Tuesday, August 2, 2016
"Am I referring my orthodontic patients too early?" Some referring dentists worry that they are sending their young patients too early when no treatment is suggested after my orthodontic consultation. Nothing could be further from the truth! Referring a patient by the age of 7 gives us the opportunity to catch developing problems when they can be easily addressed through deciduous extractions, expansion, space maintenance, habit control, class II correction, etc. Early referral allows us to begin a trusting relationship with the patient and parents that will be comforting when any necessary treatment is suggested in the future. Keep directing the young ones in and we will never complain (and we'll make sure they don't either). There is never a charge for these initial consultations, nor follow up growth and development observation appointments.
Thursday, July 21, 2016
Missing permanent teeth. You can do your patients a great service by identifying those that are missing permanent teeth. A panoramic radiograph is an easy way to quickly determine which teeth may be missing, delayed, deviant, or malformed. You can also locate supernumerary teeth. All of these will make a difference in the patient's orthodontic planning. I like to see patients with any of these items as young as possible to better plan for their future treatment and outcome. As an example, a crowded child with missing #20 and 29 may be directed down an extraction pathway rather than expand or hold future space with a lower lingual arch. Your early orthodontic referrals can make a significant difference in the ease of future orthodontics.
Wednesday, April 27, 2016
Correspondence from our office. We try our hardest to keep your office informed and updated on your patients' orthodontic status. I will send an initial email letter after their first consultation in the office and after any definitive treatment plans are established (after review of orthodontic records). An update at the time any treatment is started will be sent as well. Immediately after removal of the braces I will send an email note informing you of the removal and retainer placement. If you ever need more information before, during or after treatment please let me know. I can do text, email, letter or phone call. We enjoy you being on our orthodontic team!
Thursday, April 14, 2016
Fluoride Treatment Prior to Orthodontic Bracket Placement. If you are providing a prophylaxis immediately prior to placement of orthodontic brackets, we suggest not utilizing fluoride at that appointment. It can weaken the bond strength of the composite leading to brackets dislodging easier. We always supply the patient with their first bottle of acidulated fluoride rinse at their bonding and ask them to use it nightly throughout treatment.
Friday, February 12, 2016
Lower incisor position and profile changes in extraction treatment. I am often asked about the effect of upper premolar extraction treatment on the facial profile and many believe that this will significantly retract the upper and lower lip positions. In most orthodontic cases we must treat the occlusion to the labiolingual position of the lower incisors. This is because the bone surrounding them is thin both on the facial and lingual aspect of their roots. If the maxillary anterior teeth are more crowded than the lowers and a class II molar relationship is present, there is usually not a significant overjet. When upper premolars are removed in these cases the maxillary canines are retracted into the missing premolars' positions and the incisors are uncrowded. The lower incisors are held in their most stable and healthy location while the overbite and overjet is coordinated to them. Thus, the profile won't change much and proper canine and incisal guidances are obtained. Next we'll talk about how the anterior-posterior relationship of the maxilla and mandible relate to profile and incisor angulation.
Facial profile relationship to extraction treatment. Facial profile and lip fullness go hand in hand with skeletal and dental positions. When a thin or retracted lip appearance is present we try our best to treat the patient on a non-extraction basis. Likewise, when there is a very protrusive lip pattern we consider premolar extractions a bit more often. If severe crowding is present, extractions will not change the lip pattern much because most of the extraction space is utilized to uncrowd the dentition. This can be both a blessing and a curse. In thin lip patterns you will not lose lip support by pursuing extraction orthodontic treatment. Likewise, with very protrusive lips you will not get as much softening as you might desire. Another item to consider is the nasolabial angle (angle between the bottom of the nose and upper lip.) An obtuse nasolabial angle (with upturned nose) requires careful consideration before removing premolars for treatment. Next week we'll consider the relationship of the lower incisor to facial profile changes.
Indicated extractions in treatment of class II and III malocclusions. Extraction of premolars may be indicated in order to orthodontically correct malocclusions where growth has ceased and the maxilla and mandible are not matching. In order to mask a prognathic mandible it is sometimes necessary to remove a lower premolar bilaterally in order to incline the lower incisors lingually and distalize the canines. If we are treating a class II malocclusion without significant lower crowding we can extract two upper premolars in order to gain a tight overjet and class I canines. With these or any extractions it is wise to take the facial profile into account as we treat the malocclusion.