Each child expresses teething differently.  One child may erupt teeth without you even knowing it.  Another child may become irritable, cry or wake up more, or change their routines.  Parents often note that their child begins to “drool more” or “put everything in their mouth”.

 -Let your child chew on cold objects:  A frozen washcloth (rolled up), cold teething rings, or a frozen carrot, celery stick or bagel.  Do NOT leave your child unattended with an object in their mouth.  Use caution with the foods, take them away from your child as soon as they get soft or begin to break apart.

 -Keep their gums clean by wiping them with gauze after each meal.

 -Massage their gums with an infant oral stimulator or a tooth brush.

 -Use Children’s Tylenol as directed on the package for pain.

 -Use over-the-counter teething agents (gels, tablets, etc.) with caution.  Often they are too short acting, create irritation, or even contain high levels of sugar.

 -Keep toys very clean; teething children like to put things in their mouths.  They can pick up bacteria from those objects.  This can lead to an infection including a fever, runny nose, and often diarrhea.  Teething usually occurs at the time that the child is losing their mother’s immunity.  This makes the baby more susceptible to these infections.

Your infant will be at a higher risk for cavities if you put them to bed with a bottle containing milk, juice or soda, and if you “clean” their pacifier in your mouth or test their food in your mouth before giving it to them.   Cavity-causing germs live in our mouths on our teeth, and children get the germs from their caregivers (mom, dad, etc.).   The germs live in a white film-like substance on the teeth called plaque, so it is important for parents to brush and floss the plaque off on a regular basis (and to see YOUR dentist every 6 months to keep YOUR mouth healthy!).  Always brush your child’s teeth before they go to sleep.  Some children require one parent to hold their hands while the other parent brushes their teeth.

Germs love sugar!  The germs eat the sugar and produce acid that decays teeth.  Breast milk has a high sugar content, as well as formula, milk, juice and soda.  Always wipe the residue from your baby’s teeth after nursing or bottle feeding with a soft cloth, gauze or finger brush.  If your baby has a sippy cup, only water should be placed in it.  As the molar teeth erupt, a toothbrush is needed to clean the grooves thoroughly.  Children do not develop the small motor skills and coordination for thorough brushing until about age seven.
 

When your baby reaches 6 months of age, they should drink fluoridated water or take fluoride supplements.  With the exception of some neighborhoods in Healdsburg, Sonoma County does NOT have fluoride in the water.  As you begin to brush their teeth, begin with a fluoridated toothpaste in a very minimal amount (smaller than a pea) and make sure your child does not swallow an excessive amount of the toothpaste. 
 

A serious form of decay among young children is baby bottle tooth decay.  This condition is caused by frequent and long exposures of an infant’s teeth to liquids that contain sugar.  Among these liquids are milk (including breast milk), formula, fruit juice and other sweetened drinks.  Putting a baby to bed for a nap or at night with a bottle other than water can cause serious and rapid tooth decay.  Sweet liquid pools around the child’s teeth giving plaque bacteria an opportunity to produce acids that attack tooth enamel.  If you must nurse your baby as a comforter at bedtime, wipe their gums and teeth with a soft cloth afterwards.  Bottles should contain only water.  If your child won’t fall asleep without the bottle and its usual beverage, gradually dilute the bottle’s contents with water over a period of 2-3 weeks.  

After each feeding, wipe the baby’s gums and teeth with a damp washcloth or gauze pad to remove plaque.  The easiest way to do this is to sit down, place the child’s head in your lap or lay the child on a dressing table or the floor.  Whatever position you use, be sure you can see into the child’s mouth easily.
 

The most important part of brushing is the technique used.  You should brush your child’s teeth for them 3 times a day.  Begin daily brushing as soon as the child’s first tooth erupts.   By age 4 or 5, children should be able to brush their own teeth WITH SUPERVISION until about age eight.  However, each child is different. 

Proper brushing removes plaque from the inner, outer and chewing surfaces.   When teaching children to brush, always use a SOFT BRISTLE toothbrush and start along the gum line in a gentle circular motion.  Brush the outer surfaces of every tooth, upper and lower.  Repeat the same motion on the inside surfaces and chewing surfaces of all the teeth.  Finish by brushing the tongue to help freshen breath and remove bacteria.

