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How to Choose an Orthodontist?

August 18, 2015

If you survey the elementary schools in your town, you will likely see a sizable percentage of the students in each classroom with smiles decorated with some form of orthodontic appliances as these children reap the benefits of interceptive orthodontics.  Down the street, at the middle school, an even larger portion of students are being treated in a comprehensive manner with conventional braces, clear braces, or Invisalign’s Teen product.  In addition, many of the parents that drive the children to and from school are also wearing braces or Invisalign to idealize their smiles.  There is no doubt that orthodontic treatment is becoming more mainstream as children, adolescents, and adults continue to seek treatment to correct the aesthetic and functional concerns from an imperfect bite.  With an increasing number of patients seeking orthodontic treatment, a critical question must be answered:  how should a potential patient choose an orthodontist?

There are certainly many factors to consider when choosing an orthodontist.  It is not a decision that should be made haphazardly as all orthodontic treatment is not equal.  When planned, executed, and retained properly, orthodontic treatment can be the pathway to a gorgeous smile and a healthy bite relationship that will last a lifetime.  When done improperly, however, orthodontic treatment may leave a patient dissatisfied with a compromised result that often requires re-treatment.

So, where do we start?  We should start by making a distinction between an “orthodontist” and someone who “practices orthodontics.”  While every general or family dentist is licensed to practice orthodontics, just as he or she is licensed to do fillings and crowns, it doesn’t necessarily mean that is their expertise. Similar to how you could use a general physician to assist with your pregnancy, you would most likely rather use an obstetrician, since it is their specialty.  General dentists that practice orthodontics have typically taken a series of continuing education courses over several weekends in order to expand their knowledge regarding the science and practice of orthodontics.  Orthodontic specialists, on the other hand, spend two or three full years in an orthodontic residency program following the completion of dental school and then limit their practice to orthodontics.  In other words, they have more extensive training and practice orthodontics exclusively, so they are typically more experienced in handling the endless variety of orthodontic problems that haunt some smiles.

The next criteria that you may consider is whether the orthodontist is Board Certified with the American Board of Orthodontics (ABO).  While Board Certification is certainly not an absolute indicator that an orthodontist is one with whom you would like to work, typically, orthodontists who are Board Certified have made a commitment to practicing high-quality orthodontics.  The certification process is a grueling one; as a result, only a small percentage of Orthodontic Specialists make the effort to achieve the distinction from the remainder of their peers.

After finding a Board Certified Orthodontist, we would recommend that you speak with your dentist or dental hygienist regarding the quality of treatment results that they have seen achieved by the orthodontist you have in mind.  Also, discuss the general feedback that they have received regarding the quality of the office staff and the character of the orthodontist.  Is there an orthodontist who has a true passion for his or her profession - one who is dedicated to working to achieve the best result for every patient?  You may even consider asking your dentist or hygienist which orthodontist they would see if they or their families needed treatment!

In that same line of thinking, speak with your neighbors and friends.  Ask them if they have had any interaction with an orthodontist.  Were they pleased with the result?  Did they feel that their orthodontist prioritized the quality of the treatment result?  Would they trust the orthodontist to treat another child in their family?  You might be surprised to see how excited a friend or neighbor may be when encouraging you to see an orthodontist that took great care of them or one of their loved ones.

As with many decisions in life, the decision on which orthodontist to choose may be a difficult one - one that is often made even more difficult by advertising and marketing.  If you find yourself torn between several options, it is likely the best decision to choose the orthodontist who you feel has the best character.  A typical adolescent orthodontic case takes approximately two years to treat, but the relationship between an orthodontist and a patient often exceeds 10 years and quite frequently spans generations as it is not uncommon for an orthodontist to treat a former patient’s children or even their grandchildren.  With appropriate care, a beautiful orthodontic result can last a lifetime.  So, when making the decision as to which orthodontist to see, it is in your best interest to choose carefully as it can be a lifelong investment in a healthy and confidence boosting smile. 


When Should Children See An Orthodontist?

June 10, 2015

When should your son or daughter see an orthodontist?  This question is one that I get asked on a daily basis - not just in the office, but at my daughter’s preschool, at social events with friends that have young children, and even at meetings with other dental professionals.

If you go to our office’s website, or the website of most practicing orthodontists for that matter, you will likely find the following information: The American Association of Orthodontics recommends that a child be evaluated by age 7.  An orthodontic screening no later than this enables the orthodontist to detect and evaluate problems that exist, advise the parent on whether treatment will be necessary, and determine the best time for any treatment.  Early detection of orthodontic problems is important so that corrective action can be taken and more difficult treatment later can be avoided.

