Frequently Asked Questions About Orthodontics

Orthodontists are dental specialists.

There are three steps in an orthodontist’s education:

• Undergraduate degree (BSc or BA) 4 yrs
• Dental degree (DMD or DDS) 4 yrs
• Orthodontic degree (Masters Degree) 3 yrs.

Similar to becoming a medical specialist, such as a surgeon or an internist, orthodontists complete an orthodontic residency program for three years after dental school. They are dentists that were accepted into a specialty that only accept the top 2% of dentists in Canada.

Dr. Dagasso has gone to university for 11 years!

While there’s some instruction regarding orthodontics in dental school, it is limited. It’s in the orthodontic residency program that orthodontists receive intensive instruction to learn proper, safe tooth movement (orthodontics) and the guidance of dental, jaw and facial development (dentofacial orthopedics). These extra years of schooling make the orthodontist the dental specialist in moving teeth and aligning jaws. This is the ONLY focus of their practice.

The Canadian Association of Orthodontists (CAO) and the American Association of Orthodontists (AAO) is open exclusively to orthodontists – only orthodontists are admitted for membership. The only doctors who can call themselves orthodontists have graduated from dental school and then successfully completed the additional three years of education in an accredited orthodontic residency program. Dr. Dagasso belongs to both.

Throughout your life, your teeth move.

Though you can’t see it happening, your teeth are always on the move. Even after you’ve had braces or other dental work, your teeth will continue to shift ever so slightly throughout your life. This movement is due to several factors, including the natural age-related changes to the jaw and soft tissues that occur throughout our lives.

What causes teeth to move as you age?

As you get older, your lower teeth move forward. This is known as mesial drift. At the same time, your lower jaw becomes more narrow.

Do wisdom teeth cause my teeth to shift?

Research shows that even if people have their wisdom teeth removed, teeth continue to crowd as we age. Especially the lower front teeth. This is the case whether a person has had braces or not or whether the wisdom teeth have been removed or not. Teeth drift forward throughout life, even in the absence of posterior teeth or molars.

Retainers are the final and MOST IMPORTANT phase of orthodontic treatment.They hold the teeth in their new position or “RETAIN” them where they are.

An orthodontic retainer is an “appliance” that is custom made for your teeth after the orthodontic ACTIVE treatment has been completed. This means it is after any movement of teeth and they are in their new position, whether it was braces, Invisalign, or palatal expansion that has been achieved.

Everyone who has had their teeth moved, needs a retainer!

Why?

As your teeth move, they leave behind gaps in the surrounding bone and other tissue. Retainers hold your teeth in place while your tissue catches up. This is why it’s important to wear your retainers full-time for the first 6 months.

There are different types of retainers to hold the teeth so they don’t move back to their initial position.

Hawley retainers are the most common as they not only hold teeth that have been aligned they hold arch expansion, (for individuals who had expansion), they prevent a patients bite from getting “deeper”, where bite depth has been decreased.

Essix retainers are clear retainers similar to an aligner. They are used in a number of cases where alignment was an initial concern.

Lingual Bonded retainers are typically used on the lower teeth, but very seldom on the upper teeth. The patients that are best suited for upper bonded retainer are individuals who initially had a space between their front teeth (a gap called a diastema). The bonded wire helps the teeth from spreading apart again.

We understand most parents wish to have their children have a bonded retainer (so there isn’t a struggle with keeping it in the mouth, and not lost, or broken). As previously mentioned, this is typically not the type of retainer that will prevent the teeth from relapse.

Dr. Dagasso will decide on what is the best retainer for each individual treatment plan.

How long do I need to wear my retainer for?

This varies from patient to patient, but generally speaking, retainer wear is to be FULLTIME for 6 months, then NIGHTTIME for a lifetime.

Dr. Dagasso will see each patient 3 times in the year following active orthodontic treatment to monitor this final phase called Retention.

We typically schedule the RETENTION check appointments:

• 2 months after braces are removed
• 6 months after braces are removed
• 1 year after braces are removed

At these appointments, Dr. Dagasso is checking the fit of the retainers. THE PATIENT SHOULD WEAR THEIR RETAINER to all these Retainer check appointments.