Flossing removes plaque between the teeth where a toothbrush can’t reach.  Flossing should begin when any two teeth touch.  You should floss your child’s teeth until he or she can do it alone.  Use about 18 inches of floss, winding most of it around the middle fingers of both hands.  Hold the floss lightly between the thumb and forefingers.  Use a gentle, back-and-forth motion to guide the floss between the teeth.  Curve the floss into a C-shape and slide it into the space between the gum and tooth until you feel resistance.  Gently scrape the floss against the side of the tooth.  Repeat this procedure on each tooth, and don’t forget the backs of the back four molars.

Tooth brushing is one of the most important tasks for good oral health.  Many toothpastes, however, can damage young smiles.  They contain harsh abrasives which can wear away young tooth enamel.  When looking for a toothpaste for your child make sure to pick one that is recommended by the American Dental Association.  These toothpastes have undergone testing to insure they are safe to use.  Remember, children should spit out tooth paste after brushing to avoid getting too much fluoride.  If too much fluoride is ingested by children between the ages of 1 to 4, a condition known as fluorosis can occur where white streaks or specks appear on the front permanent teeth when they erupt.  If your child is too young or unable to spit out toothpaste, consider providing them with a fluoride-free toothpaste.

Toothache: Clean the area of the affected tooth. Rinse the mouth thoroughly with warm water or use dental floss to dislodge any food that may be impacted. If the pain still exists, contact your child's dentist.  Do not place aspirin or heat on the gum or on the aching tooth. If the face is swollen, apply cold compresses and contact your dentist immediately.

Cut or Bitten Tongue, Lip or Cheek: Apply ice to injured areas to help control swelling. If there is bleeding, apply firm but gentle pressure with a gauze or cloth. If bleeding cannot be controlled by simple pressure, call a doctor or visit the hospital emergency room.

Knocked Out Permanent Tooth: If possible, find the tooth. Handle it by the crown, not by the root. You may rinse the tooth with water only. DO NOT clean with soap, scrub or handle the tooth unnecessarily. Inspect the tooth for fractures. If it is sound, try to reinsert it in the socket. Have the patient hold the tooth in place by biting on a gauze. If you cannot reinsert the tooth, transport the tooth in a cup containing the patient’s saliva or milk. If the patient is old enough, the tooth may also be carried in the patient’s mouth (beside the cheek). The patient must see a dentist IMMEDIATELY!  Time is a critical factor in saving the tooth.

Knocked Out Baby Tooth:  Contact your pediatric dentist during business hours.  This is not usually an emergency, and in most cases, no treatment is necessary.

Chipped or Fractured Permanent Tooth: Contact your pediatric dentist immediately. Quick action can save the tooth, prevent infection and reduce the need for extensive dental treatment. Rinse the mouth with water and apply cold compresses to reduce swelling. If possible, locate and save any broken tooth fragments and bring them with you to the dentist.

Chipped or Fractured Baby Tooth: Contact your pediatric dentist.

Severe Blow to the Head: Take your child to the nearest hospital emergency room immediately.

Possible Broken or Fractured Jaw: Keep the jaw from moving and take your child to the nearest hospital emergency room.
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Healthy eating habits lead to healthy teeth.  Like the rest of the body, the teeth, bones and soft tissues of the mouth need a well-balanced diet.   Cavity-causing Germs love sugar!   We encourage parents NOT to routinely stock their pantries with sugary or starchy snacks, instead consider fruits and veggies, cheese, yogurt, nuts and seeds, and cereals with no sugar added.   Avoid dried fruit snacks or anything sticky, juice or soda, chips, crackers, cookies and candy (especially hard and long-lasting).  It’s better to have chocolate or ice-cream—they melt!  If occasionally your child has sugary/sticky foods, it is better to eat them with a meal, not in-between meals.  And limit the number of snack times!  Nibbling on one cookie all day long is worse for teeth than eating a whole bag at lunch.

