National Children's Dental Health Month - February 2012

The Delaware State Dental Society (DSDS) will host the 8th Annual "Give Kids a Smile" and provide free dental care two days this month-February 11th and February 17th, 2012. Volunteers from the DSDS will also provide education and any needed referrals in a fun and upbeat atmosphere for patients and their families.

Because of this event many children benefit and avoid more costly and possibly irreversible damage to their primary and permanent teeth. Parents and patients both are educated and encouraged to practice proper diet and home-care to reduce the need for future invasive dental treatment.

As an orthodontist I've seen some children at this event with developmental problems that need to be addressed as well.

In orthodontics there are genetic and environmental components to a malocclusion. In other words, there are conditions that are inherited and seen in a patient from a very early age, and others that develop over time.

Genetic components include:
1. Mandibular prognathism = Large lower jaw ("Hapsburg jaw")
2. Teeth size
3. Disproportionate size/shape of upper and lower jaws
4. Overbite (more significant genetically than overjet)

Environmental components include:
1. Muscular imbalances
2. Oral habits such as thumb or finger sucking
3. Diet choices, which can contribute to early tooth loss, and disruption of development
4. Overjet (more significant environmentally than overbite)

The individual attention I provide to a patient's dental age, chronologic age, and any irregularities in development are accomplished best before the permanent teeth have all erupted- before age 12 yrs. The attachment below shows images of conditions that should to be evaluated for proper timing of intervention, no matter the age of the patient:

Information Courtesy of the AAO

Choices, Choices! Invisalign® or Braces?

Frequent patient question @Orthodontics on Silverlake (OSL):

“Which should I choose-Invisalign® or Braces?

Answer: “It depends….”

The attached video produced by Align technology is short, and shows fun banter between twin sisters discussing the benefits of Invisalign® treatment over braces.

In my opinion both girls seem happy at the end of the video, as they should be; both of them are seeing their teeth get straighter. When used appropriately each treatment option is predictable over time. When the girls are finished they will each need retainers to maintain the results achieved.

Teen Invisalign® has been a great addition and advancement for all of the Invisalign® treatment options available to me as an orthodontist. Orthodontists (me included) were worried about compliance with Teens, so compliance indicators and eruption tabs were developed. Teens overall have been as responsible as our adult patients in caring for their aligners and achieving wonderful results.

FACT: I have yet to implement the ‘nuclear option’ for any teen patient due to lack of compliance!  

Braces (metal or ceramic) are still chosen by our patients -“they are always working” - as we’ve said and parents have said as well. There are lifestyle adjustments with Invisalign® and that sometimes sways patients to choose braces.

Final note- excellent oral hygiene, reduced sugars, sodas and sports drinks is paramount no matter what treatment option you choose.

Talk to you in February!

"The Six Elements of Orofacial Harmony"

Continuing education is important for an orthodontist, for a variety of reasons. One recent CE experience for me was a great opportunity to meet one of the great minds in modern orthodontics: Dr. Larry Andrews. The course was the "The Six Elements of Orofacial Harmony."

Orthodontists treat more than teeth (Element VI), even though most patients who come to see me are concerned with their "overbite, crowded teeth, or gaps." We also need to evaluate (Elements I-V):

 

I. Arch shape and length

II. Jaw Positions

III. Jaw widths

IV. Jaw Heights

V. Chin Prominence

These Elements are routinely evaluated when I see patients, but sometimes not all 6 of these elements contribute significantly to a patient's orthodontic plan.

 

I have described Dr. Andrews' Six Keys to Occlusion many times to patients over the years when reviewing treatment results or discussing planned treatment. Over the two day course I attended earlier this month, it was enlightening to to look at orthodontic treatment records and planning through the Andrews' prism.  After attending the course I have implemented a few of his ideas. His son Will is in practice with him and shares the lecture duties and does a great job describing some of the trickier concepts relating to measuring tooth position based on a patient's forehead. Several orthodontic residency programs - West Virginia and U Penn, for example - are implementing the concepts into the orthodontic curriculum. The residents I met were very enthusiastic in their experiences to-date. Perhaps a visit to the San Diego office to continue my studies is in order? Talk to you next month!

