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

 

Retained baby tooth needing extraction.The main goal of dentistry is to preserve your natural teeth and keep them healthy for as long as possible. There are times, however, when it is in your best interest (or your child's) to have a tooth extracted (removed). This could be the case for a variety of reasons. Perhaps you have a tooth that has been severely damaged by trauma or decay; or an impacted wisdom tooth that may cause trouble for you later on. Maybe your teenager will soon undergo orthodontic treatment and has insignificant space for his adult teeth, referred to as crowding. Or your younger child has a baby tooth that's stubbornly adhering, even though it's past time for it to go.

Whatever the reason, tooth extraction is more often than not a very routine procedure. How straightforward this minor surgery is will depend on where the tooth to be extracted is located in the mouth, and what its roots are like. For example, a front tooth with a single straight root is easier to remove than a molar with multiple roots. This is especially true when that molar is a wisdom tooth that is impacted, meaning it is below the surface surrounded by gum tissue and bone. Often, a wisdom tooth is blocked from fully erupting (growing in) by other teeth in its path.

Still, tooth extraction is nothing to be feared when done by an experienced hand. Keep in mind that a tooth is not rigidly fixed in its surrounding bone, though that's how some may picture it. In fact, it is attached to the bone via a network of fibers that form what's known as the periodontal ligament. By carefully manipulating the tooth, these fibers can be detached and the tooth freed without much trouble.

Reasons for Extracting a Tooth

As mentioned above, there can be a variety of reasons for extracting a tooth. Be sure to ask questions about the pros and cons of any dental treatment, including extraction.

  • Cracked tooth.Trauma or Disease — In both of these situations, there are several ways to try and save the tooth. The damaged tooth might need a full-coverage crown, a root canal treatment, or both. But sometimes even these methods are not enough to keep the tooth functioning well and looking good; it might be better to remove the tooth and replace it with a strong and lifelike dental implant.
  • Orthodontic Treatment — Teeth are sometimes extracted when there are too many of them for the size of the dental arches (jaws), a situation known as crowding. After an adequate amount of space is opened up through the extraction of one or more teeth, the remaining teeth can be aligned properly. The teeth most frequently removed for orthodontic reasons are the first premolars, which are right next to the eyeteeth (canines).
  • Impacted wisdom tooth.Impacted Wisdom Teeth — Early removal of impacted wisdom teeth can prevent damage to neighboring healthy teeth, bone, gum tissue, even nerves and blood vessels. If an impacted wisdom tooth is in a bad position, it's best to remove it before its roots are fully formed.
  • Baby Teeth — If a baby tooth is out of position or not lost in the right sequence, the permanent tooth underneath it might not erupt normally. In this case, removing the baby tooth could prevent a need for orthodontic treatment later on.

The Process of Extracting a Tooth

The first step in any extraction is a radiographic (x-ray) examination to assess the position of the tooth roots and the condition of the surrounding bone. This will allow any possible complications to be anticipated. A thorough medical and drug history is taken, to ensure that you are healthy enough to undergo the procedure, and your options for anesthesia will be discussed.

Tooth extraction is usually carried out with local anesthesia, which will numb the teeth to be removed, and the surrounding bone and gum tissues. Additional sedatives might also be used, including oral sedatives (taken in pill form), nitrous oxide (which is inhaled) and/or conscious sedation, which is given intravenously (into a vein). The latter is usually required for more complicated (or multiple) tooth extractions. By the time the sedation medication has worn off, you won't even be aware that the surgery was done.

As your tooth is being removed, steps are taken to ensure the bone that surrounds it isn't damaged. Sometimes, in the process of removing a tooth, a small amount of lab-processed bone-grafting material is placed into the socket to help preserve the bone volume there. This is particularly important when the extraction is going to be followed at some point by the placement of a dental implant, which needs to fuse to existing bone, or orthodontics, which gently moves teeth through bone.

What to Expect After Tooth Extraction

Immediately after your tooth is extracted, the socket will be covered with sterile gauze; gentle pressure will be applied for 10-20 minutes to control any bleeding. Small sutures (stitches) might also be used for this purpose. It's normal to experience some mild to moderate post-operative discomfort and/or swelling. Taking non-steroidal, anti-inflammatory drugs such as ibuprofen and/or aspirin the day of surgery should control most symptoms. Antibiotics may also be prescribed to ensure infection-free healing. Using ice packs on the outside of your jaw, and eating softer foods until you feel more comfortable can also be helpful. Within a few days, all should be back to normal.

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