Never put your child to bed with a bottle or a sippy cup that has milk, juice, or sweetened beverage in it.  The liquid will sit on the teeth and gums and lead to decay.  If your child has a sippy cup, only water should be placed in it.  Breast milk, as well, has a high sugar content.
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Fluoride is a naturally occurring substance that is essential to the development of strong, healthy teeth and vital to the prevention of cavities.  A balanced diet that does not include fluoridated water will not meet the needs of a growing child.

Fluoride is available in two forms, topical and systemic.  Topical fluorides strengthen teeth that are already present in the mouth, making them more decay resistant.  Examples of topical fluorides are fluoride toothpastes, mouth rinses containing fluoride and prescription fluoride gels.  Fluoride varnish is another form of topical fluoride that is  applied at the dental office, often during a routine check up. Topical fluorides are not meant to be swallowed.   If your child is too young to spit out excess toothpaste, use a non-fluoride brand until they develop this skill.  A small pea-sized amount of toothpaste is all that is recommended when brushing.

Systemic fluorides are ingested into the body and become incorporated in the formation of the tooth structure.  Examples of systemic fluoride are prescription fluoride supplements in drops or tablet form.  If you live in an area with a fluoridated water supply systemic fluorides are not necessary. 

Dental fluorosis, a minor cosmetic condition that is not harmful to your health, is characterized by lacy white lines or specks on the surfaces of the permanent teeth.  Fluorosis is caused by excessive fluoride ingestion at a young age while the teeth are still forming.  Always follow directions on fluoride products to avoid ingestion of too much fluoride. 

The American Dental Association and the American Academy of Pediatrics have reviewed the use of fluoride toothpastes, rinses and supplements.  Their findings were that children living in communities without fluoridated water may benefit greatly from fluoride supplements.  Fluoride is like any other nutrient, it is safe and effective when used appropriately.
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Regular dental visits are key to helping your child stay cavity free. Hygiene instructions improve brushing and flossing techniques and lead to cleaner and healthier gums.  Dr. Oliver will assess any changes that have occurred within your child’s mouth, identify problems, and offer suggestions.

Issues that are addressed at each visit include:

            -Teeth development

            -Diagnose caries and potential caries; discuss treatment options

            -Caries prevention/Brushing and Flossing techniques

            -Topical and systemic fluoride options

            -Teeth cleaning/polishing

            -Orthodontic issues:  assess bite, crowding, etc.
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Dental radiographs (X-rays) can provide essential information about oral health.  They are an important part of a patient’s dental record.  We use computers to help capture, store and transmit dental radiographs.   Digital imaging involves the use of a radiography machine like that used to create dental radiographs made with film.  But instead of using film in a plastic holder, the clinician makes digital images using a small electronic sensor or an image receptor that is placed in the mouth to capture the image..  It is then transmitted to a computer processor and can be viewed immediately on the monitor in a large format.  The clinician can use magnification to enhance specific problem areas of a tooth, as well as alter brightness and contrast.  The radiographs can be printed, copied, stored and emailed directly from the computer.  They require very low levels of radiation, approximately 70-80% less than traditional film x-rays, which makes the risk of harmful effects extremely small.  In fact, the radiographs represent a far smaller risk than an untested and untreated dental problem. 

Radiographs detect much more than cavities.  For example, radiographs may be needed to survey erupting teeth, diagnose bone diseases, evaluate the results of an injury, or plan orthodontic treatment.  If dental problems are found and treated early, dental care is more comfortable for your child and more affordable for you.  The American Academy of Pediatric Dentistry recommends radiographs and examinations every six months for children with a high risk of tooth decay.  On average, Dr. Oliver will request cavity-checking x-rays once a year, and a panoramic x-ray by age 8 or 9.
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1.  Bacteria.  Cavities are an infectious disease caused by germs.  The germs live in our mouths on our teeth.  Our children get the germs from their care givers (mom, dad, etc).  Apply the same rules to cavities as you do to colds:  don’t share the same utensils, toothbrushes, food, etc.  Don’t test your child’s food in your mouth (use a separate spoon for you).  Don’t “clean” their pacifier in your mouth.  This all spreads germs that cause cavities.  See your dentist every six months to keep YOUR mouth healthy!  The germs live in a white film-like substance on the teeth called plaque.  It is important to brush and floss the plaque off on a regular basis.

