General information

What will happen at my first visit?
During the first visit (the consultation), the orthodontist will do a detailed examination of the face, the position of the teeth and the relation between the upper and lower teeth. A radiograph will be taken to evaluate the dental development and complement the clinical examination. The orthodontist will then be able to provide you with more information on the nature of the orthodontic problem, the possible need for treatment and the best time to initiate it. A brief overview of the treatment plan including the type of appliances to be used and the anticipated length of treatment will be discussed. An estimate of the total treatment cost and payment plans will be provided. If you have dental insurance, all the requested information from your insurance company will be given to you at the end of the appointment. Do not hesitate to ask any questions or share any concern you may have about the treatment at this visit.

What are the different steps of treatment?
If the orthodontist determines that treatment is necessary, the next step will be to take orthodontic records. The records consist of taking a number of photographs of the face and the teeth, impressions of the teeth (molds), a registration of the way teeth fit together (the bite) with wax and a radiograph of the face (cephalographic x-ray). The orthodontist will then analyze the records and decide on the best way to treat the case. The next appointment is usually reserved for the placement of the braces or, if another type of appliance is required, for a new impression of the teeth. This appointment is usually the longest, taking on average 1 hour and 15 minutes. Occasionally, for more complex cases, a separate visit with the patient and sometime parents is needed to discuss the treatment beforehand. The following appointments are for adjustments and are scheduled at 6-week intervals. These appointments usually take 15 to 20 minutes to complete.

When should I start my treatment?
The start of treatment depends on the type of malocclusion. Certain conditions (see section on early treatment) must be addressed as early as the age of 5 or 6. But for most cases, the treatment starts between the ages of 9 and 15. The orthodontist will inform you at the consultation visit of the best time to initiate your treatment.

What is the length of my treatment?
The duration of treatment mostly depends on the severity of the malocclusion to correct. In general, corrections of problems that are strictly dental in origin require less time than when correction of jaw position is also required. Problems involving impacted teeth also usually require longer treatment times. Orthodontic treatment in adult patients is also usually longer due to an increase in the density of the bone surrounding the teeth which slows tooth movement. If two phases of treatment are required, the total length of treatment will usually be longer than if only one phase is needed. A single-phase treatment usually takes approximately 24 months to complete whereas a two-phase treatment can take 30 to 36 months.

How often will I be seen during my treatment?
The frequency of visits will vary based on the type of treatment recommended and the different time periods of a given treatment (early, mid-treatment, finishing, retention, etc) but a 6-week interval is the most common.

How much will my treatment cost?
The cost of treatment varies depending on the severity of the case, the type of problem to be corrected and the anticipated length of treatment. An estimate will be given to you at the initial visit.

What types of braces are available?
Many different types of brackets are available at our office. The traditional metal brackets use an elastomeric tie (different colors are available and can be changed at each visit). The same brackets are also available in porcelain. They are much less noticeable and are usually the appliance of choice in adult patients and those seeking a more discreet alternative. We now also offer self-ligating brackets (braces that don't require an elastic to hold the wire in place), which can move the teeth faster and are more hygienic. The different types of braces used will be presented to you at the consultation visit.

Click here to view the types of appliances

Do orthodontic appliances hurt?
After the insertion of the orthodontic appliances, a period of adaptation is required. A few hours after leaving the office, the pressure on the teeth will start to cause discomfort, especially when chewing. We recommended taking a mild pain medication (Tylenol, Motrin, Advil, etc), as recommended by the manufacturer, for a few days until the pain subsides. Another cause of irritation comes from the appliances themselves. The presence of hooks on the brackets or the movement of the wire as the teeth begin to align can be a local source of discomfort. We recommend that you apply wax over the irritating area (orthodontic wax will be given to you the day the braces or placed) if this happens. If the pain/irritation persists, contact our office for an emergency visit.

What will I be able to eat?
A complete list of foods to avoid will be given to you after the insertion appointment. In general, very hard or sticky foods are to be avoided. Fruits and vegetables should be cut in little pieces or cooked before being consumed. Foods high in sugar are acceptable during meals if immediately followed by tooth brushing.

Will I need extractions?
Sometimes the removal of permanent teeth is necessary when the lack of space is too great to accommodate all the teeth or when the front teeth are sticking out too much. The preferred teeth for extraction are the premolars but the pattern of extraction can vary based on the clinical situation.

Will I need retainers?
Yes. For various reasons, teeth have a tendency to move following orthodontic treatment. Retainers are removable but should be worn at all times for the first 6 months following removal of the braces, except when eating and brushing. Thereafter, the retainers should be worn at night for another year and then a few nights a week for life. In certain cases, a wire bonded to the front teeth, on the side of the tongue, is used as a retainer. This type of retainer is fixed and cannot be removed by the patient.

What do I do if a bracket breaks or in the event of any other emergency?
A detailed protocol indicating what to do in the event of an emergency will be given to you at the appliance placement visit. If a bracket becomes loose between visits, it is important to notify us. The orthodontist will determine if the bracket needs to be replaced immediately or if it can wait until the next visit. On occasions, the wires move as the teeth align and can stick out in the back, irritating the cheek or gums. If this happens, apply wax on the wire to relieve the discomfort until the next visit. If the situation is too uncomfortable, contact us for an emergency visit. If the wire becomes dislodged from the band or last bracket, try to replace it or just cut it with a clean nail cutter. If a removable appliance breaks or is damaged in such a way that it can't be placed properly, do not force it in. In this situation, please contact us for an emergency visit.

How can I keep my teeth and gums healthy during treatment?
It is of utmost importance to follow the hygiene instructions given the day the appliances are placed. Plaque (bacteria) tends to accumulate much more around brackets and other appliances and can cause gum swelling and bleeding, and in certain cases, lead to the loss of bone support around teeth. Bad oral hygiene can also cause "white spots" or cavities on the teeth, under and around the braces. The use of a small brush (proxabrush) is recommended to clean around the braces following normal toothbrushing. Flossing, although very tedious with braces, is also recommended. The use of a "floss threader" or "Superfloss" (a special kind of floss with a stiff end) is necessary to get the floss underneath the wire. When plaque control is poor, the orthodontist may recommend a fluoride-based mouthrinse.

I have heard of an invisible way to move teeth (InvisalignT). Am I a good candidate for that type of treatment?
Only a detailed examination by an orthodontist will determine whether this type of treatment is appropriate for you. The InvisalignT appliance has greatly improved over the last few years and can now be used for more complex cases. However, certain types of malocclusions are still best treated with conventional fixed appliances. More information on InvisalignT treatment is available on www.invisalign.com.