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A person’s smile is their key to the world.
Orthodontic treatment is a participatory activity in which the person wearing the braces has some of the responsibility for the success of treatment.
The orthodontist can put the braces on and adjust them periodically to help the person’s teeth to get straight. But the person wearing the braces has the responsibility of keeping appointments, of keeping the teeth brushed and clean, of wear rubber bands, of not eating hard and sticky things which can damage the braces, and of calling and coming in immediately (if there is damage) so that any damage can be repaired quickly and teeth will continue to move on schedule.
Philosophy of Treatment
Most orthodontists do braces 2 times and accordingly charge 2 times:
- Phase 1 (or pre-braces) at age 7 – 10
- Phase 2 (or braces) at age 11 – 13
We do not think that this is good because:
It usually uses up your one-time (lifetime) orthodontic insurance benefit for Phase 1 or pre-braces and then you have no orthodontic insurance benefit when you need the braces for Phase 2.
The person wearing the braces doesn’t want to wear braces again.
The latest research has shown that there is no significant benefit from doing Phase 1 (pre-braces).
We see young children and do early interceptive treatment to correct specific problems of growth and development of the teeth and jaws. For example, if the upper jaw is narrow we do an RPE (Palatal Expander) to widen the upper jaw. If baby teeth roots are not dissolving away properly, or at the proper time, and this is causing or will cause the permanent teeth to come in crooked, then we will suggest removal of the baby teeth and placement of space maintainers. Space maintainers prevent the 6 year molars from moving forward and crowding the permanent teeth and allow the permanent teeth to come in as straight as possible. This is covered under the insurance yearly general dentistry benefit, not orthodontics.
Once these interceptive appliances are placed, we generally see the children every 4 – 6 months for the next one to three years to monitor the growth of the jaws and the eruption of the teeth into the mouth. There is no charge for these recall visits.
This interceptive treatment:
- Decreases the severity of the orthodontic problem
- Shortens the treatment time with braces (treatment times are generally 18-24 months)
- Lowers the fee
- Greatly decreases the need for removal of permanent teeth
In a study in our own office of 100 consecutively treated patients:
- When the child came in early with 8 or 12 remaining baby teeth (and followed the prescribed treatment), we did not have to take out any permanent teeth later.
- When the child came in with 4 remaining baby teeth, we only had to remove permanent teeth 1% of the time.
- When the child came in with all of their permanent teeth in place, we had to remove the permanent teeth only 6% of the time.
Generally, for most insurance companies all of the interceptive treatment procedures are covered by your yearly general dentistry benefit, not by your “one-time” (lifetime) orthodontic benefit.
When it’s time for braces, then braces or Invisalign appliances are used to do the detailed aligning and placement of the teeth in their proper positions for the best smile and bite.
Once the active orthodontic treatment is finished, with braces or Invisalign, then retainers are placed. As in the past, at the patient’s request, we can place colorful plastic retainers (upper and lower) with the wires across the front. However, for the past several years, we have been placing clear upper retainers which are worn 24/7 for the first week and then only to bed at night. In the lower, a wire is bonded/glued to the inside of the 6 lower front teeth to hold them straight.
We then see the person every 4 – 6 months for several years until a decision and recommendation is made on the wisdom teeth and the wisdom teeth have either been removed or are biting and chewing with no problems. There is no charge for any of these recall retention appointments.