Ask the Orthodontist

Dr. Pang my son is preparing to get Invisalign braces in a month or so. A dental hygenist friend of mine is concerned that it can cause permanent damage to the tooth roots in teens by moving them too quickly. Should I reconsider?
LK

Dr. Pang: The most qualified person to evaluate your son's health is a dentist/doctor. If you are concerned please seek a 2nd opinion from someon qualified to give you an evaluation. You hygienist friend is partially correct though, in that permanent root damage can occur as a complication -- regardless of the technique used. Invisalign or not. In fact, root damage can occur for other reasons such as banging a tooth with a soccer ball. Root resorption often is noticed years later, and can be triggered by a traumatic accident to the tooth.

Question: I am 57 years old and last week fitted with my first set of invisalign braces. The dentist worked on one of my front teeth to make it smaller. Now I have a gap between my two front teeth and the tooth he drilled on has several hairline cracks and is very sensitive. Should I be concerned about this and contact his office before my next appointment scheduled in 2 weeks? Also I just received a test result that indicated I have osteoporosis which I was not aware of when we started this process.Should my dentist be informed of this new health issue?

Dr. Asensio: I am so happy for you that you have started your Invisalign treatment, hurray! About your new medical condition, yes it would be wise to inform your dental care doctor. However, this should not influence your treatment at this time.In regarding your sensitivity and your concerns about your actual treatment i would contact their office today and inform them of this. They might want to see you right away just to make sure you and your treatment are doing well. It is to be expected to have some soreness and sensitivity of the teeth with Invisalign every time a new aligner is used because of the new movement it creates. I hope this answers your question.
Look forward to your final results and get excited.

I have a malocclusion problem and an overbite and the malocclusion is gradually causing my face to become very asymmetrical and it is also causing me quite a bit of pain. I had to get a back molar extracted because the root was fractured and am in the process of having a dental implant placed there once the bone grafting heals up. I want to get that tooth replaced but also do not want to have it put in if I require braces or whatnot in order to get rid of this jaw pain that I am experiencing due to the malocclusion. Can a person have braces if they have crowns and implants in place in their mouth? Also, is an orthodontist fully qualified to do a proper bite adjustment, if that is all that I need to make the pain go away?

Dr. Slota: Kristine, your questions are valid. A person with crowns and implants can have orthodontics done. An orthodontist is best trained to straighten teeth. They are not necessarily the ones to do bite adjustments. I would recommend you find some one who does functional or neuromuscular TMJ to correct your bite prior to any orthodontic treatment.

My step daughter needs to have braces, her mother e-mailed me with a quote of $2380.00 for phase 1 saying that she would get a lower lingual holding arch, a bite plane, upper front braces, head gear and a retainer. This work would be done in Lancaster County Pa. Does this seem like the going rate for these procedures?

Dr. Asensio: dear Kristine it would be very difficult for me to  create a treatment plan for your step daughter's braces without conducting an examination. However, the pricing for any orthodontic treatment will be very customized and very particular for each individual.  This means that depending on the patients needs ( including complexity of the case and the time it may take to complete the case). the geographical area were you live, quality of materials used and the expertise and experience from the doctor treating the patient the prices will vary.

I'm 23 this year and wanted to wear braces.is that possible in my age? I want something that is very invisible to others.Are there any new types of braces in market? and I would like to know the total cost as well. Thank You

Dr. Asensio: There is really no age limitations or an ideal age for a person to get braces, if the person has a need for braces the earlier the intervention the better for that patient. Regarding braces that are invisible to others.... there is more than one form of treatment that could be consider. If regular braces with wires are to be used clear brackets could be placed on the front teeth that are almost invisible. However, there is a more advance product that is invisible to others in every way. This is called INVISALIGN and could work for you. The teeth are moved via an aligner that fits over your teeth . For more information on this or to find out about a dentist that is trained to do INVISALIG visit WWW.invisalign.com.

Dear Dr. Slota

I have a few Questions concerning Orthodontic Treatment that i would like to discuss with you.

1.) Is it possible to move one specific tooth with the braces and live the rest just the way they are?I noticed some changes on my Upper Jaw,One of my teeth in front (Left incisor) was crooked.I wanted to correct this problem only. I did not want to have brackets on my lower Jaw.Are the any risks of just correcting one tooth?

2.)My Wisdom teeth and 4 teeth in front were taken out.I did not want to loose my front teeth.I thought if i remove the Wisdom teeth, then there will be room for the teeth to move behind.I had 34 teeth; two extra wisdom teeth on my upper jaw.Was it really necessary to take away the front teeth?I have some facial damage, my nose is not the same as before and my cheekbones are expanding, (my face is horizontal or used to be).Everybody i meet is commenting on how terrible i look.

