Stringert Orthodontics - Frequently Asked Questions

Malocclusion is, literally, "bad bite." It refers to a less-than-optimal "fit", or "interdigitation" between the upper and lower teeth.

At what age should my child be seen by an orthodontist?

The "best" time is different for different children, especially since there is such a wide range of development in children. The American Association of Orthodontists recommends that your child be evaluated by age seven. Early detection of some orthodontic problems is important in order to take early corrective action and avoid more difficult treatment later.

Can you be too old for braces?

No, age is not a factor, only the health of your gums and bone which support your teeth. About 25% of our orthodontic patients are adults and that number is still growing!

Will orthodontic treatment hurt?

Orthodontic treatment has improved dramatically. As a rule, braces make your teeth sore for a few days, but it is not painful. This annoyance can be relieved with an over-the-counter pain reliever. Today's braces are smaller, more comfortable and use technology that reduces the discomfort. We use the latest in miniature braces and the highest quality of orthodontic materials in order to reduce discomfort and treatment time.

Can I still have braces if I have missing teeth?

Yes. When teeth are missing, adjacent teeth will often drift into the empty space. This will cause a functional, esthetic or periodontal problem. Orthodontic treatment will correct and prevent these problems from happening and will also provide proper alignment for your dentist to replace the missing teeth.

Click here for more information on preparing for the replacement of missing teeth.

Questions about the Treatment

What is Phase I (Interceptive Treatment) and Phase II treatment?

Phase I or Interceptive Treatment usually starts while the child has most of their baby teeth and a few of their permanent front incisors. This stage in development is usually age 7-9, depending on the child’s level of development. The goal of Phase I treatment is to intercept a moderate or severe orthodontic problem early in order to reduce or eliminate it. These problems include skeletal problems, crossbites and crowding. Phase I treatment takes advantage of the early growth spurt and turns a difficult orthodontic problem into a more manageable one. Phase I treatments can help reduce the need for extractions or surgery.

Please note that most Phase I patients require a Phase II treatment in order to achieve an ideal bite.

Phase II treatment usually occurs a number of years later. Usually we are waiting for 12-16 more permanent teeth to erupt before Phase II begins. This most commonly occurs at the age of 12 or 13. The goal of Phase II treatment is to achieve an ideal occlusion with all of the permanent teeth.

What is Full or Comprehensive Orthodontic Treatment?

This is another name for orthodontic treatment in the permanent dentition at any age. It is more commonly used when a Phase I treatment was not performed.

Does everyone need a Phase I treatment?

Absolutely not! Only certain bites require early intervention. All others can wait until most if not all their permanent teeth erupt. We will always try to "give you choices" so that you can have input into the type, and timing of, treatment.

Can I wait on Phase I/Interceptive Orthodontic Treatment until my child is older?

By definition, Phase I treatment takes advantage of the growth "spurts" that occur during the maturation of a human being. By "waiting", in the case of a patient who has a significant problem and who can benefit from Phase I treatment, you are precluding the possibility that the jaw growth and tooth eruption can be modified by the orthodontist. While this is not "the end of the world," a delay for a child who needs Phase I treatment may result in more limited treatment options at a later date. In addition, treatment may be more difficult, and the long term stability may be compromised. In addition, delays can result in an increase in the number of extractions, or an increased chance that oral surgery may be needed (in addition to the bracework) in order to achieve the desired result.

I have a "gummy" smile, and show a lot of my gum tissue when I smile. Is there something that can be done for this?

"Gummy" smiles can be caused by a number of things. It is commonly associated with "open bite" malocclusions (click here to see an example of an open bite), and is a result of excessive vertical growth of the upper jaw (hence, the upper jaw is "too tall"). Only rarely can "gumminess" be removed or improved with reduction of the gum tissue. Many times, full braces, in conjunction with a surgical procedure to the upper jaw, is required.

What is the length or duration of orthodontic treatment?

This generally depends on the severity of the problem. Generally, orthodontic treatment plans are designed to last from 6 months to 30 months. This can vary, depending on the age of the patient, the severity of the problem, the patient's cooperation, and the degree of movement possible.

