I recently broke a tooth. Being a child of the 1960’s, my mouth is full of good old-fashioned silver fillings. Like everyone else in my generation, I didn’t enjoy the benefits of fluoride in the drinking water. In fact, one of the most popular toothpaste commercials of my day showed a young child bouncing into the house after a dental checkup bragging “Mommy! Mommy! I only have one cavity!” Today we’d be upset if our kids had a new cavity at each visit, but back then cavities were the norm.

The minute my tooth broke I knew that I was going to need an implant. When my dentist confirmed my self-diagnosis, I asked to be referred to the oral surgeon who would do the best job. Not surprisingly my dentist gave me three names. Although I’d heard of these doctors, I didn’t know how good each was at placing implants. I immediately asked my dentist to clarify the referral. “If YOU were getting an implant today, who would you want to do it?” The dentist didn’t even hesitate. “Oh, if I were having one MYSELF, I’d go to…” I was then given the name of the doctor that I subsequently called.

Why do dentists give out more than one business card when it comes to referring you and your kids to an orthodontist? Do you really need more than one opinion? How do you choose between them?

Sadly, the practice of referring patients to more than one specialist arose out of a fear of being sued. That’s right. The reason that your dentist gives you more than one card is because he’s been told that if he only gives you one name and something goes wrong, he could be liable along with the specialist. By referring more than one, the logic is that your dentist can escape liability by saying, “Hey, I gave you several names. The choice to go to Dr. X was yours!” (BTW, this is a merely a myth as no dentist has been sued for just giving a referral unless he himself participated in the bad treatment or knowingly referred a patient to an incompetent specialist.)

Is this practice of multiple referrals good for patients? In my experience it is not. It usually just causes confusion. Most patients assume that because their dentist gave them three cards, it really doesn’t matter which one they choose. Unfortunately, only rarely does the second orthodontist offer the same treatment plan as the first. These conflicting treatment plans may then lead the patient to pursue a third opinion further complicating their decision. How could three orthodontists, all licensed by the state, have such different solutions to the same problem?

Orthodontists differ in training, experience, and in personality. Some were trained to expand, others to remove teeth. Some are just out of school and are still overly optimistic about what can be accomplished. Others have been at it too long and are overly pessimistic. Some doctors are perfectionists while others are more lackadaisical (“That’s good enough!”). Some really want what’s best for the patient while others want what is best for their practices. Regardless of why, orthodontists really are different and the results they provide will not be the same. When choosing an orthodontist for your family, consider asking the following three questions:

First, what treatment is the orthodontist proposing? How is he going to fix the crowding? How about the overbite? How come he wants to start now and doctor down the street wants to wait? How can he straighten all the teeth now when some baby teeth remain? How long will the treatment take? Can he show you examples of other patients treated in the same way? In other words, make sure you understand exactly what the doctor is proposing and why his plan is different.

Second, if there is a big difference in fees, why? Are the treatment plans actually the same? Do both fees include the same services (i.e. retainers, x-rays, etc.) We recently had a patient show us a quote that was $1500 less for a first phase. Upon investigation we found that the lower fee merely covered an expander and not braces. Another quote was more than $1000 less but only fixed the top teeth. A “six month” treatment quote was almost $2500 less but would not fix the bite. Again, if there is a difference in the fee, ask why!

Third and most importantly, ask your dentist what I asked mine. If he was having his teeth straightened today, which orthodontist would he choose? Don’t let him get away with giving you three cards! Ask him who treated his children. In that way, you’ll get his best recommendation and save you the trouble of shopping around!

NOTE: The author, Dr. Greg Jorgensen, is a board-certified orthodontist who is in the private practice of orthodontics in Rio Rancho, New Mexico (a suburb on the westside of Albuquerque). He was trained at BYU, Washington University in St. Louis, and the University of Iowa in the United States. Dr. Jorgensen’s 25 years of specialty practice and 10,000 finished cases qualify him an expert in two-phase treatment, extraction and non-extraction therapy, functional orthodontics, clear aligners (Invisalign), and multiple bracket systems (including conventional braces, Damon and other self-ligating brackets, Suresmile, and lingual braces). This blog for informational purposes only and is designed to help consumers understand currently accepted orthodontic concepts. It is not a venue for debating alternative treatment theories. Dr. Jorgensen is licensed to diagnose and treat patients only in the state of New Mexico. He cannot diagnose cases described in comments nor can he select treatment plans for readers. Because he has over 25,000 readers each month, it is impossible for him respond to all questions. Please read all of the comments associated with each article as most of the questions he receives each week have been asked and answered previously. The opinions expressed here are protected by copyright laws and can only be used with written permission from the author.

