Frequently Asked Questions
1. Why do people need braces?
There are many reasons one person may need braces: crowded teeth, missing teeth, extra teeth, jaws not growing right, bad overbite, open bite and the list continues. Not everyone needs braces if they go early enough to the orthodontists and have their teeth checked out.
2. What is the best age for braces?
There is NO best age for braces as all ages can be treated. However, the best time to be seen by an orthodontist is around 7 years old. At 7, any jaw growth problems can easily be corrected.
3. What is Phase I Treatment?
It means that if a problem exists (such as a bad overbite or a lot of crowding of teeth) treatment can or will be started as early as 7 or 8 to correct the problem. Most of the time, Phase I Treatment can save the patient from extraction of good permanent teeth, headgear or major jaw surgery.
4. What is Phase II Treatment?
Phase II Treatment is treatment with “braces”. Patients who have had Phase I Treatment to take care of a major problem (severe overbite or crowding) may need some type of Phase II Treatment with braces to detail their bite. However, not everyone needs Phase II Treatment. For someone who does not have Phase I Treatment but needs braces, they go directly to Phase II Treatment (that is, treatment with full braces).
5. How do braces work?
Braces work by putting light forces on teeth through special wires. Orthodontists also use special rubber bands to bring teeth into the right position. Treatment takes some time because teeth move slowly (only 1mm a month or less) into the right position.
6. Does it hurt to put braces on?
No, the braces are put on with special cement. However, in the beginning, teeth may become a little sore once they start moving.
7. How long does it take to put braces on?
The appointment to put the braces on is 1½ hours but to actually cement the braces in place will take approximately 10-15 minutes.
8. How long does treatment take?
Depending on the severity of a case, it could take as little as 6 weeks or up to 20-24 months for complete treatment. Once treatment is started, a patient would be seen every 8-12 weeks depending on their needs.
9. Do you talk funny with braces?
Just like anything new, it takes about a week to get used to the feeling. Most people adjust very well and have no problems.
10. Can you play sports with braces?
Yes, but with much care. You may need a mouth-guard to prevent injury and damage to the braces, your teeth and gums. We will gladly provide one for you.
11.Can I eat anything with braces?
No. There are some restrictions. We ask that you avoid sticky or hard foods (such as caramel, sticky gum, candy, popcorn, etc.). A little extra care with what you eat can go a long way and can prevent braces from breaking or becoming loose.
12.Can you get a “shock” if braces are touched with something metal (fork, spoon, etc.)?
Usually not.
13.Can the braces set off alarms in stores or airports?
No, the metal is stainless steel and does not set off alarms.
14. What are rubber bands and why do people need them?
Rubber bands bring the teeth together to make them fit perfectly. Most people need them at the end of treatment for a couple of months.
15. What are retainers and who needs them?
After treatment is finished, retainers are given to hold the teeth in position until they become used to their new “home”. All patients need retainers and Dr. Petrol will instruct you to wear them according to your personalized needs.
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Tongue Thrust
The Inside Story
Dr. Petrol cares not only about the correction of your teeth, but she is also concerned that your teeth remain as nice as they possibly can. If a potential tongue thrust problem has been discussed, naturally you’ll want to know all you can about this additional therapy. This information can help. These are the questions most often asked about Orofacial Myology and the answers will give you the inside information.
Q. What is “tongue thrust”?
A. “Tongue thrust” is the everyday name for an orofacial muscle disfunction. It refers to the resting of the tongue against the teeth, and/or pushing the tongue against the front or side teeth, or both, during swallowing. This force or pressure generally causes the teeth to move.
Q. Is this something new?
A. Although information about tongue thrust is not yet widely known, the dental field has been studying the problem since the 1930’s. In addition, speech pathologists began actively doing research and therapy for tongue thrust in the 1950’s, Research and treatment are ongoing today.
Q. Do many people have this problem?
A. You’re definitely not alone! A tongue thrust type of swallow is present in all babies, in about half of the population of five-year-olds, and in about one third of eight-year-olds. This is the age when it is most noticeable, It is also present in one-fourth to one-third of adults.
