It’s never too late to achieve your perfect smile, and now more than ever, adults are seeking orthodontic treatment. In fact, approximately 25% of orthodontic patients are adults.

Adult orthodontic treatment differs from child and adolescent treatment in a few ways. Since the bone development in adults is complete, orthodontic appliances cannot change jaw structure as they can in patients whose bones are still growing. If you are an adult with severe jaw misalignment, you might be a good candidate for surgery.

Periodontal disease is also important to address before orthodontic treatment. Braces and aligners rely on applying gentle pressure to teeth so that they can move through their surrounding bone. If the tissue and bones aren’t healthy, the excess pressure can result in bone loss and weakened teeth. Periodontal disease can be prevented with regular cleanings and good oral hygiene habits.

All orthodontic appliances use light, constant force to move teeth into alignment, but how we apply these forces vary. Braces and aligners vary by material used and visibility, and include:

• Traditional Metal Braces

Small, metal brackets are attached to the teeth, and a small metal wire runs through them beginning at one molar, going across all teeth, and ending at the opposite molar.

• Clear Braces

Clear braces are less visible than metal braces and are made of ceramic, plastic, or a combination of both They still have a visible metal wire and can be more susceptible to breakage.

• Clear Aligners

Unlike all other options, clear aligners are removable. They are made as a series of clear plastic trays that fit over your teeth exactly. Each aligner makes an incremental change to your smile, and you move through the series of aligners until you’ve reached your perfect smile.

• Lingual Braces

Lingual braces are metal like traditional braces, but they are attached to the back of your teeth (tongue side) so that no one can see them. The downside is that they might be more difficult to adjust to, and can be more expensive than other treatment options.

Once the braces are off, it’s crucial to wear your retainer. The retainer holds teeth in place, which in turn, supports new bone development around the newly positioned teeth. If the bone isn’t supported, teeth can revert to their old positions.

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Root canal therapy is often enough to treat infection in the inner tooth successfully. If pain or inflammation return, however, these symptoms can indicate a new or recurring infection. In such cases, an apicoectomy is a common surgical procedure used to save the tooth and restore the health of the surrounding bone and gum tissue.

Every tooth contains pulp tissue, both inside the crown above the gum line and in the canals within the roots. These canals are small tunnels which travel from the pulp chamber in the crown to the tip of each root.

Nerves and blood vessels connect pulp tissue to the nervous and circulatory systems in the body, entering and exiting the tooth from very small openings in the root tip. An infection in the root pulp can spread to the gum and bone tissue around it through these openings.

An apicoectomy, also known as a root-end resection, is the surgical removal of the apex, or tip, of a tooth’s root. This allows your dentist to access and remove any damaged and infected tissue within and around the root. Apicoectomies are common endodontic surgeries, performed with state-of-the-art diagnostic and surgical tools.

• Often local anesthesia is all that is needed. If you are interested in sedation, discuss your options with your dentist. Once the area around the root is numb, an incision is made in the gum tissue to allow access to the root and any affected bone tissue.
• Your dentist will carefully remove a few millimeters from the tip of the root, then clean the infected part of the root and remove any inflamed or infected tissue from the bone surrounding it. The root will be filled and the tip sealed.
• Sutures will be used to close the incision, which will dissolve on their own or be removed at a follow-up visit.
• Your dentist will let you know just how to take care of the site after surgery. You should follow post-op instructions carefully to reduce any swelling, and be sure to follow any dietary suggestions and restrictions.
• Pain or sensitivity after the procedure can be treated with over-the-counter anti-inflammatory pain relief such as ibuprofen, or your dentist might prescribe prescription pain relief. Your dentist will also prescribe antibiotics as necessary to treat infection.

Most often, an apicoectomy is performed when infection occurs after a root canal procedure. (Your dentist may also recommend this procedure if you have calcium deposits in the root, if a crown or bridge makes a typical root canal impractical, or if the root of a tooth or the bone around it suffer trauma.) Common symptoms of infection include:

• Pain which can be mild or very intense
• Sensitivity to pressure or temperature
• An abscess, pus, or discolored discharge near the tooth
• Swelling, redness, or tenderness in the gums and tissues around the tooth
• A foul taste in the mouth or persistent bad breath

If you have recurring or new pain or symptoms of infection after a root canal, see your dentist promptly. Left untreated, infection can destroy tooth, gum, and bone tissue. An apicoectomy can be your best option to preserve your tooth and protect your dental health.

