FAQ
Answering Your Questions
You have orthodontic questions, and we have answers! If your question isn’t below, use the contact form below to send it to us and have it answered.
Like a general or family dentist, an orthodontist attended 4 years of dental school after earning an undergraduate degree. In dental school, all students learn anatomy, physiology, pharmacology, pathology and many other areas of the medical sciences. Dentists then learn how to diagnose oral diseases and restore/replace teeth that are diseased, missing or need cosmetic improvement. They are taught how to remove teeth, clean and fill root canals of teeth that are diseased and provide basic care for the gums and bones around the teeth. Dental schools will also expose students to orthodontics, oral maxillofacial surgery and periodontal therapies/surgery.
To become a licensed dentist in the state of New York, dentists must complete a 1-year general practice residency. During that time, they will hone their clinical skills, often in a hospital setting. Alternatively, a dentist may complete a 2-3 year residency in a dental specialty. Orthodontists are dentists who have completed one of these specialty residencies, spending additional years focusing solely on the science of facial growth, the development of the teeth and the bite and the proper way to safely and efficiently move teeth and bites into alignment. When they begin practicing, orthodontics is the only focus of their practice.
Dentofacial orthopedics is a specialty of orthodontics that focuses on the guidance of dental, jaw and facial development via various fixed and removable appliances. While dentofacial orthopedics mostly focuses on early orthodontic treatment in children, treatment under this specialty can also benefit adults.
The decision to extract teeth is never taken lightly by an orthodontist. As dentists who are entrusted with protecting our patient’s health and well-being, our usual objective is to save healthy teeth.
When an orthodontist considers a crowded case, several detailed measurements are taken to determine how the teeth can be made to fit together in the mouth so that the end result is a beautiful smile with no crowding, no spacing, good overjet and overbite and healthy biting contacts on each side of the mouth.
There is a limit to how much teeth can be moved while still keeping them upright in supporting bone, surrounded by healthy gums, for many years into the future. If teeth are pushed too far out of their bony housing in an effort to get them straight, problems may occur. Orthodontists will consider your profile, the thickness and harmony of your facial soft tissue (lips, cheeks) and evaluate how removing teeth may affect these aspects of facial balance either positively or negatively.
Only after all of these factors are taken into account would an orthodontist make a recommendation to straighten with or without extracting—perhaps in conjunction with interproximal reduction. An orthodontist will explain why a certain treatment plan is recommended for your unique situation.
Interproximal reduction (IPR) is the conservative removal of some of the outer tooth surface, called enamel. Usually, only about 0.1 to 0.25 millimeters of enamel are removed on each surface. This technique has been used in orthodontics since the 1940s. It is also known as slenderizing, contouring, stripping, enamel reduction, reproximation and selective reduction.
Whatever the name, the intentions are the same— to acquire more space for your teeth, to reduce friction in between your teeth to facilitate movement, to improve your bite or to make the teeth more attractive. Sometimes, it is done following orthodontic treatment to improve stability.
Tooth enamel is a bit like your fingernails— it has no innervation or feeling. The tenths of millimeters removed with IPR do not hurt, do not require anesthesia and can be done in a matter of a few minutes. Studies have shown when done properly it does not increase your risk for cavities or sensitivity.
Many years ago, it was thought that developing wisdom teeth caused front teeth to be pushed forward and get crowded. However, several recent studies have shown that the growth of wisdom teeth in the back of the jaw are too far away to impact tooth position in the front. People who never had wisdom teeth or had them extracted STILL get crowding, while some people with impacted wisdom teeth keep their straight teeth. However, there are other legitimate reasons to have wisdom teeth extracted, so your oral surgeon can review considerations with you.
Each patient is unique, and therefore, there is no one-size-fits-all estimate for treatment duration. On average, treatment takes 12 to 36 months.
When teeth move from a position where they are crooked to a position where they are straight, bone is removed from one area surrounding the tooth and deposited in the area where the tooth vacated. This is a process that takes weeks to months, limited by the biology and biochemistry of bone cells. There are appliances, such as the V-Pro5® or OrthoPulse® that help keep your orthodontic treatment on track, but there is currently no independent evidence that these technologies speed up the treatment process. Other techniques such as Micro Osteo Perforation or Wilkodontics have better scientific evidence behind them, although some of it is inconclusive. Dr. Pompei can discuss the pros and cons of your options for getting in and out of treatment as fast as you can.
