Adjusting to life with your Orthodontic Appliances

Click here to view a "parts list" of braces.

The adhesive used for attaching the braces to your teeth cures rapidly initially, but takes 24 hours to cure completely. You can eat anytime after leaving our office: however, we ask that you be mindful of the suggested eating list for foods that might be harmful to the braces. Until you become accustomed to eating with your new braces, you may find it beneficial to follow a diet consisting of soft foods.

Will the braces be uncomfortable?

Initially the braces feel like they stick out from your teeth, making your lips feel "thick." This is normal. As you become accustomed to your braces and tooth alignment improves, this sensation will disappear and will cease to be a concern. Although the brackets have been rounded and smoothed, until the cheek tissues have "toughened" you may find it helpful to use a small piece of wax around the bracket that is causing the irritation. If your supply of wax runs out, call our office for more.

You will likely notice some discomfort beginning a few hours after your braces are placed. Some teeth, usually the front teeth, may be "tender" and sensitive to pressure. Occasionally, patients report that they experience no discomfort, but most have some soreness beginning during the first eight hours and dissipating within the week. Exactly when the discomfort ceases is impossible to predict and differs for each patient. You may wish to take some non-prescription pain medication (such as Tylenol or Advil) commonly taken for other discomforts, such as headaches. For maximum effectiveness, it may be best to take such medications before the discomfort begins.

Before Leaving the Office

There are routine steps which we ask you complete prior to leaving the office. These steps will minimize the discomfort related to irritation from the braces and ensure the optimal response to treatment. Please make these steps a part of each office visit:

1. Using your finger or tongue, check that wire ends do not extend into areas which might poke or abrade the cheek or tongue.
2. Make sure you understand what you are to do until your next appointment. This could include wearing headgear or elastics (rubber bands) as instructed, adjusting an expansion appliance or following specific hygiene or diet instructions.
3. Make sure you have an adequate supply of dental wax, special cleaning aids, elastic bands or other related materials that you might need between appointments.
4. Always schedule your next appointment before leaving the office. Waiting to schedule an appointment can lead to complications in the scheduling process, since appointments are set 4-6 weeks in advance. Postponing appointments will lead to an extended treatment time.
5. Make sure that your questions about treatment are answered. Treatment goes better when everyone understands the treatment process.

Scheduling Appointments

How do I fit orthodontics into my busy schedule?

Most people seeking orthodontic treatment have other important obligations during the day, most commonly work or school. When active orthodontic treatment begins, each patient is seen every few weeks and some of the appointments will inevitably conflict with work or school schedules.

We have devoted considerable time and effort to designing our scheduling system. Here is what we want to do: First, we want to see you on time for your appointment. Second, we want to have adequate time during each appointment for the necessary procedures. Third, we wish to answer questions and update your treatment progress. In addition, we will work with you to schedule around your other commitments as much as possible. As you can imagine, a well organized schedule requires considerable structure tempered with flexibility.

Our Approach

Longer appointments, which are few in number and generally occuring at the beginning and end of treatment, are scheduled during school hours. In this way, an entire afternoon is not committed to one or two patients, but rather is scheduled to accommodate as may families as possible for after school appointments. If you should ever wish to come to the office during a quieter time, please ask to schedule an appointment during school hours.

Some appointments are blissfully short. During your treatment there are times when the adjustments are completed quickly even though they may be quite technical. Treatment methods have also been designed to limit your inconvenience.

Because the schedule is carefully crafted, your late arrival can pose a problem. In fairness to the other scheduled patients, we may not be able to jam you into the schedule and therefore find it necessary to reschedule on occasion.

Rescheduling Appointments

We realize that once in a while unforeseen circumstances arise which necessitate a change in appointments; or, you may overlook an appointment. We will do our best to reschedule your appointment as soon as possible; however, in order to avoid a delay in your treatment, you may have to take an appointment time which is less convenient to you. Appointments are scheduled according to the patient's needs as determined by the treatment plan. Missed appointments, or numerous appointment changes, will inevitably result in an extension of your treatment time.