Plastic aligners use a series of clear plastic shells that are shaped so that they sequentially guide the teeth into their desired positions. Two fundamental principles must be remembered about aligners. First, plastic can only push, it cannot pull. For a tooth to move in any desired direction, there must be a surface against which the aligner can push. Second, for a tooth to remain engaged in the aligner (to “track”), there must be an undercut or purchase point that allows the plastic to grip the tooth. Some teeth have natural undercuts because they are round or bulbous in shape (primarily the back ones). Other teeth are more triangular or pyramidal in shape (the front ones). For all movements except intrusion (pushing the teeth towards the gums), attachments are necessary to create the required pushing surfaces and undercuts. These movements include tipping, rotating, and lengthening the teeth.

To create pushing surfaces and undercuts, orthodontists construct “attachments” or bumps on the teeth using tooth-colored composite (the same material used to repair chipped teeth). The size, shape, number, and location of these attachments is determined by the anatomy of the teeth and the desired movements. Although visible up close, most attachments are invisible to the naked eye at normal conversational distances (about 3 feet). Orthodontic attachments provide the same function for clear aligners as brackets do with conventional braces. They are just handles on the teeth. I tell my patients to think of their attachments as the brackets and the plastic aligners as their wires.

Some patients are adamant that they don’t want to have anything glued to their teeth. Unfortunately, trying to make certain movements without attachments is scientifically impossible. Imagine an upper lateral (second tooth from the center) that needs to be longer to look straight. Without an attachment to provide an undercut, the tooth will remain its original length no matter how well the aligner is designed or worn. Additionally, making the aligners tighter on a tooth in hopes that it will move with the plastic actually causes the opposite effect (the tooth will actually move up rather than down). Think of how a watermelon seed squirts through your fingers when you squeeze it to pick it up. Similarly, if the plastic aligners are programed to tip a pyramidal shaped tooth without an undercut, the tooth will actually slide UP the aligner rather than move with it.

Attachments glued to the teeth are necessary for accurate, predictable orthodontic movements. I wish there was a way to move teeth successfully without them using aligners, but as of 2018 one does not exist. As I mentioned in my blog post about unrealistic expectations, I once had a hair stylist who had a mug on his station that read, “I’m a beautician, not a magician.” I wish orthodontist rhymed with magician…

NOTE: The author, Dr. Greg Jorgensen, is a board-certified orthodontist who is in the private practice of orthodontics in Rio Rancho, New Mexico (a suburb on the Westside of Albuquerque). He was trained at BYU, Washington University in St. Louis, and the University of Iowa in the United States. Dr. Jorgensen’s 25 years of specialty practice and nearly 10,000 finished cases qualify him an expert in two-phase treatment, extraction and non-extraction therapy, functional orthodontics, clear aligners (Invisalign), and multiple bracket systems (including conventional braces, Damon and other self-ligating brackets, Suresmile, and lingual braces). This blog is for informational purposes only and is designed to help consumers understand currently accepted orthodontic concepts. It is not a venue for debating alternative treatment theories. Dr. Jorgensen is licensed to diagnose and treat patients only in the state of New Mexico. He cannot diagnose cases described in comments nor can he select treatment plans for readers. Please understand that because he has tens of thousands of readers each month, IT IS IMPOSSIBLE FOR HIM TO RESPOND TO EVERY QUESTION. Please read all of the comments associated with each article as most of the questions he receives each week have been asked and answered previously. The opinions expressed here are protected by copyright laws and can only be used with written permission from the author.

Following a landmark lawsuit in 1987 where a Michigan patient received a legal judgment against her orthodontist for giving her “TMJ,” hundreds of studies and millions of dollars have been spent by the scientific community to find if there really is a relationship between orthodontic treatment and the health of the temporomandibular joints (TMJ). Obviously this would be an important finding for doctors and patients alike. These studies have examined the different types of bad bite as well as the various approaches to treatment to see if there are any cause and effect relationships.

Time and time again scientific studies have found that orthodontics neither causes nor cures TMJ disorders. Except for two exceptions, malocclusion in general cannot be linked to a higher prevalence of joint problems. The two exceptions are a posterior cross bite that causes the jaw to shift to one side upon closure, and an anterior open bite where all the biting force is on the back teeth only and the front teeth do not touch at all. Neither overbite, underbites, crowding, or alignment issues have been shown to cause any problems at all. As for treatment modalities, these studies have been unable to find any links between the use of headgear, extractions, rubber bands, oral surgery, or any other orthodontic treatment and TMJ problems.

