Bloomfield Hills, MI (Michigan) Orthodontist Roy D. McAnnally, MS, PHD, DMD

FAQs

What is orthodontics?
What is an orthodontist?
What is a Board Certified Orthodontist?
Why should I have my teeth straightened?
How do braces and aligners straighten crooked teeth?
How can I tell if my child needs orthodontic treatment?
What are the early symptoms of orthodontic problems and how can I look for them?
At what age should I take my child to an orthodontist for an orthodontic screening?
Can you be too old for braces?
Will additional jaw growth allow self correction of crowded teeth visible in a eight year old?
If I wait, isn't there a chance that my child's bite will get better on its' own?
If you could look into the future
What are some potential benefits of orthodontics?
What are some signs that braces may be needed?
Is treatment more difficult for adults?
What causes crooked teeth?
Can I have my teeth straightened without having braces glued to my teeth?
What do rubber bands do?
Can I get colors on my braces?
If I don't want to show colors on my braces, what can I do to play down braces?
Can orthodontics correct TMD or jaw joint problems?
Will orthodontics improve the way I chew and digest my food?
How many people receive orthodontic care?
Will orthodontics change my lifestyle?
How long do you have to wear braces?
Will any teeth be removed?
When do you recommend extraction of teeth?
When is the best time to schedule an initial consultation?
Why should you choose a dentofacial orthopedic and orthodontic specialist?
Do you need a referral from your family dentist to see an orthodontist?
What will happen at the first appointment?
Are braces uncomfortable?
Is orthodontic care expensive?
How much does orthodontic treatment cost?
Can I negotiate lower fees with my orthodontist?
Orthodontic treatment is still costly. Is it worth the cost?
Can I pay for my children's orthodontic treatment in installments?
Can I get insurance to help pay for orthodontic treatment?
Should I attempt to acquire insurance to help pay for orthodontic treatment?
If poor bites causes so many health problems, why didn't evolution or natural selection eliminate orthodontic problems?
What is interceptive dentofacial orthopedic treatment and is it necessary?
How long does interceptive dentofacial orthopedic treatment take?
Can't I wait on interceptive dentofacial orthopedic treatment until my child is older than 7?
What steps are involved in full orthodontic treatment?
What can I expect on the initial visits to the orthodontist?
What are some of the questions commonly ask during consultation with Dr. McAnnally?
Is there anything I should do before the consultation?
Are their other treatment options that I should consider?
Should I seek a second opinion?
What are extraction and nonextraction therapies, and what are the advantages and disadvantages of each?
What is having braces like for my child?
My son/daughter does not want to get braces because they are afraid that the braces will make him/her look like a geek. Any ideas?
Do braces hurt?
What happens if my child's braces continue to hurt?
Should my children do anything special during their first week in braces?
How long do the braces take to put on?
Will it hurt to put the braces on?
What holds the braces on?
My son/daughter does not want to get braces because they are afraid that the braces will prevent them from participating in sports. Any suggestions?
My child plays a musical instrument. Will his/her ability to play be affected by orthodontic treatment?
Can my child still chew gum with braces?
Are there other foods that my child should avoid?
What happens if a bracket comes off?
What happens if my child swallows a bracket?
Why can't the orthodontist attach the braces strongly enough that the braces don't come off during eating?
Are there any other activities that my child should avoid when they have braces?
How often should my child brush their teeth when my child has braces?
How do I convince my child to brush their teeth when the child has braces?
I have noticed that some children have rubber bands in their braces. What do the rubber bands do?
How often should my child change their rubber bands?
What happens if my child leaves off their rubber bands?
What happens if my child swallows a rubber band?
What does a retainer do?
Why is a retainer needed? Do teeth move after orthodontic treatment?
What happens if my child does not wear his/her retainer?
How long should my child wear a retainer?
I notice that some braces have little colored rings around the brackets. What do the colored rings do?
What happens if my child swallows a ligating module?
Is there any chance that the sharp ends of the arch wires will hurt the insides of my cheeks?
It seems like my child is getting a lot of x-rays during their treatment. Are all of those x-rays needed?
Is there anything that can be done to minimize the x-ray exposure?
At what age should orthodontic treatment occur?
What is Phase I and Phase II treatment?
Would an adult patient benefit from orthodontics?
How does orthodontic treatment work?
How long does orthodontic treatment take?
Will braces interfere with playing sports?
Should I see my general dentist while I have braces?

1. What is orthodontics?

Orthodontics is the branch of dentistry that specializes in the diagnosis, prevention, and treatment of dental and facial irregularities. Braces, aligners, and dentofacial orthopedic appliances are devices used to make these corrections.

2. What is an orthodontist?

An orthodontist is a highly trained specialist who has completed two to three years of advanced education after graduating from dental school to learn the special skills required to manage tooth movement and guide facial development. An orthodontist not only straightens teeth but also corrects the bite and improves the skeletal harmony, facial esthetics, and airway function.

3. What is a Board Certified Orthodontist?

A Board Certified Orthodontist is a person who has completed a comprehensive written examination covering all phases of orthodontic and dentofacial orthopedic care. They also demonstrate actual accomplishment in patient care, with detailed reports on the treatment provided for a broad range of patient problems. A Board Certified Orthodontist achieves the title of Diplomate of the American Board of Orthodontics.

4. Why should I have my teeth straightened?

Orthodontic treatment improves your smile and your health. Your smile is the most striking part of your face. Look in the mirror. Do you like your smile now? Can your smile be improved? Think about how you react to someone with a pretty smile. Do you find them more attractive? Will you be more attractive with an appealing smile? Orthodontic treatment will make your smile look fabulous. The fabulous smile can last for the rest of your life. Think about how a fabulous smile will improve your life. Orthodontic treatment will also make your face look delightful. Wouldn't a delightful face be wonderful?

Your health is also affected by poorly arranged teeth that can break easily and trap food particles that cause tooth decay, gum disease, bad breath, and loss of teeth. They can also lead to poor chewing and digestion which can be bad for your overall health.

Dental problems: Crooked teeth are hard to clean. People with crooked teeth tend to have more cavities and gum problems than people who have had orthodontic treatment. Crooked teeth wear in ways that they should not. This puts extra stress on your teeth, gums, and jaw which can lead to problems later.

Breathing problems: When the roof of the mouth is narrow and the palate high, the oral pharyngeal airway is restricted. This impairs normal nasal air flow and results in a propensity to mouth breath excessively. Chronic mouth breathing has an adverse affect on the facial growth pattern and decreases the efficiency of lung and heart (cardiopulmonary) function. The additional burden on the heart can result in a weakening of the heart, heart enlargement, and lung congestion.

Lower incidence of cardiovascular disease: Statistically, children who have had braces have a lower incidence of cardiovascular disease as adults. The improvement in nasopharyngeal and oropharyngeal airway is the most likely explanation. Expansion of the dental arches and palate, and advancement of the lower jaw improves the width of the nasal passages and aids the forward and lateral posturing of the tongue. The roof of the mouth is the floor of the nose and the nasal airway improves as the palatal arch width increases. The oral pharyngeal airway is improved as the tongue can now posture itself forward and laterally. The Improved air flow results in better oxygenation of blood and discharge of the waste product, carbon dioxide. With normal nasal respiration, the air flowing into the lungs passes through the nasal apertures and increases in velocity. The lungs fill fully, and the right ventricle of the heart doesn't have to work as hard to maintain healthy oxygen levels. The concentration of oxygen in the blood increases. The concentration of carbon dioxide decreases. The burden on the heart and lungs is reduced. They do not have to work as hard to exchange gases. Mouth breathing, on the other hand, results in a lower velocity of air inflow. This is due to the larger lumen through which the air passes. Imagine, for a moment, a garden hose with and without a nozzle. Consider the velocity of the water and the distance over which it can be projected. Similarly, when the mouth breather inhales through the mouth, the velocity of the air is low, the lungs do not fill fully and the heart must work harder to maintain adequate oxygen levels and discharge carbon dioxide.