 

                         Above: Dr. Steckel with Dr. Larry Andrews and his son Dr. Will Andrews

National Orthodontic Health Month

We have celebrated National Orthodontic Health Month at OSL for over 10 years.  It's an opportunity for us to remind our patients that some Halloween treats can be harmful to people wearing braces or clear aligners. 

It is possible to enjoy some traditional candies at Halloween without causing problems with orthodontics appliances.  Kids really want to have fun on this holiday and we encourage patients to enjoy treats that are acceptable, rather than feel that they are missing out.  Parents can remind their children that when they are done with orthodontic treatment and they see their new smiles in the mirror, they will feel that any sacrifices they have made were worthwhile.

We have also included a scary hallway and examples of good candy options just for coming in during October.  The looks and responses of disbelief are the norm and we are used to it!

As promised, below are examples of patients who recently finished their Invisalign® treatment at OSL:



 
    After 15 months of aligner wear



   After 17 months of aligner wear

And a short video about the "Efficacy of Invisalign®":

Invisalign: How it Works

Since 1999 using Invisalign®, and more recently Invisalign Teen®, has been a great option for a variety of our patients’ malocclusions.  Adults and teens with:

·         Cross bites,

·         Crowding,

·         Spacing, and

·         Wear on their teeth

Have achieved great orthodontic results!

One of the best outcomes for our patients at OSL has been improved/easier daily brushing and flossing¹ which can have overall health benefits².  The video below is a short introduction and next month I’ll post some before and after images of OSL Invisalign® patients.

¹ Gingival Condition Associated with Orthodontic Treatment. Zachrisson BU. Angle Orthod (1/72)

² Increased Prevalence of Cardiovascular and Auto-Immune Diseases in Periodontitis Patients: A cross-sectional study. Neese et al. Journal of Periodontology (6/2010)

Myths about Braces - CNN Video

On June 29, 2011 CNN interviewed orthodontist Dr. Mark Johnston.  The short clip, which you can view below, is about how the stigma of having braces has changed over the years. Due to smaller brackets and more patients in treatment, children being teased for having braces is a thing of the past. Not to mention, the video states that one in five patients are adult. View the quick video below to hear more.

Dover AFB Dental Squadron Tour

“Wow, what a great service you provide”

It’s an honor to be selected as the 436^th Dental Squadron Honorary Commander this year.  Dr. Eric Cathey – Commander of the 436^th Dental Squadron – joined me at the induction ceremony, along with dozens of newly-selected business professionals and their 436^th and 512^th Air Force partners.  Dr. Cathey is also an avid “triathloner”, so we shared our sports stories as well.

Honorary Commanders are charged to learn more about the US Air Force and the mission of Team Dover, attend squadron functions, and interact with unit personnel.  The events are scheduled through-out the year and the event coordinator does a great job giving notice so even busy people can attend some of the ceremonies held on base.

My OSL team toured the DAFB dental squadron with me on May 5^th.  Dr. Cathey presented on the USAF Dental Service Mission which is to ‘provide the highest quality care to support the 436^th Airlift wing’s mission through dental readiness’.  We attended a true Air Force briefing and got to experience what briefings are like for Active Duty Military.  The staff of the Dental Squadron exhibited great structure and professionalism through the entire visit, beginning with lunch at Grottos and ending with the gift of a coin to all of our attending staff.  We have a staff member, Natalia, whose husband is Active Duty Air Force and she was very interested in experiencing a true Air Force briefing.  She said she enjoyed seeing what her husband experiences on a day-to-day basis.

MSgt. Jennifer Jones – the Superintendent of the Dental Squadron – led the tour and discussed the upgrades in the facility.  It’s great to see the facility getting needed upgrades in technology.  More importantly, both Dr. Cathey and MSgt Jones are passionately committed to their mission and to their team morale.  The team suggestion board and the “Great Patient Award” they give to their great patients demonstrate that excellence is a journey to which they are enthusiastically committed. Lunch at Grotto’s was great too!  We plan on reciprocating with a tour at OSL soon.

Next month, new topic!