Why Forever?

The bad news is your teeth are always moving. This process is called mesial drift, meaning your pearly whites are always on the move. Your retainers will help prevent this from happening as you age.

The good news is that you’ve spend lots of time and effort to get your teeth to a beautiful position and beautiful smile, and we are sure you want to keep them this way. And all you have to do, is wear your retainers. 😊

To maintain a straight smile for a lifetime, you’re going to need to wear your retainers nightly for the rest of your life.

Teeth will want to return to their original position even years later.

Invisalign is a modality to move teeth. Invisalign is a series of removable aligners that are worn for 20-22 hrs/day EVERY DAY for the duration of treatment. Invisalign treatment is typically the same length of time it would take to move teeth with braces.

Q: HOW DO I KNOW IF I’M A CANDIDATE FOR INVISALIGN TREATMENT?

A: Dr. Dagasso takes great pride in being a clinical expert with Invisalign. As a board certified orthodontist, he can determine the ideal course of action to give you the best outcome.

Q: CAN I GO TO ANY DENTIST FOR INVISALIGN?

A: Any dentist “can provide aligners such as Invisalign”, but there is a wide range of experience, expertise and skill among dentists that officer Invisalign to their patients. Satisfaction and quality to your result will greatly vary. Orthodontic specialists exist for a reason, so it would only make sense to entrust your orthodontic treatment is handled by a qualified specialist. Questions you may want to ask the dentist include, "Are you a board certified orthodontist?” “How many Invisalign or orthodontic cases have you completed?” “How many years have you been doing orthodontic treatment?” Will you just fix the alignment of my teeth or will you correct the bite as well? (This means you will have to wear elastics during Invisalign treatment also). All of these questions will give you a good idea how qualified your dentist is with Invisalign.

Q: HOW OFTEN DO I NEED TO WEAR MY ALIGNERS?

A: You MUST wear your aligners 20-22 hours per day. If you do not, they simply will not work. You only take them out when eating or brushing your teeth.

Q: WILL MY TEETH HURT WITH INVISALIGN?

A: The experience with Invisalign is very different than what you experience with braces. When you put in a new set of aligners, your teeth can be slightly sensitive for a day or two, which means the treatment is working. It is not common for patients to report pain from the pressure of the aligners.

Q: HOW OFTEN DO I NEED TO COME IN FOR APPOINTMENTS DURING INVISALIGN TREATMENT?

A: You will typically be issued enough aligners to allow you to come in approximately every two months. However, the frequency of visits is case dependant.

Q: WHAT IS DONE AT EACH APPOINTMENT?

A: At each patient’s appointment, your computer imaging of your tooth movement is brought up on the screen in front of you, and then Dr. Dagasso assesses the “tracking” of your teeth. For a precise result, Dr. Dagasso ensures your teeth are moving as he programmed the movement in his prescription to Invisalign.

Q: WHAT IS “TRACKING”?

A: In most treatment plans, Dr. Dagasso wants to be sure the end result is exactly as he prescribed and the teeth are moving as intended on the computer prescription of each individuals tooth movement. This is called tracking.

Q: WHAT IF THE TEETH DON’T TRACK?

A: At your first Invisalign appointment, we will go over the instructions of how to wear your aligners, how to take them out, and how to be sure they track as prescribed. We will provide you with “chewies” or rubber rolls to bite on as you “seat” or place your aligners in your mouth. Chewies ensure that the aligners are pushed on as tightly as possible (in particular) the front teeth in order for the aligner to grab hold of the teeth and move them.

Even if one tooth is “not tracking”, Dr. Dagasso will do a revision scan for new aligners. What this accomplishes, is that the aligners now fit again, and with precise instruction to the patient about wearing the aligners, you continue on with your treatment until both the orthodontist and you are pleased with the end result.

Q: WHAT IS I.P.R?