Other factors also may improve cardiovascular function. Children who get braces learn to take care of themselves, and good health habits translate into a reduced risk of cardiovascular disease. Orthodontics improves dental and periodontal health and that helps prevent oral infections which may have a direct affect on heart disease.

5. How do braces and aligners straighten crooked teeth?

Braces use steady, gentle pressure over time to move teeth into their proper positions. They don't look like they're doing much just sitting there. But in fact, every moment of your orthodontic treatment, there's something happening in your mouth. Something good for you. The brackets we place on your teeth and the main wire that connects them, are the two main components. The bracket is a piece of specially shaped metal or ceramic that we affix to each tooth. Then we bend the arch wire to reflect your "ideal" bite - what we want you to look like after treatment. The wire threads through the brackets and, as the wire tries to return to its original shape, it applies light pressure to actually move your teeth. Picture your tooth resting in your jaw bone. With pressure on one side from the arch wire, the bone on the other side gives way. The tooth moves. New bone grows in behind. It may look like nothing is happening - - but we're making a new smile here. Thanks to new materials and procedures, all this happens much quicker than ever before. It's kind of an engineering feat.

6. How can I tell if my child needs orthodontic treatment?

It is usually difficult for a parent to know if their child will need orthodontic treatment until the "baby teeth" have developed and there is visual evidence of problems. We recommend that you bring your child for a screening evaluation as soon as a problem is suspected but no later than age seven. Generally, the orthodontist can evaluate aspects of the dental and facial development that escape the untrained eye. If your child needs treatment, the doctor will explain why and take corrective action to avoid costly and uncomfortable treatment later on.

7. What are the early symptoms of orthodontic problems and how can I look for them?

My suggestion is to rely upon a trained professional for expert evaluation. If orthodontics was simple, it wouldn't require two to three years of specialty training after dental school!

It is most important to examine your child's teeth as the permanent teeth grow in. Although children's teeth mature at different rates, there are some averages for permanent tooth arrival. It is always better to consult a professional. Still, there are some warning signs that you can look for to help evaluate whether your child needs orthodontic treatment. Does the midline between the upper front teeth line up exactly with the midline of the bottom front teeth? Is the bite on the right side exactly the same as the bite on the left side or is there an asymmetry? Are there spaces or gaps? If a young child's teeth between ages five and eleven are well-aligned and lack spaces or gaps, the child is almost certainly going to need orthodontic treatment! I'd much rather see the teeth spaced like a picket fence since the primary teeth in the front are going to be replaced by larger permanent teeth. This is what makes it so difficult for an untrained parent to predict orthodontic need. Crooked, overlapping, rotated, and tipped teeth are more obvious indications of need.

Next ask your child to bite down. Do your child's top teeth protrude out the front of their mouth? Does your child have bucked teeth? Do the top front teeth cover more than 20% of the bottom teeth? Are any of the top teeth behind or inside the bottom teeth? Do the teeth come together smoothly, or are there any gaps? If your child's teeth do not come together smoothly and tightly, or if any of your child's teeth do not line up properly your child may need orthodontic treatment.

Now look at the alignment of your child's jaw. Do all of the teeth come together smoothly, of does your child's jaw shift off center when your child clenches the teeth together? If you see any misalignment or shifting of the jaw to the right or left as the jaws open and close, your child may need orthodontic treatment.

Examine the facial pattern from the front and the side. Does the lower facial height from nose to chin look too long or too short vertically? Look at the facial symmetry from the front. Is the face symmetrical? Do the lips parallel an imaginary line drawn between the pupils of the eyes? Is one corner of the nose higher than the other corner? Are the muscles of the chin and surrounding the mouth relaxed when the mouth is closed and the lips together? In profile view, is either jaw too long or too short? Do the vermilion borders of the upper and lower lip appear well-balanced? Is there a competent lip seal when relaxed or are the lips almost always parted?

If you see any of the above, or if you are not sure, bring your child in for orthodontic treatment. It's best not to wait hoping that the problems will go away.

8. At what age should I take my child to an orthodontist for an orthodontic screening?

The American Association of Orthodontists recommends a routine screening by age seven. The most appropriate age to treat varies depending on the problems present. We recommend that you have an initial appointment as soon as any problem is evident. We will monitor the problem if it is too soon to treat. Many orthodontic problems are treated using growth as an ally, and it is important that we see children before their minor growth spurt at eight and major growth spurt at puberty. The number of permanent teeth present is not initially important. More often than not, skeletal imbalances are present that benefit from early corrective treatment. Skeletal malocclusions or "bad bites" are characterized by Jaws lacking normal size and form, and lacking coordination with each other and the base of the skull. These skeletal issues are the object of first phase early intervention before the permanent teeth are all present.

Guiding principle: Treat all problems of growth excess yesterday! Problems of growth deficiency are more forgiving and provide greater latitude for correction. Let me offer an analogy. If you take your twelve year old daughter to the endocrinologist and correctly state, "Doctor, my daughter is twelve years old and seven feet tall. Is there anything that can be done about her height?" Doctor, "No, I'm sorry. I can't help her." On the other hand, if she was 30 inches tall, there's a window of opportunity. The doctor might suggest somatotropin or growth hormone. Problems of skeletal growth excess and deficiency exist in all three planes of space, vertical, transverse, and sagittal. You really need a specialist here since the problems and their potential solutions can become very complex.

9. Can you be too old for braces?

No. If the bone and gum tissue around the teeth are healthy, age is not a factor. Nearly 50% of my orthodontic patients are adults. My oldest patient was eighty-four. Nevertheless, the benefits of treatment are amortized over the remaining life expectancy. On balance, the benefits, though no greater or less, last longer for a sixty year old than for a ninety year old. But don't lose sight of the fact that life expectancies are rising.

10. Will additional jaw growth allow self correction of crowded teeth visible in a eight year old?

Not a chance ! This is probably the greatest misplaced hope that parents hold for their child's teeth. The space available for the front teeth doesn't increase after the permanent 6 year molars erupt. To the contrary, arch width is essentially fixed or constant and the side teeth including the first or 6-year molars are forced forward by the developing second or 12-year molars. The width of the arch is essentially constant and the sagittal depth of the dental arch is decreasing. Instead of the hoped for self correction, the crowding predictably increases with time. The skeletal and dental growth and development influences treatment timing and mechanics and should be monitored by an orthodontic specialist.

11. If I wait, isn't there a chance that my child's bite will get better on its' own?

Quite the opposite! If you wait, orthodontic problems will almost always get worse. If a few teeth are crooked or crowded, the orthodontist can realign the crowded teeth easily. However, if you ignore the crowding and hope for the best, the crooked teeth will encroach upon your child's other teeth and push them out of alignment too. As a result, your child's orthodontic problems will predictably get worse.

Further, as your child gets older, orthodontic treatment becomes more uncomfortable. As your child ages, fibers grow in to anchor your child's teeth to your child's jaw. It takes more force to move the fibers as you child ages so treatment is more uncomfortable. Also the bones in the roof of their mouth harden as you child ages, which makes treatment even more difficult.

If you avoid needed treatment when you children are teens, the children will usually need more uncomfortable treatment later in life. Isn't it better to take care of the problem when it is first discovered rather than waiting until the problems get worse? Remember an earlier axiom, "The earlier the correction, the longer the benefits of correction will be enjoyed."

12. If you could look into the future

It is hard to look into the future and predict how the lack of orthodontic treatment will affect your child. Certainly, a child who is denied needed orthodontic treatment will have problems with the teeth for years to come. Generations of adult's are now seeking orthodontic treatment to address the dental problems that resulted from lack of earlier orthodontic treatment. A partial list of these problems include::

Uneven wear of teeth leading to weak enamel and tooth loss
Teeth that are difficult to clean, leading to gum problems and eventual tooth loss
Difficulty chewing
Chronic, progress periodontal (gum) problems
The health issues, that go beyond good oral hygiene, e.g., sleep apnea, pulmonary edema and congestive heart failure
Digestive problems. Chewing is the first step in digestion. If chewing is impaired,, the initial step in the digestive process is compromised. There is evidence that esophageal, stomach, and intestinal problems are more common in those who needed but did not obtain corrective orthodontics.