Q. Do I really swallow that often to hurt anything? And how does swallowing affect the position of my teeth?
A. Most people swallow between 800-1500 times each day. We all swallow saliva 24 hours a day, in addition to liquid and food during meals and snacks. A person with a tongue thrust problem exerts at least a pound of pressure against the teeth every time he or she swallows. This frequent force, combined with resting the tongue against the teeth most of the day and night, can potentially cause considerable tooth movement.
Q. Now that I’m aware of the problem, couldn’t I correct it on my own?
A. Trying to do this does not usually result in a permanent change. Learning the new swallowing technique involves more than a position change. It is a series of movements requiring the coordinated efforts of eight oral-facial muscles. Normally, people with a tongue thrust problem use only one or two muscles.
Q. What will happen if I don’t change my tongue thrust swallowing pattern?
A. The end result is that your teeth may go back to, or stay, in their malocclusion. Your openbite, or overjet (protrusion of the teeth), or spaces between your teeth, will remain the same, or possibly get worse. If you don’t have braces on your teeth yet, this is the ideal time to begin therapy! Otherwise, your teeth may continue to move in the direction that you don’t want them to. Braces may only temporarily fix the problem. Relapse is very probable.
Q. I am already wearing braces. Why wasn’t I told about this problem sooner?
A. Tongue thrust is not always readily observable at first glance. Although most orthodontists/dentists and their staffs thoroughly check every patient, at times, for various reasons, the tongue thrust is not identified right away. When the teeth are especially difficult to correct or they relapse into their former position, this then signals a potential tongue thrust problem. As both professionals and the general public become more informed about this muscular dysfunction, it is anticipated that it will be identified sooner in the orthodontic process.
However, you should be aware that if you are currently wearing braces, your tongue thrust could be competing with the re-alignment of your teeth and interfering with the purpose of the braces. You could end up wearing your braces longer than you had planned.
If you have worn braces, and they are now off, there is a good possibility that your teeth may lapse back to or near their original position. We certainly don’t want that to happen!
Q. I’m still not sure that I (or my child) have this problem. What are some of the symptoms of tongue thrust?
A. Some of the symptoms of a possible tongue thrust problem are:
1. Low, forward tongue resting posture.
2. Breathing through an open mouth, instead of the nose.
3. Thumb-sucking, as a small child.
4. Problems saying the “s” sound. If you’re still not sure, pay attention to where you place your tongue when you are relaxed. Does your tongue rest in the middle of your mouth and/or does it touch the front teeth?
Q. Is there a “best” age to successfully enter myo-functional therapy?
A. A mature seven-year-old can usually understand the principles of the full therapy program, and will accept the responsibility for practicing. However, younger children can learn basic corrective techniques.
Q. Is there an upper age limit for successful therapy?
A. Happily, there is no upper age limit, Adult patients are well motivated, practice faithfully, and consequently, make excellent progress.
Q. I’ve been swallowing this way for a long time. Does “myo-functional therapy” really work to correct my tongue thrust?
A. Yes. Myo-functional therapy really can work, and it can be the critical factor in maintaining your straight teeth. Although most of us typically don’t think about how we swallow, we can learn to focus on the swallowing process and make changes. The activities are easy to understand and to do.
One final note—as this basic swallowing problem becomes more widely known and identified, you will see many people who call themselves “professionals” advertising this type of therapy. Be sure to choose a therapist who is a certified Orofacial Myologist, preferably accredited through the International Association of Orofacial Myology (IAOM). It is also beneficial to choose a specialist who has a degree or background in either speech pathology or a dental field.
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The Braces
We are pleased you have chosen our office to provide your orthodontic care. We enjoy working with both young people and adults. Helping people improve their appearance and dental health is our greatest reward.
Dr. Petrol is committed to providing you with the best possible orthodontic care.
Success in your treatment depends largely upon patient cooperation. If braces are worn properly and checked regularly, the best results can be attained in the shortest amount of time. Both the estimate of time required to complete treatment and the fee for this care are based on the assumption that there will be full cooperation.
Orthodontic Treatment is a Team Effort and you are the Star Player!
Know the Appliance:
1. BAND
2. BRACKET
3. TIE WIRE
4. ARCHWIRE
5. ELASTIC LIGATURE
6. ELASTIC
7. HEADGEAR TUBE
8. BUCCAL TUBE
1.Brackets or bonds are �glued� onto the front surfaces of the teeth. They work only when they remain glued to the teeth. Patients will break the brackets or bonds off the teeth if they eat the wrong type of foods, have a habit of �picking at their teeth�, chewing their fingernails, pens or pencils or are accidentally hit in the mouth.