2.  Diet.  The germs love sugar!  The germs eat the sugar and produce acid to decay teeth.  Sugar is found in juice, soda, cookies, candy, etc.  Carbohydrates also break down into sugars and lead to decay.  Carbohydrates are found in bread, pasta, chips, bakery goods, pretzels, etc.  How often your child snacks on sugars and carbohydrates throughout the day will lead to more decay.  Your child should eat a healthy diet and snack on fruits, vegetables, yogurt, cheese, nuts, etc.  Sticky foods like fruit snacks and gummy candy should be avoided as they stick in between teeth and in the grooves.  These are the hardest areas to keep clean.  Never put your child to bed with a bottle or a sippy cup that has milk (including breast milk), juice or soda in it; use water only.

3,  The shape of teeth and the amount of saliva.  Teeth that are close together and crowded are harder to keep clean, so are teeth with deep pits and grooves. People with low levels of saliva are also at a high risk for decay. 
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We are an amalgam (silver filling) free office. The majority of mild to moderate decay can be treated with the use of composite (white filling) material. In cases when the decay is so extensive and very little tooth structure remains a stainless steel crown may be recommended (most frequently on primary molar teeth).

Preventive Resin Restorations: The deep grooves of the molar and bicuspid teeth are the most vulnerable to decay. These grooves often have pits and fissures where bacteria harbor and the toothbrush bristles cannot reach. There is often very minimal enamel at the bottom of these grooves. A preventive resin restoration prevents a cavity in the early stages by filling these deep grooves with a composite resin. There is minimal prepping to the tooth and the material used is very wear resistant to chewing forces. This procedure, although similar to a sealant provides significantly longer protection for the tooth..

To learn more about filling materials go to Dental Materials Fact Sheet link

http://www.dbc.ca.gov/formspubs/pub_dmfs_english_webview.pdf

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Parents are often concerned about the nocturnal grinding of teeth (bruxism).  Often the first indication is the noise created by the child grinding on their teeth during sleep.  Or the parent may notice wear (teeth getting shorter) to the dentition.   The majority of cases of pediatric bruxism do not require any treatment, and most children outgrow it:  grinding becomes less between the ages of 6-9 and tends to stop between the ages of 9-12.  If grinding continues into the permanent dentition (age 12 and up), a nightguard may be recommended to prevent wear to the permanent teeth. 

One theory as to the cause of grinding involves stress.  A new environment, changes in the family or school, etc. can influence a child to grind their teeth.  Another theory relates to pressure in the inner ear at night.  The child will grind by moving his jaw to relieve this pressure.
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When a child begins to participate in recreational activities and organized sports, injuries can occur. A properly fitted mouthguard or mouth protector is an important piece of athletic gear than can help protect your child’s smile, and should be used during any activity that could result in a blow to the face or mouth.

Mouthguards help prevent broken teeth and injuries to the lips, tongue, face or jaw.  A properly fitted mouthguard will stay in place while your child is wearing it, making it easy for them to talk and breathe.
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-What is a Pediatric Dentist?

The pediatric dentist has an extra two to three years of specialized training after dental school, and is dedicated to the oral health of children from infancy through the teenage years.  The very young, pre-teens, and teenagers all need different approaches in dealing with their behavior, guiding their dental growth and development and helping them avoid future dental problems.  The pediatric dentist is qualified to meet all these needs.

-How can parents help prevent cavities?

Parents should take their children to the dentist regularly, beginning with the eruption of the first tooth.  Then we can recommend a specific program of brushing, flossing, and other treatments for parents to supervise and teach to their children.  These home treatments, when added to regular dental visits and a balanced diet will help give your child a lifetime of healthy habits.

-How do you work on very young children?

Dental care should not be an unpleasant experience, even for toddlers.  We  strive to give every child the appropriate and necessary attention that will make them feel special, welcomed and at ease.   We offer several techniques to help them relax for their restorative work, including sedation options such as nitrous oxide, conscious sedations, and general anesthesia.
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-When will my baby start getting teeth?