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Knowing what to expect after your first orthodontic appointment will help alleviate any anxiety or concerns you may have about treatment. Your orthodontic team will do what they can to help you feel at ease, such as answering all your questions and discussing possible financing options.

What happens at the initial appointment?

• Introductions: Getting braces for the first time can be daunting, so it’s important that proper introductions are made to help ease anxiety. You will meet with your orthodontic team; they will do everything they can to make sure you’re comfortable.
• Paperwork and health history: A team member will ask you to fill out paperwork regarding your relevant health history. It also informs your orthodontic team if you’ve had X-rays in the past or any previous oral issues you may have experienced.
• Exam and X-rays: During a thorough examination of your teeth, an orthodontic team member will use advanced 3D scanning, X-rays, and visual inspection. This helps them understand the unique needs of your teeth to build an effective treatment plan.
• Treatment plan: Generally, there may be a few orthodontic treatment options available to you. Together with your team, you will decide which plan works best for you. This can even be based on budget, predicted results, and treatment length.
• Patient questions: Once a treatment plan has been chosen, you will be given the floor to ask any and all questions. Your orthodontic team wants to make sure you have a solid understanding of what to expect in the next coming months, so questions are highly encouraged in order to address concerns and alleviate anxiety.
• Finances: A team member will review your insurance and discuss the payment options for your treatment. Some orthodontic offices offer flexible financing options or payment plans to help make costs more manageable.
• Your next appointment: Once your first appointment is completed, a team member will schedule your following appointment to put your treatment plan into action.

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Metal Braces

Traditional metal braces are the most common type of braces, as they correct a variety of orthodontic conditions and are generally the most affordable. Made of high-grade stainless steel, metal braces straighten your teeth using metal brackets and archwires. With metal braces, you have the option of adding colored elastics (ligatures) for a unique and colorful smile.

Self-Ligating Braces

Traditional braces make use of bands around the brackets to hold the adjusting wire in place. “Self-ligating” means “self-binding” or “self-tying.” These braces use brackets, but with a very different design. Self-ligating brackets have mechanisms such as doors or clips, which hold the wire to the bracket without the need for rubber bands or metal ligatures. Without these ligatures, brackets are smaller and less noticeable. They also don’t need as many adjustments, so you’ll require fewer appointments and generally undergo a shorter treatment time.

Clear Braces

Clear braces use brackets made of clear or tooth-colored ceramic, which blend beautifully with the color of your tooth. The elastic ligatures, or rubber bands, can be chosen to match the brackets or your enamel.

Clear brackets can sometimes be somewhat larger (though this isn’t always the case), and, because they can be more abrasive than their metal counterparts, they are often recommended for upper teeth only.

Clear Aligners

Clear aligners use a series of custom-made trays that shift teeth gradually into place. For patients who need mild-to-moderate corrections, this can be a great option.

In addition to being clear, you can change your aligners at home instead of having to visit our office every few weeks. They can even be removed while you eat, brush, and floss.

Lingual Braces

If you want corrective braces but don’t like the look of traditional braces with the metal showing on the front, you have an alternative in lingual braces. As opposed to metal braces visible across the front of the teeth, lingual braces are placed on the backsides of the teeth. Most of the metal in lingual braces is not visible to other people, unless you have widely spaced teeth.

Lingual braces are just as effective as traditional braces and are worn for the same amount of time. They are helpful for people who play contact sports or play wind instrum

• Created in Orthodontics

Metal Braces

Traditional metal braces are the most common type of braces, as they correct a variety of orthodontic conditions and are generally the most affordable. Made of high-grade stainless steel, metal braces straighten your teeth using metal brackets and archwires. With metal braces, you have the option of adding colored elastics (ligatures) for a unique and colorful smile.

Self-Ligating Braces

Traditional braces make use of bands around the brackets to hold the adjusting wire in place. “Self-ligating” means “self-binding” or “self-tying.” These braces use brackets, but with a very different design. Self-ligating brackets have mechanisms such as doors or clips, which hold the wire to the bracket without the need for rubber bands or metal ligatures. Without these ligatures, brackets are smaller and less noticeable. They also don’t need as many adjustments, so you’ll require fewer appointments and generally undergo a shorter treatment time.

Clear Braces

Clear braces use brackets made of clear or tooth-colored ceramic, which blend beautifully with the color of your tooth. The elastic ligatures, or rubber bands, can be chosen to match the brackets or your enamel.

