please contact the nearest office of Sax Dearing Orthodontics Limited immediately (see also “Ulcers” in First Aid Page).
Care of removable appliances
Your removable appliance consists of an acrylic base plate with wire clasps for retention and gently activated springs andor screws to move individual teeth.
There is wide variation in the way springs are designed depending on the job we want them to do. Never try to adjust clasps or springs yourself – this is a difficult task to perform correctly.
- Wear your appliance all the time night and day to obtain maximum benefit. It works on the principle that a gentle pressure applied for a long period will be most effective.
- The plate may feel uncomfortable at first and talking may be difficult, but this will pass shortly and your speech will quickly become normal again.
- Once your teeth have moved into better positions, Mr. Dearing will ask you to wear the plate at night time only (like pyjamas for your teeth). Keep you plate in the special container Mr. Dearing gave you during the day.
- Remove your plate to eat your meals. Place it in the special container given to you. After each meal clean your teeth and plate with your toothbrush and toothpaste.
- Do not rinse your plate under hot water, as it will warp.
- To remove your plate, pull with a fingernail on the back clasps, but never on the springs or front wire, as these will bend and result in undesired tooth movement.
- Do not eat chewing gum or bubble gum, as these stick very badly to plates.
- Do not wear your plate when swimming, as it may wash out and be lost.
- Do not remove your plate unnecessarily, as it is easily mislaid. When you do take your plate out put it in a small container – use the special container we gave you or something like a soapbox is a good idea – to make it easy to find and to protect it.
- Do not put your plate in your pocket – you might break it when you sit down.
- If the plate becomes uncomfortable or is broken make an appointment with Mr. Dearing immediately. If you are out of town when this happens, most dentists can repair retainers. However, it would be wise to check with Mr. Dearing on your return if this happens.
- Always bring your plate with you on each appointment.
- A fee will be charged to replace lost plates. This fee is currently $170.00 so take good care of your plate!
- Although you are receiving orthodontic treatment it is still necessary to attend your family Dentist or School Dental Nurse for regular dental check-ups.
Care of fixed appliances
Oral Hygiene
The teeth, gums and braces must be kept spotlessly clean by proper tooth brushing after every meal and immediately before each appointment. Brush along the arch wires with a soft toothbrush to clean the teeth and massage the gums. Watch in a mirror to ensure that the brush is correctly placed. Time yourself to ensure that a full five minutes of tooth brushing and gum massaging is given. Some “over-the-counter” mouthwashes help dislodge plaque (specially those containing chlorhexidene) and are very useful.
If you have any doubts on the methods of tooth brushing bring your toothbrush to your next appointment and ask Dr Dearing’s advice. If oral hygiene is not up to standard a separate appointment will be made with the nurse to go over your technique. Remember that the braces themselves will not damage your teeth but that food left around them will cause both tooth decay and swollen gums.
Eating
Your initial arch wires are heat-activated so keep to food and drink that do not feel warm to your mouth initially. Once you feel comfortable with your brace start having hotter food and drinks. You will feel the wire stiffen momentarily. Make sure that your diet is also soft for the first few days. We suggest mince, eggs, yoghurt, soft fruit, ice-cream and an increased fluid intake.
Sweets of any sort are strictly forbidden at any time. This includes muesli bars, popcorn, chewing gum, sucking lollies, throat lollies, all types of nuts, biting ice-blocks, chocolate and roll-ups. Biscuits or crackers should be broken before being eaten. Raw fruits and vegetables must be eaten with care. Peel them and then cut into small segments before eating. The picking of chop and chicken bones and sweet-corn should be avoided. Avoid biting firmly when chewing your food. Modifying your eating habits will help avoid any breakages. If you follow these directions faithfully, your brace should not break. Each breakage costs about $50.00 to repair and these costs will be passed onto you if you experience more than four breakages.
Elastics
Wear your elastics all the time unless instructed otherwise. Remove them only to eat your meals and clean your teeth. Never, ever leave them off for more than two hours and change or renew elastics every day and whenever they break. When you do take them off – put them on your little finger to avoid loosing them or forgetting to replace them.
Discomfort
It is normal for teeth to become tender and even a little loose after braces have been fitted and sometimes after adjustments have been made also. The time taken for this discomfort to disappear varies from a few hours to more than a week depending upon the severity of the case and the adaptability of the individual. This discomfort can easily be controlled with “over the counter’ remedies such as aspirin and panadeine.
Asthmatics should avoid non-steroidal anti-inflammatory drugs (NSAID’s) such as aspirin, Ibobrufen and Indomethacin/Naproxen (such as Indocid & Naprosyn), which can trigger serious attacks in 3% of asthmatics. Generally, paracetamol is safer for asthmatics than any NSAID but the results of a study reported in 2000 suggests paracetamol might exacerbate symptoms in some asthma patients – a finding yet to be confirmed. If you have any doubts about which drug to take, consult your medical practitioner.
If you get ulcers in your mouth, mould a pinch of wax over the brace to reduce friction and cover the ulcer with orobase or wash out your mouth with warm salt-water. We recommend that you rub lip salve, lipstick or vaseline into your lips a few hours before each appointment to reduce the possibility of cracking.
Excellence
Only well proven materials and techniques are used in this practice. Remember, we are only a telephone call away and we will be pleased to hear from you if there are any problems.
Regular dental care
It is important that you still see your dentist or school dental nurse regularly while you are wearing braces.
Care of fixed and removable retainers
Your retainers will normally consist of a removable acrylic plate for the upper teeth and a wire bonded on behind the lower incisors where it cannot be seen. Mr Dearing will normally ask you to wear the acrylic plate all the time (night and day) for four months and then go to night-time wear of this appliance for several years. For most patients this will mean until they leave high school. Dr Dearing will provide you with a special container to protect your plate while you eat your meals or play sport.
The lower wire should be left in place indefinitely, and certainly until the positions of the third molars (wisdom teeth) have been checked in several years time. There is no charge for this service for the first three years after your braces have been removed. Appointments made after that time may be charged for.
The plate may feel uncomfortable at first and talking may be difficult, but this will pass shortly and your speech will quickly become normal again. After four months of full-time wear, Mr Dearing will normally advise you to wear the plate at night time only (like pajamas for your teeth).
- Remove your plate to eat your meals. Don’t forget to place your plate in its protective box. Clean your teeth and plate with your toothbrush and toothpaste after each meal. Do not rinse your plate under hot water as it will warp
- To remove your plate, pull with a fingernail on the back clasps, but never on the springs or front wire, as these will bend and result in undesired tooth movement.
- Do not eat chewing gum or bubble gum while wearing the plate, as these can really stick to plates.
- Do not wear your plate when swimming, as it may wash out and be lost.
- Do not remove your plate unnecessarily, as it is easily mislaid. When you do take your plate out put it in your retainer-box.
- Do not put your plate in your pocket – you might break it when you sit down.
- Always bring your plate with you on each appointment.
If the wire behind your lower front teeth becomes uncomfortable or is broken make an appointment with Mr Dearing immediately. If the wire behind your lower incisors comes off be sure to save it so that you do not experience any delays while a new one is made. If you are out of town when this happens, most dentists can repair retainers. However, it would be wise to check with Mr Dearing on your return if this happens.
A fee will be charged to replace lost retainers. The current fee for acrylic plates is $170.00 including GST, and for lower lingual retainers $100.00 including GST.