Teething is variable among individual babies, but in general children begin to erupt their first teeth at about 6-8 months.  The first tooth is usually the lower front tooth, and they continue to erupt teeth until about 33 months.  They will have 20 primary teeth in total.
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-Why are primary teeth so important?

It is very important to maintain the health of the primary teeth.  Neglected cavities can and frequently do lead to problems which affect developing permanent teeth.  Primary teeth are important for (1) proper chewing and eating, (2) providing space for the permanent teeth and guiding them into the correct position, and (3) permitting normal development of the jaw bones and muscles.  Primary teeth also affect the development of speech and add to an attractive appearance.  While the front 4 teeth last until 6-7 years of age, the back teeth (cuspids and molars) aren’t replaced until age 10-13.
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-Why does my child grind his/her teeth at night?

One theory as to the cause of “bruxism” (grinding of teeth) involves a psychological component.  Stress due to a new environment, changes, etc. can influence a child to grind their teeth.  Another theory relates to pressure in the inner ear at night.  If there are pressure changes (like in an airplane during take-off and landing when people are chewing gum, etc to equalize pressure) the child will grind by moving their jaw to relieve this pressure.  The majority of children outgrow bruxism between the ages of 6-12.
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-What is the best time for orthodontic treatment?

Stage 1 – Early Treatment:  This period of treatment encompasses ages 2 to 6 years.  At this young age, we are concerned with underdeveloped dental arches, the premature loss of primary teeth, and harmful habits such as finger or thumbsucking.  Treatment initiated in this stage of development is often very successful and many times, though not always, can eliminate the need for future orthodontic treatment.

Stage ll – Mixed Dentition:  This period covers the ages of 6 to 12 years, with the eruption of the permanent incisor (front) teeth and 6 year molars.  Treatment concerns deal with jaw malrelationships and dental realignment problems.  This is an excellent stage to start treatment, when indicated, as your child’s hard and soft tissues are usually very responsive to orthodontic forces.

Stage lll – Adolescent Dentition:  This stage deals with the permanent teeth and the development of the final bite relationship.
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-How safe are dental X-rays?

We are especially careful to limit the amount of radiation to which children are exposed by offering digital radiographs instead of conventional x-ray films.  Digital radiographics utilize computers to help capture, store and transmit the x-rays, and  the radiation is reduced by 70 to 80 percent, sometimes even more.  The risks are far smaller than undetected and untreated dental problems.
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-When should I start taking my child to the dentist?

According to the American Academy of Pediatric Dentistry (AAPD), your child should visit the dentist by  his/her first birthday.  We recommend making the appointment as soon as your child’s teeth begin to erupt.  But no age or time is too late, and we always strive to make the first visit enjoyable and positive.

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• Braces Care
• Appliance Care
• Elastics Care
• Proper Diet

• Loose Bracket
• Poking Wire
• Wire Out of Back Brace
• Poking Elastic (Rubber Band) Hook
• Sore Teeth

Orthodontic Frequently Asked Questions

What age should my child have an orthodontic evaluation?

The American Association of Orthodontists (AAO) recommends an orthodontic screening for children by the age of 7 years. At age 7 the teeth and jaws are developed enough so that the dentist or orthodontist can see if there will be any serious bite problems in the future. Most of the time treatment is not necessary at age 7, but it gives the parents and dentist time to watch the development of the patient and decide on the best mode of treatment. When you have time on your side you can plan ahead and prevent the formation of serious problems.

Why is it important to have orthodontic treatment at a young age?

Research has shown that serious orthodontic problems can be more easily corrected when the patient’s skeleton is still growing and flexible. By correcting the skeletal problems at a younger age we can prepare the mouth for the eventual eruption of the permanent teeth. If the permanent teeth have adequate space to erupt they will come in fairly straight. If the teeth erupt fairly straight their tendency to get crooked again after the braces come off is diminished significantly. After the permanent teeth have erupted, usually from age 12-14, complete braces are placed for final alignment and detailing of the bite. Thus the final stage of treatment is quicker and easier on the patient. This phase of treatment usually lasts from 12 - 18 month and is not started until all of the permanent teeth are erupted.