Clear brackets can sometimes be somewhat larger (though this isn’t always the case), and, because they can be more abrasive than their metal counterparts, they are often recommended for upper teeth only.

Clear Aligners

Clear aligners use a series of custom-made trays that shift teeth gradually into place. For patients who need mild-to-moderate corrections, this can be a great option.

In addition to being clear, you can change your aligners at home instead of having to visit our office every few weeks. They can even be removed while you eat, brush, and floss.

Lingual Braces

If you want corrective braces but don’t like the look of traditional braces with the metal showing on the front, you have an alternative in lingual braces. As opposed to metal braces visible across the front of the teeth, lingual braces are placed on the backsides of the teeth. Most of the metal in lingual braces is not visible to other people, unless you have widely spaced teeth.

Lingual braces are just as effective as traditional braces and are worn for the same amount of time. They are helpful for people who play contact sports or play wind instruments because lingual braces don’t get in the way. Finally, lingual braces are a great option for patients who are sensitive to plastic and can’t wear other types of clear or invisible braces.

ents because lingual braces don’t get in the way. Finally, lingual braces are a great option for patients who are sensitive to plastic and can’t wear other types of clear or invisible braces.

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Elastics

Elastics are small rubber bands that help move teeth into proper alignment. Typically, one side is connected to the top jaw and the other side to the bottom jaw, and are helpful in creating an ideal bite.

Forsus Nitinol Flat Spring

A Forsus is a small rod with a spring surrounding it, and is meant to replace or prevent the need of a headgear or even jaw surgery. These are typically used to address overjet or an overbite.

Headgear

A headgear is used to treat patients with either an overbite, where the front jaw extends well beyond the lower jaw, or an underbite, where the lower jaw rests in front of the top jaw. Headgear gently “pulls” on the orthodontic appliance in your mouth to encourage ideal jaw placement.

Herbst® Appliance

This appliance attaches to the back teeth and applies constant forward pressure on the lower jaw, and constant backwards pressure on the upper jaw in order to correct an overbite.

Palatal Expander

This device is used to widen the upper jaw. Adjustments are made periodically to maintain pressure on the jaw so that it keeps growing. Once you’ve achieved desired expansion, you will wear the appliance for several months to solidify progress made.

Positioners

Similar in feel to clear plastic retainers, positioners are used to complete final tooth movement and placement without the need for braces.

Retainers

Made from plastic, metal, or a combination of both, retainers are necessary to help keep your teeth in place once your braces come off.

Separators or Spacers

Separators or spacers are tiny rubber bands that are placed between your back teeth. The bands push the teeth apart, making space for metal bands, which hold other appliances in place, like braces or palatal expanders.

Twin Block Appliance

The twin block appliance is made of two acrylic blocks that work together to advance the lower jaw position and correct an overbite. This appliance is made to be worn full time, including while eating, though it is removable for easy hygiene.

Mara Appliance

MARA stands for Mandibular Anterior Repositioning Appliance. It is not removable and anchored to the molars, requiring periodic adjustment by your orthodontist. It works to encourage lower jaw growth to correct severe overbites.

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Thumb sucking is a damaging habit that can cause tooth and surrounding skeletal structures to develop abnormally as your child grows. If your child has a persistent thumb sucking problem past the age of four to five, thumb and finger appliances, or thumb sucking appliances, can help your child stop this habit.

There are a variety of appliances available, each one different from the other, and they all do the same thing: they prevent your child from placing their thumb into their mouth. Over time and with consistent wear, your child’s thumb sucking days will be over.

Types of Thumb Sucking Appliances

There are five types of thumb sucking appliances available to your child. Choosing one just depends on the severity of the habit and what will work best for your child. These types include:

• A removable appliance can be removed and replaced in the mouth at any time. This appliance will only work if your child constantly wears it as instructed. A child who does not want to stop their thumb sucking habit will more than likely remove the appliance often. Because of this, the success rate of removable thumb sucking appliances is quite low. However, a great advantage to this type of appliance is that it can be removed before eating and thorough cleaning of the teeth and gums can continue without it inserted.
• A fixed appliance cannot be removed from the mouth at will. Thumb suckers will have no choice but to break their habit. However, since they cannot be removed, eating, speaking, and thoroughly cleaning your child’s teeth and gums will be a little more challenging.
• A thumb crib uses a sort of cage or fence that rests just below the roof of your child’s mouth. Thumb crib appliances work by preventing the pressure and sucking sensation at the roof of the mouth. Without the comforting stimulus that comes with thumb sucking, the habit is deemed useless by the wearer over time.
• A bluegrass appliance involves a roller, which is placed at the front half of the roof of the mouth. Instead of sucking their thumb, your child is given the alternative of turning the roller over with their tongue. This device is based around positive reinforcement and is less aggressive. It can be placed in children as young as six or seven years old.

