Other Treatments

Two-Phase Treatment

If you have a growing kiddo, you could start thinking about a two-phase orthodontic treatment. We recommend children start visiting the orthodontist at around seven years old — or sooner.  We have found that we can prepare them much better for braces by giving them a first phase of orthodontic work before all their baby teeth are out.

More and more parents are seeing the common sense in two-phase treatments. Children already have a mix of baby teeth and adult teeth at six to nine years of age. When they visit us at that age, we can already see if teeth are growing in at bad angles or other issues.

The overall plan includes:

1. First Phase — We guide the teeth and jaws as they grow and your little one still has a mixture of baby and adult teeth.
2. Resting Phase — We observe your child’s development for about one to three years as the baby teeth fall out. We may intervene to help healthy development, which could include extracting certain baby teeth as adult teeth come in.
3. Second Phase — We use braces to complete the orthodontic treatment.

If teeth are extremely crooked in the first phase, we can straighten them out and guide their development. This makes braces in the teenage years much easier when the foundation is already laid with straighter teeth.

Does my child need a two-phase treatment plan?

The first step is to bring your child to us at an early age. Ages six and seven are typically perfect, but you can bring your child at any age if you think there’s a problem earlier or later.

Here are some of the top reasons a child needs to start a two-phase treatment:

• Abnormal Jaw Development — Jaw development issues are caused by a wide range of issues, such as late or early losses of baby teeth, crowded teeth, underbites, undersized or oversized jaws, and other causes.
• Early or Abnormal Loss of Baby Teeth — The typical pattern is for children to lose their first teeth when they’re about six years old — the front teeth first, then generally moving back to the molars. If your child loses teeth before they turn five or loses them seriously out of order, they may need early treatment.
• Late Thumb Sucking — If your child is still thumb-sucking at age five or older, he or she may need orthodontic treatment. This behavior can lead to malformation of the roof of the mouth or an overbite.
• Difficulty Chewing or Biting — These problems are often caused by a misaligned bite, tooth infection, or jaw joint problem.
• Crossbite — This is diagnosed when the bottom and top teeth overlap irregularly in a combination of left–right and forward–back misalignment.
• Early Crowded Teeth — As the teeth are growing in, they might overlap, rotate, or grow high in the gums. At an early age, we can guide the jaw to expand, making room for the teeth.

Catching orthodontic issues early could give your child an improved ability to bite, chew, and speak. Plus, he or she should have a much easier time with braces and a great-looking smile when the teeth and jaw have already been guided for several years.

These phases could also save your child from later procedures. Making more space in the jaw might prevent the need for later tooth extractions or surgical jaw realignment.

During phase one, we’ll start building your child’s orthodontic records, including x-rays, photos, and more. Once all the adult teeth have come in, we’ll be ready to use these records, our treatment plan, and braces and retainers to complete your child’s beautiful adult smile.

Whatever age your child is now, we’re happy to meet with you and give him or her an exam. By guiding their teeth and jaws throughout childhood, we’ll be able to give them a healthy, great-looking smile in their teen years.

Dentofacial Orthopedics

At Macdonald Orthodontics we have built our knowledge both in general orthodontics and dentofacial orthopedics, which we often use to help our younger patients during a two-phase treatment plan.

Using dentofacial orthopedics, we can guide the growth of a patient’s facial bones, along with correcting imbalances between the face and jaws — a process that can start when a patient is about seven or eight.

Dentofacial orthopedics is a specialized branch of orthodontics, earned after building the orthodontic specialization and completing two to three years in an orthodontic residency.

Orthodontics vs Dentofacial Orthopedics

Here are our simple definitions to help understand this specialty:

• Orthodontics — This dental specialty is the science of guiding teeth into different positions.
• Dentofacial Orthopedics — Guiding facial growth and development.

“Dentofacial” refers to the teeth and face, while the term “orthopedic” refers to working with bones and muscles. So, along with already understanding dentistry and orthodontics, this specialty includes a deep knowledge of how the face, jaw, and teeth all interact and develop.

guiding children’s facial development

Children are often the best candidates for dentofacial orthopedics because most of the development of the face happens while they’re still growing.

The American Association of Orthodontists (AAO) recommends a first orthodontic exam for children at around age seven. This lets us catch issues before they go too far. If a problem is developing, we can start a phase-one treatment to gently guide your child’s teeth and jaw.

Using dentofacial orthopedics, we can also step back and diagnose issues in the overall facial structure. By integrating this into the treatment plan, your child could get an even better-looking, healthier smile.

Jaw Bones: Defining the smile

The growth of the jawbones has everything to do with the way the smile looks — often for life. The upper and lower jaws help to position the lower and middle parts of the face, including the sinuses, bottom of the nose, and cheekbones.

As a child grows, the upper and lower jaws can grow at different speeds, changing the alignment between them. For example, the lower jaw might end up in front of the upper jaw, causing an underbite.

