Why are my
braces still on?A short skit with 5
Questions!
Those of you who have
been in braces at our office may have experienced my “Are your teeth straight”
stand-up comedy act!It goes something
like this:
Q. Are your teeth straight? (I never ask this question
unless they really are pretty much straight!)
A.Yes they are… (Sometimes we have to give the
patient a mirror to look at their own teeth)
Q. So if your teeth are straight… “Why are your braces still
on?”
A. Because my “bite”
is off (sometimes we have to explain to our patients that you can have straight
upper and lower arches but still have some type of overbite, overjet, openbite,
etc.)
Q. So what do you think fixes your “bite”?
A. Robber bands!
Q. What happens if you do not wear your rubber bands as we
instructed?
A. My bite will not
get fix and MY BRACES WILL NOT COME OFF.
Q. So who is in charge of how much longer the braces are on?
A. You… the patient, are
in charge, not the doctor, not your parents!
Q. What is the biggest misconception about orthodontic
treatment?
A. If I could just tell people one thing about orthodontics
it would be this: Teeth are NOT like fence post that are set in concrete.With a fence post, you place it where you
want it, pour concrete around the base, hold it in place (retain) and, when the
concrete sets up, the fence post is stable and should never move.Now this is NOT what happens with teeth!Teeth are never fixed to the jaw bones.They always have the capability to move.So why don’t they…why do crooked teeth stay
crooked until the orthodontist moves them…why do straight teeth stay straight
if a patient is blessed with straight teeth and never needed orthodontic
treatment?The answer is that, in both
cases, the teeth still can move…they just don’t “want” to move, at least not right
then.In both cases, the teeth are stable
(crooked and straight) in their respective positions because the forces on them
from the bite, tongue, lips and cheeks balance out (for you science types: static
equilibrium).Change the forces with
braces, or with just normal aging, and the teeth will move. This is why we
never tell a patient to stop wearing their retainers.Even if the teeth might stay straight for
years, forces change over time, and the teeth will move. Retainers will hold
teeth in position because they can overcome any unbalanced forces that might affect
the teeth.
Now all of this is not to say that in makes NO difference
where the orthodontist puts the teeth.Ideally, we try and find the most stable position possible for each
patient.If we do this, then the teeth
will tend to stay straight, with or without retainers (not that we recommend
not wearing retainers).And this is
where diagnosis comes in.Let’s say a
patient has extremely crowded teeth due to very large teeth and a small mouth.
The teeth are stable in their crooked position, but if we just expand the
arches to make room for all the teeth, are we not moving them out to an
unstable position?But if we extract
some teeth (so we can leave the remaining teeth in the arch, but straight),
then the final result should be much more stable.
My wife had orthodontic treatment 50 years ago and, like
many people, she stopped wearing her retainers after a few years.Yet, because she had teeth taken out for
crowding, her final result was stable and, even 50 years latter, her teeth look
great.Now this doesn’t happen for
everybody, but this is what we try to achieve, and this is the reason why we
try so hard to get everything perfect and why we reluctantly are forced to
extract teeth in some patients. Now some people will say that treating people
without extractions is a more “conservative” way of doing orthodontics.But is getting a stable result with
extractions more radical than leaving someone with an unstable result that will
collapse the second they stop wearing their retainers?
Bottom line: want to keep your teeth as perfect as the day
the braces came off?Then wear your
retainers!
We have used Invisalign since 1999, and we were one of the very first practices in the country to use this amazing technology. Since its introduction, there have been numerous upgrades in the computer algorithms that allow us to program the tooth movement and make it more efficient.
There has also been upgrades in the attachments, those little bumps that are glued to some teeth to allow more difficult movements.
In all this time however, there has not been any change in the "plastic" used for the aligners. The company has during this time been researching a better plastic and this January SmartTrack is now the new standard for all Invisalign appliances. So why is the new SmartTrack plastic better?...well the characteristics that were important were:
1. The aligners should be esthetic for daytime wear
2. The aligners should produce gentle consistant forces
3. The aligners should fit well and have excellent elasticity
And, after much testing, SmartTrack material proved to be far superior to the old material.
