Giannetti & Booms Blog

Welcome to our blog, where you can learn more about how orthodontics help people enjoy healthy, beautiful smiles.

 

When Am I Getting My Braces Off?

When am I getting my braces off?

“When am I getting my braces off?” This is perhaps the most common question I get in my office. I know that patients are eager to get to the finish line. After all, they’re excited to see the final results and show off their beautiful new smiles. But it’s hard for the orthodontist to answer that question with an exact date. The amount of time a patient will wear braces can be estimated based on our previous experience. As professionals, we use years of experience with various cases to predict how new cases will unfold. While we give patients a goal for completion, the reality is that the actual amount of time can be more or less than we estimate. Because as humans we’re complex biological creatures, there are many variables that affect the amount of time patients spend in braces.

What are the factors that affect the length of orthodontic treatment?

There are several factors that affect the length of treatment:

• Coming to all appointments: this is the most important factor. Missing or delaying appointments will likely extend treatment time.

• Keeping teeth clean: plaque causes inflammation, which is “the root of all evil” and inhibits optimal tooth movement.

• Wearing the auxiliaries as instructed is of utmost importance, such as rubber bands. (for example, rubber bands) according to instructions is of utmost importance.

• The complexity of the treatment: more complicated treatment means longer treatment time.

• A patient’s overall health. For example, smoking and underlying systemic health problems such as diabetes can lengthen treatment time and can even cause less ideal results.

• Individual biology is a factor, too. Some people respond to treatment more easily than others.

Why did I reach my goal date and still have to wear braces?

As mentioned above, a variety of factors can affect the length of treatment, but the most common issues we see are broken brackets, missed appointments, and inconsistent wear of rubber bands. If a patient reaches their end goal date but all problems have not been corrected through the treatment, the patient can choose to continue treatment to reach the final goal or, if the patient is satisfied with the result, he or she can choose to end treatment at that point.

What is your office doing to maximize minimize treatment time?

As we can see, the average treatment time varies on a case by case basis. In the United States, the average amount of treatment time in braces is 30 months, or 2.5 years. At our office, the average time is just 22 months. We pride ourselves on being forward thinking. Through the use of the latest technology and innovative practices, we get better results without extractions. We use Damon braces, which lessen pain discomfort and decrease treatment time. We also offer accelerated options for those who want to speed up treatment even more.

So if you want to minimize your treatment time and maximize your results, you can do so with good compliance and we guarantee you will LOVE your smile!


 

How Can I Speed Up My Orthodontic Treatment?

 

One question that my patients sometimes ask is, “Can I speed up my orthodontic treatment?” For example, a patient is planning to get married or is preparing to apply for their dream job. In these cases, the patient may want to accelerate their treatment. The first and most important factor in keeping treatment moving on time is to commit to coming to all appointments and, in the case of Invisalign, wearing the aligners for the time specified in the treatment plan. Fortunately, beyond that there are some safe, effective ways to speed up orthodontic treatment.

Low-level laser:

The first way that orthodontic treatment can be accelerated is through the use of low-level laser. With this method, a very low intensity medical laser is used to recruit cells that are responsible for moving teeth. It results in faster turnover of bone, which causes healthy acceleration of tooth movement. The application of this laser also decreases pain.

If a patient opts for this method, the procedure is done in the office every couple of months. It takes about 20 minutes and is normally done at the same time as the patient’s regular appointment, meaning that there is no need to come in to the office additional times.

High-frequency vibrations:

The second way to accelerate orthodontic treatment is through the use of high frequency vibrations. Like the low-level laser described above, high frequency vibrations are also effective in controlling pain and recruiting the cells responsible for tooth movement. In this case, the patient is given a device to use for about 5 minutes per day at home. An added bonus is that it can also be used anytime to control pain – this is especially handy if the patient feels discomfort after a new adjustment.

This method works well for patients who are using Invisalign because they’re already taking care of their treatment at home and not coming into the office very often. It can also be especially good for busy people who prefer an at-home solution.

Micro-trauma:

Another way to accelerate orthodontic treatment is through the use of what’s called micro-trauma. In this procedure, the orthodontist focuses on areas that are being stubborn and are therefore difficult to move. In this case, tiny holes are poked in the gums to create cells that are needed to move teeth. This method can be used anytime during the course of treatment when stubborn teeth are noticed. An example of its effectiveness is that patients who are using Invisalign can change their aligners every four days versus every week.

Patients should know that this method requires a special appointment that takes about 20 minutes. Anesthesia is given during the appointment to numb the gums. It gets the fastest results but may not be the right choice for everyone because of the use of anesthesia.