13. What are some potential benefits of orthodontics?

A more attractive smile
Reduced appearance-consciousness during critical development years
Better function of the teeth Increase in self-confidence
Increased ability to clean the teeth
Improved force distribution and wear patterns of the teeth
Better long-term health of teeth and gums
Guide permanent teeth into more favorable positions
Reduce the risk of injury to protruded front teeth
Aid in optimizing other dental treatment

14. What are some signs that braces may be needed?

Upper front teeth protrude excessively over the lower teeth, or are bucked
Upper front teeth cover the majority of the lower teeth when biting together (deep bite)
Upper front teeth are behind or inside the lower front teeth (underbite)
The upper and lower front teeth do not touch when biting together (open bite)
Crowded or overlapped teeth
The center of the upper and lower teeth do not line up
Finger or thumb sucking habits which continue after six or seven years old
Difficulty chewing
Teeth wearing unevenly or excessively
The lower jaw shifts to one side or the other when biting together
Spaces between the teeth

15. Is treatment more difficult for adults?

Adults can be treated successfully at any age. The biology of tooth movement is similar for all ages. Adults, however, generally are no longer growing, more likely to have missing teeth or prosthetically restored or replaced teeth, age-related loss of supporting gum and bone around the roots of teeth, and time constraints imposed by family and work.

Treatment options using growth are limited though not entirely absent. Remodeling of the alvolar bone that supports the roots of teeth, repositioning and/or remodeling of the temporomandibular joints, and induction of vertical alveolar bone growth is possible at any age. Invisalign offers many advantage for adult treatment.

16. What causes crooked teeth?

Just as we inherit eye color from our parents, mouth and jaw features are also inherited. Local factors such as finger sucking, high cavity rate, gum disease, airway obstruction, trauma and premature loss of baby teeth can also contribute to a bad bite. Airway obstruction and consequent mouth breathing are major causes of malocclusions or poor bites.

17. Can I have my teeth straightened without having braces glued to my teeth?

Probably, although there is no categorical answer to this question. The answer depends on your unique condition and, to some measure, on your age. Yes, A series of 3-D computer generated invisible aligners made by Align Technology (Invisalign) or OrthoClear may allow creation of a beautiful smile without braces glued to your teeth. This advanced technology is generally limited to adolescents and adults with fully developed permanent teeth and, therefore, is not suitable for most growing children. Nevertheless, there are creative ways to move teeth with removable appliances at any age. These approaches are often subject to limitations. Since every patient's condition is unique, the doctor must examine you to determine the alternative treatments that might be suitable for you.

18. What do rubber bands do?

Small, tooth colored rubber bands or elastics ranging in diameter from 1/8 to 3/8 of an inch contribute a lot to straighter teeth. They are an important part of the orthodontist's energy delivery arsenal. They are marvels of physics. Attached to your braces or aligners, elastics exert light forces that pull your teeth toward correct positions. The force of your elastics and the active force exerted by deflections in resilient arch wires work together to correct your bite. At other times, when the teeth have been leveled and their rotations corrected, your arch wires become passive and no longer apply force to your teeth, Then your elastics are the only source of motive force. Under that force your bracketed teeth are simply sliding along the arch wire like a trolley car moving along a trolley car track. At this time, the arch wire is only a guidance system. It is no longer applying force to the teeth. That is why it is so important to wear your elastics as prescribed and change them every day. Teeth only move when the applied force is light and continuous or constant. A lack of consistent elastic wear can bring treatment to an absolute standstill. Fortunately, teeth never fail to move when elastics are worn consistently as directed. As for bouncing an elastic off someone across the room, it will happen (don't worry, your aim will improve).

19. Can I get colors on my braces?

Colors have gone over very big with countless braces wearers. With colors, patients decide to become involved in their treatment and usually take better care of their braces. Patients won't take time to choose special colors unless they intend to use them and speed their treatment. There are soft pastels that coordinate with wardrobe to bright hues for celebrating holidays or expressing team spirit. These colors can be changed when the wires are changed to add constant variety. Orange and black are favorites at Thanksgiving; red, white, and blue on the 4th of July; and green and red at Christmas. Once the braces are off, retainer color choices are only limited by your imagination.

With the introduction of high tech self-ligating and friction free bracket systems the use of colors is declining. With space age nickel titanium arch wires and self-ligating brackets the colored O-rings used to anchor the arch wire in traditional bracket slots are no longer needed. In fact, the colored O-rings create a binding force or bungee cord affect and can inhibit sliding mechanics and movement of teeth. This is not always bad, especially in the mixed dentition when permanent and baby teeth are present. This binding of the arch wire in the slot by colored O-rings can prevent the arch wire from sliding about, possibly coming out of the molar bracket tube, and poking in the cheek. But don't worry, Dr. McAnnally will decide which bracket is best for your child or you.

20. If I don't want to show colors on my braces, what can I do to play down braces?

Give clear tooth colored braces a try or if you use makeup, use it to draw attention away from your mouth. Go wild using eye shadow and keep the lips simple with beige or nothing at all. Stay away from lip gloss that makes the metal parts of braces more reflective.

21. Can orthodontics correct TMD or jaw joint problems?

Quite possibly! Yet it depends. When teeth are not in their correct positions, the teeth can force the lower jaw out of its correct position. As lower teeth approach the upper teeth, the lower jaw may deviate from a normal, healthy trajectory of closure to avoid dental interferences. If there is a discrepancy between the best fit of the teeth upon closure and normal, healthy muscle and jaw joint function, the teeth will prevail to protect them from clashing and possibly fracturing, and the muscles and jaw joints will suffer. This is true whether we have a normal, healthy bite or a bad bite. We will close into the best bite that we have, for better or worse, and that bite may or may not be consistent with symmetrical, healthy muscle and jaw joint function.

Will correction of the bite help? It will depend upon the adaptive change that have occurred in the jaw joints, the presence or absence of irreparable damage to the joints, and other factors. Our success rate ranges from 72% to 93% depending upon the problems present and treatment employed. A more extended discussion can be found in the section entitled Temporal Mandibular (TMJ) Joint Dysfunction.

22. Will orthodontics improve the way I chew and digest my food?

The benefits of orthodontic treatment go beyond making your smile look its best. You will be able to chew your food more efficiently. Chewing is the first step in digestion. If your " bite is off" or your teeth are misaligned, you may not be chewing your food as well as you should. This can lead to indigestion, "heart burn", and acid reflux disease or GERDs (gastro-esophageal reflux disease). Chronic acid irritation of the esphagus can lead to esophageal ulcers, restless and uncomfortable sleep, and possibly esophageal cancer. How common are the antacid commercials on TV? Examine the shelf space in your local pharmacy. Nexium, the purple pill, TUMS, Pepto-Bismol, Alka-Seltzer and generic antacids are testimony to the "heat burn" that afflicts so many.

23. How many people receive orthodontic care?

Approximately 4 million people are in braces in the US at any one time. About 70% of people in the US need orthodontic treatment.

24. Will orthodontics change my lifestyle?

You'll have to avoid extremely hard and sticky foods. These foods can get caught on the braces and can mechanically damage your braces. Softer foods are much better. You'll have to spend a few extra minutes cleaning your braces after meals. But, for the most part, you'll find braces don't cramp your style. You'll still have fun. You'll still be able to sing, play your musical instrument, smile, play sports and of course, kiss. You can even make a fashion statement by having your orthodontist add color to your braces.