When reading the aforementioned recommendation, many parents might ask themselves, “Why age 7?  Doesn’t my 7-year old still has a lot of baby teeth?”  This question is a valid one and deserves definite consideration.

Although the timing of eruption of the permanent teeth can vary greatly from one child to another, 7-year old children are typically entering the “early mixed dentition.”  In other words, their permanent six-year molars are erupting and they are starting to lose baby teeth in the front of their mouth as the permanent four front teeth (called incisors) erupt in both the upper and lower arches.  At this point in time, an orthodontist can begin to formulate a diagnosis and can start to develop the answer to two key questions:  1.  Will this patient ever benefit from any type of orthodontic treatment?  2.  If so, when is the appropriate time for orthodontic intervention?

To determine whether a patient will benefit from orthodontic treatment, an orthodontist typically performs a clinical exam as well as a radiographic exam.  The clinical exam allows the orthodontist to identify features of the patient’s bite relationship and tooth positioning, as well muscular/joint function that deviate from ideal.  The orthodontist may identify traits such as overjet, overbite, spacing, crowding, protrusion, crossbites, etc.  The radiographic exam typically includes the review of a panoramic radiograph to identify conditions that may not be able to be diagnosed with clinical exam alone such as the congenital absence of permanent teeth (agenesis), the presence of extra permanent teeth (supernumerary teeth), the failure of teeth to erupt despite complete root formation (impacted teeth), or the presence of potential pathology within the patient’s bony structures. The fact of the matter is that most patients that make their way into our office, whether it be via a recommendation from their dentist, neighbors, or friends, will benefit from orthodontics at some point in their life - the more salient question remains!  

When is the right timing for orthodontic treatment?

The easiest way to walk you through the our approach to this question is to start with the following premise:  in our office, classic comprehensive orthodontic treatment typically begins when a patient is on the verge of losing their last few baby teeth.  In most cases, patients are approximately 11 or 12 years old at this time.  However, there is an amazingly large variation the timing of permanent tooth eruption in our patient pool.  In fact, we have 9 year-olds that are ready for comprehensive treatment, but we also have 15 year-olds that are still waiting to lose a few more baby teeth prior to our initiating treatment.  As I mentioned above, most patients that we see in the office will benefit from comprehensive orthodontic treatment.  Patients with perfectly aligned teeth and ideal bite relationships rarely make it into our office!

The key element that we need to discuss with younger patients and their parents is whether or not the patient will also benefit from any “early,” “interceptive,” or “Phase I” orthodontics.  These terms are all synonymous and refer to orthodontics that takes place while a patient still has a significant number of permanent teeth that have not yet erupted.

Interceptive orthodontics typically takes place in patients who are between 7 and 10 years of age.  When patients are just entering the early mixed dentition (7-8 years old), the interceptive orthodontics that we consider is most frequently prescribed to guide the eruption of teeth that seem to be headed in a poor direction (ectopically erupting teeth), to alleviate severe crowding that may result in failure for teeth to erupt (impaction), problems with gum tissues (most commonly recession), and hygiene issues.  As patients mature dentally (9-10 years old), the interceptive orthodontics that we typically prescribe is related to the correction of crossbites (when upper teeth are stuck inside of lower teeth) with expansion appliances or with braces, closure of anterior open bites (when front teeth don’t touch although a patient is biting down on their back teeth), and correction of severe protrusion or crowding.  While nearly every potential patient that seeks our opinion regarding their orthodontic treatment would benefit from comprehensive orthodontics, only a small percentage of the young patients that we evaluate truly need interceptive orthodontics.  However, when necessary, interceptive orthodontics can make a dramatic impact on the overall prognosis of a patient’s final treatment outcome.

So, let’s go back to our initial question:  why age 7?  It is at this point that an orthodontist can identify ectopic eruption, impacted teeth, severe crowding/protrusion, crossbites, and open bites, etc. in order to determine whether the patient will benefit from comprehensive orthodontics alone or whether a period of interceptive orthodontic treatment is also necessary.

Is it necessary for all patients to see an orthodontist at age 7?  Not necessarily!  Without the aforementioned issues, patients don’t need to be seen by an orthodontist until they are losing their last few baby teeth and are transitioning into the permanent dentition.  Unfortunately, it can be difficult for parents to determine whether these conditions exist or not.  As a result, they typically rely on their family dentist or pediatric dentist to inform them of the appropriate timing for treatment.  However, it’s never a bad decision to have a child evaluated by an orthodontist if you are unsure whether they would benefit from early treatment.  It will only help the patient and their parents get a better idea of what lies ahead.

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