Custom braces:

The final option to speed up orthodontic treatment is the use of Insignia braces, which are custom braces with a prescription designed by Dr. Booms and myself. A scan of the teeth is taken, just like we do for Invisalign patients, and then prescription brackets and wires are custom milled based on the patient’s specific individual needs. Insignia braces do not require any additional appointments, but patients should note that there is a waiting period of about 6 weeks while the custom braces are being made.

When patients indicate that speed is particularly important, I’m happy to recommend one of the above acceleration options based on their individual needs. These options can be added to a treatment plan for one additional fee, which can be included in the patient’s regular payment plan.

Image credit: pngtree.com  


 

Should you use activated charcoal toothpaste as tooth whitening?

Should you use activated charcoal toothpaste as tooth whitening?

Using activated charcoal toothpaste to whiten teeth is a new trend, but before you try it, you should know if using activated charcoal toothpaste is a safe, effective way to get a whiter smile.

What is activated charcoal toothpaste?

Activated charcoal toothpaste is a porous black toothpaste made from processed natural materials such as wood or coconut shells. Because of its ability to extract and trap toxins, activated charcoal has been used to treat poisoning. It can be found not only in toothpaste but also in other beauty products, such as face masks. In recent years, it’s become increasingly popular for a variety of beauty regimens due to its ability to draw out toxins. Some believe that when applied to teeth, the activated charcoal will absorb stains on tooth enamel. However, does it really work?

Does activated charcoal toothpaste work?

According to a recent article in the Journal of the American Dental Association (JADA) that analyzed the results of 118 studies, there was insufficient evidence that activated charcoal toothpaste is an effective or safe way to clean or whiten teeth. In other words, these 118 studies were not able to find evidence to back up the claims that activated charcoal toothpaste works. In addition, some studies found that advertisements for activated charcoal toothpaste included unsubstantiated claims.

Is activated charcoal toothpaste safe?

“Yes and no” is what I would tell my patients. If it is used infrequently or temporarily, the risks are minimal. However, with repeated or frequent use, the toothpaste can wear down the enamel of your teeth, which can lead to tooth sensitivity and more risk of tooth decay. Another concern about activated charcoal toothpaste is that most of them do not contain fluoride. In fact, according to the JADA article, only one of the 50 activated charcoal toothpastes studied contained fluoride. By using a toothpaste that lacks fluoride and potentially damages enamel, you could be risking the health of your teeth. So I do not recommend brushing with activated charcoal toothpaste.

What are some safe, effective ways to whiten teeth?

If you are using Invisalign, you can easily and safely whiten your teeth with our complimentary whitening gel. Not only is it effective, but it’s safe and easy to use. If you are in braces, you can start the whitening process once they are removed using trays with whitening gel. If you are looking for a DIY option, over-the-counter whitening strips are a good alternative. Since the whitening agent is not as strong as the ones you can get from a dental professional, it may take longer to see results. Another consideration is that the strips don’t reach as far back as the whitening trays do. So if you’re interested in whitening your teeth, we recommend checking with your dental professional first. We want you to enjoy your dazzling smile of healthy teeth.

 

Creating beautiful smiles is our passion…Maintaining them is our mission!

For a long time we have been thinking about how to make it affordable and convenient for our patients to get replacement retainers. This way, if patients lose or break their retainers, they could get a replacement right away, before their teeth shift. This would also make it a no-brainer for our teenage patients to tell their parents as soon as they lose or break a retainer.

The good news is that scanning technology and 3-D printing have made that possible. We now scan our patients’ teeth and produce a resin model that can be used over and over again to make retainers.

what to do retainers lost

How does it work?

When you finish treatment, you get to take your resin models home. If you lose or break your retainer, simply drop off your models at the front desk (no appointment needed) and come pick up translucent retainers within 72 hours (no appointment needed). It’s convenient, fast and easy!

You can get as many retainers as needed for the first 5 years after completing your orthodontic treatment. No questions asked. After 5 years, you have the option to renew the retainer warranty.

“Retainers for Life”?!

As we discussed on the last blog, in order to keep your straight smile after orthodontics, retainer wear needs to be a part of your routine. When retainers are not worn routinely, teeth shift back towards their original position. I tell my patients they need be worn “nighttime for lifetime.”