2.Bands are cemented around the entire tooth. A great deal of care is taken to find the right size band to fit each tooth. Bands will become �loose� if the cement bond breaks down between the tooth and the band. Chewing sticky foods and large wads of bubble gum will actually pull the band off the tooth.
If a band or bracket loosens, please call the office for an appointment to have it removed, replaced, or re-cemented. If a band comes off, bring it to the office in a small box so it won’t be crushed. Unnecessary delay may cause gum irritation, tooth decalcification or possibly decay.
3.Separators are placed between certain teeth to make room for the bands. They will feel like a piece of meat is caught between your teeth. They may cause a slight bit of discomfort depending on how tight your teeth fit together. You may wish to take some Tylenol. If they should fall out, please call the office. It might be necessary to replace before your Banding appointment.
4.Arch Wires are the main wires, which act as tracks for the teeth to follow.
A-Lastics or Ligatures�are used to tie the arch wires to the brackets. A-Lastics are tiny rubber bands and ligatures are tiny fine wires. Occasionally a ligature loosens and will jab into the inside of your mouth. Just push it back into place using a pair of tweezers or eraser.
Bite Plates: If you are required to wear a bite plate, it should be worn ALL THE TIME except while eating or if instructed otherwise. Always bring it with you to your appointment.
Headgear: If you are required to wear a headgear, it should be worn NO LESS THAN 14 hours a day. It has many uses and is a CRUCIAL part of your treatment. Always bring it with you to your appointment.
Retainers: When treatment reaches the stage that the braces are to be removed, you will be fitted with a retainer. The retainer is a very important part of treatment and should be worn until the teeth are in a fixed position. It is important that you wear your retainers as instructed; otherwise the teeth maydrift back to their original positions. In certain situations, retainers must be worn indefinitely to insure stabilization of teeth. Think of your retainers as pajamas for your teeth! You might wish to wear them nightly!
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At what age should someone come in for an exam?
We recommend that children have their first orthodontic appointment between the ages of seven and eight. If you are past that age, don’t worry! We have procedures designed specifically for adults, and as long as you have the desire for straight, aesthetically pleasing teeth, we’re the place for you!
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Will any of this hurt?
At the start of treatment, it is not uncommon to have some irritation of the tongue, lips, or cheeks. This can be relieved with warm salt-water rinses 4-6 times a day and usually dissappears in a few days. Also, there may be some mild discomfort from tooth movement. If there is any pain, headache medicine such as Tylenol should help.
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How long will I have to wear my braces?
Duration of treatment varies on the complexity of your case. Each case is different, but as a general guideline, our new technology allows us to reduce the typical 24-month treatment time to 18 months or less!
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Will I still be able to play sports while in treatment?
Absolutely! Most of our teenage and adult patients participate in sports. The braces of tomorrow are designed with the activities of today in mind. There are a variety of mouth guards and protective appliances specially designed to protect your mouth and braces.
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What foods should I avoid while in treatment?
While in treatment, it is important to minimize the consumption of foods that are high in sugar. We have also found that chewing on pens, pencils, fingernails, and hard, sticky, or chewy foods can damage your braces. Some aditional foods to avoid are: caramel, Tootsie rolls, Doritos, gum, taffy, and other foods of that nature. In addition, it is important to cut all foods into smaller, bite-sized pieces for consumption.
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What should I do if a bracket comes loose or an appliance breaks?
If anything breaks or comes loose, please call our office as soon as possible to let us know and make schedule changes accordingly. If a bracket comes loose, you can attempt to isolate it and fix it into place using wax until you can be seen. If anything such as a retainer or any Phase I appliance break, please save the pieces so they may be repaired.
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Do I still need to get my regular dental checkups?
Absolutely! We have a strong working relationship with out referring dentists. General hygiene is vital to the strength and cleanliness of your teeth. Regular brushing and flossing are necessary for your teeth to stary healthy and great-looking when your braces come off.
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When my braces come off, will I have stains on my teeth?