There are many conditions that can cause pain in the area of the TMJ that are not related to the teeth at all. Some are serious like degenerative arthritis and cancer. Others are related to functional habits (like clenching and grinding). While cross bites and open bites may be linked to joint problems, not all bad bites result in TMJ pain. Many orthodontic patients have “bad bites,” and yet very few report TMJ pain. On the other hand, many patients who report severe TMJ pain often have ideal bites. This simple observation supports the scientific studies that have separated the fields of TMJ and orthodontics. If all bad bites had TMJ symptoms and all great bites never had any pain, a direct relationship would be defensible.

For the latest on the relationship between orthodontics and TMJ, check out this lecture by the most respected expert on occlusion in the world, Dr. Jeffrey Okeson. He is not an orthodontist and has no motivation to protect orthodontists. he just reports the facts.

NOTE: The author, Dr. Greg Jorgensen, is a board-certified orthodontist who is in the private practice of orthodontics in Rio Rancho, New Mexico (a suburb on the Westside of Albuquerque). He was trained at BYU, Washington University in St. Louis, and the University of Iowa in the United States. Dr. Jorgensen’s 25 years of specialty practice and nearly 10,000 finished cases qualify him an expert in two-phase treatment, extraction and non-extraction therapy, functional orthodontics, clear aligners (Invisalign), and multiple bracket systems (including conventional braces, Damon and other self-ligating brackets, Suresmile, and lingual braces). This blog is for informational purposes only and is designed to help consumers understand currently accepted orthodontic concepts. It is not a venue for debating alternative treatment theories. Dr. Jorgensen is licensed to diagnose and treat patients only in the state of New Mexico. He cannot diagnose cases described in comments nor can he select treatment plans for readers. Please understand that because he has tens of thousands of readers each month, IT IS IMPOSSIBLE FOR HIM TO RESPOND TO EVERY QUESTION. Please read all of the comments associated with each article as most of the questions he receives each week have been asked and answered previously. The opinions expressed here are protected by copyright laws and can only be used with written permission from the author.

I love my adult patients. They are typically better informed, more motivated, follow instructions better, and usually have better oral hygiene than adolescents. With the availability of information on the Internet, most adult patients have a better understanding of their own condition and the possible treatment options than younger patients. Unlike teenagers who are many times compelled by their parents, adult patients usually pursue treatment because they want it or because they have been referred by their dentist. These differences usually result in better compliance.

Adult patients do face some challenges not faced by younger patients however. First, they are no longer growing. Growth can be a helpful in correcting many types of malocclusion (the exception being underbites). Examples of this include expanding the palate, opening the bite (by changing the direction of growth), and reducing the “overbite” (by restricting the forward growth of the upper jaw). Additionally, because their metabolism is slower than in growing patients, tooth movement in adults is usually slower and therefore their treatment times longer. Finally, adults tend to have more missing and compromised teeth (worn, misshaped, restored, etc.). This sometimes limits the options that are available to them.

Because of these differences, adult treatment varies from adolescent treatment in the following ways. Adult treatment usually takes longer than the same treatment in younger patients. Because there is no growth, extractions and surgery are more common if full correction is to be achieved. If teeth are missing or compromised, there may be fewer treatment options than with teenage patients. Since many adults don’t want to have teeth removed or have jaw surgery, many are willing to accept a degree of compromise not necessary in their children. On the upside, adult patients are usually more motivated and compliant than adolescents and are therefore better candidates for esthetic options like Invisalign clear aligners.

If you are an adult who is considering treatment for yourself, take heart. Although your treatment may take a little longer and may be more complicated, improved appearance, better function, and healthier teeth are achievable at any age. Make an appointment today to see how an orthodontist can help give you your best smile.

NOTE: The author, Dr. Greg Jorgensen, is a board-certified orthodontist who is in the private practice of orthodontics in Rio Rancho, New Mexico (a suburb on the Westside of Albuquerque). He was trained at BYU, Washington University in St. Louis, and the University of Iowa in the United States. Dr. Jorgensen’s 25 years of specialty practice and nearly 10,000 finished cases qualify him an expert in two-phase treatment, extraction and non-extraction therapy, functional orthodontics, clear aligners (Invisalign), and multiple bracket systems (including conventional braces, Damon and other self-ligating brackets, Suresmile, and lingual braces). This blog is for informational purposes only and is designed to help consumers understand currently accepted orthodontic concepts. It is not a venue for debating alternative treatment theories. Dr. Jorgensen is licensed to diagnose and treat patients only in the state of New Mexico. He cannot diagnose cases described in comments nor can he select treatment plans for readers. Please understand that because he has tens of thousands of readers each month, IT IS IMPOSSIBLE FOR HIM TO RESPOND TO EVERY QUESTION. Please read all of the comments associated with each article as most of the questions he receives each week have been asked and answered previously. The opinions expressed here are protected by copyright laws and can only be used with written permission from the author.