25. How long do you have to wear braces?

Bite problems are like finger prints. No two problems are identical. Your treatment time will depend on the (1) complexity of your problems, (2) the combined efforts of you and your doctor, (3) your biological response to treatment, and (4) the experience and skill of your doctor. If you keep your appointments, wear and take care of your appliances, maintain good oral hygiene, dental care and diet, your treatment time will be minimized. Clean teeth rooted in healthy bone and gums really do move faster! The better you are about wearing and taking care of your braces, the sooner your teeth will improve.

26. Will any teeth be removed?

Only if you'll be better off without them! Teeth are only removed when their removal will make you and your teeth healthier and more attractive. Don't worry, if you have teeth removed, we will close the spaces and no one will notice.

27. When do you recommend extraction of teeth?

When it will improve your smile, facial appearance, and the health of your remaining teeth. Extractions, when needed, can be compared to removing "a few bad apples from the barrel". You don't want a few bad apples spoiling a barrel full. We extract teeth when you will be better off without them.

28. When is the best time to schedule an initial consultation?

Every child should see an orthodontist at an early age. This could be as young as 2 or 3, but should be no later than age 7. Early consultation allows Dr. McAnnally to determine the best time to begin treatment. Many parents and some family dentists incorrectly assume that a child must have all of their permanent teeth before they can be treated. In fact, treatment is often much easier and better results are obtained, if treatment is started earlier. Early treatment can often eliminate extractions and take advantage of growth to improve the appearance of the face. With proper timing, children may not have to endure added years of embarrassment, lowered self-esteem, and detrimental affects on personality development. Adults, though subject to growth limitations, can normally be treated at any age.

29. Why should you choose a dentofacial orthopedic and orthodontic specialist?

The teeth, bite, smile and face are often permanently changed by dentofacial orthopedic and orthodontic treatment. You and I want those changes to be excellent ones! The benefits of expert treatment can be enormous and they can last for a lifetime. Most of us want to be and look our best. Few of us want to be average. Few of us want average results. We want to be the best that we can be. We want the best outcome possible. We want outstanding results. You can entrust your family's smiles to a licensed orthodontic specialist because he/she has two to three years of additional specialty training after completing dental school. This training includes mentoring by experienced licensed orthodontic specialists. Licensed specialists are expertly trained to correct your bite, align your teeth, improve your smile, maximize your facial esthetics, and work with you to help make sure your teeth stay in their new positions. Licensed specialists are expertly trained to aid the growth and development of the face and jaws of developing children. Licensed specialists are expertly trained to to treat adult dentitions.

30. Do you need a referral from your family dentist to see an orthodontist?

You don't need a referral from your family dentist unless you are in a managed care plan with a "gatekeeper" primary care dentist. Even then, if you choose to forego insurance benefits to which you may be entitled, you do not need a referral. Word of mouth recommendations from friends and families of existing patients is often the primary way orthodontists meet new patients. Spread the word if you like your orthodontist!

If you are a member of a limited provider network, preferred provider organization (PPO), or other restrictive provider plan, you should compare the "out-of-pocket" costs and the services provided within your plan to costs and services outside your plan. You might find the right choice for you resides outside your plan.

31. What will happen at the first appointment?

We offer a FREE, no-obligation screening examination. At your initial appointment we will obtain a panoramic radiograph, digital photographs of the face and teeth, and a medical and dental history. The doctor will establish your chief concerns then complete a thorough clinical examination. Following the examination, the doctor or his communication communicator will present the doctor's diagnostic findings and treatment recommendations. Treatment recommendations normally include a discussion of the the potential benefits, risks, estimated treatment times and costs of alternative plans of treatment, and the risks of no treatment at all.

The doctor and his staff will answer questions you may have regarding the doctor's findings and recommendations. Common questions include: What can be done? How is it done? How long will it take? How much will it cost? How can I make payment? Will insurance help defray my cost? Are payment options available? We are prepared to assist you with insurance inquiries and claims, and present payment options. Normally, this appointment takes 1 to 1/2 hours.

32. Are braces uncomfortable?

Each person finds braces quite different. Placing braces takes about an hour. However, it is a relatively painless procedure. The following couple of days the teeth may be uncomfortable however they soon settle down and you get used to the new feeling. Patients generally adjust very quickly to the braces and, before you know, it is just another part of everyday life.

33. Is orthodontic care expensive?

Orthodontic fees have not increased as fast as many other consumer purchases. In 1952, it cost the ordinary US worker about 432 hours of labor to purchase orthodontic treatment for a child. In 1997, that parent will only work 279 hours to purchase orthodontic treatment. Compare that to a single family home which cost 6,528 hours of work in 1952 and today costs 10,480 hours of labor. There is no fee for an initial consultation. Financing is usually available. Many insurance plans now include orthodontics. Well-timed orthodontic treatment to correct a problem is often less costly than the additional dental care required to treat the more serious problems that can develop years later.

34. How much does orthodontic treatment cost?

Your particular orthodontic needs must be evaluated before that question can be answered. The cost depends on the problems present and the solutions undertaken. Let me give you some analogies. Let's assume you have just had an automobile accident. You call your local Auto Collision shop. When the receptionist answers the phone you say, "I have had an automobile accident. How much will it cost to fix my car?" Like orthodontics, it depends. You call Mr. Belvedere at Home Improvement, Ltd. and ask, "How much do you charge to paint a house?" You call the neighborhood lawn care service and ask, "How much do you charge to mow a lawn?" In each case, it depends. It depends on the severity of the auto collision damage, the size and structure of the house, and the size and condition of the lawn. In each case, the service provider will need to obtain more information and, most likely, view the collision damage, home, and lawn, before estimates of cost can be provided.

It matters where you live and how much needs to be done. If you live in a rural area, where rents are low and malpractice attorneys rare, orthodontic treatment can be found for under $3,000. Typically orthodontic treatment costs between $3,000 and $7,000 in the USA. The cost can be as high as $18,000 in Tokyo! This may seem like a lot but the benefits are for a lifetime. Your investment in dollars may be returned many times over. A winning smile can translate into economic advantage, improved employment, advancement in the workplace, dateability, marriageability, income, and lifestyle. Think about how much, over time, you spend on your wardrobe, cosmetics, and to maintain car after car.

35. Can I negotiate lower fees with my orthodontist?

Generally, orthodontists will not cut their fees to individuals. Orthodontists need to pay for a lot of specialized, expensive equipment and instruments and their maintenance, including computer networks, and to pay their staff, utilities, and their rent. The Orthodontists need to pay for all of their materials, operation of their sterilization centers, laboratory fees, and for the doctor and staff's continuing education. Then there is the cost of malpractice insurance, accounting and legal fees and, never to be neglected, federal, state, and local taxes. Most of an orthodontist's fee goes to paying their fixed cost.

36. Orthodontic treatment is still costly. Is it worth the cost?

Yes! Think about the lost opportunity cost, the cost of not getting braces. It is hard to see into the future, to tell how the lack of orthodontic treatment will affect you or your child. Certainly, a child who needs orthodontic treatment and does not get the treatment will have problems with their teeth for years to come; so much so that many adult patients are now going back for orthodontic treatment. The health issues go well beyond good oral hygiene. Breathing problems can often be corrected without major surgery.

Also stomach problems are very common in people who skip needed orthodontic treatment. If you/your child cannot chew their food right, a lifetime of gastrointestinal problems may ensue. There also is data that suggests dentofacial orthopedic and orthodontic treatment can lower your children's chance of respiratory and cardiovascular disease.

We cannot predict whether your child will develop breathing, heart, or stomach problems if they do not undergo orthodontic treatment. However, lifetime orthodontic treatment generally costs less than the lifetime maintenance on a car. Isn't it worth investing as much time in maintaining your children's teeth as you invest in maintaining your car?

37. Can I pay for my children's orthodontic treatment in installments?

Yes. We cannot finance the entire cost of your treatment or the greater start up costs that are incurred as treatment begins. A substantial initial payment is usually required to cover the initial start up costs of treatment. However, once the initial start up costs are covered by your initial payment, the balance of your treatment cost can be paid in installments.