Our smaller brackets make it easier to clean your teeth than normal braces, which means a lessened chance of staining. That’s one reason we developed the skills to use the braces we do–to keep your teeth in tip-top shape. With proper home care and regular visits to your family’s dentist, staining should not be a problem.
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How much does it generally cost?
The cost of orthodontic treatment varies due to the type of treatment decided upon and the number of months necessary to complete treatment.
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The consultation appointment consists of a thorough clinical examination followed by a comprehensive discussion. Dr. Kogod and his staff are compassionate and sensitive to the anxiety that some children and adults have before their consultation appointments. They are nervous and more concerned that they experience pain during the examination. Often people are just “scared that it’s going to hurt.” Since people may never have been seen in an orthodontist’s office, their only reference is their experience with a dentist. At the dentist’s office they may have received injections with needles to have a cavity removed with a drill. For orthodontic examination, no needles or drills are used. The examination does not hurt; the examination is absolutely painless.
Dr. Kogod is interested in learning the reason or reasons why orthodontic treatment is being considered. For example, some adults have said, “I don’t like the way my teeth look.” Or others may say, “I’ve noticed over the years that my teeth have shifted.” For others, they may have lost a tooth and their dentist suggests straightening their teeth before an implant can be put in.This is referred to as the chief complaint. Any relevant background information is also helpful. For example, “I had braces as a child, but I didn’t wear my retainers” or “My teeth started to shift before my wisdom teeth were taken out” or “I grind my teeth at night.”
For most children, their dentist or pedodontist has observed a problem with the bite or a problem with erupting adult teeth and has recommended an orthodontic consultation. For example, a parent may be told that there is a problem with the back teeth, like a crossbite or that there is not enough room for an erupting adult tooth; or that there is a problem with the front teeth, like an open bite, commonly due to a thumb sucking habit. These are common problems that occur in younger children who have a combination of baby or primary teeth and adult or permanent teeth.
Dr. Kogod, just like the dentist, will look at your teeth. But as an orthodontist, Dr. Kogod also looks closely at the shape of your face, especially at your profile. Dr. Kogod believes that the difference between a good orthodontic treatment result and a truly spectacular orthodontic treatment result has to do with where those teeth are in the face. Dr. Kogod and the orthodontists with a similar treatment philosophy refer to this as “face-driven” treatment. So, for Dr. Kogod, his examination of you or your child starts with the profile.
Anything you can tell Dr. Kogod about your or your child’s teeth and mouth is helpful. These include night grinding; acid reflux; speech issues; mouth breathing; and tongue thrusts. Family histories are important and may be helpful since the occurrence of missing teeth is a trait that is passed along genetic lines.
To summarize, the examination is a process where Dr. Kogod essentially takes an inventory of the your facial features, teeth and gums, and jaw joints so that he can tell you exactly what is necessary to properly fix your teeth. Dr. Kogod will explain everything to you in plain English. He will give you his opinion with regard to the appropriate orthodontic treatments that could be used to address your chief complaint and to correct the alignment of your teeth or bite problem. He will answer any questions that you might have and respond to other orthodontic opinions that you may have gotten previously. And finally, Dr. Kogod will tell you how long it will take to complete treatment.
The office manager or patient coordinator will give you the TREATMENT FEE and discuss the FLEXIBLE AND CONVENIENT PAYMENT OPTIONS. She will explain the next step in the process, DIAGNOSTIC RECORDS, and give you the fee for the records.
Understand that you have made no commitment to proceed with treatment if you have records taken. The diagnostic records are absolutely necessary, however, for Dr. Kogod to thoroughly review. Although Dr. Kogod is completely confident with the information he has discussed with you during the consultation appointment, he thoroughly analyzes the diagnostic records to confirm his diagnosis and to finalize your orthodontic treatment plan. The diagnostic records are yours. You may take them with you to obtain additional orthodontic opinions.
In Dr. Kogod’s office, you will NEVER feel pressured to hastily make a decision. As Dr. Kogod frequently says, “There is no emergency here!” Dr. Kogod says that “there is a best time for everybody” and refers to “windows of opportunity.” With regard to orthodontic treatment for children specifically, there are periods in a child’s development when certain bite problems can be treated most easily and effectively with the greatest opportunity for a successful treatment outcome.