How long should my child use this device?

The appliance can be used to break a thumb sucking habit until it stops altogether, but it also needs additional use after the habit breaks. This is to ensure that the habit does not promptly return. Typically, for children with mild to moderate thumb-sucking habits, it is worn for around three to six months. A persistent thumb sucker may need to use the appliance for a year.

Benefits of Thumb Sucking Appliances

More than just breaking the habit of your child sucking their thumb, there are other great benefits to using this appliance.

• Allows proper development of the upper jaw and front teeth: Thumb sucking constricts the upper arch, flares the upper teeth, and tips the lower teeth back.
• Increased confidence and self-esteem: Thumb suckers are often embarrassed of the act of thumb sucking and of the physical changes it does to their teeth and bite.
• Easier to speak and eat: The changes in the position of a thumb sucker’s teeth make it challenging to speak and bite into food. Your child may be self-conscious about smiling, speaking, and eating in public.

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Temporary anchorage devices (TADs), also known as “mini implants,” are titanium devices that are screwed into your gum and jaw. TADs act as anchors to support the movement of your teeth. They can be positioned in different areas of your jaw, depending on what anchorage and movement you need. Since they essentially become part of your body for a time, they are specifically compatible with human tissue.

A Simple Procedure

Your orthodontist will begin the procedure by using a local anesthetic to numb a small portion of your gum, specifically where the TAD will be anchored. When your TAD is inserted, you should only feel slight pressure. Some discomfort may occur after the procedure is finished and the anesthetic wears off. Over-the-counter pain medication will be enough to alleviate your residual pain.

It’s as simple to remove a TAD as it is to insert one. It is a quick and painless process that requires no anesthesia. After a few days have passed since its removal, the site generally heals with no lingering pain.

Taking Care of Your TAD

While the chance of your TAD getting infected is small, it’s important to prevent this from happening. The following are some helpful tips to take care of your TAD:

• After the TAD is inserted, it’s recommended to rinse your mouth twice a day for five days with an antimicrobial mouthwash. After five days, you can just dip your toothbrush into the mouthwash and gently clean around the TAD every day.
• Do not use an electric toothbrush while there are TADs placed in your mouth.
• Refrain from touching or fidgeting with your TAD.
• Your orthodontist may recommend that you switch from your normal toothpaste to one that kills oral bacteria.

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Teens should begin orthodontic treatment between the age of 11 and 13, especially if they experience oral problems such as a bad bite, tooth gapping, or misaligned teeth. During adolescence, the body is still growing and developing, making it more malleable to work with. Today, there are a variety of orthodontic treatment options, such as traditional metal braces, clear braces, and clear aligners. Teens can rest easy knowing that whichever appliance their treatment plan requires, it will improve their appearance and facial function in a short period of time.

Types of Orthodontic Appliances

It’s important to know that oral problems requiring orthodontic treatment do not improve over time; they actually get more difficult to treat. Below are several orthodontic treatment options from which you can choose:

• Clear aligners: Perfect for patients who desire a more discreet way of correcting their teeth, clear aligners use transparent plastic trays to fix mild to moderate orthodontic problems. Even though they are removable, you will need to wear them often, no less than 20 to 22 hours a day. Teens will need to decide if they will be diligent in wearing them enough so that they are effective.
• Ceramic braces: These braces are attached to each tooth and connected with an archwire. Teens won’t have to worry about how much time they’ve worn them because they straighten their teeth all day, every day. Their treatment plan will also move forward smoothly. Ceramic braces are a common alternative to clear aligners as they use tooth-colored material.
• Lingual braces: Similar to braces that also use brackets and wires, these braces are placed on the back of the teeth facing your tongue, rather than the front of your teeth. Lingual braces are used for correcting teeth misalignment, and they are also almost completely invisible.
• Self-ligating braces: These braces look like traditional braces; however, they lack the ligature, which is the elastic that is wrapped around traditional braces. Clips and brackets encourage your teeth to move in their correct places. Self-ligating braces have also been known to produce less pain and discomfort.
• Metal braces: An orthodontist’s go-to for treatment, metal braces are great for teeth that move significantly. Clear aligners cannot do the same. With the advancements of technology, traditional braces are lighter and more versatile.
• Growth modification appliances: Most commonly used on younger patients, growth modification appliances help correct an overbite without tooth extractions. Since this appliance modifies the growth of bone, it is the perfect choice for teens and children who are still physically developing, as their bone tissue is more pliable. This treatment is also used for patients who have an underlying jaw discrepancy due to genetics, trauma, or bad habits.