There are three options when a permanent tooth is missing: 1) preserve the baby tooth, 2) replace the missing tooth, or 3) orthodontically close the space. These options are not necessarily interchangeable and the best choice is determined by other variables that include the condition of the teeth, the bite, and the amount of crowding.

If the bite is good and there is no crowding, the best option is to keep the baby tooth as long as possible and then replace the permanent one after the baby one is gone. If the baby tooth is in good condition, it may remain in place indefinitely. If it is in poor condition or if its root has been lost, the tooth can be replaced by an implant or a bridge. Trying to close a space orthodontically when there is no crowding and the bite is good is a long, difficult process that can introduce problems as bad or worse than the original. The extended treatment time and asymmetrical mechanics can lead to uneven arches as well as bone and gum problems.

If there is crowding or a bite issue that would require the removal of teeth anyway, removing the baby tooth and closing the space is a good option. This is the case in the lower arch when there is crowding or an underbite. If all of the teeth had developed normally, one treatment option involves the removal of lower bicuspids. If a bicuspid is already missing, only one other permanent tooth would need to go (since the other was never there). If there is crowding or protrusion in the upper, it is not uncommon for upper bicuspids to be removed. If upper laterals or bicuspids are congenitally missing (from birth), the space can be closed leaving no need for a bridge or implants. Again, closing a space where there is no crowding or a bite problem is not usually prudent.

What is the most appropriate treatment for your child? An examination by an orthodontic specialist is the best way to find out. During the exam, he [she] will examine the alignment of the teeth, the amount of crowding, and the bite. If the space can be closed orthodontically, that option will be presented. If space closure is not appropriate, he will work with your dentist to prepare the mouth so that the tooth can eventually be replaced.

NOTE: The author, Dr. Greg Jorgensen, is a board-certified orthodontist who is in the private practice of orthodontics in Rio Rancho, New Mexico (a suburb on the Westside of Albuquerque). He was trained at BYU, Washington University in St. Louis, and the University of Iowa in the United States. Dr. Jorgensen’s 25 years of specialty practice and nearly 10,000 finished cases qualify him an expert in two-phase treatment, extraction and non-extraction therapy, functional orthodontics, clear aligners (Invisalign), and multiple bracket systems (including conventional braces, Damon and other self-ligating brackets, Suresmile, and lingual braces). This blog is for informational purposes only and is designed to help consumers understand currently accepted orthodontic concepts. It is not a venue for debating alternative treatment theories. Dr. Jorgensen is licensed to diagnose and treat patients only in the state of New Mexico. He cannot diagnose cases described in comments nor can he select treatment plans for readers. Please understand that because he has tens of thousands of readers each month, IT IS IMPOSSIBLE FOR HIM TO RESPOND TO EVERY QUESTION. Please read all of the comments associated with each article as most of the questions he receives each week have been asked and answered previously. The opinions expressed here are protected by copyright laws and can only be used with written permission from the author.

First, for a permanent tooth to erupt into place, there must be sufficient space. The permanent teeth in the front of the mouth are much wider than the baby teeth they replace. Ideally, by the time a baby tooth is lost, there should be extra space on either side of it so that the permanent tooth will have plenty of room. If there is not enough space however, the permanent one won’t come in. This is surprising to parents whose child’s teeth “looked perfect” before the baby one fell out. But baby teeth shouldn’t look perfect by age six; there should be spaces between all the front ones. If there is insufficient space when the baby teeth are lost, your child may need orthodontic treatment to help the permanent teeth erupt.

Second, when a permanent tooth does not come in after a baby tooth has been lost, it may be because the tooth underneath is heading in the wrong direction. There are times when a permanent tooth just doesn’t follow its baby tooth and erupt correctly. This is very common with upper canines and lower second bicuspids. Even when there is enough space (which is almost always the case in the lower arch), the permanent teeth can veer off course and end up in the wrong place. In many cases, removing a baby tooth as soon as the problem is identified may help correct the path of eruption. If the path doesn’t change however, orthodontic treatment is usually required to rescue the wandering tooth and guide it into the right position.