Office Hours:

Monday 8:00 am to 5:00 pm
Tuesday 8:00 am to 5:00 pm
Wednesday 8:00 am to 5:00 pm

Foods and Eating

Foods that are hard to clean off of braces should be avoided as they can lead to discoloration of the teeth and/or cavities. Even though braces are made of materials that cannot decay, they are fragile and can be damaged by eating the wrong foods. Although we can repair broken appliances, each time you come in with broken braces it adds time to your treatment. As we know you want your braces off as soon as possible, please assist us in your care by choosing foods that are compatible with your appliances.

Foods to Avoid - Sticky, chewy and hard foods:

• Gum, caramels, taffy/toffee, sugar daddies, sugar babies, tootsie rolls, starbursts, skittles, licorice, gummy bears and other such candies
• Bagels, pizza crust, hard pretzels, hard baguette bread, popcorn, whole apples, whole carrots, nuts, ice cubes, hard candy, corn on the cob, Doritos/corn chips, jerky
• Avoid chewing on pens, pencils and fingernails too!

Foods to minimize - Sugary foods:

• Candy, ice cream, cookies, cake, pies and other deserts
• Soda pop and other drinks with sugar
• Syrup and honey

Miscellaneous Foods to minimize or avoid:

• Lemons (citric acid in lemon juice can dissolve tooth enamel and if eaten to frequently can lead to decalcification of the enamel)
• Popcorn (husks can become lodged beneath the braces causing irritation to the gum tissue and kernels can break the braces off the teeth)

Common Problems and Solutions

Unfortunately from time to time some patients will experience an injury to the mouth. The following brief outline describes how dental emergencies are handled with patients in orthodontic appliances. Dental emergencies while wearing braces or other orthodontic appliances generally fall into two categories:

1. Direct injuries to the mouth and teeth:

Following a direct injury to your mouth or teeth, whether undergoing orthodontic care or not, you should be seen by your regular dentist as soon as possible. Usually an x-ray is required to determine the extent of injury to the teeth and surrounding bone. If a tooth has been "knocked out," severely displaced or fractured, it is best to contact your family dentist first since we may not have the necessary materials to treat these injuries. If the appliances are dislodged, we will need to adjust or repair the appliances as soon as possible.

Please call our office immediately after seeing your general dentist. If you are unable to reach your family dentist or an alternate emergency facility, call our office and we will try to assist you in either locating someone to care for the injury or provide palliative care. Please discuss potential emergency procedures with your family dentist.

2. Emergencies related to orthodontic appliances:

Broken or disturbed appliances are likely to occur from time to time during your orthodontic care. If there are any disturbances in your appliances, call our office as soon as possible so that we can evaluate the urgency of the problem and schedule you to be seen accordingly. Common problems are as follows:

Loose Band or Bracket

• If the band or bracket is still attached to the wire, leave it in place. If it is poking your cheek or gum, place wax over the area and call for an appointment. Loose appliances need to be recemented as soon as possible to prevent unwanted tooth movement or decay under the appliance.
• If the band or bracket comes out of your mouth completely, wrap it in tissue and bring it in to your next appointment. Please call to let us know what has broken.

Loose or Poking Wire

• Try to place the wire back into the brace with a pair of tweezers. If it is not possible, clip the wire with fingernail clippers behind the last tooth that is connected. If there is any discomfort, place wax over the area.
• If a tie wire is poking, try to push it down with a blunt object such as a spoon, pencil eraser or Q-tip. If this is not possible, place wax on it.

Lost Tie Wire or Elastic Tie

• If a tie comes off, please notify the office and have it replaced when scheduling permits

• Sometimes caused by not wearing as prescribed. Stop wearing the appliance and have the fit checked at the next visit. Call to book an appointment as soon as possible.