The American Association of Orthodontists (AAO) recommends that children first see an orthodontist at age 7. At this age, your child has a mixture of baby and permanent teeth, and Dr. Pompei can determine whether they are a good fit for early orthodontic treatment.
Early orthodontic treatment, also sometimes called Phase 1 or early interceptive treatment, aims to guide the growth of your child’s jaw and bite, and make room for permanent teeth to grow in. This helps to prevent tooth extractions and severe orthodontic issues in the future.
Orthodontics is largely an elective health care service. As the saying goes, “nobody ever died of crooked teeth.” However, orthodontics has the potential to tremendously improve quality of life. Straight teeth are easier to keep clean and a healthy bite helps prevent enamel wear over a lifetime. Additionally, studies have shown that a person’s teeth may impact whether they will be hired for a job. Lastly, orthodontic treatment that is completed while a child is still growing has many advantages, it is often faster and better tolerated than treatment in an adult who is done with growth.
In short, usually, it is advisable to undergo comprehensive treatment, even if there is “just one crooked tooth.” Here’s why: your upper teeth and your lower teeth have to fit together when you bite down. Although there may be one tooth that is rotated, the adjacent teeth will have to be moved to make space to move the problem tooth or teeth. When you change teeth in one arch, you change that arch shape, and thus the relationship to the opposing arch when you bite down. Comprehensive treatment allows correction of alignment and assurance that your bite at the end will be proper.
Yes! Please keep going to your dentist for regular check-ups and cleanings. Although you see us more frequently than your general dentist, we will not be doing explicit exams for cavities or cleanings every time you come in for an orthodontic adjustment. Additionally, healthy teeth and gums move easier during orthodontic treatment.
It’s never too late to get your smile straight! While adults are offered many of the same treatment options as teenagers, the overall treatment experience does differ. While teens’ bones are still soft and growing, adults’ bones are denser and more mature. As a result, adult orthodontics sometimes takes longer. Additionally, adults may have other dental issues that teenagers do not usually face, such as fillings, gum disease or implants. Regardless of your situation, Dr. Pompei will work with your dentist to help you achieve the smile you deserve.
It’s normal to feel some slight discomfort and soreness when you first get your braces on or after you have your braces tightened, but braces should not be significantly painful. If you are experiencing soreness, try these tips:
- Take over-the-counter pain relievers
- Use a warm saltwater rinse to soothe mouth sores
- Use orthodontic wax to cover a poking bracket or wire
If you are straightening your smile with braces, there are some foods that you will want to avoid. These foods can easily get stuck between brackets and wires, and possibly damage or break your braces.
- Sticky and chewy foods. Foods such as candy, pizza and bubblegum can easily get stuck in braces brackets
- Hard foods. Biting directly into hard foods such as apples can damage or break your brackets
- Crunchy foods. Avoid particularly crunchy foods such as popcorn or nuts
TMJ pain is usually multifactorial, and a bad bite alone is rarely the only cause of jaw joint pain. If you are experiencing chronic, radiating TMJ pain that interferes with your daily activities, you should see an orofacial pain specialist first to address the many possible causes of this pain before undergoing orthodontic treatment.
You should wear your retainer regularly for as long as you want your teeth to stay straight. For most people who are years out of orthodontic treatment, “regularly” means several nights per week during sleep time. Nothing in your body stays the same with time and age. Just like you can’t go to the gym, acquire peak fitness, and then stop exercising and expect to keep the same level of fitness, you can’t straighten your teeth and expect them to stay in the same place at age 80 as they were at age 14. Maintenance, via retainer wear, is required or there is a risk your teeth will shift. Even people who have never had orthodontic treatment may notice their teeth shifting with age. Some lucky people will stop wearing their retainers and notice no changes over the years, but we cannot predict who will and will not fall victim to relapse.
There are numerous ways to achieve an excellent orthodontic result for every case, but every treatment approach, appliance, and technique has several pros and cons. Each orthodontist will weigh these factors differently and advise accordingly. It is not uncommon to receive slightly different recommendations if you consult with various specialists. The important thing when making a decision is that you feel comfortable and you understand the risks and benefits of your choices. You should feel you have selected an orthodontist who has listened to and understood your concerns so that you are on the same page from the beginning and know what to expect along the way.