38. Can I get insurance to help pay for orthodontic treatment?

Many dental plans now include orthodontic benefits. You will need to check with your employee benefits department or your insurance agent to determine your eligibility. If you need assistance call us. Our staff may be able to help you.

39. Should I attempt to acquire insurance to help pay for orthodontic treatment?

This is a personal decision. I suggest that you look at the cost/benefit ratio. Are there tax benefits? Is there a government tax subsidy or incentive? Who will pay the premiums? You or your employer?

I do advocate catastrophic insurance. It makes sense when large groups of people pool their insurance premium dollars to insure against the risk of a less probable catastrophic occurrence. On the other hand, I believe its best to save, which is to self insure, for reasonably predictable, noncatastrophic expenses. It makes little sense to purchase insurance to cover the costs of common colds, occasional headaches, auto oil changes, mowing the grass, painting your house, cleaning your carpet and, in my opinion, most dental care. Dental expenses including orthodontics are reasonably predictable routine expenses and rarely catastrophic. Medical savings accounts that allow payment for orthodontics with pretax dollars, however, provide a hugh tax incentive. The discount on the orthodontic fee is equivalent to your federal income tax rate.

40. If poor bites causes so many health problems, why didn't evolution or natural selection eliminate orthodontic problems?

According to Alex Duncan of the Anthropology Department at the University of Texas, "With very few exceptions, fossil hominids (cave men) had nearly perfect bites."

Malocclusion (overbites and underbites) developed mainly over the last 10,000 years. As people's diets improved, people got bigger. The average height of an adult male increased from 4 ft (1.3M) 10,000 years ago to about 5 1/2 feet (1.9M) today. Human mouths and human teeth did not grow at the same rate. In many cases your child's teeth will be larger than your child's mouth. If so, your child will need orthodontic treatment.

41. What is interceptive dentofacial orthopedic treatment and is it necessary?

The objectives of interceptive dentofacial orthopedic treatment are to correct the relative sizes and forms of the jaws, and the relationship of the jaws to each other and the cranial base. These objectives are best accomplished during childhood periods of exuberant growth, and the earlier the better. By normalizing the size and form of the jaws, the orthodontist makes room in your child's jaws for your child's permanent teeth. Treatment objectives are largely skeletal and are accomplished by dental facial orthopedics rather than orthodontics. Your orthodontist may expand your child's palate and initiate correction of overbites, underbites, and crossbites. As noted above, orthodontic problems arose over thousands of years during which the growth of the human jaws evolved at a slower rate than the teeth. Your orthodontist can often improve the growth rate of the jaws to insure there will be room for all of your child's permanent teeth.

42. How long does interceptive dentofacial orthopedic treatment take?

It varies greatly according to the complexity of the problems present. Treatment can take anywhere from 6 to 24 months. Problems of growth excess may take longer.

43. Can't I wait on interceptive dentofacial orthopedic treatment until my child is older than 7?

The American Association of Orthodontists (AAO) and American Dental Association (ADA) Joint Council on Education recommend evaluation by age 7 or as soon as a problem is suspected. We do not recommend waiting unless advised by an experienced and qualified dentofacial orthopedic and orthodontic specialist. I recommend the following guideline: "When in doubt, check it out." Early examination and early interception offer many treatment advantages that diminish with age. Avoid the too common occurrence of "too little, too late." Avoid well-intentioned benign neglect.

Expansion of the palate and correction of jaw size, form, and position is accomplished best during growth and development. By age 4 sixty percent of the facial growth is completed. By age 12, ninety percent of the facial growth is completed and growth imbalances are more fully established and difficult to correct. If you wait, for example, until age 20, growth is essentially complete and the opportunity to guide the growth and development of the face, jaws, and teeth has been lost. From age 5 to age 20, nonsurgical dentofacial orthopedic opportunities are progressively diminishing while the probability of a compromised outcome or the need for major surgical correction is increasing.

44. What steps are involved in full orthodontic treatment?

The objectives of full orthodontic treatment are to correct your child's bite, and to make sure that their teeth are in proper alignment. Bite correction includes leveling and aligning the teeth, correcting rotations, tip, and torque of teeth, closing spaces, eliminating crowding, and insuring that lower teeth close into upper teeth properly. Healthy symmetrical function, improved stability, and longevity of the teeth are also objectives.

First, the orthodontist examines your child's mouth and determines what is needed. A problem list is generated. The problems are prioritized according to their severity and prognosis or prospect for correction. Alternative plans of treatment are evaluated including their potential benefits, risks, estimated treatment time and costs, and mechanotherapy, or how the correction will be done.

Second, a diagnostic and treatment planning conference is held with the patient or responsible parent or guardian of a minor. The diagnostic findings and acceptable treatment alternatives are presented. This conference also affords the opportunity to ask questions pertaining to the doctor's findings and recommendations..

Third, Once an acceptable course of treatment is mutually agreed upon, An Agreement for Professional Services and Consent to Treatment is completed. The doctor will provide a Guide to Successful Treatment and a Privacy Notice to Patients in compliance with HIPPA regulations.

Treatment normally begins with the preparation and delivery of the initial dentofacial orthopedic (functional) appliance, Invisalign aligners, or braces are placed on the teeth. The duration of treatment will depend upon the problems present but typically ranges from from 6 to 30 months. During that time, you are seen periodically for observation and adjustments. When active treatment has been completed, retainers are normally provided. These are worn during the posttreatment retention phase which lasts at least 1 year or until certain criteria have been met. The retainers are initially worn full time for 3 days then nights only during the retention period. After the posttreatment criteria have been met, the retainer wear is gradually phased out with a "weaning off" protocol. The old saying, "there are many ways to skin a cat" ramains true but, keep in mind, the paths may be different.

45. What can I expect on the initial visits to the orthodontist?

Generally, it takes one or two visits to start your treatment. On your first visit the doctor's staff will obtain a medical-dental history, essential diagnostic x-rays, photographs, and impressions of your teeth. The purpose of the x-rays, photographs, and impressions (castings) of your teeth is to gather as much information about your bite as possible.

Dr. McAnnally will then complete a clinical examination, present his findings and recommendations, and explain the treatment process. You will have an opportunity to ask questions. The initial examination and consultation with the doctor are FREE.

46. What are some of the questions commonly ask during consultation with Dr. McAnnally?

The most common and useful questions are: What problems are present? (2) What can be done to correct them? What alternatives are available? What are the potential benefits and risks of treatment? Will there be elements of compromise? When should treatment begin? How long will it take? How much will it cost? What will correction involve? How often will I have to be seen? What is expected of me?

47. Is there anything I should do before the consultation?

Most patients find their first visit to our office rather overwhelming. The doctor may be overheard using all of these complicated words, such as Class II malocclusion, mandibular retrognathia ..., and his fee for treatment is $3,000 - $7,000. You want to do the best for your child but you have so many questions. Rest assured we will do our best to accurately diagnose and plan your treatment. We, too, want to be sure all of your questions are answered.

If you are totally unfamiliar with orthodontics, you might want to do some reading about orthodontics before you come to the consultation appointment. This FAQ is a good start, and a dictionary of orthodontic terms would also be helpful. I have looked for a good book to help patients through orthodontic treatment, but have not found one yet.

Most of us really do need orthodontic treatment. Human growth patterns were designed back in the days of the cave men, when nutrition was terrible. Today, most jaws are too small for their teeth, and orthodontics is needed. Estimates indicate that 70% to 90% of all children, teenagers, and adults will benefit substantially from corrective treatment.

48. Are their other treatment options that I should consider?

The following statement should give you pause for thought. "There is only one correct diagnosis but there can be many treatment plans." It doesn't matter how many doctors look at you, your objective condition remains the same. You should be aware that diagnostic perceptions, or what the doctors perceive to be your condition, can vary from doctor to doctor but do not change your condition. The diagnostic perceptions of the examiner reflect the experience, education and training, keenness of observation and thought, and frequently the personal bias of the examiner. An objective and accurate diagnostic perception is absolutely essential to optimum treatment planning. Once your condition is accurately diagnosed, there may be acceptable alternative plans of treatment. Some plans may be equal in outcome. Some may contain elements of compromise. Some will be more efficient, some less efficient. The mechanotherapies, treatment times, potential benefits, risks, cost, and posttreatment stability are just a few of the variables that may exist between different treatment plans.