How can I make my treatment go faster?

Though we are aware of the public’s desire to obtain straighter teeth in as short a time as possible, we want you to be aware that excessive forces, or "doubling up" your elastics, can actually SLOW your treatment. Our research has shown that the chief causes of delays in treatment are: broken braces, missed appointments, and lack of compliance with the doctor’s recommendations (not wearing your elastics, or not wear your retainer or other appliance, as instructed, etc.).

Why do braces come loose?
With few exceptions, braces are broken as a result of eating hard, or sticky, chewy foods. Click here to see our "LIST OF FOODS TO AVOID", and use common sense, in determining which foods should be avoided. We have also found that traumatic blows to the face/mouth break off a number of braces.

I am leaving for college in 3 months, or I will be out of town all summer. Will this adversely affect my treatment, or should I just have my braces removed?

Advances in orthodontic supplies and materials have resulted in MORE WORK being done, by your braces and wires, between your appointment times. This work is also MORE GRADUAL, and less uncomfortable, i.e., the forces are spread over an increased number of days, or weeks. Consequently, you may have noticed that there has been an increase in the amount of time between orthodontic appointments (it used to be every 3-4 weeks, and is now every 4-6 weeks, depending on your status in treatment). Consequently, if a college student, or a frequent business traveler, can get to our office every 6-8 weeks, and they are diligent in their diet management and brace care, we have found that there is little time lost in treatment. Dr. Stringert uses the most up-to-date materials, and utilizes the wires and brackets that allow for this more gradual work, over longer periods, with less discomfort.

What are extraction and non-extraction therapy, and what are the advantages and disadvantages of each?

Extraction therapy is a technique in which some teeth are removed in order to make room for the other, adjacent teeth. Though no one really enjoys the prospect of having teeth removed, in some cases, this is unavoidable and very necessary. Commonly, the teeth that are removed are several "bicuspid" teeth (since these come in "pairs" anyway, i.e., if you take one bicuspid, you usually have another bicuspid next to it). Occasionally, because of badly broken down molars, or an unusual pattern of missing teeth, other teeth may be the preferred choice of extraction.

Though many patients and parents are intent on not having any teeth removed at the outset of treatment, and indeed "shop" for an orthodontist who will do as they prefer, we have found an increasing number of patients, who have had "expansion or "non-extraction" therapy who DO NOT LIKE how their teeth, or their smiles, look after the expansion is completed. Consequently, a percentage of these people then ask us to have their dentist remove some teeth in order to "upright" their front teeth, or to reduce the "toothiness" of their smiles.

Preparing for the replacement of missing teeth

Many times, orthodontics involves the treatment of cases in which there are missing teeth. Typically, the general dentist will ask the orthodontist to upright some teeth that have tipped over, or align teeth that are adjacent to a space that is a result of a missing or extracted tooth. It is not incommon for a patient to be "congenitally missing" (simply meaning that the patient was born without the tooth buds for those praticular teeth) some teeth, especially the upper "lateral incisor" teeth, or one or more "bicuspid" teeth. Dr. Stringert always works closely with your dentist on such cases, as the needs for a BRIDGE may not be the same as for the use of IMPLANTS. Again, Dr. Stringert will refer you back to your dentist so that you can have a consultation regarding the options available to you, as well as the "pros and cons" of each option.

Though an implant will prevent the need for "shaving down" adjacent teeth (this occurs with the use of a traditional "bridge"), an implant cannot be used in all cases. There are other factors, such as the height and thickness of the jaw bone in the region of the missing tooth, that must be taken into consideration when planning for the use of an implant. Many times, your dentist will recommend some bone grafting (sometimes known as "ridge augmentation") to prepare a site for the use of an implant.

Sometimes, especially when the space for the missing tooth is small, or the tooth that is missing was small itself, a MARYLAND BRIDGE (a "bonded" bridge) can be employed without nearly as much "shaving" of the adjacent teeth. It is thus a "less intrusive" procedure. There are pros and cons to using a Maryland bridge, when compared to a traditional bridge, however. Once again, Dr. Stringert will reger you to your dentist for a consultation regarding the possibility for using a Maryland bridge.

