Click on a topic of interest for more
Eruption of your Child’s Teeth
Thumb, Finger, Pacifier Habits
Brushing and Flossing
Routine Dental Health Visits
What Causes Cavities?
Composite Resin Fillings
Frequently Asked Questions
For more information on oral health care
needs, please visit the website for the
American Academy of Pediatric Dentistry.
Eruption Of Your Child’s Teeth
Children’s teeth begin forming before birth.
Around 6 months, the first primary (or baby) teeth to erupt through the
gums are the lower central incisors, followed closely by the upper central
incisors. Although all 20 primary teeth usually appear by age 3, the pace
and order of their eruption varies.
Permanent teeth begin appearing around age
6, starting with the first molars and lower central incisors. This process
continues until approximately age 21.
Adults have 28 permanent teeth, or up to 32
including the third molars (or wisdom teeth).
Please click on the timeline below to see
the teeth erupt and to learn more.
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
-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.
their gums with an infant oral stimulator or a tooth brush.
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
Care of New
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
Tooth Decay (Early Childhood Caries)
serious form of decay among young children is baby bottle tooth decay.
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.
Thumb, Finger, Pacifier Habits
Sucking is a natural habit in infants and
young children. They may use fingers, thumbs, pacifiers or other objects to
suck on. Sucking is relaxing and makes them feel secure and happy.
A sucking habit that continues beyond the
eruption of permanent teeth can cause problems with proper growth of the
mouth and tooth alignment. Children who rest their finger/thumb/pacifier in
their mouth passively are less likely to cause tooth alignment problems than
those who vigorously suck.
Damage to the teeth
Sucking can cause front teeth to angle forward
and create an open bite. An open bite is when your child is biting down on
his/her back teeth and the front teeth do not come together. There is a gap
where the object they suck on usually sits. In addition to an open bite,
sucking can also cause a crossbite and tongue thrust. Crossbite is when the
back molars don’t come together correctly when biting. Tongue trust is when
the tongue pushes against the front teeth during swallowing instead of
against the roof of the mouth.
Stopping the habit
Usually at about four years of age your child
is emotionally ready to quit and can actually participate in deciding how to
go about quitting. However, every child is different and some may be
emotionally ready even younger. It’s best to begin by talking about it at
least a few weeks/months before you begin, and try to choose a time when
there are no other big changes or stresses in your child’s life.
Suggestions on how to stop
Start talking! Explain to your child that
their sucking habit is causing their teeth to not come together right, and
as they are getting older they will be getting their new big teeth and it’s
important that they look and work right for their whole life. (It takes a
lot of patience on the part of the parents to constantly help remind their
child of their habit to make them more aware and aid them in quitting.)
Usually the hardest time for them is nighttime. The sucking habit can be
very active during the sleeping hours. One way to help your child not to
suck while sleeping is to wrap their arm straight with an ace bandage so
that when they try to bend their elbow to get their hand to their mouth the
bandage constricts and becomes uncomfortable. Another is to paint what they
suck on (finger/thumb) with a bitter ointment, i.e. Thumb Don’t or Stop.
With a pacifier you can begin to trim it smaller and smaller every day until
there is not enough of it to suck on. Encourage your child that they are
getting older and it’s time to give the pacifier to the Tooth Fairy or set
aside a special day for your child to discard their pacifier. And reward
your child when they are not sucking—start with a few hours and work up from
After you’ve conquered the sucking habit
occasionally, you still have the tongue thrust. Remind your child to press
their tongue against the roof of their mouth when they swallow.
If these suggestions don’t work there are
appliances that can be placed in your child’s mouth that will help them.
Bands are placed on the back molars with a wire basket attached that sits on
the roof of their mouth. This prevents them from getting anything against
the roof of their mouth and also prevents the tongue from pushing into the
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.
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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
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
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.
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
-Diagnose caries and potential
caries; discuss treatment options
-Caries prevention/Brushing and
-Topical and systemic fluoride
-Orthodontic issues: assess bite,
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.