Dr. McAnnally is a licensed dentofacial and orthodontic specialist. He has examined your dentofacial and orthodontic needs and knows what is required for correction. We recommend that you explore the potential benefits, risks, mechanotherapies, and estimated treatment times and costs of suitable alternatives with him.

Prosthetic solutions, dentures, cosmetic veneers and crowns are rarely an acceptable or preferred alternative to placing your natural teeth in good alignment where they belong. Veneers, e.g., are rarely the treatment of choice for the correction of misaligned, crooked teeth. We advocate dentofacial orthopedic solutions for orthopedic problems, orthodontic solutions for orthodontic problems, and refer prosthetic problems to the general dentist or prosthodontist for a prosthetic solutions.

You may have a choice between near invisible Invisalign aligners; traditional metal, ceramic, or gold braces; or contemporary, high-tech, self-ligating, low friction brackets. You may choose traditional or something modern and stylish. We provide a full range of options but try to match the patient's needs to the most suitable appliance available. All things equal, we recommend the most stylish braces whenever possible.

49. Should I seek a second opinion?

Some patients want to seek a second opinion as reassurance that they are making the best decision. Second opinions are occasionally sought when the treatment findings and recommendations are not fully understood, or don't seem to make sense to you. We apologize. We haven't done our job well. We have failed to communicate effectively. Our effort to fully inform you in a manner that you can understand has come up short. We hope you will discuss your unaddressed concerns with Dr. McAnnally. If we can not allay your concerns and answer all of your questions to your satisfaction, we encourage you to seek a second opinion. We will be happy to loan the study models, x-rays, and photographs to you, so you can show them to another dentist for confirmation of the treatment plan.

50. What are extraction and nonextraction therapies, and what are the advantages and disadvantages of each?

When there is not enough room for the teeth, there are two alternatives: You either increase the space available for the teeth by expansion or reduce the requirement for space by extraction or slenderization of teeth.

Extraction therapy is an technique where some teeth are removed to make room for the other teeth in your mouth. Extraction therapy is often the treatment of choice when there is normal jaw width but extremely crowded or protrusive teeth.

Extraction advantages: Extraction therapy can improve the facial profiles of patient's with bimaxillary (both jaws), bialveolar (bone that supports the roots of teeth), and bidental protrusion. Excessive convexity of the lower face is reduced. Severe crowding is eliminated.

Disadvantages: Extraction therapy may restrict the forward lower jaw growth of developing youngsters. Extraction therapy may lead to anterior dental interferences, posteriorly-locked mandibles, and myofascial or temporomandibular joint problems. This has been controversial in the dental literature.

Nonextraction therapy generally involves one or more of the following: Expansion of the width and/or depth of the dental archs, and slenderization of teeth. The back teeth are moved further back making room for the crowded front teeth. Crowded front teeth may be advanced or proclined and their crowns placed on a circle of larger radius. The jaws may be widened. Correction of rotated teeth, especially the molars, often results in a further space gain.

Advantages: Nonextraction therapy can avoid excessive retraction of the lips and flattening of the lower face that can occur with extraction therapy. This can lead to a more attractive, youthful appearance. Nonextraction therapy leaves more intraoral space for the tongue. This can improve the airway and cardiovascular function. Expansion of the upper jaw and proclination of upper anterior teeth can lead to more favorable lower jaw forward growth in developing younsters.

Forty years ago, extraction therapy was very common. Nonextraction therapies have greatly increased since then. There is now evidence that adult nonsurgical expansion may be as effective and have many advantages over adult surgical jaw expansion. (Dr. Chester S. Handelman, private practice of orthodontics, Chicago, Ill, Assistant Professor, Department of Orthodontics, University of Illinois, Chicago. Non-surgical transverse expansion in adults. Presented to the Ann Arbor Orthodontic Study Club, September 19, 2006).

51. What is having braces like for my child?

On the plus side: Today braces are commonplace. The child who doesn't get braces may be the exception rather than the rule. Peer group acceptance is not the problem it was 50 years ago. The teeth may be tender initially and as new forces are applied but analgesics are seldom needed. Any discomfort soon subsides as the teeth begin to move. Modern braces use light, continuous forces to move the teeth. The braces are not tightened! This greatly improves the level of patient comfort.

On the negative side: Braces are "food traps" and must be cleaned following eating to avoid demineralization or decay. Braces can be damaged by hard and sticky foods so these foods must be avoided. Your child will get so used to the braces, they will go unnoticed unless your child is hit in the mouth.

On balance: Certainly, it is much easier for your child to wear braces now than to go through life with crooked, irregular, or buck teeth with lower self-esteem, lower self confidence, and an unattractive smile.

52. My son/daughter does not want to get braces because they are afraid that the braces will make him/her look like a geek. Any ideas?

Youngsters tend to live in the here and now. They lack future focus. They seldom look beyond the next weekend. There is a sense of immortality. Youngsters have difficulty projecting future or long term benefits. They are seldom worried about cholesterol, diet, and aging. One parent said, "Children are like little birds fluttering their wings, trying to get out of the nest." Another mother of two teenage boys, said. "It's like someone came in through the bedroom window at night and sucked all their brains out." A fifteen year old girl ask, "What's the worst thing that could happen if I get my braces off now." I flippantly said, "All of your teeth could fall out." She responded, "If they will last until I am 40, I want them off." I think she was serious!

This is hard because some teens are so worried about their appearance. Youngster's with low self-esteem and lacking confidence seem to worry the most. These kids are growing rapidly. They are maturing and changing in many ways. They simply want to know that they are alright and that they will come out alright in the end.

You might point out that most people who need orthodontic treatment don't look their best before they get braces. How would you like to go through life with buck teeth and a jaw that is too big or too small? If your child is really concerned about their appearance, assure them that braces will really help them. A smile is the most striking feature on your face, and at the end of orthodontic treatment your child's smile will look fabulous. Doesn't your child want to look their best?

Braces have changed a lot since the days when we had braces. Braces now come in a series of styles and colors.

53. Do braces hurt?

Braces have been progressively improved over the last 20 years. They are more comfortable now than they have ever been. Our initial arch wires are space-age, very resilient nickel titanium and are only .014 mm in diameter. These wires deliver very light forces. Research on tooth movement has proven that light forces move teeth more efficiently and effectively than heavy forces.

There may be slight discomfort a few hours after the initial placement of the braces and when new vectors of force are applied to the teeth. This discomfort seldom requires more than over-the-counter Tylenol or baby aspirin and soon subsides. Moreover, modern cast, low profile brackets are designed to minimize your children's discomfort between visits to the orthodontist. Though most patients experience some tenderness of the teeth during their first week in braces, the presence of the braces goes largely unnoticed after the first week.

54. What happens if my child's braces continue to hurt?

Dr. McAnnally should check your child. Some patients continue to complain for the sake of complaining. The complaint is a protest statement. However, complaint can also be the result of real problems, teething as new teeth emerge, a poking archwire, a bracket impinging on the soft tissue, or food entrapped around the braces and possibly under the gums. Your child's mouth may also be sore if the teeth are not thoroughly cleaned after eating. If your child complains of discomfort call our scheduling secretary. Describe the nature of the problem and he/she will provide an appropriate appointment. Dr. McAnnally can help.

55. Should my children do anything special during their first week in braces?

We generally recommend that parent's review our Guideline for Successful Treatment and quiz their youngsters to insure their familiarity with the Guideline. A review of the Guidelines is certainly a good exercise for the custodial parent or guardian. This first week it is important to quickly establish dietary and oral hygiene habits consistent with successful treatment.

56. How long do the braces take to put on?

We normally schedule 1 hour to place the braces and initial archwire. The actual time may vary.