A: I.P.R. stands for Interproximal Reduction. Interproximal is the place on the tooth where they touch each other. Dr. Dagasso in specific orthodontic treatments, removes a slight amount of tooth “mass” on each side of a specific tooth. He also ensures this is only done once initial alignment is done, so the “smoothing” or “slimming” of the tooth is done with a straight tooth, not a rotated tooth (as is unfortunately done if an orthodontist is not doing the Invisalign treatment). The amount that were referring to is 0.2mm (which is the thickness of a piece of paper) and is very similar to “smoothing” a person’s fingernails with an emery board. The process of IPR takes 10-30seconds in total. It does not hurt, and there is no freezing.

Expanders are an orthodontic “appliance” or device used to create a wider space in the upper jaw.

This can be done easily in a growing patient by widening the bone in the upper arch. This allows the palate to widen and create more room for the adult teeth or widen the arch to allow for a better fit of the upper and lower jaws, correcting a narrow arch or crossbite.

What does it feel like?

Palatal expanders do not usually cause pain. Some patients feel a tingling feeling on the roof of the mouth or in their nose (as the base of the nose is the connected to roof of the mouth (the palate).

You may experience a slight lisp initially as speech is achieved by placement of your tongue on the roof of your mouth. With practice (typically a week) the lisp goes away. Hint: the more you practice talking or reading aloud the quicker the lisp goes away.

When you first have the expander placed, your mouth may produce more saliva. If this occurs, make a conscious effort to swallow normally by closing your lips and pushing your tongue up against the roof of your mouth. With practice and patience, you will get better. (typically one week can make a huge difference.)

How does it work?

Activation

1. You will be given a key to activate the expander.
2. Place key in anterior hole of appliance, towards the front teeth.
3. There is an etched arrow in the appliance pointing in the direction the key should be pushed, towards the throat.

The frequency and number of turns is dependant on each individual case. Please activate as directed by Dr. Dagasso. If you have any questions, please call our office to clarify.

Turning WILL NOT HURT. Each turn is 1/4mm. Never turn the expander more than one turn/2nd day. If you miss a day, please don’t panic. Do NOT try and make up a missed day by doing an extra turn.

Care

Cleaning under the expander is VERY important. Removing the food particles and plaque is necessary to prevent inflammation on the roof of the mouth. This can be done by a combination of a water flosser and proxy brush.

At first, eating will be more difficult. Take small bites and eat soft foods, then you will gradually become more comfortable to the eating and swallowing process. You will figure out which foods are more difficult to clean under the expander (the space between the expander and the roof of your mouth) and due to the difficulty and time to clean under the expander, patients typically avoid these foods.

How long is it in my mouth?

Palatal expanders usually don’t take very long to do their work. Average time is 2 months. BUT, once the expansion is done, this does not mean the expander comes out. It will need to stay in the mouth 4-6 months AFTER the last of the turns is completed. So total time is around 9 months. Of course there are cases where it is in for a shorter amount of time, and cases in which it is in longer.

Elastics are tiny rubber bands that move your teeth in a way that braces alone cannot. They help how the upper and lower teeth fit together. This part of your orthodontic treatment is entirely up to you and we need your full cooperation.

Correcting the bite (with elastic wear) is usually the longest and most difficult part of the whole process. Your cooperation and compliance is VERY IMPORTANT.

Here are some instructions you must follow to make the wearing elastics go smoothly.

• Wear elastics 24 hours a day A continuous light pull will move your teeth. Starting and stopping is very counterproductive. For 1 hour of missing elastic wear, this “erases” about 4 hours of wearing elastics.
• Change elastics 2 times /day (minimum) This means change them every morning and night when you brush your teeth, or as much as every 4 hours. By changing the elastics more often, the elastic will be “a bit stronger” and “fresher” if you want (but not necessary). You can take them out to eat if you want (but not necessary). We know that eating CAN BE DONE with them in, and we also know that when they are taken out for eating, they typically are not put back in afterwards (which reverses all the work that was previously done).
• The pattern of elastic wear can change at each appointment. Dr. Dagasso will give instructions for elastic wear and the pattern may differ on the right side and on the left side. We will give you instructions each time it changes.
• Do NOT double up. We get it ….. You forgot to wear them as directed, and now you want to “make up for it”. But by doubling, this causes too much pressure on the tooth and can slow things down.Never double up.