Doing orthodontic treatments in two steps provides excellent results often allowing the doctor to avoid removal of permanent teeth and jaw surgery. The treatment done when some of the baby teeth are still present is called Phase-1. The last part of treatment after all the permanent teeth have erupted is called Phase-2.
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What causes crooked teeth?

Crowded teeth, thumb sucking, tongue thrusting, premature loss of baby teeth, a poor breathing airway caused by enlarged adenoids or tonsils can all contribute to poor tooth positioning. And then there are the hereditary factors. Extra teeth, large teeth, missing teeth, wide spacing, small jaws - all can be causes of crowded teeth.

How do teeth move?

Tooth movement is a natural response to light pressure over a period of time. Pressure is applied by using a variety of orthodontic hardware (appliances), the most common being a brace or bracket attached to the teeth and connected by an arch wire. Periodic changing of these arch wires puts pressure on the teeth. At different stages of treatment your child may wear a headgear, elastics, a positioner or a retainer. Most orthodontic appointments are scheduled 4 to 6 weeks apart to give the teeth time to move.

Will it hurt?

When teeth are first moved, discomfort may result. This usually lasts about 24 to 72 hours. Patients report a lessening of pain as the treatment progresses. Pain medicines such as acetaminophen (Tylenol) or ibuprofen (Advil) usually help relieve the pain.
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Orthodontic Terms

Class I A Malocclusion where the bite is OK (the top teeth line up with the bottom teeth) but the teeth are crooked, crowded or turned.

Class II A Malocclusion where the upper teeth stick out past the lower teeth.

Class III A Malocclusion where the lower teeth stick out past the upper teeth. This is also called an "underbite".

Occlusion

The alignment and spacing of your upper jaw and lower teeth when you bite down.

Openbite Anterior opening between upper and lower teeth.	Overbite Vertical overlapping of the upper teeth over the lower.
Overjet Horizontal projection of the upper teeth beyond the lower.	Crossbite When top teeth bite inside the lower teeth. It can occur with the front teeth or back teeth.

O Rings

O rings, also called A-lastics, are little rings used to attach the arch wire to the brackets. These rings come in standard gray or clear, but also come in a wide variety of colors to make braces more fun. A-lastics are changed at every appointment to maintain good attachment of the arch wire to the bracket, enabling our patients to enjoy many different color schemes throughout treatment.
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Separator

A plastic or rubber donut piece which the dentist uses to create space between your teeth for bands.

Fixed and Removable Appliances

Band & Loop (B & L)

A Band & Loop is routinely used to hold space for a missing primary (baby) posterior (back) tooth until the permanent tooth can grown in.

Herbst

An appliance designed to encourage the lower jaw to grow forward and “catch up” to upper jaw growth.

Lower Lingual Arch (LLA)

A lower lingual arch is a space maintainer for the lower teeth. It maintains the molars where they are, it does not move them. This is fabricated by placing bands on the molars and connecting them to a wire that fits up against the inside of the lower teeth. It keeps the molars from migrating forward and prevents them from blocking off the space of teeth that develop later. This is used when you have the early loss of baby teeth or when you have lower teeth that are slightly crowded in a growing child and you do not want to remove any permanent teeth to correct the crowding.

 

Palatal Expander

An appliance which is placed in the roof of the mouth to widen the upper dental arch. The maxilla, or upper dental arch, is joined in the center by a joint, which allows it to be painlessly separated and spread. Temporarily you may see a space develop between the upper two front teeth. This will slowly go away in a few days. Once this has occurred, the two halves knit back together and new bone fills in the space.

 

Quad Helix

This appliance provides continual, gradual pressure in as many as four directions, to move molars, expand or contract arches or assist in eliminating finger or thumb habits.  

 

 

 

 

Bi Helix

An appliance used to expand the lower arch without interfering with tongue posture or movement.

Hawley

A universally used retainer with many applications; to move teeth, close spaces, maintain alignment during or after treatment.

 

 

 

Nance

This appliance maintains the position of the maxillary molars without using any other teeth.  The plastic button on the palate provides stability.

