Ten Questions to Ask an Orthodontist

by Dr. Joseph Thompson

Orthodontic treatment is a long endevor and good information known upfront can be beneficial in obtaining a good experience and good results.  Here are some questions you should consider asking your potential orthodontist.

1. Did you graduate from a recognized post-dental school graduate program?  Are you an Orthodontic Specialist?

This question is probably the most important question to ask.  Your family general dentist can provide orthodontic treatment, but they are not a specialist in the field.  Specialists of Orthodontics are dentists who have gone to a full time orthodontic graduate program for two to three years after graduating from dental school.  A way to know if your orthodontist is not a specialist and a general dentist performing orthodontic treatment, is to evaluate their services they provide.  Does  your dentist offer all the other services that a general dentist provides like crowns, fillings, dentures, plus orthodontics?  An Orthodontic Specialist will stay within their field and provide only orthodontic services.  If they provide more than orthodontic services, chances are, they are a general dentist providing orthodontic treatment.  You might ask why this is a concern?

Let’s consider the primary care or family physician.  Would you want your family doctor doing specialized surgery?  Wouldn’t you want a specialist in their field?  A Specialist of Orthodontics are people who receive a Masters of Orthodontics after their doctorate degree from dental school.  They have studied the growth and maturation of the child, gone through numerous case studies, developed diagnostic skills, learned biomechanical techniques to properly move teeth and learned how to change development of the dental alveolar complex and facial  growth of the child.  Besides the didactic part of their training, orthodontic graduate students have numerous patients during that two to three year program and they are closely monitored/supervised by orthodontic faculty to provide orthodontic treatment.

Most Orthodontic Specialists are members of the American Association of Orthodontists.  The American Association of Orthodontists is the largest national organization of Orthodontic Specialists who have met the extra educational requirements and good standing to be a member.  Look for their logo which indicates a Orthodontic Specialist.

Some State governments have a license for specialty fields of dentistry.  This license allows the dentist to proclaim that they are a specialist in their field to the general public in commercials and printed materials.  Look for these credentials when considering who is going to provide orthodontic care for you or your child.

2.  Is your fee a flat fee?  Are there any hidden costs?

Fees are usually the deciding factor for whether a person will go through orthodontic treatment.  You don’t want to be surprised later during treatment with a fee you didn’t know about in the beginning.  Most orthodontists will quote a flat fee that is spread over a period of time without interest accruing.

Beware of the open ended fee structure.  The open end structure is that you will be paying for every visit that you have your braces adjusted.  Sometimes treatment will last longer than two years and it would be more costly for the patient with an open ended fee structure than over a fix flat fee.

Also, is there a replacement fee for a broken retainer or lost retainer?  Usually there is a fee, so keep an eye on those retainers.  Don’t loose them.  Keep them in their retainer box to keep them from being broken.  Ask your orthodontist, is there any other fees I need to be aware of during the initial consultation before treatment begins?

3.  Can my child play sports with braces on their teeth?

Your child can play all sports with braces.  There are no limitations.  There are some sports that you need to wear a mouth guard like football, soccer, basketball and wrestling.   Ask your orthodontist what type of mouth guard they suggest.  Some mouth guards are made of thermal plastic where you boil the mouth guard in hot water and then impress your teeth into it while it’s malleable.  Thermal plastic mouth gaurds are not the best type of mouth guard to use since as your teeth move and it will not fit over time.  It can work against the braces and how we are wanting to move the teeth.

The best type of mouth guard has flanges that you bite on to hold it in place and flanges that protect the lips from being pushed into the braces.  Ask your orthodontist about what type you should use.

4.  When should my child be seen for a first time visit?

As rule of thumb the answer is about 6 years old for a first time orthodontic visit.  Some orthodontists will suggest older or even younger ages.  You do not need a referral from your family dentist to be seen by an orthodontist.  Just call the office and make an appointment.  Most orthodontist do not charge for this initial exam and consultation.

The orthodontist evaluates  at a young age the eruption of the teeth, developement and growth of the jaws.  Early intervention and treatment of some problems can make treatment at a later age more effective and obtain better results.

5.  How often will my child be seen for office visits?

This varies from 4 to 8 weeks for active treatment while active appliances are being used.  Some appliances work the whole time they are placed in the mouth.  Some appliances need activation to apply new forces.  Some appliances need to be monitored or cleaned.  It just depends on what the orthodontist is using and trying to accomplish.  You should anticipate frequent visits to the office, so pick an office with a convenient location.

Does the orthodontist have multiple office locations?  If they do, what days of the week are they open at this office?  Remember they are only at that office location part time whereas an orthodontist with just one office location will have a larger number of appointment slots for you to choose an appointment time.

With retainers, patients are seen often right after braces are removed because teeth try to move the most right after braces are taken off.   After a period of time, retention visits can be spread out to every 6 months or a full year.  The main purpose of retention is to allow settling of the teeth, natural forces of the mouth to take over and keep the teeth is good functioning positions.

6.   Do I need to change the way I brush my teeth with braces in place?

Yes, you do need to change the way you brush.  When braces are placed on the teeth, it becomes harder to keep your teeth clean, free from plaque and food.  You have to be aggressive in your brushing by tilting the toothbrush bristles up under the wire of the braces.  If you don’t tilt your toothbrush and just brush over the braces, the bristles of the brush are deflected away from the tooth surfaces directly below the wire of the braces and you will not remove bacteria and food right underneath the wire.  To get that food and bacteria right underneath the wire, tilt that brush head and dig at the braces.  You will not hurt your braces by brushing in an aggressive way.

