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

 

Impacted wisdom tooth.In most people, the third set of molars, generally called “wisdom teeth,” start coming in around age 17-25. However, the arrival of these teeth is often far from trouble-free. The extraction (removal) of one or more third molars is a relatively common procedure, performed on some 5 million patients every year. After a thorough examination and diagnostic tests such as x-rays or a CT scan, you may be told that you should have your wisdom teeth extracted. Here are some typical reasons why:

  • Your jaw may be too small to accommodate all your teeth, leading to excessive crowding and the chance of your wisdom teeth becoming impacted — that is, unable to emerge from the gums, and potentially harmful to adjacent bone or teeth
  • Your wisdom teeth may be erupting (coming in) in a crooked orientation, which can damage other teeth or anatomical structures in the jaw, and/or cause bite problems
  • If your wisdom tooth does not fully erupt (emerge from the gums), it can increase the chance for bacterial infection
  • A cyst (a closed, fluid-filled sac) may develop around the unerupted wisdom tooth, which can cause infection and injury to the adjacent bone or nerve tissue

Whether it is aimed at preventing future problems or needed to alleviate a condition you already have, the extraction of wisdom teeth can be an effective treatment. But, as with all medical procedures, its benefits must be weighed against the small risk of complications, and should be discussed in detail.

The Extraction Procedure

X-ray of an impacted wisdom tooth.Wisdom tooth extraction is usually an in-office procedure which may be performed by a dentist or an oral surgeon. It's quite possible to have the treatment done with only a local anesthetic (numbing shot) to keep you from experiencing any pain; however, if multiple teeth are being extracted at one time (as is often the case), a general anesthetic or conscious sedation may be administered. The type of anesthesia that's best for you will be determined before the procedure.

Once you have been appropriately anesthetized, the gum tissue at the extraction site may need to be opened if the tooth is impacted. The tooth itself will then be gently removed. When the extraction is complete, you may need to have the site sutured (stitched) to aid healing. After the procedure is over, you will rest for a short time before going home. Depending on what type of anesthesia you have had, you may need another person to drive.

After the Procedure

The recovery period after wisdom tooth extraction generally lasts only a few days. During this time, you should rest when possible to encourage healing, and take any pain medication as prescribed. It's normal to experience some bleeding at the extraction site; this can be controlled by gently biting on gauze pads, changing them as needed, and resting with the head elevated on pillows rather than flat.

Holding an ice pack on the outside of your cheek for a few minutes at a time (for example, 5 minutes on / 5 minutes off) may help reduce swelling on the first day after the procedure. Starting on day 2, the warm moist heat of a washcloth placed on the cheek may make you more comfortable. Rinsing the mouth with warm salt water a few times a day can also help relieve discomfort.

You may want to eat soft foods for a few days after the extraction; likewise, be careful when brushing or putting anything in your mouth until your healing is complete. Be sure to follow the postoperative instructions you are given, as each situation is a little different; this will help you to be as comfortable as possible.

Related Articles

Wisdom Teeth - Dear Doctor Magazine

Wisdom Teeth – To Be Or Not To Be Wisdom teeth, which typically make their appearance between the ages of 17 and 25, can cause significant problems when there is not enough room for them to grow in properly. As a person ages, the effects of retained and impacted wisdom teeth can be more consequential. This article reviews the issues associated with wisdom teeth and whether or not they should be removed... Read Article