As you begin wearing elastics, it will take a few days to get used to putting them in your mouth. Persevere. Elastic wear is IMPORTANT!!!!

It is normal for your mouth, teeth, and jaws to be a little sore for the first few days to a week of wear. If you wear your elastics only intermittently (NOT FULL TIME), you will have constant discomfort and the process will be slowed.

The success and of your orthodontic treatment is dependent upon your cooperation. Please wear your elastics to all your orthodontic appointments, so we can assess how you have been wearing them.😊

How to wear your Elastics

Elastics move the upper and lower teeth together so they “mesh” correctly (like gears). Most of the time, the movement is to move the upper teeth back and the lower teeth forward. are tiny rubber bands that move your teeth in a way that braces alone cannot. They help how the upper and lower teeth fit together.

Class II Elastics

Top teeth: Hook on canine (first hook in the front)

Bottom teeth: Hook on first molar (second-to-last tooth from back or tooth with NO color on brace)

Triangle

Top teeth: Hook on canine (first hook in the front)

Bottom teeth: Hook on canine and first premolar (first two hooks in front)

Class III Elastics

Top teeth: Hook on first molar (or tooth with NO color on brace)

Bottom teeth: Hook on canine (or 3rd tooth from centre line)

Horseshoe (or Rainbow)

Top teeth: Elastic goes AROUND the canine hook (first hook in the front)

Bottom teeth: Hook elastic on first premolar (second hook from front), then go AROUND the upper canine, then back down to hook on first premolar (second hook from front)

Crossbite Elastics

The elastic is attached from the inside of the bottom molar tooth to the outside on the upper molar tooth to help correct a crossbite.

Class I Elastics

Top teeth: Elastic goes AROUND the canine hook (first hook in the front) to the first molar.

Bottom teeth: Hook elastic on second premolar (third hook from front), then go AROUND the upper canine, then back down to hook on first premolar (second hook from front)

You will not feel any discomfort when you are getting your braces bonded on your teeth. But in the days following the initial placement and after your adjustment appointments, your teeth will likely feel uncomfortable and sore.

The discomfort of braces feels like a dull soreness or throbbing. We recommend you take an over-the-counter anti-inflammatory pain reliever such as ibuprofen (Advil) for relief.

Once you get your braces, eating will become different and will take some adjusting. The first week we recommend only eating soft foods or foods where there is not a lot of chewing as the teeth will be quite sensitive.

Here are some suggestions to make your first week manageable:

• Mashed potatoes
• Yogurt
• Soups
• Scrambled eggs
• Oatmeal
• Bananas
• Cooked vegetables
• Pasta
• Rice
• Pudding, applesause, jello, fruit cups
• Ice-cream

Sensitivity after getting braces will improve after 3-4 days, and in some circumstances up to 6-7 days. At that point, you’ll be able to somewhat resume your typical diet.

You will be able to eat the following:

• Dairy products
• Meats (no bone)
• Soft breads and sandwiches
• Pizza (no crust)

Hard, Crunchy, Chewy foods will break off braces.

Please avoid or be very careful with the following foods and/or cut into small pieces.

• Apples (cut into small wedges)
• Carrots (cut into slim pieces = julienne cut)
• Corn on the cob (cut off the corn from the cob)
• Hard candy, Caramel candies
• Pizza crusts
• Popcorn kernels
• Beef jerky
• Ribs or Chicken (don’t put the bone in your mouth)
• Hard crackers (croutons too)
• Hard chips (Miss Vickies)
• Toast or Bagels (barely toasted and rip into small pieces)
• Granola bars, Protein bars, Chocolate bars (dense and stiff varieties)
• Ice (don’t crunch on)
• Nuts (no whole nuts)

Please avoid these non-food items and habits which can also lead to broken brackets.

• Pen or pencil chewing
• Nail biting
• Toothpicks
• Straw chewing
• Chewing on a mouthgaurd