57. Will it hurt to put the braces on?

Not usually. The orthodontist is usually just attaching the braces to your child's teeth. Some discomfort may occur a few hours later as the teeth begin to move. Some patients initially "doodle with their brackets,' exploring them with the lips, cheeks, and tongue. This "doodling" may cause some initial irritation to the soft tissues. This irritation soon resolves as accommodation to the new braces and an involuntary avoidance response to the discomfort is acquired.

58. What holds the braces on?

Generally, the brackets are bonded directly to your child's teeth using a special FDA approved adhesive.

59. My son/daughter does not want to get braces because they are afraid that the braces will prevent them from participating in sports. Any suggestions?

Years ago people who wore braces were advised to avoid sports. However, in 1981 people started using orthodontic mouth guards. The mouth guards have allowed patients to continue to participate in sports while they have braces. Therefore, there is nothing for your child to fear.

60. My child plays a musical instrument. Will his/her ability to play be affected by orthodontic treatment?

Be sure to mention your child's musical abilities to the orthodontist. Dr. McAnnally may give you something called "lip protector" which will make it possible for your child to still play musical instruments. We have had reports of entire bands having orthodontia with no problems.

Please consult Dr. McAnnally regarding musical instruments. There is theoretical advice and practical advice in this area. Much below is correct in theory. From a practical perspective, age, interest, hours of practice, seriousness of purpose, and alternative instrument choices are factors to be considered. A correctly chosen instrument can help correct a malocclusion. An incorrectly chosen instrument can create a malocclusion or make the correction of a malocclusion more difficult.

To be more precise, embouchure matters. The embouchure is the use of facial muscles and the shaping of the lips to the mouthpiece of a wind instrument. The proper embouchure allows the instrumentalist to play the instrument at its full range with a full, clear tone and without strain or damage to one's muscles. Certain instruments are contraindicated with certain type malocclusions. Certain instruments are indicated with certain type malocclusions. For example, a bugle, coronet, or french horn may help correct a protrusive malocclusion with spaced front teeth. If the upper front teeth protrude, the embouchure of certain instruments, e.g., a clarinet, may tend to worsen the maloclcusion or make the correction more difficult.

Class A instruments - cup Shaped tubular mouth pieces - trumpet, coronet, french horn, bugle, trombone, baritone, tuba, alto horn, bass horn, and fleguel horn are indicated (favorable) for Class I malocclusions having protruding upper incisors, and Class II, Division I malocclusions (buck teeth) having weak or hypotonic lips. Class A instruments are contraindicated for Class I Complicated malocclusions, Class II, Division II malocclusions, and Class III malocclusions.

Class B instruments - clarinet, bass clarinet, double bass clarinet, alto clarinet, saxophone, base saxophone. Class B instruments are indicated (favorable) for Class III malocclusions. Class B instruments are contraindicated for Class I malocclusions with protruding upper incisors, Class II, Division I and Class II, Division II malocclusions.

Class C instruments (double reed) - oboe, bassoon, contra-bassoon, sarrusophone, and english horn. Class C instruments are indicated (favorable) for all cases presenting hypotonic lips requiring general stimulation and muscle toning, short and flabby lips, and lips that roll away from the teeth. Class C instruments are contraindicated for Class I Complicated malocclusions.

Class D instruments (aperture mouthpiece) - piccolo. Class D instruments are indicated (favorable) for Class I and Class III malocclusions with a short upper lip and unruly mentalis action. Class D instruments are contraindicated for Class II Division I, Class II Division II, and Class I Complicated malocclusions.

61. Can my child still chew gum with braces?

The sugar in the gum can get trapped behind the braces and cause cavities. Still, you might want to talk to your orthodontist if your child really wants gum. In some cases, it may be possible for your child to chew a sugar free, non stick gum such as Freedent or Wrigley's Extra. A study in the American Journal Of Orthodontics Vol107 (1995) p. 497 indicates that the xylitol in the Freedent or Wrigley's Extra prevents cavities, and the gum does not stick to some styles of braces. It is difficult to know if your child can safely chew Freedent or Wrigley's Extra. Check with your orthodontist to be sure. Chewing gum increases the mechanical action in the mouth and may lead to arch wire deformation, loose brackets, and unnecessary arch wire and bracket repair appointments.

62. Are there other foods that my child should avoid?

Dr. Mcannally recommends a well-balanced,soft-textured diet free of foods high in sugar and acids, and hard and sticky foods. Foods high in sugar and acids promote decay and may lead to gum inflammation. Hard and sticky foods may cause mechanical damage to your braces. We generally recommend that your child avoid hard sticky, gooey or crunchy foods. Caramel and taffy can stick on your child's braces. Crunchy foods like carrots and apples and hard rolls can occasionally detach a bracket from a tooth or deform an archwire.

63. What happens if a bracket comes off?

This will require a special adjustment or repair appointment. We will reattach the loose bracket, if necessary. We will replace a lost bracket if necessary. However, every time a loose or lost bracket is replaced, orthodontic progress is delayed. Call us in advance, indicate the nature of the problem, and an appropriate appointment for repair will be provided. Your arrival at progress appointments with unreported loose or lost brackets or other problems will delay your treatment. It will normally be necessary to schedule you at a more appropriate time for adjustment or repair. Bracket repair appointments are normally scheduled during school hours and may require added time away from school, work, or both.

64. What happens if my child swallows a bracket?

It generally is NOT a serious problem. Brackets are usually made of a medical grade stainless steel and should not have any adverse effects if swallowed. The bracket passes through the digestive system and leaves in the feces.

Inhaling a loose or lost bracket is a different matter. If your child inhales a bracket, and it enters your child's lungs, we would refer you to an MD for removal of the bracket with the aid of a bronchoscope.

65. Why can't the orthodontist attach the braces strongly enough that the braces don't come off during eating?

A balance must be obtained between keeping the bracket on and getting the bracket off. The orthodontist needs to remove your braces at the end of the orthodontic treatment. If the orthodontist attaches your braces too firmly, removal of the braces could be difficult and possibly cause damage to the teeth upon removal. About 5% of brackets loosen or are lost during treatment.

66. Are there any other activities that my child should avoid when they have braces?

No. However, contact sports like boxing, wrestling, football, and hockey require a suitable athletic or orthodontic mouthguard.

67. How often should my child brush their teeth when my child has braces?

We recommend brushing after every meal or snack and flossing before going to bed. Brushing and flossing is especially important during orthodontics because food can get caught in or around the appliances and braces and cause cavities. We also recommend daily use of a supplemental fluoride gel.

68. How do I convince my child to brush their teeth when the child has braces?

Appeal to reason. This can be difficult with a rebellious teenager. However, if they do not brush their teeth, food will get caught in their braces and their breath will smell awful. One parent said that she started calling her son Mr. Yuch Mouth. It was amazing how fast her son started to brush his teeth.

69. I have noticed that some children have rubber bands in their braces. What do the rubber bands do?

Small tooth-colored rubber bands may be used to move teeth forward or backward in your child's mouth. They could be used to move a misaligned tooth to a well aligned position, or to close spaces in your child's mouth. The rubber bands are often used in the middle and latter stages of the orthodontic treatment.

70. How often should my child change their rubber bands?

At least daily unless otherwise advised.

71. What happens if my child leaves off their rubber bands?

The orthodontic treatment may enter a period of suspended animation. If the elastics are supplying the sole source of energy to move the teeth, treatment will come to a standstill. Compare the situation to a clock that has stopped or a car that has run out of gas.

72. What happens if my child swallows a rubber band?

Orthodontic rubber bands are made of a medical grade latex rubber which is similar to the grade of rubber used in medical implants. The rubber is thought to be safe for human consumption but has no nutritional value. If your child swallows an orthodontic rubber band, the rubber band will pass through your child's digestive system and leave in the feces. It is unlikely that your child would get indigestion even if a bag of rubber bands was swallowed. Please make sure that your child does not eat a bag of rubber bands (just kidding).