While crowding and crooked eruption paths are the most common reasons why permanent teeth don’t come in on time, there are three rare conditions that must also be considered. First, it is possible that the permanent tooth that corresponds to the lost one just never developed. In cases of missing permanent teeth, most baby teeth do not get loose on their own. Sometimes however, they are lost and there is nothing to replace them. Second, there is a rare condition called primary failure of eruption in which the permanent teeth are present, they just don’t come in on their own. In these cases, braces and oral surgery are required to rescue them. This condition usually affects multiple teeth and treatment times may be three or more years. Lastly, there is a condition called ankylosis where the teeth are fused to the bone and won’t erupt. Although it is sometimes possible to “wiggle” them loose during a surgical procedure, there are many times when these teeth just cannot be moved and must either be left where they are or removed.

If your child lost a baby tooth and no replacement one has come in, you should have him or her evaluated by an orthodontist. An orthodontist is a dental specialist who has two to three additional years of training after dental school in diagnosing and treating problems related to development. Even if there is nothing wrong, it is good to have the peace of mind that comes with knowing that everything is normal.

NOTE: The author, Dr. Greg Jorgensen, is a board-certified orthodontist who is in the private practice of orthodontics in Rio Rancho, New Mexico (a suburb on the Westside of Albuquerque). He was trained at BYU, Washington University in St. Louis, and the University of Iowa in the United States. Dr. Jorgensen’s 25 years of specialty practice and nearly 10,000 finished cases qualify him an expert in two-phase treatment, extraction and non-extraction therapy, functional orthodontics, clear aligners (Invisalign), and multiple bracket systems (including conventional braces, Damon and other self-ligating brackets, Suresmile, and lingual braces). This blog is for informational purposes only and is designed to help consumers understand currently accepted orthodontic concepts. It is not a venue for debating alternative treatment theories. Dr. Jorgensen is licensed to diagnose and treat patients only in the state of New Mexico. He cannot diagnose cases described in comments nor can he select treatment plans for readers. Please understand that because he has over 40,000 readers each month, IT IS IMPOSSIBLE FOR HIM TO RESPOND TO EVERY QUESTION. Please read all the comments associated with each article as most of the questions he receives each week have been asked and answered previously. The opinions expressed here are protected by copyright laws and can only be used with written permission from the author.

Functional appliances are so named because they are designed to encourage patients to function (bite and chew) with their jaws in an improved relationship in hopes that the body will respond by growing the jaw in that direction. “Old school” functional appliances like the Bionator, the Frankel, and the Twin Block are removable devices made of plastic and wire that force the patient to bite into a corrected jaw position. The Herbst appliance was one of the first “fixed” functional appliances to gain popularity. Modern functional appliances also include the MARA appliance, Forsus Springs, the Myobrace appliance, and Jasper Jumpers. In every case, functional appliances use the teeth in one arch to push on the teeth in the other jaw in hopes of making the jaws grow differently than they would naturally.

The size and shape of our jaws is determined by genetics (DNA). Orthodontists can measure the size, shape, and position of the dental and skeletal structures of the face using an accurate technique called cephalometrics. This technique involves tracing and measuring standard structures on an x-ray of your head. Such analysis performed on siblings of the same parents reveals that their underlying skeletal structures are very similar and mostly inherited. Even if your teeth are arranged differently than your siblings, the size and shape of your jaws are primarily determined by your genealogy.

Another important use of cephalometrics is determining the effects that orthodontic devices have on the mouth during treatment. A tracing made before treatment can be compared to a tracing made afterwards to reveal how correction was really achieved. If there has been jaw growth, the tracings will indicate that. If the jaw sizes remain the same and only teeth have been moved, the analysis also shows this. University-based cephalometric studies conducted over the past several decades have all come to the same conclusion. The changes produced by functional appliances of all types are primarily DENTAL in nature. In other words, the size and shape of the jaws remains almost unchanged while the teeth in both arches are shifted so that they come together better.

The reasons that patients (and some orthodontists) mistakenly believe that functional appliances actually grow the lower jaw is that when they are used, overbites get better! If an overbite gets better, does it really matter how the functional appliance achieved it? Not really if there is enough bone and gum tissue to support the teeth in their new position. If a patient has a really short lower jaw however, they may not have enough bone to safely allow for the amount of tipping needed to correct the overbite. This is why orthodontists (orthodontic specialists) are trained to analyze jaw size and tooth position before functional appliances are prescribed. While they may work great in some patients, they may actually be harmful in others. There is nothing wrong with functional appliances when used in the right patients. I prescribe them all the time. Understanding that they primarily tip teeth and don’t “grow” jaws is critical in determining for whom they are appropriate.