These issues can develop because of other factors, such as thumb-sucking or breathing problems. Before the jaws stop growing in the mid- to late-teens, we can intervene to guide the bones.

We use several time-tested, reliable devices to improve the jaws, make room for adult teeth, and balance the face. These include:

• Lower Jaw Expander — This gradually moves the lower teeth further apart, making room for adult teeth as they come in.
• Palate Expander — This widens the space in the upper jaw by expanding the cartilage.
• Block — These are small ramps that use the natural movement of the bite to gradually correct misalignment.
• Activator — This is a device that looks a little like a retainer that moves the jaws as they develop and helps to guide adult teeth as they come in.
• Headgear — Certain bite issues require forces outside of the mouth; headgear applies this force using straps around the face.

Before or after using one of these solutions, we might also install traditional braces to move teeth to better positions and/or realign your child’s bite.

You can wait until your child is seven to request their first orthodontist appointment. Or bring them in at any age if you notice problems with the jaws or teeth. If issues stand out to you, it doesn’t hurt to at least get a quick evaluation.

You can get help for your child so their face, teeth, and jaws will develop in the healthiest and best-looking way possible. Orthodontics and dentofacial orthopedics can lead to a beautiful smile.

Surgical Orthodontics

Imagine showing up for your first orthodontic appointment and sitting down for your exam. Near the end, your orthodontist says that you need an orthodontic surgery. It’s okay!

Though that may seem scary, there are some issues that need surgery to help correct them. These problems include the following:

• Severe misalignment of the upper and lower teeth
• Unhealthy bite patterns
• Jaw bone problems

Your orthodontist knows the limits of braces and Invisalign and knows how to enhance your treatment with surgery when needed. We’ll explain your options, and we’re always open to spending extra time answering any questions you have.

Do i need orthodontic surgery?

We will only recommend surgery if your jaw has certain issues and we see that traditional orthodontics won’t fully solve them. Orthodontics is the science of repositioning the teeth and jaws, and only surgery can complete those tasks in some cases.

Some common goals that might require surgery include:

• Fixing the way your upper and lower teeth fit together (your bite)
• Helping you breathe better while you sleep or reducing mouth breathing
• Saving your teeth from being worn down more
• Improving the way you chew, bite, or swallow
• Finding a remedy for a facial condition or injury
• Improving your facial symmetry
• Relieving the pain of jaw joint conditions

Orthodontic surgery is usually performed on a patient whose jaw has finished growing, which means they’re in their late teens, 20s, or later. In patients younger than this, we often can correct the bite and jaw through braces alone while the jaw is still growing.

Benefits of orthodontic surgery

Remember, the goal of the surgery is to give you better dental health and function. It often realigns the upper and lower teeth, helping you bite, chew, or speak better and much more.

We sometimes use surgery to quickly move a jaw that is out of position because of genetics, an issue during development, or injury. Jaw misalignment can cause an overbite or underbite — or cause the upper and lower teeth not to touch at all or only to touch on one side.

Improving the alignment of the jaw will help you eat more easily, prevent faster wear and tear on your teeth, and could even improve your facial appearance.

Jaw misalignment can also cause sleep apnea (poor sleep because your airway is partly blocked), mouth breathing, and problems swallowing and eating. These issues can lead to chronic pain, jaw disorders, and fatigue. Getting surgery could help prevent these issues.

What to expect: The process

We’ll start your orthodontic treatment, such as braces, before surgery. This will align your teeth to get them ready to fit together after surgery. Then, we’ll also keep using braces after surgery to complete your healthy new smile.

The surgery itself involves these steps:

1. Consultation — We’ll discuss your case with you and bring in a surgeon if you choose to move forward.
2. Planning — The team will create a custom plan for your treatment, including moving your teeth before surgery, the surgery itself, and the steps to finish your orthodontic treatment.
3. Surgery — With you under anesthesia, your surgeon will use the procedure(s) in your plan to improve the relative positions of your jaws.

After surgery, you may need to spend the night in the hospital. You also should plan to take time off of work or school, as well as eat differently while you recover.

Take the first step of getting an orthodontic consultation at Macdonald Orthodontics! Don’t worry about any orthodontic surgery before it starts. You may need only Invisalign or braces — or no orthodontics at all. What’s important is taking the first step and finding out more.

Mouthguards

Are you an athlete? Does your child play on a sports team at school? Then you might be interested in custom-made mouth guards, which athletes use to protect their teeth during play. A mouthguard is made of a semi-flexible material that comfortably fits over your teeth.

Sports are fun and exciting, but they shouldn’t put your teeth in danger. Emergency dental procedures can be costly—maybe not worth the fun of the sport.

But with custom mouth guards, you or a family member can play your sport or engage in other types of recreation without the fear of teeth being knocked out, chipped, or cracked.

do i need a mouthguard?