Mouthguards and Braces.

When should I wear a mouthguard?

You will be pleased to know that the braces are great protection for the teeth in an accidental blow to the mouth or face, but can result in some laceration to the lips and cheeks if a mouthguard is not worn when needed (as, for example, during basketball, football, wrestling, and contact sports in general). We generally have a run of 2-4 serious accidents, each year during baseball "Spring Training", for catchers who are "warming up" a pitcher in the bullpen without wearing a catcher’s mask. This happens even at the advanced levels of baseball (18-22 year olds). Generally, we encourage you to wear a protective mouthguard whenever you feel that you need to do so.

What type of mouthguard should I wear?

We have special mouthguards available in our office. Please do not make the mistake of buying an inexpensive mouthguard that is boiled, then "sucked onto" the teeth, when you have braces in place. You will either have extreme difficulty getting the mouthguard off, or you will break your braces while trying to remove the mouthguard.

"TMJ" refers to that part of your jaw anatomy, the jaw joint, known as the temporomandibular joint. You have a left TMJ and a right TMJ. Hence, it is not a disease in and of itself. The problems, or "dysfunctions" of the TMJ are often referred to as "TMJ dysfunction", "TMJ syndrome", "CMD dysfunction" (some people prefer "CMD", as it describes "craniomandibular", and it represents any anatomical connection between the upper part of the skull and the lower jaw), and so on and so forth.

Is it possible for braces, or a specialized mouth splint, to cure my TMJ problem?

We would encourage our patients to discern between "treatment" and "cure" when asking a question such as this. While there have been many articles written about "cures" for TMJ, and associated problems, involving bracework and splints/mouthguards, we have, in dentistry, not been able to scientifically, and accurately, answer two basic questions: a) Why some people with "perfect occlusion" and perfect dental alignment STILL SOMETIMES suffer from TMJ problems, and b) Why some people, who have less-than-ideal, or even horrible, occlusions, or even facial and skeletal deformities, with multiple missing teeth, NEVER have any TMJ problems during their lifetimes. While we have certainly seen some patients, with TMJ problems, improve with the correction of their malocclusion, we cannot guarantee that this would be the case with everyone. Some of the chief causes of TMJ problems, including a history of trauma to the face and chin, or chronic emotional distress that results in habitual (even "subconscious") grinding and clenching, cannot be "cured" with braces or the use of "splints" or special mouthguards.

Occasionally, we have patients who are more concerned with perhaps one or two teeth, in one jaw only. We would need to make an individual evaluation of your teeth, and your "bite", to give you an intelligent answer. Sometimes, simple problems can be solved with limited braces, or even a removable retainer, in one jaw only. You need to understand, however, that though the TOOTH ALIGNMENT may be improved with treatment of one jaw only, you may need to have braces, or a retainer, in the opposite jaw in order to conform and coordinate the SHAPE of the upper and lower arches to each other. Simply having your teeth aligned may LOOK GOOD, but it may end up in a less-than-ideal occlusion ("bite").

I have a lot of dental work to be accomplished. Should I have this done before having braces?

We require that any cavities, cleaning, and gum tissue "treatments" are accomplished before we commence bracework. If, however, you are anticipating have "crowns", or "bridges" done for cosmetic, or tooth-replacement, purposes, we ask that you consult with the doctor before doing so. The bonding, or cement material that is used to hold a brace to a tooth is often very similar to that used in "cosmetic" bonding. Placing and removing braces, on a tooth with a great deal of cosmetic work, sometimes damages the surface of the cosmetic work. The same holds true for porcelain crowns, or "veneers." Consequently, we generally recommend that "final" cosmetic work be postponed until after bracework. Each case is different, so we will work with you, and your dentist, to determine exactly what is best for you.

I am considering implants to replace some missing teeth. Should I have this done before, or after, bracework?

Again, we have found that it is best for Dr. Stringert to see you first, then have him consult with the doctor who will place the implants. Sometimes, "site preparation" is required before the implant can be properly placed. Consequently, we have patients who have implants placed DURING bracework, as well as after bracework is complete.

