Frequently Asked Questions: Teenage Orthodontic Patients (tm) Part 7
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This section continues to explain what happens during orthodontic treatment.
- If you and your parents decide to go ahead, what is next?
If you and your parents decide to accept the orthodontist's treatment plan, then the orthodontist will install "separators" between the teeth in the back of your mouth. The separators could either be little springs, or little plastic pieces to create space for bands on your back teeth.
You usually leave the separators on for a week or two, and then come back to the orthodontists office to have your braces put on.
- What happens if I swallow a separator?
I know it sounds bad, but nothing bad should happen if you swallow a separator. The separator just passes through your digestive system.
- What are the steps in putting your braces
Generally, the orthodontist needs to attach bands and buccal tubes to your back teeth, brackets to your front and side teeth, and then attaches an archwire.
- What are the steps in putting the bands on?
The first step is get your teeth ready for the bands. The orthodontist's assistant will remove the separators from your mouth and polish your teeth until your teeth are perfectly clean. It takes a few minutes, but the orthodontist's assistant needs to do this carefully, so that you do not get any cavities under your bands.
Once your teeth are clean, the orthodontist's assistant will measure your teeth and try to determine what size bands you need. Bands, though, are like shoes. Even if the bands are the right size, the assistant needs to try them on to make sure they fit. It usually takes several tries before the orthodontist's assistant finds a band which exactly fits your teeth. Do not worry though. Bands come in 50 different sizes, so there is sure to be one which fits.
Next the orthodontist or his assistant will attach the bands to your teeth. First, your teeth must be dried completely. The orthodontist or the orthodontist's assistant will place cotton rolls on both sides of your teeth. They will also put a tube into your mouth which looks like a straw. The tube is attached to a small wet-dry vacuum to suck up all of the liquid from your mouth.
Next the orthodontist or the orthodontist's assistant will put some special cement onto the band and push the band onto your tooth. The orthodontist will usually ask you to help him get the band on, by you biting down on a special "bite stick" to help push the band on the tooth.
The orthodontist or his assistant will repeat this process until they have installed bands on four of your teeth. Then you will be asked to bite down on cotton rolls for approximately 5 to 10 minutes to hold the bands in place until the cement hardens.
After the cement hardens the orthodontic assistant or orthodontist will take a special tool called a scaler to remove the excess cement from around the band.
The scaler looks sharp, but do not be afraid. It does not hurt.
- What's next?
The next part of the process is called "bonding". In bonding, the orthodontist attaches little "brackets" to your teeth. The brackets are used to hold the wires onto your teeth.
- What are the steps in the bonding process?
First big plastic things, called cheek retractors are used to draw back your lips. You make a funny face, like you did in the mirror when you were little. Then your teeth are dried and a tube like a straw is put in your mouth to remove all of the liquid from your mouth. Once, your teeth are perfectly dry, a liquid called "etchant" is placed on the teeth for 30 to 60 seconds. The teeth are then rinsed and dried.
Next the orthodontist uses a special glue to attach the brackets to your teeth. Most orthodontists use a special glue called "light cure" which only hardens under ultraviolet light. It usually takes the orthodontist about an hour to attach all of the brackets to your teeth. The light cure hardens in about a minute, so it will not be sticky in your mouth.
Do not be afraid of this part of the procedure. Your cheeks sometimes get a little uncomfortable from the cheek retractor, but the bonding process should not hurt.
- Wow, I have already been at the orthodontist for two hours. Do
I have to do anything else?
Unluckily, yes. You orthodontist's assistant still has to put on your arch wire. Usually, the assistant sticks the wires through the buccal tubes on the bands at the back of your mouth, pulls them tight, cuts off the end of the wire, and then uses little rings called "ligating modules" to hold the wires into the brackets. This process only takes 15 minutes, but it is at the end of the process, so it seems longer. Just remember that it is almost over.
- How long do the braces take to put on?
Depending on the case, two to two and a half hours.
- Will it hurt to put the braces on?
Not usually. The orthodontist is usually just attaching the braces to your teeth. The pain comes later, when the braces first begin to rub up against your lips and your teeth begin to move. Generally, your mouth will hurt the first night you get braces. Ask the orthodontist to give you a Kissable Kover or some wax in case the braces begin to rub and be sure to ask your mom for some Aspirin or Tylenol if your mouth hurts. Aspirin or Tylenol really helps the pain. Putting salt or salt water on you gums can also lessen the pain.
- What holds the braces on?
Generally, the brackets are attached directly to your teeth using a special glue. The glue is completely edible and will not hurt you.
- Should I do anything special during my first week in
Your mouth will hurt for your first week in braces. You should be careful about what you eat. You need to only eat softer foods and to be very careful with your mouth.
Manufacturers are working to find ways to reduce the pain during your first week in braces but we have not found anything yet. However, try to remember that the pain will be gone in a few days.
- Is there any chance that the sharp ends of the braces
will hurt the insides of my cheeks.
Hmm. This is a hard question. In the beginning part of orthodontic treatment, your teeth will move a lot. Sometimes the end of the wire will stick out past the end of the tube, and create a sharp edge. We recommend that you if you notice a sharp wire you go back to the orthodontist and ask the orthodontist's assistant to trim the sharp edge before the wire before it cuts your cheeks.
- How often should I go back to the orthodontist after my initial visit?
- What happens on all of those visits?
Sometimes the orthodontist just looks at your mouth. Sometimes your braces are "tightened" and sometimes the orthodontist changes wires. Each time the braces are tightened your teeth are pushed a little closer to where your teeth need to be.
The orthodontist may install rubber bands sometime during your treatment or ask you to wear a facebow. Rubber bands and facebows are used to make your teeth in your lower jaw line up with your teeth in your upper jaw.
- Why do my braces need to be tightened?
During orthodontic treatment, the orthodontist stretches your jaw and moves around your teeth so that everything fits. If the orthodontist would try to move your teeth all at once, it would hurt too much, and it might damage the roots of your teeth. Generally, the orthodontist moves your teeth slowly to avoid hurting you too badly.
Still, the orthodontist does have to move your teeth. Every time the orthodontist tightens your braces, the orthodontist moves your teeth a little bit. Then the orthodontists waits for your teeth, jaw and gums to shift, before the orthodontist tries moving your teeth again.
- Will tightening hurt?
Unfortunately, tightening hurts but the pain does not last long. You know the old saying "No Pain, No Gain". Don't be a Frady Cat.
- Can anything be done to lessen the pain?
We are working on it. People just started selling new wires which are designed to minimize the pain of tightening. The orthodontist installs the wire, and the wire slowly moves by itself. The result is that the orthodontist is able to move your teeth without having to tighten your braces so often.
- What Happens When I am Done?
Eventually, your orthodontist will remove your braces, give you a retainer and tell you that you are done. You should wear the retainer 24 hours a day for the first year, and then a few nights a week until you are 24. After that it is up to you. One of my orthodontist friends told me that teeth start to move again when you are around 30, so you might keep your retainer until you are 35.
- Will It hurt to remove my braces?
Do not worry, it should not hurt to remove your braces. The brackets are easy to remove. They just twist off. Sometimes, removing the bands at the back of your mouth is painful. If so, please tell the orthodontist. He can cut the bands so it does not hurt.
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