If you feel that you are unable to handle the problem on your own, please do not hesitate to call the office (Northgate 206-362-5911 and Kirkland 425-821-7888). After hours, a doctor can be reached as follows:

Dr. Hall pager number 206)663-6280
Dr. McCulloch pager number 206)663-4020

Retention

Removing braces signals the start of the "retention and observation" phase of your treatment. Please remember that this part of your orthodontic treatment is just as important as the active phase of treatment in determining the ultimate success of your treatment. Once teeth have been moved into their desired positions, a period of time is needed to stabilize the teeth so that the surrounding bone and soft tissues can conform to your new dental alignment. When braces are removed, it is a good time to review several important aspects of care.

How long are retainers worn?

The final observation and retention period of treatment normally spans approximately two years. During this period, appointments are scheduled with decreasing frequency. Usually retainers are worn at all times during the first six to twelve months after braces are removed, except when eating, brushing, flossing or during active sports. As retention continues, the retainers are generally worn at night for an additional year and then progressively less as instructed. Each person's requirements are different and a longer period of a different schedule may be recommended if facial growth is not complete. In some cases, indefinite wear on a part-time basis may be recommended to maintain the desired changes that have been achieved. Remember, your retainer is your "insurance policy" that the teeth will not move!

Will my teeth move back after treatment?

Orthodontists are aware that as retainers are discontinued, there may be minor changes in tooth position. The position and fit of teeth generally changes throughout your life, with or without orthodontic treatment. Our goal in the retention phase of treatment is to limit these changes to the natural process of accommodation while maintaining both a good functional and aesthetic result.

Taking care of retainers:

Keeping the retainer in either the mouth or its case (provided to you when you get your retainer) will avoid loss or breakage, which would lead to extra expense. Brushing the retainer with cool water and toothpaste and soaking it in a cleanser or mouthwash periodically will keep it fresh. Never place your retainer in hot or boiling water, or in the dishwasher or microwave as it will melt. If a brush is not available after eating, rinse the retainer in cool water and place it back in your mouth or retainer case. Beware of putting your retainer in a pocket as it might become broken. Also, avoid leaving it out where pets could find it or where it might become lost.

What if a retainer becomes lost or broken?

Phone the office right away for an appointment to replace or repair your retainer. Although there may be a charge for replacement or repair, it's a relatively inexpensive way to protect the investment that you have made in your orthodontic care.

A word about final records:

We will be recommending a set of X-rays, photographs and models of your teeth soon after the braces have been removed. These will be used to evaluate your treatment, plan the retention period and determine space for your wisdom teeth.

Transfer Policies

What happens if we move during care?

Changing orthodontists during treatment requires additional planning. We will help you make the transition go as smoothly as possible. With the help of a national directory, we can give you a recommendation for an orthodontist in the town or city to which you will be moving. Oftentimes, we will know the person we recommend personally, but not always.

Will a move prolong orthodontic treatment time?

The estimated treatment time will generally take longer when a transfer is made during active treatment. Treatment takes longer because the new orthodontist must do a complete evaluation with recent models and X-rays. Additionally, it may take a few months for the new orthodontist to become familiar with the patient's response to treatment.

What effect will a move have on the overall costs?

Treatment costs will generally be increased when there is a transfer of care. The additional expense is related to updating the treatment plan, as well as progress records and the added length in treatment time. Our office will calculate the treatment fee to date and make arrangements for payment of any remaining balance. Progress records will need to be taken to help in our evaluation of care and to help the new orthodontist in continuation of care. There will be a transfer fee to cover the additional expense of obtaining and duplicating the records for the new orthodontist. You may take these records with you, or we can mail them for you. The transfer fee is due prior to the transfer.

What should I do after arriving at our new residence?

When you have completed your move, make contact with the new orthodontist as soon as possible to avoid any delay in treatment. When you check in with the new orthodontist, decide if you are happy with the referral , or if you wish to contact a second office. We would rather not send your records and treatment summary until you are satisfied with the new orthodontic office. Once an acceptable office has been found, the orthodontist will request a transfer report from our office and we will respond as quickly as possible.

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