So what does this mean for Invisalign patients?...simply more aesthetic, more comfortable and more efficient orthodontic treatment!
Q.) I have heard about the new hi-tech braces like the Speed, Fast and Damon brackets that are suppose to radically shorten treatment time and “grow” jaws to avoid extractions.Do you use them?
A.) Orthodontic companies are always coming on the market with new appliances,
promising orthodontists that they can perform “miracles”. Over the years we
have tried many of these supposedly supper braces…. and guess what?Braces are pretty much braces…. it’s the skill
of the orthodontist that determines the quality and speed of the
treatment. Not that we do not invest in
the best appliances, but there is no magic way of doing orthodontic
treatment.If there were…every
orthodontist would be using it! As of
now we know of no good scientific study that shows any of these brackets to be
any better or faster than the traditional brackets we use.
We are
always open to new ideas.As a matter of
fact we were the first orthodontic practice in the Midwest to use Invisalign
(which really does work wonders!)
So if some new appliance does prove to be
superior you can be assured we will be one of the first to adopt it.
Orthodontic treatment has two major components: getting the teeth straight so they look good, and getting the “bite” correct so that they function as they should. Now, in general, it is much easier to just straighten the teeth than it is to fix a bite, and often we have the teeth “straight” very early in orthodontic treatment, yet spend months more doing things to fix the bite.
So the question we often get is: “Doc, how important is it to fix the bite”
Our answer runs something like this:
Say you go to your regular doctor for a checkup. The doctor checks your blood pressure, studies your blood profile, exams you and finally says: “Well everything checks out fine EXCEPT the fact that you are slightly overweight. Now it is your turn to ask: “doc, what does that mean to my health to be overweight? Does it mean I will get diabetes, have an early heart attack? Should I be worried?
Now, if your doctor is honest, she should answer you like this: “NO, it doesn’t necessarily mean anything bad will happen, but, all things being equal; it would be BETTER if you weren’t overweight”
And this is the same answer we give for the question: “do I need my bite fixed?”
Of course everything is relative, so you should watch your diet and lose the weight, but should you get your stomach stapled if you are 20 pounds overweight?….we don’t think so! By the same reasoning, if we can fix your bite with a reasonable degree of effort, we think it is worth it. If it would take 3 years or jaw surgery…maybe the “cure is worse than the disease” and we should settle for straight teeth and a less than ideal bite. In these situations, we are happy to spend whatever time is necessary to help you make the right decision!
The parable of the Corvette and the 18-wheeler, or why you should wear your elastics full time.
Now everybody knows that with traffic flowing freely, high powered sports cars like Corvettes, as well as giant 18-wheeler trucks, all move down the freeway at the speed limit. But what happens when the there’s a problem and all the traffic comes to a halt? When the jam clears the Corvette can take off like a rocket and in 4 or 5 seconds it’s going the speed limit again. But what of the huge trucks loaded down with 10’s of thousand of pounds of cargo? They take forever to get going again...until they too are going full speed with the rest of the traffic.
Now the question we ask is: are your teeth like high-powered sports cars or are they like heavy trucks? And, of course, you know the answer… they behave like trucks: as long as things are moving no problem. But let things stop and it is a long, long time to get moving again. Stop wearing your elastics for a few hours and everything grinds to halt… even when you start wearing your elastics again, it can be hours and hours before they start moving a full speed again. So missing even a few hours can significantly slow your treatment.
The moral to the story is: Be like the driver of a big truck..... peddle to the metal and you’ll get there
on time.
How Forks Gave Us Overbites and Pots Saved the Toothless
By Scott Douglas
inShare2065Historical changes in the ways we cook and eat have dramatically altered public health.
