"Thanks Dr. Steckel- we're glad we consulted with you at the right time!"

October is Orthodontic Health month. If your little Ironman, Princess or (fill in your 2013 costume selection here=__________________) is 7 years old, then it's time for an orthodontic consult. 

Why age 7 years? The teeth and jaws are developing and some emerging problems are easier to correct if found at this age. For these reasons, the American Association of Orthodontists recommends an orthodontic consult no later than age 7 years.

Your family dentist may refer you for this consult, and Dr. Steckel communicates her findings with you, your child and your dentist. Also, you and your child can consult with Dr. Steckel without a referral.

Some orthodontic problems are inherited, and some are caused by harmful habits. Some orthodontic problems are noticeable by the patient and parent, and some are not without an x-ray and clinical exam by Dr. Steckel. Proper timing of treatment is based on the type of problem present, esthetic concerns, and other concerns that are discussed. Examples of some younger patients and their concerns are shown below:

The 7 year old patient (below) and her mom saw she did not have room for her teeth coming in, and she had a cross-bite on her right side. Her jaw was shifting as well-this is a big concern. The after view shows the results after the upper jaw was expanded, and upper braces used.
See how her teeth now line up in the front?

The 8 year old patient (below) had a cross-bite in the front and blocked out teeth. She had braces for less than a year to correct the damaging cross-bite-see her results to the right. This correction also reduces the risk of losing the lower permanent tooth.

The 6 year old patient below had a cross-bite due to her jaws not growing properly. See how flat her face is from the side? She was treated to correct her jaw position- see how her profile is much improved on the second image?

 

 

As you can see, there are malocclusions that are best treated early with the goal to reduce the future need for extractions and or jaw surgery; and address esthetic concerns. That being said, there are malocclusions that can wait for the proper time to take advantage of greater growth potential and to streamline the orthodontic experience.

In summary- the best time for an evaluation is 7 years of age. The best time for treatment is best decided with an orthodontic consult. Call Orthodontics on Silver Lake (302) 672-7776, to schedule your child's consult-it's fun, informative, and not scary!

Good, Better, "Best"? Braces

When a patient is referred for orthodontic treatment these days, many times he/she will learn or ask questions about braces before arriving at Orthodontics on Silver Lake (OSL). 

 

The internet can provide brand names of braces (brackets) and it is sometimes confusing. Some marketers claim superiority for things like treatment results or saving time.  There has been significant research done - nine randomized clinical trials, and two systematic reviews (1). The research found there is no enhanced efficiency in using self-ligating brackets.

 

So, there is no "Best".


Traditional metal brackets with colors

Self-ligating metal brackets

 

Self-ligating ceramic brackets

                                                                

Good vs Better?

 

By definition, self-ligating brackets or braces hold the wire without an extra tie or color. The wire is positioned into the bracket and the door is closed to securely hold the wire.  Non self-ligating brackets usually have colors applied to the bracket to hold the wire - there is no door. The colors can loosen and not hold the wire as securely, but this problem is not common.

 

Some of the key benefits of using self-ligating brackets seen @ OSL:

• The patient's teeth will more likely move along the wire as prescribed. 
• These brackets are also easier to adjust chairside, and therefore the patient's time in the chair has been shown to be slightly less. This is great for our busy families and patients!
• There is less surface area to clean than with non-self-ligating  brackets-easier homecare.

 

Benefits of Non-Self-Ligating brackets:

• Colors! 
• Consistent improvements in design have made these brackets a reliable option as well for our patients.

 

Ultimately, the orthodontist's experience with a variety of brackets can optimize the outcome, regardless of the type of bracket/braces. Braces are only a tool we use for achieving excellent results and addressing the patient's concerns. See you next month!

Reference

1. Fleming, P.S. and O'Brien K., "Self-ligating do not increase treatment efficiency" Am. J. Orthod.,143:11-19,2013. 

Are Straight teeth Healthier Teeth?

 

Patients who consult with me at Orthodontics on Silverlake (OSL) about their smile are motivated to make changes so that their teeth are straighter and their smile is more esthetic and appealing. They can point to the pictures we take at the consult and tell me what they want to change about their smile. It's an exciting time because orthodontic treatment is in most cases a very predictable process that yields excellent esthetic results for our OSL patients. 

Malocclusion also known as a "Bad Bite" affects about 75% of American adults. Malocclusion can include an excessive overbite, protruded front teeth, crowded teeth, and other conditions. When your teeth are not well-aligned they are harder to clean and this can increase your risk for periodontal or gum disease.