If you’re active in competitive sports, there may be a chance that a person or piece of equipment may hit your teeth unexpectedly. Getting a mouthguard is a smart precaution, similar to wearing a helmet in football or baseball — or a seatbelt while driving.

A mouthguard can help prevent:

• Knocked-out teeth
• Chipped teeth
• Damage to internal tooth pulp
• Injuries to your lips, gums, and inner cheeks

If you’ve completed orthodontic treatment or are currently in treatment, you might have an extra incentive to protect your teeth. All that hard work wearing braces shouldn’t go to waste.

A ball or elbow striking the metal brackets of braces can cause extreme damage. You’ll be much better off covering your braces with a mouthguard.

Store-Bought vs Custom Mouthguards

Here’s a very important matchup, sports fan. Is an off-the-shelf mouth guard good enough, or does a custom-made one from your orthodontist have the advantage? Let’s look at their stats:

• Store-Bought — You can buy a stock mouth guard that you wear right out of the box or a boil-and-bite version that you can customize a little bit. These both come with lower price tags but don’t protect teeth as well, because they’re not designed to follow the contours of your unique teeth (or any orthodontic appliances).
• Custom — Your orthodontist will construct these using impressions of your teeth, molding the final guards exactly for your unique smile. Because of this customization, they come with a higher price but provide the greatest levels of protection and comfort.

Mouthguards must be made of a combination of both rigid and flexible materials to protect your lower jaw and teeth. At Macdonald Orthodontics, we have a laboratory where we balance these materials in constructing our own appliances.

how do i get a mouthguard?

When you visit us for a mouth guard, your main job is to sit back and relax in our comfortable office. You can get ahead in our rewards program — and enjoy ice cream after you’re done.

Your team will also go through these steps:

1. Impressions — Instead of having you bite a messy impression material, we’ll take digital scans of your teeth with a handheld device.
2. Fabrication — We’ll send the impressions to our lab and build guards that conform to your teeth.

By getting mouthguards at your orthodontist office, you’ll also get the advantage of any records and knowledge we have about your teeth and jaws. If you’re going through orthodontic treatment, we’ll also know how best to protect your braces or other appliances.

It can take a little time to break-in your mouthguard, like a good baseball mitt. In the end, a customized mouthguard should fit snugly and feel comfortable. If you have any issues, visit us again for an adjustment.

Do you love sports? So do we! We even donate our time and money to local athletic programs in our community. We know the value of sports — and of your teeth or your child’s teeth. Let’s protect those beautiful smiles for many years. Visit us for the quick process of getting customized, comfortable mouthguard!

Retainers

When your braces come off — or you finish with your last Invisalign aligner — the orthodontic journey isn’t over. The tooth-movement phase is over, but you then enter a new phase.

In this final step, we’ll keep your teeth in the right positions using retainers. Your bone will then thicken and strengthen around your teeth, locking in your amazing new smile for the long term.

do i need to wear a retainer?

We always provide retainers after the active part of orthodontics is finished. Teeth can shift positions for many reasons. Retainers prevent teeth from moving back to their old positions after the active phase of treatment.

We want you to keep benefitting from the hard work you put in while you were wearing braces or aligners. Retainers help:

1. Your bone rebuilds itself after teeth have recently moved through it.
2. Your teeth stay in healthy new positions with a better bite.

When it’s time to get your retainers, we’ll discuss instructions that will give you the best results.

You can’t use retainers too much. The more you wear them, the more secure your teeth will be for the rest of your life. After you finish the main phase of orthodontics, expect to wear retainers most of the time for a few weeks, except during meals.

After the first period of time using retainers, you may be able to wear them only at night. This can go on as long as you like, especially when retainers become part of your before-bed brushing and flossing routine.

clear retainers

In general, retainers are either fixed or removable, which means they either:

• Stay in your mouth all the time: fixed.
• Can be popped out (for meals) or only worn at certain times (like at night): removable.

Fixed retainers usually include a thin, customized wire that is hidden behind your teeth. It’s bonded in place and stays out of the way, holding your teeth in their best positions.

For removable retainers, we use clear retainers. These are practically see-through trays that are custom-designed to fit around your teeth. These retainers firmly fit over your teeth and help maintain their positions.

Clear retainers are exciting because they don’t stand out. If you have a busy school or work schedule, don’t worry about them getting in the way. Other people will hardly notice them, and you can take them out when you have to.

caring for your retainer

Maintaining retainers is easy. If you take care of them, they have a lifespan of many years before needing replacements. Just remember to:

• Carry them in their designated case when not in use.
• Keep them away from high heat (don’t leave them in a hot car).
• Keep them out of reach of pets.

Take a look at your retainers now and then. If their shape has changed — or if you have trouble putting them in — let us know. If the retainer feels tight, your teeth might have shifted a little, and you should wear it a little more each day.

Do you want a healthier, better-looking smile? At Macdonald Orthodontics, we provide every step of the orthodontic process in our offices, including consultation, digital impressions, and creating braces and retainers.