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

 

Normal bone vs osteoporosis.Osteoporosis is a condition that weakens bones and makes them more prone to fracture. Estimated to affect about 10 million Americans at present, it causes some 2 million fractures each year — and as our population ages, these numbers are expected to increase. Osteoporosis can affect any part of the body — including the jawbone that supports the teeth.

This may be of particular concern if you are considering certain dental procedures — for example, getting dental implants to replace missing teeth. Implants are today's gold standard for tooth replacement, because they look and function so much like real teeth. But their success depends on a process known as osseointegration, by which they fuse to living bone in the jaw. For this to occur, that bone must be relatively healthy; yet osteoporosis — and certain medications used to treat it — may affect your oral health.

Bone: An Ever-Changing Tissue

The living bone tissue in the body isn't like the dry, white skeleton you may have seen in a doctor's office or on TV. It is constantly being remodeled by two natural processes: resorption, in which the body removes and breaks down old, damaged bone; and bone formation, where the removed material is replaced by new, healthy bone. In an ideal situation, both processes happen at an equal rate; osteoporosis, however, tips the balance toward resorption, weakening the bone structure.

A class of drugs called bisphosphonates (whose brand names include Fosamax, Boniva, Reclast and Prolia) can inhibit resorption and help bring the two processes back into balance. But for reasons that aren't fully understood, these medications sometimes have a different effect on the bones of the jaw. In rare cases, long-term bisphosphonate users experience osteonecrosis of the jaw (ONJ), a condition in which isolated areas of jawbone lose their vitality and die. If you are a candidate for oral surgery, tooth extraction or implant placement, it's important to consider the possible effect of bisphosphonate use before you have this type of procedure.

Taking Medication

Over 90 percent of the people who suffer from bisphosphonate-associated ONJ received high doses of the medication intravenously — often for cancer treatment. Only a small percentage of those who take the drug orally are likely to develop this condition. So generally speaking, if you have osteoporosis or are at high risk of bone fractures, the benefit of taking these medications far outweighs the risk.

But if you are about to begin therapy with high doses of bisphosphonates, it's ideal to have a dental exam and resolve any oral disease before beginning the medication. Likewise, while you're receiving the medication, it's best to avoid invasive dental treatments if possible. However, since untreated oral disease may cause serious health problems, be sure to discuss the situation with all members of your medical team before making treatment decisions.

Most people who take oral bisphosphonates for osteoporosis won't have to postpone or avoid dental procedures, because they have little risk of developing ONJ. In the case of dental implant placement, the decision to proceed is made on an individual basis, after a thorough examination of the quality and quantity of tooth-supporting bone in the jaw. The presence of osteoporosis may influence the type of implants used, and the amount of healing time needed to complete the osseointegration process.

No matter what dental procedures you are considering, it is vital to keep us informed about any medical conditions you have, and any drugs you may be taking — both prescription and non-prescription.

Preventing Osteoporosis

There are several ways you can help prevent osteoporosis. For a start, make sure you're getting enough calcium and vitamin D. It also helps to decrease your caffeine and alcohol intake, and quit smoking. Weight-bearing exercise — physical activities that force you to work against gravity, like walking, jogging or weight training — can bring a host of benefits. And don't forget your regular visits to the dental office. Your dental professionals don't just help you to maintain good oral health — we encourage you to keep up your overall health as well.

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Osteoporosis - Dear Doctor Magazine

Osteoporosis & Dental Implants If you are taking a bisphosphonate drug for treatment of osteoporosis, any kind of surgery involving the jawbone has a small risk that bone healing may be compromised. This includes tooth removal and the placement of dental implants. It's an important subject that requires a better understanding... Read Article