NOTE: The author, Dr. Greg Jorgensen, is a board-certified orthodontist who is in the private practice of orthodontics in Rio Rancho, New Mexico (a suburb on the Westside of Albuquerque). He was trained at BYU, Washington University in St. Louis, and the University of Iowa in the United States. Dr. Jorgensen’s 25 years of specialty practice and nearly 10,000 finished cases qualify him an expert in two-phase treatment, extraction and non-extraction therapy, functional orthodontics, clear aligners (Invisalign), and multiple bracket systems (including conventional braces, Damon and other self-ligating brackets, Suresmile, and lingual braces). This blog is for informational purposes only and is designed to help consumers understand currently accepted orthodontic concepts. It is not a venue for debating alternative treatment theories. Dr. Jorgensen is licensed to diagnose and treat patients only in the state of New Mexico. He cannot diagnose cases described in comments nor can he select treatment plans for readers. Please understand that because he has over 40,000 readers each month, IT IS IMPOSSIBLE FOR HIM TO RESPOND TO EVERY QUESTION. Please read all of the comments associated with each article as most of the questions he receives each week have been asked and answered previously. The opinions expressed here are protected by copyright laws and can only be used with written permission from the author.

There really is no upper age limit for getting braces. As long as you have teeth and they are healthy, you may benefit from orthodontic treatment. Because of advances in dentistry, especially the diagnosis and treatment of periodontal disease (gum disease), patients are keeping their natural teeth longer than ever. My grandparents both had full dentures and my parents each lost several permanent teeth along the way. My generation still has most of their teeth but have many crowns due to decay earlier in life. None of my children are missing teeth or even have a crown. The improving condition of dental care, especially in the United States, means that a lot more adults will keep their teeth throughout their lives and that adult orthodontics will become more common.

When I started my practice in 1992, most of my patients were kids. While that is still generally true, the ages of my patients have gradually increased over the past two decades. Half of my current patients are between the ages of 12 and 18. 25% are younger than that and 25% are older. Although most adult patients are in their 20’s, 30’s, and 40’s, I have a growing number in their 50’s, 60’s, and 70’s!

Adult patients seek treatment for a variety of reasons. Most times they are referred by their general dentist because of teeth that are hard to keep clean, are wearing out because of a bad bite, or that need to be moved so that other dental procedures can be performed (making room for an implant for example). Other times patients come in on their own because there is something about their smile that bothers them and they finally decide to address it. It is not uncommon for this to happen upon retirement as these patients have more time and some savings they want to invest in themselves. My older patients are some of the most informed, appreciative, and compliant patients in the practice.

Adult patients have most of the same options as younger patients with a few exceptions. Correction of posterior crossbites cannot be accomplished with an expander alone. Although it can be corrected, expansion may require surgical re-opening of the midpalatal suture. Because expansion is not as easy in adults, correcting moderate to severe crowding usually requires more extractions than with adolescents. And although “overbites” can be corrected in adults, doing so with headgear, springs, or rubber bands is not as effective as it is with younger, growing patients. For this reason, adult patients require more bicuspid extractions and jaw surgeries than teenagers.

When I consult with adult patients who are considering orthodontic treatment, we discuss their reasons for seeking treatment, their goals and expectations, and their options. Sometimes they want to address a specific problem. Other times they want “the whole enchilada” as we say here in New Mexico. If you have always felt you could benefit from orthodontic treatment, maybe it is time to schedule an appointment for yourself!

NOTE: The author, Dr. Greg Jorgensen, is a board-certified orthodontist who is in the private practice of orthodontics in Rio Rancho, New Mexico (a suburb on the Westside of Albuquerque). He was trained at BYU, Washington University in St. Louis, and the University of Iowa in the United States. Dr. Jorgensen’s 25 years of specialty practice and nearly 10,000 finished cases qualify him an expert in two-phase treatment, extraction and non-extraction therapy, functional orthodontics, clear aligners (Invisalign), and multiple bracket systems (including conventional braces, Damon and other self-ligating brackets, Suresmile, and lingual braces). This blog is for informational purposes only and is designed to help consumers understand currently accepted orthodontic concepts. It is not a venue for debating alternative treatment theories. Dr. Jorgensen is licensed to diagnose and treat patients only in the state of New Mexico. He cannot diagnose cases described in comments nor can he select treatment plans for readers. Please understand that because he has over 40,000 readers each month, IT IS IMPOSSIBLE FOR HIM TO RESPOND TO EVERY QUESTION. Please read all of the comments associated with each article as most of the questions he receives each week have been asked and answered previously. The opinions expressed here are protected by copyright laws and can only be used with written permission from the author.