There is strong epidemiological evidence that periodontal disease provides an increased future risk for cardiovascular disease, and there is also a moderate link associating periodontal disease with diabetes. (1,2)

One study (3) found orthodontic treatment normalized the

bite forces on the newly-straightened teeth and resulting recovery of the gum tissues, even a year after orthodontic treatment was completed.  Another study (4) found that  overlapping of  incisor teeth is directly related to gingivitis (which can lead to periodontal disease) and this relationship cannot be explained simply by an effect on oral hygiene.  

So, straight teeth are healthier teeth. 

Invisalign® Treatment can be used to address most patients’ malocclusions and esthetic concerns.  The patient pictured below finished her orthodontic treatment in 18 months:

 

 

 

 

 

                            

Call us at Orthodontics on Silverlake  (302-672-7776) to discuss your healthier smile!

References:

1.   Periodontitis : A future risk of acute coronary syndrome? A follow-up study over 3 years. Rehnvert S. Ohlsson O., et al., J. of Periodontology (7/2010)

2.   Perio.org: New Reports confirm perio-systemic connection and outline clinical recommendations (AAP)

3.   Eismann, D., Prusas R. Eur J Orthod. 1990 Aug;12(3):281-3. Periodontal findings before and after orthodontic therapy in cases of incisor cross-bite.

4.   Eur J Orthod. 1998 Feb;20(1):65-72.

The relationship between irregularity of the incisor teeth, plaque, and gingivitis: a study in a group of schoolchildren aged 11-14 years.

Start Smiling More!

The days of middle school and high school braces - whether metal, colored or clear ceramic braces - are all but gone, thanks to Invisalign Teen®.

Although braces are still a viable option for many of our patients (see June/July 2013 issue of Women’s Journal article - page 9), some teenage patients may be reluctant to undergo braces treatment for social reasons. Doctors and parents may be skeptical about their teenager’s willingness to cooperate with removable clear aligners.

Invisalign Teen® is a method of straightening teeth using clear, almost invisible removable aligners. My clinical treatment plan is combined with proprietary 3-D computer-generated software to make sets of unique, custom-made aligners that move your teeth in precise increments.(1)

Some of the benefits I have found with Teen Invisalign® vs. Braces:

·        Easier to brush and floss, less worry about cavities forming

·        No wire poke emergency visits
·        Less treatment visits needed to complete treatment (great for busy moms!)
·        Photos can be taken easily for school pictures
·        Blue indicator tabs are included for compliance checks
·        Eruption compensation to allow natural eruption of teeth

A recent prospective study(2) looked at teen oral health and teen satisfaction during Invisalign® treatment. Four different orthodontic offices participated and evaluated plaque, gingival-bleeding and cavity scores for two years during the treatment. In addition, quality of life questions about physical and social comfort were asked every three months.

The findings indicated significantly less plaque and bleeding than patients wearing braces. Patient satisfaction was good, since 70% of the patients “seldom” or “never” experienced discomfort from their aligners, and 80% “seldom” or “never” used pain relievers.

At OSL, my team and I enjoy the process and the results we’ve seen with our Invisalign® patients.

We congratulated Sam after recently finishing his Invisalign® treatment in 14 months after wearing 27 sets of aligners - see his pictures below:

 

  

 

BEFORE

 

  

 AFTER

 

Please call us at Orthodontics on Silver Lake @ (302) 672-7776 to find out how you can smile more!

 

 



References:

1.     Align Technology, Inc. M00081 Rev.1

2.     Tuncay, O, Bowman, J, Amy, and Nicozisis,J Aligner Treatment in the Teenage Patient, JCO.VolumeXLVII, No.2 2013.

 

Study on Soreness Relief for Braces

Practicing "Evidence-Based" Orthodontics @ OSL

 

"Will it hurt to get braces?" Most of us remember getting started and "bracing" for the expected discomfort. We're instructed to eat soft foods, take pain medications (NSAIDs like ibuprofen, etc.) and take good care of the braces. A week later (if we're adolescents) we are back to normal. 

The ibuprofen we recommend @ OSL is biochemically designed to "wash-out" the pain chemicals around your teeth, thus relieving the inflammation...

 

 BUT

...What if you want to avoid the side-effects of, or cannot take ibuprofen? What else besides drugs would be effective at relieving discomfort? Is it evidenced-based?

A recent randomized clinical trial was done to investigate the efficacy of ibuprofen, chewing gum (sugar-free), and viscoelastic wafers during the first week after initial arch wire placement. The 50 participants were asked to fill in surveys and were divided into 5 groups; All were female, ages 13-18 years, and had full braces placed.