Retainers

At the completion of the active phase of orthodontic treatment, braces are removed and removable appliances called retainers are placed. To retain means to hold. Teeth must be retained or held in their new positions while the tissues, meaning the bone, elastic membranes around the roots, the gums, tongue and lips have adapted themselves to the new tooth positions. Teeth can move if they are not retained. It is extremely important to wear your retainers as directed!

Orthodontic Care

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Braces Care

You will be shown the proper care of your braces when your orthodontic treatment begins. Proper cleansing of your mouth is necessary every time you eat. Teeth with braces are harder to clean, and trap food very easily. If food is left lodged on the brackets and wires, it can cause unsightly etching of the enamel on your teeth. Your most important job is to keep your mouth clean. If food is allowed to collect, the symptoms of gum disease will show in your mouth. The gums will swell and bleed and the pressure from the disease will slow down tooth movement.

BRUSHING: You should brush your teeth 4-5 times per day.

1. Brush back and forth across……between the wires and gums on the upper and lower to loosen any food particles.

2. Next, brush correctly as if you had no brackets or appliances on.

3. Start on the outside of the uppers with the bristles at a 45 degree angle toward the gum and scrub with a circular motion two or three teeth at a time using ten strokes, then move on.

4. Next, do the same on the inner surface of the upper teeth.
5. Then, go to the lower teeth and repeat steps 1 & 2.

Look in a mirror to see if you have missed any places. Your teeth, brackets and wires should be free of any food particles and plaque.

Appliance Care

Clean the retainer by brushing with toothpaste. If you are wearing a lower fixed retainer be extra careful to brush the wire and the inside of the lower teeth. Always bring your retainer to each appointment. Avoid flipping the retainer with your tongue, this can cause damage to your teeth. Place the retainer in the plastic case when it is re-moved from your mouth. Never wrap the retainer in a paper napkin or tissue, someone may throw it away. Don't put it in your pocket or you may break or lose it. Excessive heat will warp and ruin the retainer.

Elastics Care

If elastics (rubber bands) are worn intermittently, they will continually "shock" the teeth and cause more soreness. Sore teeth between appointments usually indicate improper wear of headgear or elastics or inadequate hygiene. Wear your elastics correctly, attaching them as you were told. Wear elastics all the time, unless otherwise directed. Take your elastics off while brushing. Change elastics as directed, usually once or twice a day.

Proper Diet

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Orthodontic Emergencies or Problems

Please feel free to contact the office if you are experiencing any discomfort or if you have any questions. Below are a few simple steps that might help if you are unable to contact us or if you need a “quick fix”.

Loose Bracket

Occasionally, a glued bracket may come loose. You can remove the loose bracket and save it in an envelope to bring to the office or leave it where it is, if it is not causing any irritation. Call the office as soon as possible in order for us to allow time to re-glue the bracket.

Poking Wire

If a wire is poking your gums or cheek there are several things you can try until you can get to the office for an appointment. First try a ball of wax on the wire that is causing the irritation. You may also try using a nail clipper or cuticle cutter to cut the extra piece of wire that is sticking out. Sometimes, a poking wire can be safely turned down so that it no longer causes discomfort. To do this you may use a pencil eraser, or some other smooth object, and tuck the offending wire back out of the way.

Wire Out of Back Brace

Please be careful to avoid hard or sticky foods that may bend the wire or cause it to come out of the back brace. If this does happen, you may use needle nose pliers or tweezers to put the wire back into the hole in the back brace. If you are unable to do this, you may clip the wire to ease the discomfort. Please call the office as soon as possible to schedule an appointment to replace the wire.

Poking Elastic (Rubber Band) Hook

Some brackets have small hooks on them for elastic wear. These hooks can occasionally become irritating to the lips or cheeks. If this happens, you may either use a pencil eraser to carefully push the hook in, or you can place a ball of wax on the hook to make the area feel smooth.

Sore Teeth

You may be experiencing some discomfort after beginning treatment or at the change of wires or adjusting of appliances. This is normal and should diminish within 24-72 hours. A few suggestions to help with the discomfort:

1. Rinse with warm water, eat a soft diet, take acetaminophen (Tylenol) or ibuprofen (Advil) as directed on the bottle.

2. Chewing on the sore teeth may be sorer in the short term but feel better faster.

3. If pain persists more than a few days, call our office.