“Phase 1” Treatment | A “Gummy Smile | Crowding | Tongue Thrust | Openbites | Spacing | Invisalign®
"Phase 1" Treatment
We are frequently asked, "When is the best time to start treatment?" The answer depends of what the goals of treatment are, and whether they can be effectively dealt with when the patient is young, before the eruption of the permanent teeth. Making room for permanent teeth, improving the relationship between the upper and lower jaws, stopping retained finger habits or tongue thrust problems, or correcting the development of either deep overbites or anterior open bites, are some of the problems that can be effectively dealt with in "Phase 1" treatment.
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A "gummy smile," or excess gingival display, is a condition where too much pink tissue can be seen when a person speaks or smiles. Approximately 7% of men and 14% of women have excess gingival display in full smile. A gummy smile is usually associated with an enlarged upper jaw, a short upper lip, short upper front teeth, or a forward position of the front teeth. This condition may also result from disproportionate lip length or tooth height.
A gummy smile can be corrected by orthodontic treatment, periodontal surgery, jaw surgery, or a combination of these procedures. In general, active treatment time with orthodontic appliances ranges from 1 to 3 years. The actual time depends on the growth of the patient's mouth and face, the cooperation of the patient, and the severity of the problem. Custom-made appliances are designed by the orthodontist according to the problem being treated. They may be removable or fixed (cemented and/or bonded to the teeth), and made of metal, ceramic or plastic. By placing a constant, gentle force in a carefully controlled direction, braces can slowly move teeth through their supporting bone to a new desirable position.
The actual cost of treatment depends on several factors, including the severity of the patient's problem and the treatment approach selected. You will be able to thoroughly discuss fees and payment options prior to beginning treatment.
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Crowding
If your teeth are crooked, turned, or overlapped, you are not alone. Virtually 90% of the population has an orthodontic condition known as crowding. Generally caused by genetics (eg, a relatively small jaw or relatively large teeth) or by habits such as nail biting and thumb sucking, crowding is easily corrected with orthodontia.
In younger patients, Phase 1 treatment can be used to expand the jaws and improve the alignment of the permanent teeth that are present.
After eruption of the permanent teeth, Phase 2 treatment is undertaken. In Phase 2, typical treatment for crowded teeth involves the placement of orthodontic "braces" on all the upper and lower teeth. In adolescents or adults, braces may be worn between eighteen months or longer, depending on how crowded or misaligned the teeth are. Once the teeth are stable in their alignment, the braces are removed, and removable retainers are placed to hold the teeth in place. Retainers are worn for up to five years depending on the severity of the original condition. The lower retainer should be worn as long as possible, as the highest chance of relapse occurs with the lower front teeth.
Phase 1 expansion applied when crowding is detected early in children (when baby teeth are still present), orthodontic appliances can be placed so that when the baby teeth fall out, the appliance/braces hold back the rest of the molars, acting as a "spacer." These appliances slowly widen the upper jaw in order to make room for the impending adult teeth, and align the permanent teeth that are present. Although the expansion process is achieved in approximately 6 to 12 months, a retainer should be worn for the next 12 months to ensure maximum long-term results.
Whether it be Phase 1 for expansion, or Phase 2 for alignment, orthodontics can provide dramatic relief of crowding! Often Phase 1 treatment, followed by Phase 2 is the best way to go!
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Tongue Thrust
Swallowing occurs 24 hours per day and about 2000 times each day. Each time you swallow, one to six pounds of pressure is applied to the inside structures of the mouth. Normally when a person swallows, the middle section of the tongue is placed on the roof of the mouth. When the tongue is placed between and behind the teeth, this pressure pushes the teeth apart and out, causing distortions of the face and teeth. This abnormal swallowing motion is known as "tongue thrust." This condition is most common in children with prior severe thumb sucking habits.
Myofunctional therapy (with a speech therapist) is a popular method of treating tongue thrust. In severe cases, a special appliance may be prescribed with or without braces. The appliance is clear and has two heavy wires curving back onto the roof of the mouth behind the upper front teeth. These wires do not interfere with the tongue as long as the tongue is in the proper swallowing position. If the mouth is opened during the swallow (tongue thrust position), the motion brings down the wires into the path of the tongue and the thrusting motion is prevented.
As with any orthodontic therapy, the earlier a problem is detected, the less time is required for treatment. If you suspect your child (or yourself!) is a tongue thruster, be sure to let your orthodontist know as soon as possible. Unfortunately, many parents fail to recognize the importance of correcting tongue thrust while the child is still young, and the problem goes unnoticed for years. When this occurs, the time required for treatment increases and the child's self-esteem is affected. The problem can usually be corrected in a small child in under two years. It is important, however, that both the parent and patient strictly comply with the treatment prescribed by the doctor.
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Openbites
Openbite is an oral condition that occurs when certain teeth, usually your front teeth, do not make contact with each other. Openbite gives the illusion that a person's mouth is never really closed, because there is always space between the teeth. For patients that have moderate to extreme open bite, treatment is important since the condition can affect the joints of the jaw and cause recurring pain.
There are a number of circumstances that could be responsible for openbite. Among these are thumb sucking, tongue thrusting, speech problems and heredity.
While openbite can often be treated with braces, in moderate to extreme cases a more complex solution is required. These cases are more difficult to handle because both the teeth and the jaw are involved. Many individuals with moderate to extreme open bite require surgery to correct their jaw. In addition, they need braces before and after the surgery to achieve proper alignment. The entire treatment procedure requires a significant financial investment, and in severe cases, may take more than 3 years to complete.
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Spacing
In orthodontics, spacing means exactly what it sounds like: there is too much space between your teeth. Like crowding, spacing may be caused by genetic factors. Spacing may affect all of your teeth, or just a portion of them. In addition, chronic thumb sucking as a child can also create or widen spaces between the teeth.
The most popular (and least-invasive) type of treatment for spacing is braces. Typically, patients with excess space between their teeth wear braces for twelve to eighteen months followed by the use of a retainer (to maintain the teeth's new position). Depending on the severity of the case, braces may be placed on the upper or lower teeth.
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Invisalign®
You've seen the ads. A smiling face of someone claiming to be wearing braces, but you can't see them because they are clear. It sounds wonderful....so what is the story of Invisalign?
The development of next-generation high-technology adult orthodontic products uses 3-D computer imaging to design and manufacture customized clear removable orthodontic appliances called "aligners." As an alternative to conventional orthodontic therapy, aligners are essentially undetectable and comfortable to wear. A high level of detail in treatment planning and impression taking is necessary to ensure a proper fit.
State-of-the-art computer technology is used to fashion the treatment program and the removable aligners. The concept behind this newer technology utilizes a series of customized removable aligners for the duration of treatment from start to finish. Each aligner in the series represents a 2-week stage in the treatment program. The removable system is effective only for mild to moderate crowding or spacing, and is also designed to treat relapse cases.
All this technology does not come cheap. The patient fees for Invisalign tend to be about 1 1/2 times that of conventional braces.
Not everyone is a candidate for "Invisalign," but we'll be happy to have a look and advise you of the possibilities.
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