The American Association of Orthodontists recommends that all children see an orthodontist by at least age seven and sooner if something is obviously wrong before age seven. Fortunately, most young patients don't need anything more than observation while the permanent teeth are growing into place.

Many young patients have problems, which will not, or should not wait. Most orthodontic problems are inherited and cannot be totally prevented; however something can usually be done before these problems become more difficult and more expensive to manage.

It is advisable to consult with an orthodontist prior to having your dentist remove any baby teeth or permanent teeth. To ensure the best overall dental and facial development, all patients should have an orthodontic consultation sometime between the ages of four and seven.

Dr. Bock offers early examinations and observation consultations. Contact us to schedule a complimentary consultation.

Classifications of Teeth

The classification of bites is divided into three main categories: Class I, II, and III. This classification refers to the position of the first molars, and how they fit together.

Class I
Class I is a normal relationship between the upper teeth, lower teeth and jaws or balanced bite.


Class I normal



Class I crowding

 

Class I spacing
 

 

Class II
Class II is where the lower first molar is posterior (or more towards the back of the mouth) than the upper first molar. In this abnormal relationship, the upper front teeth and jaw project further forward than the lower teeth and jaw. There is a convex appearance in profile with a receding chin and lower lip. Class II problems can be due to insufficient growth of the lower jaw, an over growth of the upper jaw or a combination of the two. In many cases, Class II problems are genetically inherited and can be aggravated by environmental factors such as finger sucking. Class II problems are treated via growth redirection to bring the upper teeth, lower teeth and jaws into harmony.

 

 
Class II division 1

 
 
Class II division 2

 

 

Class III
Class III is where the lower first molar is anterior (or more towards the front of the mouth) than the upper first molar. In this abnormal relationship, the lower teeth and jaw project further forward than the upper teeth and jaws. There is a concave appearance in profile with a prominent chin. Class III problems are usually due to an overgrowth in the lower jaw, undergrowth of the upper jaw or a combination of the two. Like Class II problems, they can be genetically inherited. Class III problems are usually treated via surgical correction of one or both jaws.

 
Class III functional or dental

 
 
Class III skeletal

 

 

Orthodontic Problems

 
Overjet
Upper front teeth protrude


 
 
Deep bite
Upper front teeth cover lower front teeth too much

 
 
Underbite
Lower front teeth protrude


 
 
Open bite
Back teeth are together with space between the front teeth


 

Crowding
Upper and/or lower teeth are crowded


 

Excess Spacing
There is excess space between teeth


 

Mid-Line Misalignment
Mid-lines of upper and lower arches do not line up

 

Crossbite
Upper back teeth fit inside lower teeth

Phases of Treatment

Phase I: Treatment usually takes 12 to 18 months and is done between the ages of 7-9. A variety of appliances may be used to correct specific problems.

Maintenance / Recall Phase: During the time between the first and second phase the patient will be seen every few months per year. This is to monitor the eruption of the permanent teeth and exfoliation of primary teeth.

Phase II (if required): During the first phase of treatment Dr. Bock has no control over 16 unerupted permanent teeth. If they grow in and problems still exist, further treatment, known as Phase II, will be required. A separate fee will be quoted at that time. Treatment usually takes 12-24 months.

Full Treatment: If you decide to wait, treatment will be started when all permanent teeth have erupted. Full treatment usually takes 18-30 months. The length of treatment depends on the severity of malocclusion and orthodontic problems.

Proper Braces Care and Brushing Techniques

Brushing and flossing your teeth can be challenging when wearing braces but it is extremely important that you do both consistently and thoroughly.

 
 
 


Foods to Avoid During Treatment: Eating proper foods and minimizing sugar intake are essential during orthodontic treatment. Your braces can be damaged by eating hard, sticky, and chewy foods.

  • Hard foods : Nuts, Candy, Hard Pretzels
  • Crunchy foods : Popcorn, Ice, Chips, etc.
  • Sticky foods : Gum, Chewy Candy (Skittles, Taffy, Gummy Bears, Caramel, etc.)
  • Chewy foods : Bagels, Hard Rolls, etc.
  • Foods you have to bite into : Corn on the Cob, Apples, Carrots (cut these foods up into smaller pieces and chew on back teeth)
  • Chewing on Hard Objects (for example, pens, pencils or fingernails) can damage the braces. Damaged braces will cause treatment to take longer.

Hard Foods

 

Soft Foods

 

Vomiting.Millions of people in the United States, particularly teenage girls and young women, suffer from health-threatening eating disorders, and dentists are often the first to spot the signs. Why? The repeated, self-induced vomiting that characterizes bulimia nervosa has a pronounced effect on teeth. Anorexia nervosa (self-starvation) can also have some noticeable effects on oral health.

More than 90% of those with bulimia experience tooth erosion. This is caused by acid from the stomach, which can dissolve the enamel when it comes in contact with teeth during vomiting. Teeth that have lost enamel can appear worn, chip easily, and become sensitive to hot and/or cold. Of course, acid erosion can also affect people who drink a lot of soda, sports drinks and energy drinks — even the diet varieties. But acid erosion in bulimics has a particular pattern: It is evident on the upper front teeth, particularly on the tongue side and biting edges. The bottom teeth, on the other hand, tend to be protected by the tongue when a person throws up.

Once enamel is lost, it can't grow back. But the damage can be repaired with various restorative techniques including veneers and/or crowns. The best treatment will be determined by how extensive the damage is, which in turn depends on how frequently the person has engaged in binge-purge behavior.

To protect teeth in the short term, it is important not to brush them immediately after vomiting as this can scrape off more of the softened enamel. It is better to rinse with water to which a little baking soda has been added, which neutralizes the acid. Even a plain water rinse is helpful. Sometimes a sodium fluoride mouthrinse is recommended to strengthen the enamel and reduce its loss.

Erosion is not the only sign of an eating disorder that a dentist or hygienist may notice. In severe cases the salivary glands can become enlarged, causing the sides of the face under the ears to look puffy. Also, the throat, back of the tongue and roof of the mouth can appear reddened or otherwise traumatized from the use of fingers or other objects to induce gagging. Soft tissues of the mouth can also be damaged by acid.

Only about 20% of anorexics experience tooth erosion, but there are other signs that may become apparent in the dental office. Nutrition and hygiene suffer in general, which in turn can mean more tooth decay and gum disease. There is also considerable overlap between anorexia and bulimia.

If you are struggling with an eating disorder or believe that a loved one is, please let your healthcare professionals know. We will make sure you get the help you need for healthy teeth and a healthy life. You can also visit the National Eating Disorders Association for some helpful information.

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Bulimia Anorexia - Dear Doctor Magazine

Bulimia, Anorexia & Oral Health Eating disorders, particularly bulimia nervosa, can leave telltale signs on the teeth that dentists and hygienists are trained to spot. The frequency with which a person engages in binge-purge behavior will determine how seriously the teeth are affected... Read Article