One common reason patients stop wearing their retainer is because they no longer have it – it was lost, broken or chewed up by their pet (dogs think retainers are yummy chewy toys!). The most common way to lose a retainer is when a patient wraps it in a napkin at a restaurant or school cafeteria, and it ends up in the trashcan. I am sure most of you know someone who has been in this situation, which usually results in dumpster diving. Some lucky winners will actually find it, but still, it’s not an ideal situation.

However it happened, once lost, the retainer is now gone, and many patients find themselves in a tough spot. These patients can be adults–adult patients or parents of a patient—who did not plan on having the expense of a new retainer. It’s similar to when your car is in sudden need of a repair that you had not budgeted for. Or these patients can be the child or teenager who has been told by the parent “You’d better wear your retainer” because the family has just invested a lot of money in their orthodontic treatment. Naturally, that child or teen is dreading telling the parent.

In any case, patients tend to wait too long to get a new retainer, often long enough for teeth to shift. What I end up seeing at my office are patients who, after a couple years of orthodontic treatment, significant financial investment, hard work and a beautiful result, come back with crooked teeth. It is just heart breaking. That’s why we are so excited to offer our patients this option to help them keep their beautiful smile for a lifetime.


 

Why do I need retainers?

Why do I need to wear retainers?

If you’ve just finished braces or Invisalign, you may be thinking, “I’ve worked hard on achieving my beautiful smile…Am I done now?” The truth is that retainers play an essential role in orthodontic treatment. If retainers are not worn faithfully after orthodontics, teeth will quickly shift back toward their original position.

Why are retainers necessary?

For the first six months, teeth are extremely unstable because the bone and gums need time to readjust to the new position of the teeth. After a couple of years of retainer wear, teeth become more stable, but they will still shift, just at a slower rate than before.

How long do I need to wear my retainers?

When asked this question, I tell my patients that retainers need to be worn for as long as they want to keep their teeth straight.

It used to be common practice for orthodontists to tell patients to wear their retainers until they were done growing or went to college. However, long-term research and clinical experience show that, like everything else in our bodies, teeth continue to shift with age. In fact, this is especially true for the bottom front ones.

How often do I need to wear my retainers?

For the first 6 months, retainers need to be worn either full time or 12 hours per day depending on the design of the retainers. After that, they need to be worn at night time.

types of retainersThere are different options for retainers. For the upper arch, I typically like the “Invisible retainer” because it can be worn 12 hours for the first 6 months, and then at night only. Because it’s needed no more than 12 hours per day, there is less interference with speech and lifestyle than a retainer that needs to be worn full time.

For the lower arch I like either the Invisible retainer or the traditional Hawley retainer which need to be worn full-time for the first 6 months and then only at night. Since the retainer is on the lower arch, it does not interfere with esthetics or speech as much as the upper retainer may.

How long will my retainer last?

The typical lifespan of a retainer varies. If you clench or grind your teeth, or if you wear the retainer full time, it will not last as long. You can expect a retainer to last several years but not forever.

What should I do about my wisdom teeth?

Research shows that wisdom teeth have no effect on teeth crowding. So whether you have your wisdom teeth removed or not should not affect your retainer use. In other words, what’s important in terms of keeping your teeth straight is wearing your retainers. However, there are other reasons we recommend wisdom teeth removal – we will assess that with a final X-ray when your treatment is completed.

So, to answer your question, yes, retainers are for life. Keep your eye out for our next blog on “Lifetime Retainers.”


 

How Does Orthodontics Affect Your Gums?

Why do people get their teeth straightened? The most obvious answer is for aesthetic reasons. However, orthodontics goes well beyond the look of straight teeth. Ease of cleaning the teeth, correct load on the jaw bones, and an improved wear pattern on the teeth are some other benefits of orthodontic treatment. Did you know there is also a connection between orthodontics and gum health? Orthodontics can affect gum health and shape in a variety of ways. Let’s look at a few common scenarios – gingivitis (gum inflammation), gum recession, and gingival windows  — and see how these can differ between children and adults.

Keeping gingivitis at bay:

First, patients undergoing orthodontic treatment experience changes in the way they take care of their teeth and, for this reason, we recommend that patients receive more frequent dental cleanings during orthodontic treatment to help prevent gingivitis. It is important to keep teeth clean during orthodontic treatment so the gums respond in a healthy, natural way. When teeth are clean, the orthodontic experience is more comfortable for the patient, and the results are nicer. And after the teeth are aligned, it is easier for patients to keep gingivitis at bay in the long term since aligned teeth are easier to clean.