One of the most common “adjuncts” or additional tools that orthodontists use to straighten your teeth are orthodontic elastics or rubber bands. Why are they used? How do they work? How many hours do you need to wear them?

Braces and aligners are both effective ways of aligning your teeth. Braces are devices glued onto the teeth (either on the inside or outside) that move the teeth via forces produced by wires that span from tooth to tooth. Aligners (most commonly Invisalign) move teeth using a series of clear plastic shells that snap over the teeth and produce force by changing the shape of each successive aligner. Either technique can successfully align the upper and lower sets of teeth separately, but both require that something be connected between the arches to correct the bite.

While there are several options for correcting the relationship of the upper and lower sets of teeth (i.e. headgear, springs, functional appliances, surgery, etc.), the most common method is elastics (aka rubber bands(. Elastics are commonly used for several reasons. First, they are not as noticeable as other options (like headgear). They are usually tooth colored so that they blend in with the teeth (although they also come in bright colors that kids love!). Second, they are stretchy and flexible. This allows patients to maintain a full range of motion during talking, yawning, and other normal jaw functions. Third, elastics are easy for patients to remove and replace. This allows fresh rubber bands to be placed daily and facilitates eating and brushing. Fourth, elastics can be used to correct most types of bite problems (overbites, underbites, open bites, and crossbites). Few other devices are as versatile. Finally, elastics are more cost effective than other gadgets available for bite correction.

Although the advantages of rubber bands for bite correction outweigh the disadvantages, there are two issues I want to highlight. First, rubber bands rely 100% on patient cooperation. If they are not worn as prescribed, they will not work. For teeth to move, there must be constant pressure present for most of the day. Although I can’t quote a study that shows exactly how many hours you need to wear them, I will share my personal observations. Patients who take out their elastics only to eat or to brush (i.e. 23 hours per day) see fast, consistent results. Patients who wear them nights only (8 hours per day) rarely see any change at all. That is because any improvements that take place during those hours almost always relapse (or reverse) during the other 16 hours they are not in place. If a patient wears their elastics more than half of the day (12+) hours, they may see some improvement, but it will be much slower than if they are worn fulltime. My instructions to patients are: “Wear your rubber bands fulltime except for when you eat or brush.” Those who follow these guidelines see excellent results. Those who don’t never achieve their best smile.

The other issue with rubber bands is that there are potential side effects. First, rubber bands create force at both ends (equal and opposite reactions). If you want to move your top teeth backwards, rubber bands from the front upper teeth to the back lower ones can achieve this. Like it or not however, the same rubber bands will also move the bottom teeth forward. This can be a problem if you don’t have enough bone to permit the teeth to go that direction. Second, there are undesirable movements created along with the desirable ones. Since the elastics are pulling at an angle, not only do the upper front teeth move back, they also move down (and the lower teeth move up as well as forward). As a result, gummy smiles may be created or get worse and the depth of the bite will be reduced (creating or accentuating an open bite). Understanding and predicting these side effects is another reason why choosing an orthodontist with advanced specialty training is so important. It is possible for a simple orthodontic problem to become very complex if elastics are prescribed in the wrong way.

Orthodontic elastics work great in the right patients. If you are asked to wear them as part of your treatment, keep them in all the time except when you eat or brush. If you notice side effects like the ones I’ve mentioned, please notify your orthodontist right away. Good luck!

NOTE: The author, Dr. Greg Jorgensen, is a board-certified orthodontist who is in the private practice of orthodontics in Rio Rancho, New Mexico (a suburb on the Westside of Albuquerque). He was trained at BYU, Washington University in St. Louis, and the University of Iowa in the United States. Dr. Jorgensen’s 27 years of specialty practice and nearly 10,000 finished cases qualify him an expert in two-phase treatment, extraction and non-extraction therapy, functional orthodontics, clear aligners (Invisalign), and multiple bracket systems (including conventional braces, Damon and other self-ligating brackets, Suresmile, and lingual braces). This blog is for informational purposes only and is designed to help consumers understand currently accepted orthodontic concepts. It is not a venue for debating alternative treatment theories. Dr. Jorgensen is licensed to diagnose and treat patients only in the state of New Mexico. He cannot diagnose cases described in comments nor can he select treatment plans for readers. Please understand that because he has over 40,000 readers each month, IT IS IMPOSSIBLE FOR HIM TO RESPOND TO EVERY QUESTION. Please read all of the comments associated with each article as most of the questions he receives each week have been asked and answered previously. The opinions expressed here are protected by copyright laws and can only be used with written permission from the author.