Many people I talk to tell me that wisdom teeth should be removed in the late teen years. Is this really necessary?

Again, everyone is different. In general, however, humans have evolved to the point of having shorter jaws (but still the same number of teeth!). The wisdom teeth, also known as the "third molars" (since they are the "third molar" in line behind the second molar), are "left out" when it comes to sufficient space. Being unerupted, and unfavorably positioned, the wisdom teeth are therefore the most common "impacted" tooth in the mouth. The main reasons that dentists generally recommend removal in the late teen years are as follows: a) the bone is less dense, and therefore easier to remove (if necessary), in getting the wisdom tooth out, b) the wisdom teeth are not fully formed until, perhaps, age 22-25. Therefore, a tooth with less-developed roots is not only easier to remove, the roots are also not as close to the "nerve", and there is less chance for nerve damage, c) wisdom teeth are difficult to keep clean, and can result in periodic gum tissue infections (also known as "pericoronitis", or "periodontitis" in this area), and d) teenagers heal faster than adults. We have found that the incidence of "dry socket" and complications of tooth removal, in general, are greater in adults than they are in teenagers.

I have heard of teeth being stuck in the roof of the mouth, or near the point of the chin. Is this possible and, if so, can they be retrieved?

It is relatively common to see impacted or ectopic ("improperly erupting") teeth, especially those teeth that are referred to as canine teeth (the "eye" teeth). If the problem is diagnosed and treated early, it is sometimes possible to avoid a surgical procedure. Many times, however, impacted, ectopic teeth need to be "uncovered", and to have a brace bonded to them (by your dentist, or by an oral surgeon) so that the orthodontist can gradually guide this tooth into its proper position.

If you do not like the shape or color of your teeth

Many patients come to the orthodontist with the general idea of having their smile improved. In the great majortiy of cases, however, the true source of the problem lies in the shape, size, or coloration of the teeth. Dr. Stringert will reger you back to your dentist, who is the best source of information on what has become known as COSMETIC DENTISTRY (bonding, bleaching, veneering, crowning, etc.).

IF YOU HAVE SHORT TEETH, and you feel that your smile is "gummy", sometimes this can be more easily corrected by your dentist by the use of crowns, veneers, or bonding techniques.

IF YOU HAVE NARROW OR TAPERED TEETH, bracework may be able to bring these teeth together somewhat, by, especially if there is a taper to these teeth, you may still have spaces near the tips of the teeth, where they are supposed to "touch" the adjacent teeth. This may give the patient the illusion that the braces have been unable to close the space. In fact, the teeth may be wider near the gum line, there is still a space near the tips. This is an ideal situation for the use of bonding, veneering, or crowning.

IF YOU HAVE STAINED TEETH, OR SIMPLY WANT A DIFFERENT SHADE, again, Dr. Stringert will likley refer you back to your dentist for a cosmetic consultation. Many times, internal stains (those that cannot be removed by polishing) are due to a high fever at a young age (1-3, when the permanent front teeth are forming inside the jaws), excessive mineral content in your drinking supply (this is common in many parts of Colorado, especially in the Arkansas River Valley, or in well water), a dental infection in the "baby" teeth, or the ingestion of certain antibiotics (tetracycline was commonly used years ago, for the treatment of certain early childhood diseases).

Occasionally, there will be a situation where the lower front teeth, when aligned, are "TOO WIDE", collectively, for the upper front teeth. Or, vice versa: the upper front teeth are collectively "too wide" for the lower front teeth. In these situations, while the teeth are aligned, there could be an improper bite relationship between the upper and the lower front teeth. This is known as a "tooth size discrepancy", and it may call for the "slenderizing" of excessively wide teeth, using diamond polishing discs. Occasionally, some of the teeth (notably the upper "lateral incisor" teeth, i.e., the teeth just next to the two large central front teeth) NEED TO BE ENLARGED. If this is the case, Dr. Stringert may elect to leave some spacing in these areas, so that your dentist can have sufficient space to provide the necessary WIDTH increase to the narrow teeth.