Preventing gum recession:

A second way in which orthodontics can affect gum health is gum recession. One of the causes of gum recession is a tooth not being centered in the jaw bone. The opportunity to treat growing patients allows the orthodontist to direct the teeth to come in more centered in the bone; this results in better gum quality around those teeth in the long run.

gums and orthodontics      gums and orthodontics after treatment

Sometimes, gum recession issues completely resolve due to orthodontic treatment. Other times, patients with pre-existing gum recession may need grafting to resolve it, either before or after orthodontics, and the patient is referred to a periodontist (gum specialist) for treatment. Generally, the gums of growing patients are more resilient and therefore can regenerate more easily than the gums of adults.

Gingival windows in adults:

When teens have crowding and get their teeth aligned, their gums respond and fill in the new space. In adults, the gums are less resilient and may not fill in the space between the newly aligned teeth. The resulting space is called a gingival window, which is not a concern for gum health. In case of an aesthetic concern for the patient, it can be easily solved by reshaping of the teeth, aesthetic bonding, and/or gum procedures. These are some of the reasons that we will communicate with you and your dentist throughout treatment to make sure that at the end, we will all be rewarded with a beautiful outcome.

 

Snoring is Never Normal in Children

If your child snores, something’s wrong, and your orthodontist may be able to help you figure out what it is.

When my daughter, Isabella, was a baby, she snored and occasionally gasped in her sleep—it was obvious she couldn’t get enough air. I took her to the doctor, who diagnosed her with obstructive sleep apnea, a sleep disorder caused by a person’s airway collapsing while they sleep.

At age two, Isabella had surgery to remove her tonsils and adenoids in an effort to unblock the airway leading from her nose to her throat. She improved for a while, but then symptoms returned. As the years progressed, she began snoring again and gasping in her sleep, and she was constantly sick with a runny nose and watery eyes.

By age ten, she didn’t want to participate in sleepovers because she was embarrassed: classmates made fun of her snoring or said they couldn’t sleep next to her because she was so loud. She was sleep deprived, her schoolwork suffered, and she didn’t like to participate in activities that required exercise. I took her to the doctor and received various medications and nasal sprays, none of which seemed to make any difference. As Isabella moved into her teen years, her symptoms worsened and I dedicated myself to finding a solution.

As luck would have it, I had registered for a seminar as part of my professional continuing education, and one of the speakers shared information about sleep apnea, explaining that the adenoids could grow back if they were removed in young children. I started putting the pieces together and realized Isabella must have obstructive sleep apnea, again.

The adenoids are glands located in the roof of the mouth, behind the soft palate where the nose connects to the throat. When everything is functioning properly, adenoids trap germs coming in through the mouth and nose; however, when the adenoids are enlarged, they can prevent air from coming in as it should.

One of the best tools to begin diagnosing obstructive sleep apnea is three-dimensional radiography called a cone beam scan, used by most orthodontists. I had the very technology I needed right in my office to figure out whether Isabella’s adenoids were causing her trouble. When I looked at her test results, I was astounded to find that she was getting absolutely no air through her nasal passage; she had 100 percent blockage. This was not a problem medication could solve. She needed another adenoidectomy.

At age 15, she had the surgery, and her life improved instantly and dramatically. It’s been two years and she is a different kid. She’s almost never sick. She’s a straight-A student. She exercises. She’s alert and happy. And, she’s having the most amazing time experiencing the world through her newly discovered sense of smell.

As a parent and an orthodontist, I encourage you to be an advocate for your child’s health. Well-meaning, well-trained medical professionals do not know your child the way you do. If you feel like something’s wrong, trust your instincts. If your child’s symptoms don’t improve, insist on a new approach.

The classic symptoms of sleep apnea include:

  • Loud or frequent snoring
  • Choking or gasping while you sleep
  • Bedwetting (especially if a child previously stayed dry at night)
  • Morning headaches
  • Daytime sleepiness or tiredness
  • Trouble concentrating
  • Behavioral problems, sometimes diagnosed as attention deficit disorder

It breaks my heart to think of how long Isabella suffered unnecessarily, and I know she is not the only one. Fortunately, orthodontists who keep up with continuing education are now well versed in the symptoms related to obstructive sleep apnea, and we can alert you to the possibility that you may need to follow up with your child’s pediatrician or an otolaryngologist (ear, nose, and throat doctor), so your child can get the treatment they need to enjoy life to the fullest.


 

Thumb sucking: How to help children quit

When babies suck their thumb or a pacifier, it can help soothe restless or nervous feelings, but as babies grow into toddlers, thumb sucking can get in the way of normal facial and oral development.