73. What does a retainer do?

The purpose of a retainer is to hold the teeth in their new, corrected positions after braces have been removed.

74. Why is a retainer needed? Do teeth move after orthodontic treatment?

Retainers are needed to hold teeth in their new positions until the supporting tissues of the teeth, the bone and gums surrounding the roots of the teeth, reorganize and stabilize. Bone must firm up around the roots of the teeth. The elastic fibers in the gum tissue must reorganize. The facial muscles, cheeks, lips, and tongue must adapt to the new tooth positions. Retainers are also needed to stabilize the positions of the teeth in the event the two jaws grow at different rates. Retainers are needed to insure that developing wisdom teeth or third molars do not force the side teeth forward and crowd the front teeth.

75. What happens if my child does not wear his/her retainer?

All bets are off. The teeth may or may not remain well-aligned. The best assurance of a stable orthodontic outcome is a well implemented plan of retention followed by a disciplined weaning off process. The worst case scenarios included recurrent crowding, the return of a poor bite, and the need for retreatment at additional cost.

76. How long should my child wear a retainer?

When the retainers are first delivered, the retainers are worn full time except when eating for 3 days. After 3 days the retainers are generally worn at night only.

Retainers are worn until the bone surrounding the roots of the teeth has had time to become firm again. This takes about 6 to 8 weeks or about the amount of time a broken arm in a cast takes to mend. Retainers also should be worn until the gum tissues and fibers that connect the roots of teeth to the supporting jaw bone reorganize. Research studies have shown that soft tissue reorganization of these tissues takes 12 to 24 months. Retainers should also be worn until the post pubertal growth is largely completed and impacted third molars are removed. The post pubertal growth is largely completed by age 17 or 17 1/2. This generally coincides with the age at which we recommend the removal of impacted wisdom teeth.

This is followed by a gradual "weaning off process" with vigilance. During the "weaning off process" the retainers are worn 8 hours every 48 hours or every other night for 2 to 3 months with vigilance. If the teeth remain reasonably straight as they settle, and there is no concern or alarm, the retainers are worn every 3rd night or 8 hours out of 72 hours, then every 4th night or 8 hours out of 96 hours, etc. until the retainers are no longer worn or needed. If, during the weaning off process, there is any concern about the esthetics, alignment of the teeth, or the bite, resume full time retainer wear, call us without delay, and schedule a prompt appointment for attention to your concern.

We do not recommend life long retainer wear. We believe that if the teeth need life long retention, they have not been moved to stable positions. The recommendation of life long retention simply shifts the responsibility for relapse from the doctor to the patient. We believe the doctor shares this responsibility. If our "weaning off" protocol is followed, the likelihood of significant relapse is minimal.

77. I notice that some braces have little colored rings around the brackets. What do the colored rings do?

The colored rings are called ligating modules. They hold the wires into the brackets.

78. What happens if my child swallows a ligating module?

Orthodontic ligating modules are made of a medical grade polyurethane which is similar to the grade of polyurethane used in medical implants. The polyurethane is thought to be safe for human consumption. If your child swallows a ligating module, it just passes through your child's digestive system and leaves in the feces.

79. Is there any chance that the sharp ends of the arch wires will hurt the insides of my cheeks?

The answer to this question most likely will be confusing. To understand the answer, you really need some knowledge of orthodontic mechanics. Yet the simple answer is "Yes."

Poking arch wires are a relatively common occurrence during initial leveling and alignment of the teeth. Poking arch wires may also occur later during space closure. During space closure the arch wire must feed out the end of the terminal bracket tube as closure occurs. Of course, if space closure isn't needed in your treatment, you don't need to worry. This doesn't apply to you.

Initially, very light .014 nickel titanium arch wires are used for leveling and alignment. These wires tend to slide from side to side, right to left or left to right. The arch wires we use have a dimple at the midline. This dimple serves as a stop to minimize this side to side slippage. Nevertheless, in the early weeks of orthodontic treatment, poking arch wires may occasionally need to be adjusted. Sometimes the end of the arch wire will stick out past the end of the tube on the last tooth in the back and the arch wire will need to be recentered. During space closure the protruding arch wire may need to be trimmed.

In another variation on the problem, at other times, the light compliant .014 arch wire will be deflected by food and escape through the front opening of the tube. This will typically result in a pokey arch wire. We suggest you cover the sharp end of the wire with a moist ball of cotton until we can trim the arch wire or restore it to its position within the tube.

80. It seems like my child is getting a lot of x-rays during their treatment. Are all of those x-rays needed?

Actually, we don't take a lot of x-rays. Those we do take are essential. An initial panoramic and lateral skull x-ray are essential for treatment planning. Progress films may be taken to examine root paralleling and confirm proper bracket placement. At the end of active treatment, final records may be taken to evaluate third molar or wisdom tooth development.

We believe the benefits far outweigh the risks. Your x-rays help insure that your treatment plan is safe and effective. The panoramic x-ray and the cephalometric x-rays allow us to look for weaknesses in the jaw, short rooted teeth, congenitally absent or supernumerary (extra) teeth. We are able to look for jaw joint abnormalities and skeletal deformities. This may help us avoid painful temporomandibular joint problems and other difficulties later on.

81. Is there anything that can be done to minimize the x-ray exposure?

Yes. Leaded cervical collars and aprons, a collimating device that narrows the x-ray beam, high speed film, intensification screens in the x-ray cassettes, and double-sided emulsions are some of the measures taken to minimize x-ray exposure. The precision x-ray collimator on the x-ray machine narrows the x-ray beam so the x-rays shine only on the target area. Our x-rays provide about the same x-ray exposure as one experiences from cosmic radiation when sun bathing on the beach for a couple of days, or when flying from Detroit to Los Angeles.

82. At what age should orthodontic treatment occur?

Orthodontic treatment can be started at any age. Many orthodontic problems can be treated more effectively if detected and treated at an early age, before jaw growth has slowed. Early treatment may avoid serious complications later including facial deformity, temporomandibular joint problems, and early loss of teeth. The American Association of Orthodontists recommends that every child first visit an orthodontist by age seven. Dr. McAnnally recommends examination earlier if a problem is suspected by parents, the family dentist or the child's physician. When in doubt, check it out!

83. What is Phase I and Phase II treatment?

Phase I, or early interceptive treatment, is limited orthodontic treatment (i.e. expander or partial braces) before all of the permanent teeth have erupted. Such treatment can occur between the ages of six and ten. This treatment is sometimes recommended to make more space for developing teeth, and correct crossbites, overbites, underbites, or harmful oral habits. Phase II treatment is also called comprehensive treatment, because it involves full braces when all of the permanent teeth have erupted, usually between the ages of eleven and thirteen.

84. Would an adult patient benefit from orthodontics?

Orthodontic treatment can be successful at any age. Everyone wants a beautiful and healthy smile. About 40 percent of our orthodontic patients today are adults.

85. How does orthodontic treatment work?

Braces use steady gentle pressure to gradually move teeth into their proper positions. The brackets that are placed on your teeth and the archwire that connects them are the main components. An ideally shaped archwire is placed into the brackets. As it return to its original shape. it applies pressure to move your teeth to their new, more ideal positions.

86. How long does orthodontic treatment take?

Treatment times varies on a case-by-case basis but the average time is about two years with traditional fixed appliances or 14 months with Invisalign. Actual treatment time can be affected by rate of growth and severity of the problems present. Treatment length is also dependent upon patient compliance. Maintaining good oral hygiene and keeping regular appointments helps insure that treatment will not be unduly extended.

87. Will braces interfere with playing sports?

No. We do recommend, however, that patients protect their smiles by wearing a mouth guard when participating in any sporting activity. Mouth guards are inexpensive, comfortable, and come in a variety of colors and patterns.

88. Should I see my general dentist while I have braces?

Yes, you should continue to see your general dentist periodically as he recommends for cleanings and dental checkups.

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