If you don’t remove the plaque, which is bacteria, from the tooth surface on a daily basis, decalcification will occur on the surfaces of the tooth over time.  This decalcifiation will cause white spots to appear on your enamel of the tooth.  They usually are seen after the braces are removed and do not look nice.  People think the braces caused the white spots to occur but it was the patient not keeping the plaque off of their teeth that caused the white spots.

7.  What if I move before treatment is completed? What do I need to do?

When a person transfers out of the area before treatment is completed, the patient needs to get connected with a new orthodontist to continue treatment.  Most Orthodontic Specialists are members of the American Association of Orthodontists (AAO).  The AAO has a directory of all their members in one book categorized by location.  You can easily copy the list of orthodontists in your new location and start the process of selecting  a new orthodontist.  Most orthodontists will be able to use the braces that are already on your teeth.  If the new orthodontist wants to replace all your braces to their type, get a second opinion.

You will need to make new financial arrangements with the new orthodontist.  The new orthodontist may take up the old fee schedule that you were under.  However, every orthodontist does things differently so don’t think that they should.  Also, estimated treatment time may change due to loss of time during the transfer.

After you have selected your new orthodontist, your records and information will be transferred via an AAO form so that your treatment can continue smoothly.

8.  How long will treatment take?  Will teeth need to be extracted?

Orthodontic treatment with braces can last from 12 months to 2 years or longer.  Some orthodontic appliances require the patient to grow to change positions of the jaws so it is not possible to be very accurate in estimating time.  So ask how long but remember, the answer you get is an educated guess by your orthodontist.  Most treatment time with braces is 20 to 24 months and it depends on the arrangement of the malocclusion.  Finally, adult treatment can last longer than 2 years.

Permanent adult teeth sometimes are extracted to create enough room for a proper alignment of the teeth.  In those patients who have severe crowding or jaw sizes that are small or teeth that are too wide, two to four teeth are extracted to create enough room to coreect the malocclusion.  All the space that is created is usually closed.  The teeth that are usually considered for extractions are the first or second premolars.

Additionally, some primary teeth may need to be extracted before treatment begins.  If a permanent tooth is having a hard time erupting into the moutrh due to crowding, or the permanent tooth bud was pointing into the wrong direction, extracting a primary tooth may help.

9.  What other alternatives are there to standard braces?  Can I be treated by those alternatives?

There are alternatives to standard stainless steel braces like lingual braces, ceramic braces and invisible braces.  When comparing standard braces to these, here are the problems with the alternatives I’d like to point out.

Lingual braces are not used often due to the fact that invisible braces have cornered that niche.  Lingual braces are hard to use because the braces are on the tongue side of the teeth and they can make your tongue very sore.  They also take up tongue space and are harder to visually see if you are trying to keep them clean.  Lingual braces use to be very popular among celebrities and people who didn’t want to show any braces.

Ceramic braces are brackets that are made of ceramic and not stainless steel.  The problem with ceramic braces is that they can break easier and are harder to remove.  Also, if a ceramic bracket touches the opposing tooth, it can abrade the enamel away.  So orthodontists that use ceramic braces usually only place them on upper teeth to avoid this problem.

Invisible braces are the newest fad for moving teeth.  Invisible braces are the thermal plastic type of retainers that slip over the teeth and have minor changes in the plastic to put pressure on the teet to move them.

To use Invisible braces, impressions of your teeth are sent to a lab that scans them into the computer.  With the scan in the computer, a technician will slowly move the computer scan mesh into how they think the teeth will move.  After a number of tooth movements, a set of thermal plastic retainers are made from this new position.  At every visit, the orthodontist will give you a new set of new invisible braces to wear and they move your teeth slightly until you need the next set.

I have issues with the invisible type of braces.  First, they are very expensive and cannot move the teeth as much as standard braces. There are some movements invisible braces cannot do.  Second, a computer technician can’t predict exactly how teeth are going to move over a long period of time.  An orthodontist diagnoses every visit how the teeth are moving and makes changes accordingly.  Finally, standard hawley retainers can be used to make the same types of minor tooth movement that Invisible braces will produce and the hawley retainer is cheaper.

10.  What are your sterilization procedures?

This shouldn’t be a problem but you could ask.  In all orthodontic practices, sterilization procedures are very important.  An orthodontic practice sees a large number of patients per day and cross contamination and infection control is a concern.

Sterilization of an instrument is the best form of infection control because all living organisms and spores are dead.  Disinfecting the instrument means that the number of microbes are reduced but not all are dead.

All instruments that can withstand high heat are sterilized with a steam autoclave or high dry heat.  Dry heat sterilization is used on cutting instruments since steam will dull them.  Instruments that cannot be sterilized with an autoclave or dry heat are disinfected with chemical disinfectants.

All surfaces are wiped down with disinfectants.  The uses of consumables between each patient helps contain cross contamination and control transfer of disease.

Again, sterilization procedures are constantly monitored by the orthodontist and staff.  Procedures are in place to keep the public safe.  If you have questions about sterilization procedures, ask.


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