3.)My front teeth were pulled out against my Wish.Now am really affected with this.What can i do about this?

4.)I would like to change my Orthodontist.How should i go about this?

Dr. Slota: 1. Correcting one tooth may be possible.  Other cases are more involved, like a jigsaw puzzle,  and may need more comprehensive treatment.

2. Without seeing records it is impossible to determine whether or not your 4 front teeth needed to be removed.  Losing teeth does affect facial appearance.

3. You need to locate a dentist that you can communicate with.  Finding someone that listens to your concerns and helps you obtain what you want is important.

4. First try to work things out with your current dentist.  If  you can't, ask your orthodontist for a referral.  If you are uncomfortable doing that, start interviewing dentists that do orthodontic treatment.  Find someone you are comfortable with and that you can communicate with.  That Dr. will help you in communicating with your current orthodontist.

HI I'M A SINGLE PARENT WITH NO INCOME AND MY DAUGHTER JUST TURNED 14 AND HER DENTIST REFFERED HER TO SEE AN ORTHONDTIST FOR BRACES BUT WE MEDICAID AND HER TEETH IS IN VERY BAD SHAPE SHE HATES TO GO TO SCHOOL CAUSE ALL THE KIDS TALK ABOUT HER SO HOW CAN I FIND AN ORTHODTIST THAT ACCEPT MEDICAID

Dr. Slota: You may have to call each orthodontist in your area to see who would be accepting patients with Medicaid.   Your daughter has an obvious need, unfortunately Medicaid may not see this as "need".   That would mean you would need to pay for it yourself.

Unfortunate but reality.

My daughter (19) had a baby tooth that never fell out. Finally pulled it (Oct.) after adult tooth grew in behind it. According to dentist, adult tooth is too far back and not likely to come forward, so there is a big gap. Have had 2 orthodontic consultations. Unfortunately my husband's store may be going out of business, a weekly paycheck has become an iffy thing, and we are facing an uncertain financial future. Health insurance has been canceled and our savings is dwindling. Braces are the last thing we can afford at the moment. I wouldn't even presume to go on a payment plan because I have no idea what's coming. My daughter is attempting to save the money herself, but she is also paying for college. She is discouraged and feels extremely uncomfortable and conspicuous with the space in her mouth. (I'm not sure of the names of teeth, but it's not a front tooth, nor the one immediately next to it, but the next one in line. When she smiles it looks like she's 7 with a missing tooth since the adult one is too far back to see.) Any solutions other than full braces? Can we just do the top row of teeth for half the price?

Dr. Slota: Georgianne, sorry to hear of your daughter's predicament.  Sometimes limited treatment (one or more teeth) can be done.  Each case is individual.  You will have to pick a doctor your daughter trusts and follow their professional advice.

I went to an appointment earlier today, and when I got home I had noticed that something was different. My bands were connected together and only 6 of them were separate (bottom-left-last 3 & top-right-last 3). I have not seen this before, and when I searched the internet for pictures of this, all of them had pictures with the bands separate so I was wondering if my orthodontist took a shortcut and decided to be lazy or if there was an actual scientific reason to her methodology?

Thanks,
Alex

Dr. Pang: Dear Alex ....please understand that it is difficult to determine exactly the nature of your case without consulting with your orthodontist or thoroughly reviewing your records.   However,    I am trying to imagine how your orthodontic bands are "connected together".   I can think of several methods when I would connect bands together, but I can't determine if this is the situation with your particular case.    Sometimes we will attach a larger lingual wire from one side to the other.   Other times, we will "undertie" bands/brackets together with a light wire.  And, still yet I have also bonded some temporary material to the chewing surface of several back teeth to help correct a deep overbite.   Furthermore,  there are times when we will use sectional arch wires that connect teeth together in just one area.    All these techniques are viable treatment options when appropriate.

I would strongly encourage you to ask your orthodontist at your next visit. Believe it or not, we do have your best interests in mind.   ;-)    And, you must have established some trust with your office at some point or you probably would have chosen another office.  Right?   So, what has caused you to lose trust?  Perhaps this is also something you should discuss in private with your orthodontist.    I would want to know if there was a problem. That's the only way we grow and become better.   Thanks Alex.

Peter Pang, DDS

"After completing invisalign braces, is there a need for a refinement process?"

Dr. Pang: A refinement process may be needed for some cases.   Even with conventional fixed-wire appliances some minor adjustments may be indicated. Your dentist/orthodontist may want your occlusion or bite to be refined further.   However, the amount of refinement should be minor and in the neighborhood of microns ( about a hair's width or less). Thanks for your question.