With regard to teen and adult orthodontics, Dr. Kogod understands that for most people, they have been thinking about “fixing their teeth” for a long time. He knows that for most teenagers and adults, they have been battling with their parents or themselves just to make the consultation appointment; just to find out what it would take to fix their teeth; even though they already know that they need braces, but remain hopeful that there is the slightest chance Dr. Kogod will say that all they need is a retainer. Dr. Kogod understands this. Again, Dr. Kogod will tell you exactly what you need to know so that you can “think about it.” When you leave, however, unlike when you came, will have all the information you need to make an INFORMED decision for you or your child. Be assured that Dr. Kogod and his staff will be there when you are ready.
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Thumb Sucking
THE THUMB SUCKING DILEMMA
What? Me worry?…
One troubling concern for parents of small children is non-nutritive sucking of thumbs, fingers, pacifiers, or bottles. Will non-nutritive sucking (NNS) lead to orthodontic or facial growth problems? At what age does damage start? Should I encourage my child to stop sucking or wait until the habit is given up naturally? Will forcing a child to give up NNS cause them to develop a substitute habit or psychological disturbance?
Authorities in the field of dental and facial development agree that prolonged NNS can lead to disturbances in tooth position, facial growth and speech development.
The amount of damage is related to the frequency, intensity and duration of the habit, and often needs to be professionally evaluated. The important thing to realize is that the digit or pacifier sucking habit is only part of the picture. The real danger is that the sucking habit changes the dental and oral environment in ways that encourage other, more permanent, problems such as tongue thrust swallowing and abnormal resting position of the tongue. These habits are dangerous because they are more difficult to observe. They are subconscious and therefore, hard to break, and they often continue the problems of facial and dental development even after the NNS habit has been given up.
Studies show that 50%-70% of children have NNS habits in the first year of life. During this period, NNS is considered normal and perhaps even beneficial. By age four, this percentage is reduced to 25%. By this age, any real benefits of NNS are gone, and all that remains is empty habit. The danger of permanent effects on teeth and jaws is becoming very real. In addition, there are other health and social adjustment problems such as peer rejection which can become problematic as a child makes the transition from close ties with parents at home to a school environment.
Methods of discouraging NNS habits vary greatly, ranging from simple behavior modification problems, to reminders and mild impedances like a sock or glove, to dental devices such as “rakes” or “spurs” that definitely make sucking less pleasurable. Scientific studies have shown that encouraging a child to give up an NNS habit rarely causes the development of nervous habits. To the contrary, giving up sucking usually marks a period of improved self-esteem and social adjustment.
Factors common to all cessation methods are; the desire to stop on the part of the child, the maintenance of the child’s self-esteem and the caring support of family and involved professionals. It is important that the child views the habit correction not as punitive but as something that is beneficial and will help him or her accomplish a goal.
Age five is then the upper limit of when non-nutritive sucking should be discontinued. Warning signs to look for are:
DENTAL AND FACIAL WARNING SIGNS
*Upper front teeth spaced or protruding in front of lower front teeth.
*Upper front teeth don’t show enough and seem pushed up under the lip.
*Bite is “open” in front and upper teeth don’t cover the lowers.
*Tongue seems visible or protruding.
*Upper row of teeth appears to narrow for the face.
*Lips are apart at rest.
*Lower jaw often seems to be moving or wiggling.
*Lower jaw and chin are shifted to one side.
BEHAVIORAL WARNING SIGNS
*Age five or older.
*Vigorous sucking.
*Sucking at school or during the day at home.
*Family arguments regarding the habit.
SPEECH WARNING SIGNS
*Lisping (using the tongue to help pronounce sounds like “S”).
*Substitution of “th” for “s” as in “thither” instead of “sister.”
(Note the above speech signs are normal when upper front baby teeth are missing while being replaced by permanent teeth.)
Dental, speech or other professionals can help in ways other than by placing discouragement devices. It is often possible for an interested bu independent authority to have more impact and success in convincing a child to abandon sucking habits by pointing out the damage that is occurring. When professionals become involved, and the issue is no longer confined to the parent and the child, the sucking habit is less likely to become grounds for a parent/child power struggle.
We recommend examination by an orthodontist at age five if a habit persists, and at age seven if a habit has been given up but any of the above warning signs remain.