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.
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.
Composite Resin Fillings
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
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.
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.
-What is a Pediatric
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
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
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.
-When will my baby start
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.
-Why are primary teeth so
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.
-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.
-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
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
-How safe are dental
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
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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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Orthodontic Frequently Asked Questions
What age should my child have an orthodontic
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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The part of your braces which actually moves the teeth.
The arch wire is attached to the brackets by small elastic donuts or
ligature wires. Arch Wires are changed throughout the treatment. Each change
brings you closer to the ideal tooth position.
Brackets are the “Braces” or small
attachments that are bonded directly to the tooth surface. The brackets are
the part of your braces to which the dentist or assistant attaches the arch
Occasionally, a bracket may come loose and become an
irritation to your mouth. You can remove the loose bracket and save it in an
envelope to bring to the office. Call the office as soon as possible and
make an appointment to re-glue the bracket.
Elastics (Rubber Bands)
At some time during treatment, it will be necessary to
wear elastics to coordinate the upper and lower teeth and perfect the bite.
Once teeth begin to move in response to elastics, they move rapidly and
comfortably. If elastics (rubber bands) are worn intermittently, they will
continually "shock" the teeth and cause more soreness. When elastics are
worn one day and left off the next, treatment slows to a standstill or
stops. 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.
Often called a “night brace”. The headgear is used to
correct a protrusion of the upper or lower jaw. It works by inhibiting the
upper jaw from growing forward, or the downward growth of the upper jaw or
even by encouraging teeth to move forward, if that is the case.
Poor positioning of the teeth.
Types of Malocclusion
A Malocclusion where the bite is OK (the top teeth line up with the
bottom teeth) but the teeth are crooked, crowded or turned.
A Malocclusion where the upper teeth stick out past the lower teeth.
A Malocclusion where the lower teeth stick out past the upper teeth.
This is also called an "underbite".
The alignment and spacing of your upper jaw
and lower teeth when you bite down.
Types of Occlusion:
Anterior opening between upper and lower teeth.
Vertical overlapping of the upper teeth over the lower.
Horizontal projection of the upper teeth beyond the lower.
When top teeth bite inside the lower teeth. It can occur with the
front teeth or back teeth.
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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A plastic or rubber donut piece which the
dentist uses to create space between your teeth for bands.
Fixed and Removable
& 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.
An appliance designed to encourage the
lower jaw to grow forward and “catch up” to upper jaw growth.
Lower Lingual Arch
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.
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.
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.
An appliance used to expand the lower arch without
interfering with tongue posture or movement.
universally used retainer with many applications; to move teeth, close
spaces, maintain alignment during or after treatment.
This appliance maintains the position of the maxillary
molars without using any other teeth. The plastic button on the palate
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!
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.
You should brush your teeth 4-5 times per day.
Brush back and forth across……between the wires and
gums on the upper and lower to loosen any food particles.
Next, brush correctly as if you had no brackets or
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.
- Next, do the same on the inner surface of the upper
- 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
If your gums bleed when brushing, do not avoid brushing, but rather continue
stimulating the area with the bristles. Be sure to angle your toothbrush so
that the area under your gum line is cleaned. After 3 or 4 days of proper
brushing, the bleeding should stop and your gums should be healthy again.
Use a special floss threader to floss with your braces on. Be sure to floss
at least once per day.
FLUORIDE RINSE OR GEL:
May be recommended for preventive measures.
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.
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.
Avoid Sticky Foods such as:
Candy bars with caramel
Candy or caramel apples
Avoid Hard or Tough Foods Such as:
Cut the following foods into small pieces and
chew with the back teeth:
Corn on the Cob
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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”.
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
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
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.
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:
Rinse with warm water, eat a soft diet, take
acetaminophen (Tylenol) or ibuprofen (Advil) as directed on the bottle.
Chewing on the sore teeth may be sorer in the short
term but feel better faster.
If pain persists more than a few days, call our