If you are reading this and you have an infant who may be able to switch from a thumb to a pacifier, I highly recommend making the switch. At some point, you’ll be able to take the pacifier away. Clearly, this is not the case with their thumb.

HOW TO STOP SUCKING

If you have a dedicated thumb sucker reaching age three, it’s time to help your child make a transition from thumb sucking to a new stress relieving technique, one that won’t damage their bite, teeth and jaw development.

At your local bookstore, you can find several books on the subject. Many of the parents I work with like David Decides About Thumbsucking by Susan Heitler or The Berenstain Bears and the Bad Habit by Jan Berenstain. These books help children understand why they suck their thumb, that it is a normal part of childhood for many kids, and that there comes a time to give it up. Also, the books give children strategies to cope with giving up a habit that, frankly, just feels good.

By age three, children have reached a developmental stage to self-soothe without thumb sucking; they just need some encouragement and support. These books help parents provide that support. Once the child decides to quit, the process is far easier.

At age three, children often like the idea of becoming “big kids.” Many have recently moved away from diapers or are in the process, and stopping thumb sucking can be part of this changeover.

By reading these books to your children and rewarding efforts to quit thumb sucking, you can keep things positive.

ADDITIONAL STRATEGIES

The longer your child sucks their thumb, the more difficult it can be to quit and the more harm it can do.

When a child reaches age six or seven and still sucks their thumb, parents sometimes come to my office asking me to install an appliance that makes thumb sucking so uncomfortable that their child will finally stop. Before we consider this drastic measure, I typically ask the child if they want to stop. Children must decide to stop sucking on their own at this age. Once they make the decision to stop, our intervention will work. If your child does not WANT to stop sucking, it does not matter what you or I do, they will continue the habit.

If a child says, “yes,” I can help with techniques to break the habit such as putting athletic tape around the thumb before they go to bed, or covering the thumb in a bad tasting film designed to prevent nail biting. These strategies help children by serving as reminders. Click here for a whole list of ideas.

If the child doesn’t want to quit, it’s best to try to assess why. Is he or she trying to exert control over their life? Does he or she feel vulnerable, nervous, anxious, or insecure and lack other ways to cope? Occasionally, it can be a power struggle and they are not going to stop because they know we desire it. Addressing these issues will help your child quit thumb sucking.


 

WHY DO KIDS GET BRACES TWICE?

Have you ever wondered why kids get braces so early these days, and sometimes get them twice? Are orthodontists just out to make more money? What’s going on?!

When many of us were in school, kids got braces for a couple years in middle school or high school, and that was that. So, for many of us, the idea of getting braces in elementary school seems strange. But when you understand how the human mouth develops, it makes sense.

The upper part of the jaw, called the maxilla, has soft spots that eventually harden and interlock with the rest of the jaw (much like the soft spots on a baby’s skull). Some problems are far easier to correct while the maxilla is still pliable, including under-bites, cross-bites, narrow palates, and the type of crowding that might necessitate having teeth pulled if left untreated.

The American Association of Orthodontists recommends that every child see an orthodontist for a consultation at age seven, because by age nine the window for easy, effective treatment has often passed. Problems can still be treated, but not as comfortably.

If you’re wondering whether your child might need braces, you’ll be happy to know that most orthodontists offer a free initial consultation—and a referral is not necessary. Our consultation includes an hour-long assessment that comes with a full set of x-rays. Once we know the problem(s) we’re dealing with, we work with you to decide what makes sense for your child and your family.

If your child needs treatment, but isn’t ready yet, we begin growth guidance monitoring (evaluating the child every six months to monitor facial and dental development). This allows us to get to know your child, work with your general dentist, and correct oral problems at the optimum time. Like the initial evaluation, this monitoring is free of charge.

When we complete the initial evaluation, we discuss your child’s whole diagnosis with you. Early treatment is appropriate for some problems, while other problems can only be corrected after all the adult teeth have fully grown in—usually around age twelve. That’s why we sometimes recommend that children have braces in two phases: one phase to correct the under-bites, cross-bites, narrow palates, and crowding; then a second phase to correct crooked teeth.

When it comes time for treatment, we recognize that you know your children better than anyone. If you think your child can handle the responsibility of a removable retainer at age eight, we can go that route, depending on the diagnosis. If you believe a retainer will likely end up in the school cafeteria trash can by the end of the week, we generally recommend braces.

So, no, we’re not out to make more money. We’re dedicated to giving your child the healthiest smile we can with the least discomfort. Having a healthy, beautiful smile helps children thrive. It increases health, comfort and self-confidence. If you’d like to learn more, contact us for a free consultation today.


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