After your Invisalign aligners have been designed by your orthodontist and manufactured by Align Technology, the entire set is shipped to your doctor’s office. There is more to achieving a successful result however than merely handing a box full of plastic shells to a patient. If that were not the case, Align would merely ship the aligners directly to the patient and cut out the “middleman.” There are three additional procedures provided by your orthodontist at the delivery appointment that are essential for the success of your treatment.

The first procedures is the bonding of “attachments” onto the surfaces of some teeth to enable movements that without them would be physically impossible. Imagine a generic tooth that is not only smooth and round, but also tapers to a point at the end. By itself, a plastic shell would have no way to hold onto such a tooth to rotate (turn) or extrude it (make it longer). These movements require some mechanism for the aligners to grip the tooth. Tooth-colored bumps or attachments serve this function for Invisalign. Picture the colorful hand holds that are attached to climbing walls so climbers have something to hold onto as they ascend. Similar “hand holds” are bonded to some of the teeth prior to Invisalign treatment using the same tooth-colored composite that a dentist uses for restoring broken or decayed teeth. Attachments have different shapes and sizes that are dictated by the desired direction and amount of force that must be generated. If a tooth needs to rotate, the attachment will have a flat surface on which the plastic can push to cause that movement. For a tooth to be made longer, there is a different shaped attachment onto which the aligner can push to accomplish that. While patients may wish they didn’t need to have anything glued to their teeth during treatment, there are just some movements that are impossible without attachments. Although computers algorithms at Align Technology initially propose the size and shape of the bumps, it is up to the prescribing doctor to dictate exactly how fast and which direction a tooth moves. For this reason, some doctors are better than others at straightening teeth with aligners. Remember that Invisalign is just a tool the doctor uses to move teeth. The Invisalign manufacturer does not determine how to move the teeth or what the final result will look like.

The second procedure performed at the delivery appointment (or some time along the way) is the reshaping of the teeth so that they will fit correctly at the end of treatment. I use slenderizing or Inter-Proximal Reduction (IPR) in about 75% of my conventional braces patients. The timing and amount are determined along the way. The digital setups created for the manufacturing of the aligners however let me know up front which teeth must be altered and by how much. The most common reasons for IPR include crowding, mismatched tooth sizes, or the creation of dental compensations to help correct skeletal problems (i.e. slenderizing the upper anteriors to reduce excessive “overbite”). Cases can be treated without IPR, but it may be impossible to arrive at the best result without it. As with braces, about 75% of my aligner patients require some enamel reshaping.

The last step of aligner delivery is the delivery of any adjunct (additional) devices required for treatment. The most common of these are elastics or rubber bands. Although aligners can make teeth straight within their respective arch, the correction of bite problems between the upper and lower sets of teeth require that something be connected between the two. Conditions requiring that elastics be worn include overbites, underbites, and crossbites. Attaching rubber bands to the teeth may required that “buttons” be bonded to the teeth in one or both arches. Although some elastics can be attached directly to the aligners, others create a direction of pull that would unseat them and make them ineffective. High tech alternatives to classic rubber bands have been developed (i.e. the Motion appliance), but the result is the same.

After the attachments, buttons, and IPR are completed, the orthodontist finally delivers the aligners and gives the patient instructions on how to wear and care for them. Look for articles on my blog discussing these and other aligner topics.

NOTE: The author, Dr. Greg Jorgensen, is a board-certified orthodontist who is in the private practice of orthodontics in Rio Rancho, New Mexico (a suburb on the Westside of Albuquerque). He was trained at BYU, Washington University in St. Louis, and the University of Iowa in the United States. Dr. Jorgensen’s 25 years of specialty practice and nearly 10,000 finished cases qualify him an expert in two-phase treatment, extraction and non-extraction therapy, functional orthodontics, clear aligners (Invisalign), and multiple bracket systems (including conventional braces, Damon and other self-ligating brackets, Suresmile, and lingual braces). This blog is for informational purposes only and is designed to help consumers understand currently accepted orthodontic concepts. It is not a venue for debating alternative treatment theories. Dr. Jorgensen is licensed to diagnose and treat patients only in the state of New Mexico. He cannot diagnose cases described in comments nor can he select treatment plans for readers. Please understand that because he has over 40,000 readers each month, IT IS IMPOSSIBLE FOR HIM TO RESPOND TO EVERY QUESTION. Please read all the comments associated with each article as most of the questions he receives each week have been asked and answered previously. The opinions expressed here are protected by copyright laws and can only be used with written permission from the author.