An excellent book with more information on this subject is “David Decides” by Susan M. Heitler, Ph.D. It is available at some book stores. We have a copy at our office which we would be pleased to loan.
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Our Philosophy
WHAT MAKES A WINNING SMILE?
IT’S MORE THAN STRAIGHT TEETH! And why do some people appear radiant after orthodontic treatment – while others have straight teeth but an unnatural appearance to their smile? The answers to these questions are found in a branch of orthodontics called Facial Orthopedics. For many years orthodontists have been improving the appearance of young people and adults by straightening crowded or poorly aligned teeth. However, some orthodontists have discovered there is more to an attractive smile than straight teeth. More important than perfect alignment is the position of the front teeth related to the rest of the face. In a “winning smile,” the teeth must properly support the lips and not appear “tipped in.” The upper teeth “fill the smile.” The profile should look attractive and balanced. These goals are not always accomplished by orthodontic treatment alone.
The bones of the upper and lower jaw are the foundation for the teeth. The growth of the jaws is considered by some orthodontists to be genetically determined and unchangeable. They wait until all permanent teeth are present and then determine whether there is enough room for the teeth. If the teeth seem larger than the jaws, this orthodontist removes some teeth so that the others will fit the small jaws. In other cases, if the lower jaw does not grow forward enough to match the upper, the upper teeth are pulled back against the lower teeth creating a very unnatural look. The lips sink inward, making the nose appear large. The face has an unnatural appearance. The teeth appear straight, but the face has changed.
An orthodontist who understands Facial Orthopedics knows that the muscles surrounding the teeth and jaws play an important role in establishing proper jaw size and alignment. Thumb sucking, mouth breathing, and improper swallowing have been targeted as prime causes of improper jaw development. He believes that is the jaws are not properly formed, orthodontic “tooth repositioning” alone cannot create a balanced face and attractive smile. The foundation must first be corrected if the end result is to be a fully natural “winning smile.” Only Facial Orthopedics can do that.
By starting treatment between age seven and ten when the head is growing, the orthodontist has a “window of opportunity” to influence the growth of the jaws and to change bad habits. He works with other medical specialists to establish proper breathing and tongue habits. He uses jaw growth stimulators and limited braces to guide the jaws to the proper size and position before the last permanent teeth erupt. In most cases, he can avoid the severe crowding and misalignment of teeth that necessitates extraction of permanent teeth. This interceptive phase of treatment lasting twelve to eighteen months is followed by an “intermission” while the remaining permanent teeth are erupting. After the early orthopedic phase of treatment and the intermission, braces are usually required on the permanent teeth to perfect their alignment for the best appearance and function. However, the length of time that braces are worn during the teen years is usually reduced. The results of this interceptive approach are a more attractive facial appearance and a “winning smile.”
Older children who have all their permanent teeth can also be helped by orthopedic procedures. Facial growth can be influenced until the mid-teens, but to a lesser degree. The orthodontist who uses Facial Orthopedics and standard braces combines the best of both methods. The advantages of this combined therapy are many:
*More balanced facial features
*Avoidance of extraction of permanent teeth
*Less time in braces during teen years
*Reduced use of headgear
*Bad habits corrected early
*Improved speech development
*More treatment accomplished early
*A “winning smile!”
If Facial Orthopedics brings about such dramatic results, why don’t all orthodontists use these techniques? Some orthodontists simply concentrate only on straight teeth and a good bite and ignore the “art” that is part of creating a beautifully balanced face and smile. Or, they may be participating in an insurance plan which does not provide for Facial Orthopedics. Of course, not all children who need orthodontics need orthopedic procedures. But, if they do, the orthodontist who is also a facial orthopedist can make a difference. He has the training and experience to combine the best treatment methods to achieve a truly radiant smile. As with all good things, extra effort is required to achieve “a winning smile.” But when it comes to your child’s facial appearance, the best result is what you should expect. We all have our smile for a lifetime. You want that smile to be the best that it can be. And that may mean starting early to build a proper foundation.
The ideal time for an orthodontist to evaluate your child is seven years of age. Although many family and children’s dentists recognize the early signs of developing problems, it is not necessary for you to be referred before calling for more information. There is no charge in our office for an initial evaluation.
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