In any case, Dr. Stringert will work closely with your dentist on your cosmetic dental needs.

Other Frequently Asked Questions

What are the different types of braces? There are, basically, choices between metal braces (silver or gold), clear braces (ceramic or sapphire), and colored braces.

Is there a difference between the clear and the metal braces?
In general, the metal braces are somewhat stronger than the clear braces, though there have been great improvements in the clear braces in recent years. We have generally found that treatment takes several months LESS for people who select metal braces. Clear braces can be made of ceramic material, plastic material, or a composite of both. We have found that clear braces that have a small metal slot, which engages the orthodontic wires, suffer much less breakage.

What are the different types of metal braces?

There are silver and gold metal braces. The silver braces are simply stainless steel. The gold braces are basically a stainless steel that has been plated with 24 karat gold, or treated with a solution/technique that results in a gold color.

I see braces that are actually a different color. How is this accomplished? There are some types of braces, generally made of colored plastic. This color cannot be changed without actually changing the brace itself. We generally find that patients enjoy having a chance to change the color of the front of their braces every month.

How do you change the colors of the elastics, or the "front" of the braces?

The "ties", also known as ligatures, that hold the main archwire in place, are REMOVABLE, and are made of a plastic material that comes in a multitude of colors. There are now so many colors available that they are difficult to adequately describe without seeing a color chart. This is also true of the rubber bands sometimes used to move the teeth and jaws (but there are fewer color options for these elastics than for the plastic ligatures that go around the braces). You could probably have us change the color of the ligatures around your braces every time you came to your appointment, and you would not exhaust the number of choices available.

I have heard, or read about, "invisible braces", and "removable braces". Are these things really possible and, if so, are they effective?

Again, we are aware of the occasional tendency for "marketing" and "advertising" to overwhelm a consumer’s common sense and judgement. Nothing is truly "invisible" that is a useful treatment device in your mouth. The only exception to this might be the retainer wire/device that is occasionally bonded to the BACKS of the teeth (and hence, is "invisible" to someone looking at it from the front) in some patients. The "clear" braces, which are available to you, while they may be less noticeable, are certainly not "invisible." While certain orthodontic problems are amenable to removable appliances, they are not really "removable braces", but rather a special retainer-like device that goes by a number of different names, such as "spring retainer", "spring aligner", "invisible aligner", "positioner", etc. Again, Dr. Stringert may offer one of these devices to you, if your case permits. Dr. Stringert is a certified provider for the "Invisalign" removable, clear aligners that can be used in certain cases. If you are interested, please contact us to arrange a consultation regarding this. You should be aware that, many times, actual bracework when compared to "invisible braces", or "removable braces," is less expensive, less time-consuming, and more effective, in achieving the desired result.

What are the braces that fit behind the teeth?

These are known as LINGUAL BRACES, and they are mounted behind a patient's teeth. While they are still used occasionally, their use has declined with the advent of the smaller, more cosmetic or styled braces (clear and colored). Generally, lingual braces are more uncomfortable than standard braces, and treatment involving lingual braces generally takes longer, and is more expensive.

I don’t like the look of my chin - I think it’s too big (or too small). Do I need to have braces and jaw surgery to get the result I want?

Though orthodontists commonly treat patients who have jaws that are too big, or too small, and do so in conjunction with an oral surgeon, on occasion we see patients who simply have a "surface" problem, i.e., their teeth, and their occlusion, are fine, but they lack sufficient contour. We work with oral surgeons who are highly trained, and experienced, in achieving the cosmetic results that a patient desires. We will refer you to one of these oral surgeons in the appropriate instances.

We have video imaging available in our office. You may be interested in seeing computer-generated images of what you might look like with various orthodontic, or combined surgical-orthodontic treatments.

Is orthodontic care expensive?

When orthodontic treatment is implemented at the proper time, treatment is often less costly than the dental care required to treat the more serious problems that can develop years later.

Orthodontic fees have not increased as fast as many other consumer products. Financing is usually available and our office offers many payment programs that will meet your needs. In addition, many insurance plans now include orthodontics.