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

 

Dental exam.When you come into the dental office for an examination, you might assume that the focus is on your teeth. That's often correct — but don't forget that there are a number of other parts of the oral and facial anatomy that are examined as well. These include areas around and inside the mouth (such as the lips, gums, hard and soft palate, and the tongue) as well as outside the mouth (the skin, muscles and glands in the neck, and the temporomandibular joint). In fact, when it comes to detecting certain oral or systemic (whole-body) diseases, a thorough dental exam may be your first line of defense.

How are diseases in the mouth discovered? Most of the time, it's simple: You will be asked about any changes you have noticed, or symptoms you may be experiencing. Your face, mouth, and neck will then be visually inspected, and certain areas may be palpated (gently touched or pressed with fingers) or probed (touched with a small instrument). If needed, additional tests or diagnostic imaging (X-rays or other methods) may be used to aid in diagnosis.

Occasionally, an abnormality such as a lesion (an unusual localized change in your tissues) is found that needs to be examined further. Lesions may resemble white or red spots or lumps (tumors), but they are typically benign. However, it is often better to err on the side of caution and perform a biopsy to be sure. This may involve making a small incision and removing a part of the suspicious area. The tissue sample will be sent to a pathologist, who examines it under a microscope for signs of disease.

Some Oral Diseases To Look For

Oral diagnosis and biopsies.Oral cancer is perhaps the most significant disease to look for in an examination — both because it can be life-threatening, and because early detection is proven to increase the survival rate. But it's important to remember that a large majority of unusual growths are found to be benign. Some other oral diseases that may be screened for include:

  • Fibroma, a thickened mass that may feel like a lump in the lining of the mouth.
  • Leukoplakia, a condition that causes white patches to form inside the mouth. While usually benign, the lesions may be precancerous and are often biopsied.
  • Lichen Planus, an inflammatory disease that sometimes causes discomfort.
  • Mucous Membrane Pemphigoid, an autoimmune disease that may cause oral lesions, but is not life threatening.
  • “Pregnancy Tumors,” benign red swellings that may form on gum tissue of pregnant women due to hormonal changes.

In addition, some systemic diseases (such as diabetes, Crohn's disease, and heart disease) may produce effects that can be observed in the mouth. We are always on the lookout for signs of these potentially serious conditions.

When a Biopsy Is Needed

Although the majority of oral lesions are benign, if there is any possibility that the growth could be cancerous or pre-cancerous, it's likely that a biopsy will be performed. Depending on how much tissue needs to be removed, this may be a simple in-office procedure, or it may be done in a hospital setting. Typically, the procedure requires only local anesthesia, and it doesn't take long. If incisions are made, they are often closed with self-dissolving sutures (stitches) that don't need to be removed.

Because the oral tissues are rich in blood vessels, some bleeding is normal for a period of time afterward. You will be given follow-up instructions as needed, including how to manage swelling and discomfort, when to take medication, and what to eat and drink. Getting some rest and maintaining good oral hygiene will also help you get back to normal as quickly as possible. When the pathology report is complete (usually in a few days), you will be given the results.

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