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

 

Gum disease.Periodontal (gum) disease is an infection caused by bacterial plaque, a thin, sticky layer of microorganisms (called a biofilm) that collects at the gum line in the absence of effective daily oral hygiene. Left for long periods of time, plaque will cause inflammation that can gradually separate the gums from the teeth — forming little spaces that are referred to as “periodontal pockets.” The pockets offer a sheltered environment for the disease-causing (pathogenic) bacteria to reproduce. If the infection remains untreated, it can spread from the gum tissues into the bone that supports the teeth. Should this happen, your teeth may loosen and eventually be lost.

When treating gum disease, it is often best to begin with a non-surgical approach consisting of one or more of the following:

  • Scaling and Root Planing. An important goal in the treatment of gum disease is to rid the teeth and gums of pathogenic bacteria and the toxins they produce, which may become incorporated into the root surface of the teeth. This is done with a deep-cleaning procedure called scaling and root planing (or root debridement). Scaling involves removing plaque and hard deposits (calculus or tartar) from the surface of the teeth, both above and below the gum line. Root planing is the smoothing of the tooth-root surfaces, making them more difficult for bacteria to adhere to.
  • Antibiotics/Antimicrobials. As gum disease progresses, periodontal pockets and bone loss can result in the formation of tiny, hard to reach areas that are difficult to clean with handheld instruments. Sometimes it's best to try to disinfect these relatively inaccessible places with a prescription antimicrobial rinse (usually containing chlorhexidine), or even a topical antibiotic (such as tetracycline or doxycyline) applied directly to the affected areas. These are used only on a short-term basis, because it isn't desirable to suppress beneficial types of oral bacteria.
  • Bite Adjustment. If some of your teeth are loose, they may need to be protected from the stresses of biting and chewing — particularly if you have teeth-grinding or clenching habits. For example, it is possible to carefully reshape minute amounts of tooth surface enamel to change the way upper and lower teeth contact each other, thus lessening the force and reducing their mobility. It's also possible to join your teeth together with a small metal or plastic brace so that they can support each other, and/or to provide you with a bite guard to wear when you are most likely to grind or clench you teeth.
  • Oral Hygiene. Since dental plaque is the main cause of periodontal disease, it's essential to remove it on a daily basis. That means you will play a large role in keeping your mouth disease-free. You will be instructed in the most effective brushing and flossing techniques, and given recommendations for products that you should use at home. Then you'll be encouraged to keep up the routine daily. Becoming an active participant in your own care is the best way to ensure your periodontal treatment succeeds. And while you're focusing on your oral health, remember that giving up smoking helps not just your mouth, but your whole body.

Often, nonsurgical treatment is enough to control a periodontal infection, restore oral tissues to good health, and tighten loose teeth. At that point, keeping up your oral hygiene routine at home and having regular checkups and cleanings at the dental office will give you the best chance to remain disease-free.

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