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Getting your braces off is definitely a cause for celebration. You can finally enjoy your new smile after all that work and effort! But getting your braces off isn’t the end of treatment. Once your braces come off, you will enter the retention period of treatment.

During the retention period, you will be given a retainer to wear for at least 22 hours a day, for at least 24 months. After the retention period, you can wear your retainer less, going from nightly to only a few nights a week.

If you don’t wear your retainer, your teeth might revert to their former position, and you will lose the progress made. Teeth aren’t set in the jawbone, instead, they are held in place by a network of fibers called periodontal ligaments. After teeth have been moved, it takes several months for the periodontal ligament to support and adjust to new positions of the teeth. When you wear your retainer, you are supporting the periodontal ligaments and making sure that your teeth stay exactly where you want them.

In most cases, you will be fitted for a retainer right after your braces come off, and it will be made and prepared for you in office. There are three types of retainers:

• Hawley retainer

The most popular and durable type of retainer, the Hawley retainer is designed with a thin, tongue-shaped mold that holds a wire across your teeth to keep them in place.

• Clear plastic retainer

These look and feel like clear aligners. They are made from plastic to fit exactly over your teeth and secure them.

• Fixed bonded retainer

A fixed bonded retainer is typically used on the front bottom teeth. A small wire is cemented to the tongue side of the teeth to keep them in place.

It’s important to clean your retainers. For Hawley retainers, you can brush them with a regular toothbrush. For clear plastic retainers, denture cleaner might be the best option. Fixed retainers have similar cleaning methods to braces, and you’ll likely need special tools to floss underneath the wire.

It’s also very important to carry your retainer case with you. So often, retainers are lost in a napkin and accidentally discarded. Retainers must also be kept away from very hot water, as that can warp them. With proper care, a retainer can help you keep your new smile.

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Orthodontic headgear is used to correct a severely abnormal bite, correct dental overcrowding, and support normal jaw alignment and growth. It is typically recommended for younger children whose jaws are still developing.

Types of Orthodontic Headgear

Whereas braces are permanently fixed on the teeth, headgear can be removed and is worn partially outside the mouth. Depending on the patient’s needs, there are three types of orthodontic headgear your orthodontist can choose from:

• Cervical Pull: This type of headgear is used to correct a malocclusion called an overjet, which appears as a protruding top jaw and front teeth. This device can also correct overbites, which is when the top and bottom teeth don’t meet properly. Cervical pull headgear uses straps that wrap around the neck and attach to the braces in the mouth.
• High Pull: This type of headgear corrects an overjet or overbite. Straps are attached from the upper jaw to the top and back of the head. This device is also used in children with excessive jaw growth in the back of their mouth.
• Reverse Pull: This type of headgear is used for underdeveloped upper jaws or underbites. When the lower teeth jut out past the upper teeth, it results in an underbite. This device uses rubber bands to attach to braces on the top teeth.

Using Orthodontic Headgear

It is vital to follow the orthodontist’s instructions when using headgear. Successful treatment can only be achieved if the device is worn anywhere from 12 to 14 hours a day, sometimes longer. A strict routine is important, for even small lapses will inhibit the rate of treatment. In total, headgear may be required anywhere from one to two years.

Orthodontists understand that wearing such a device in public may be embarrassing. That is why they recommend wearing the headgear promptly after school, through the rest of the evening, and overnight.

Discomfort is normal, especially when using headgear for the first time. At each visit, the orthodontist will adjust the headgear, and it could feel like there is more pressure being applied on the jaw. This sensation is very temporary. If discomfort does not lessen, over-the-counter pain medication may be taken to relieve pain. Additionally, cold foods such as popsicles may provide some relief.

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