MLazarevski/Flickr
Bee Wilson is the author of Consider the Fork,
which documents
the evolution of cooking and eating technology. In the book, Wilson
describes many unintended consequences of new methods of or materials
for cooking and
eating. Here she talks about some of the health ramifications of
such changes.
I was struck while reading your book by how changes in the
instruments we use to cook and eat can have large-scale health
implications. It's especially fascinating that overbites didn't
become standard until we all
started eating with a knife and fork. Can you describe how that
happened?
Yes, I found to be this one of the most fascinating and surprising changes to be brought about by kitchen utensils.
Until around 250 years ago in the West, archaeological evidence suggests that most human
beings had an edge-to-edge bite, similar to apes. In other words, our
teeth were aligned liked a guillotine, with the top layer clashing
against the
bottom layer. Then, quite suddenly, this alignment of the jaw
changed: We developed an overbite, which is still normal today. The top
layer of teeth fits
over the bottom layer like a lid on a box.
This change is far too recent for any evolutionary explanation.
Rather, it seems to be a question of usage. An American anthropologist,
C. Loring Brace,
put forward the thesis that the overbite results from the way we use
cutlery, from childhood onwards.
"Women were particularly at risk from open
hearths, on account of the combination of billowing skirts, trailing
sleeves, and open flames."
What changed 250 years ago was the adoption of the knife and fork,
which meant that we were cutting chewy food into small morsels before
eating it.
Previously, when eating something chewy such as meat, crusty bread
or hard cheese, it would have been clamped between the jaws, then sliced
with a knife or
ripped with a hand -- a style of eating Professor Brace has called
"stuff-and-cut."
The clincher is that the change is seen 900 years earlier in China, the reason being chopsticks.
As with any such thesis, we will probably never have definitive
proof that the overbite results from the adoption of the fork, but it
does seem the best
fit with the evidence.
The first time I read Brace's work, I was truly astonished. So
often, we assume that the tools we use for eating are more or less
irrelevant -- at most, a
question of manners. I found it remarkable that they could have this
graphic impact on the human body.
At the same time, you write in the "Pots and Pans" chapter how until the 18th
century most families had one big pot, a cauldron, that had a
sort of palimpsest porridge in it -- they just kept adding new things to
cook along with whatever was left
over from the day before. So a lot of what people ate was soft.
Were there dental changes once other ways of cooking became readily
available?
The big dental change that was seen with pots happened with the initial adoption of pottery for cooking around 10, 000 years ago. Until the cooking pot was invented, no one who had lost all their teeth would survive into adulthood. There are no traces of edentulous -- toothless -- skeletons in any population without pottery. Pots made it possible
for the first time to cook nourishing stew-like meals that required no
chewing but could, rather, be drunk. So having teeth was no longer
necessary for survival. This is another clear example of how
utensils have acted as a kind of robotic extension of the human body.
On the question of why eating these soft foods didn't lead to
dramatic dental changes -- such as is seen with the fork and the
overbite -- I think the
answer must be that they tended to be eaten alongside other, tougher
foods.
But switching from a diet of mostly chewy foods to one of very soft
foods can definitely have an impact on human teeth. Studies of
Australian aboriginals
have found that within a single generation of leaving their homes in
the Outback and moving to cities (where the diet becomes one heavy in
refined white
flour and sugar), teeth have far less attrition (wear and tear from
chewing) but many more cavities.
In Lewis Carol's story Alice in Wonderland the Cheshire Cat has a remarkable ability to vanish except for its grin "which remained sometime after the rest of it had gone." With all our concern for the teeth and bite, it might seem as if we are dealing with only the GRIN and missing the PERSON to whom it belongs. That's why we would like to take this time to let you know that we do appreciate the opportunity of serving your orthodontic needs.
Our goal is to provide the highest quality treatment in a caring and friendly manner. We hope that all of your visits with us are pleasant, and that you will feel comfortable recommending us to your friends and family!.