 

 

 

 

Group #1  Placebo - asked to take Vitamin B6 immediately after wires were placed,  and at 8 hour intervals for a week if discomfort persisted*

Group #2  Ibuprofen - asked to take Ibuprofen, per schedule above*

*NOTE - Group #1 and #2 did not know what drug they were taking.

Group #3  Chewing gum - asked to chew sugar-free gum per schedule above

Group #4  Soft viscoelastic wafer - asked to chew on wafer for 5 minutes per schedule above

Group #5  Hard viscoelastic wafer - asked to chew on wafer for 5 minutes per schedule above 

The Results:

1. For all groups the intensity of the pain increased from 2 hours after wire placement to 24 hours, then decreased. 

2. Bite wafer chewing was more effective than ibuprofen, and more effective than the placebo for reducing discomfort.

3. Chewing gum was also more effective than a placebo for reducing discomfort. 

Contact us at OSL if you want more information. Check with me next month for more "Evidence-Based" orthodontic info. Thanks!

Ref: 

Farzanegan, F., Zebarjad S.M. Pain reduction after initial archwire placement in orthodontic patients:A randomized clinical trial. AJODO 2012;141. 169-173

Straight Teeth, Healthy Gums

 

So You're Saying I Can Straighten My Teeth and Make my Gums Healthier at the Same Time...?

As we know, fixed braces can create numerous plaque-retention sites which increase a patient's risk to develop demineralizations or "white spots", cavities, or gum infections. The risks are real-whether the braces are on the front of your teeth or on the inside (lingual braces). (1)

Recent clinical trials at the University of Florida and the University of Washington show that periodontal response, or gum health, improves during orthodontic treatment with Invisalign®. (2) This is due to the fact that patients can remove the aligners to brush and floss normally. They also found in surveying the patients that these patients spent more time brushing and flossing, and cleaning the inside of the aligners to keep them invisible.

The other benefit of Invisalign® is the additional splinting effect, which is greater than that of fixed braces. The teeth that are not moving are held stationary without receiving a net force. So tooth mobility-which is normal and necessary during orthodontic treatment- is minimized.(2)

See the video below that dramatizes the health benefits that can be yours when you decide to try Invisalign® therapy. See you next month!

                                 

References:
(1)Miethe R.R., Vogt S. "A Comparison of the periodontal health in patients during treatment with Invisalign(R) system and with fixed orthodontic appliances." J Orofac Orthop 1999;115:83-8.

(2)Boyd, R.L. "Improving Periodontal Health through Invisalign Treatment" Access 2005; 24-26

It's Allergy Season!

It's allergy season...how are your children breathing? Is it allergies, or is it something else?


It's April, and Spring allergy season is well underway in Kent County, Delaware. This month's blog post is looking at breathing in our younger patients from an anatomic perspective.

A recent study published (Iwasaki et al., American Journal of Orthodontics and Dentofacial Orthopedics; February 2013 Vol 143 Issue 2, pgs. 235-245) by researchers at Kagoshima University, Kagoshima, Japan demonstrated the benefits of orthodontic expansion therapy for younger patients. The purpose of the study was to clarify the effect of orthodontic expansion therapy on the position of the tongue and the airway space in children with nasal airway blockage.

The study included patients ages 9 to 11 years old who had a Class II jaw relationship with no previous orthodontic treatment, no jaw discrepancies, and no enlarged adenoids or tonsils. They were divided into two groups; a control group and a group who received expansion therapy. The airway volume was measured in four areas before and after expansion for both groups; the mouth, in the nasal area, upper throat (retropalatal) and lower throat (oropharyngeal).

After expansion, the measurements showed the mouth airway region decreased significantly for the control group, whereas the three other areas increased. In the control group, two areas increased in volume, and two areas did not change. Overall there was no significant difference for mouth airway volume between the two groups after orthodontic expansion.

The effect of orthodontic expansion is this: the tongue improvement in posture and going to a higher position in the mouth. But in some patients, the low tongue posture did not improve because the nasal obstruction remained even after orthodontic expansion.

So, for our OSL patients who present for treatment (which may include expansion therapy): Orthodontic expansion enlarges the airway both with and without improvement in nasal obstruction. Some patients will need additional intervention, and we will continue to refer for allergy, or ENT evaluations.

To our patients and friends of OSL - here's to a great spring, and many good nights sleep...

See you next month!