Braces for Dummies

Braces for Dummies

I think we are all familiar with the popular book series "(Insert Problem Here) for Dummies".  These books can teach us how to do anything! Today I am going to teach you about braces and what is in your child's mouth. So many times parents call us and the conversation goes something like this:

Parent: "Something on my son's braces broke"
Me: "Is it a bracket or a wire?"
Parent: "It's the little thingy on the tooth. I'm not really sure."

OR

Parent: "Something broke on my daughter's braces"
Me: "Is it a bracket or a wire"
Parent: "I don't know. They just said something broke."

Now, it may seem like it doesn't matter what is broken, it should just matter that something is broken, but it does help us out a lot when we know ahead of time. A long wire poking takes a minute to correct. A broken bracket can take 15-30 minutes to fix it. Knowing ahead of time helps us to plan better in our schedule when we are squeezing emergencies in.

I always say to look in  your child's mouth and know what is in there. But...how will you know if no one ever tells you to begin with? That's why you have me.



This is an excellent photo of the parts of braces.
These parts may not be in your child's mouth all at one

time but you get the idea. 



Here's another one....

I

I like this one because it also shows a rubber band
in place. Not all rubber bands fit this way so DO NOT assume that this is how your child's should be worn.

In both photos, the "colors" are called either elastic ligatures or elastic ties. These are the same thing. Your child will call them "colors" most likely.



So now you know. There are a host of other appliances that may be cemented into the roof of the mouth. Although you may not be able to identify these by name, it is pretty easy to explain about the "thing in the roof of their mouth". Maybe we'll cover all of those appliances in another entry.

I hope you find this info helpful. I know we will when scheduling appointments for your kids.

Special Needs--Revisited

Re-publishing this today because I received a comment about a special needs child--thought this might be helpful.


I would like to blog today about kids with special needs. We have seen everything in our office from ADD to Celiac Disease to Cerebral Palsy to Down's Syndrome and anything in between.

It is important to know that if your child has a special need that your orthodontist is able to deal with it appropriately. For instance, for children with severe allergies or intestinal disorders it is important that all the materials in the office be evaluated to be safe for that child. That includes latex and peanut allergies. In our office, we have special instrument trays for latex allergies. If a child is allergic to nuts, it is clearly marked on their chart so that a staff member who may have snacked on nuts is not working on them.

We also find it helpful in our office if the parent supplies us with as much information as possible about the child's condition. Some learning disabilities require that things are explained in a certain way. Some conditions are not visible but may deal with a weakness in muscle tone or ligaments which can affect how the supporting structures of the face will behave with teeth moving around.

We had a patient with Cerebral Palsy and she was in a wheelchair. Her dad had to lift her into the chair for her appointments. She had limited use of her hands which made elastic use somewhat impractical. Treatment plans can be altered to accommodate the abilities that a patient does have. This is a perfect example of how the result may not have been perfect due to limitations beyond anyone's control,  but it was pretty darn good and everyone was pleased.

Down's Syndrome kids need an informed orthodontist to manage their treatment. Down's Syndrome has very specific implications on the mouth. It is common for a child with Down's to have a small upper arch which can cause an underbite and open bite. There is usually a general reduction in  muscle tone, which in the face, may cause an imbalance on the forces that are placed on the teeth and may give more influence to the tongue. There is an extremely high rate of missing teeth (both baby and adult) as well as delayed eruption of the teeth. The teeth may also erupt in an unusual order. If the teeth are all present, the undersized mouth will produce severe crowding. There also tends to be constant mouth breathing due to a small nasal passageway. Mouth breathing has an adverse effect on the development of the palate, making it narrow.

You can see why you need an orthodontist who knows about this stuff. We have had many patients with Down's Syndrome over the years. First, let me say that they are the sweetest kids ever. Absolutely delightful. Secondly, we have successfully treated them keeping the above concerns in mind. There is no reason to believe that your child with Down's Syndrome, or any other special concern, cannot be treated successfully and with understanding and compassion.

I heard a story about a mom with a blind son who brought him in for treatment. The story goes that her friends and family could not believe she would bother with braces for a blind child. Her explanation was, " I want him to be as beautiful on the outside as he is on the inside."

I think we're done here.

Does your kid need braces? The short answer to this question is, "Yes.".  Now, I am not an Orthodontist, however, I have seen enough mouths in my 12 years of managing an orthodontic practice to know that there's very few people on Earth who would not benefit from orthodontic treatment.

The more important question here is: Why does my kid need braces?

Let's do this. Let's think about teeth on a spectrum. The spectrum goes between cosmetics and function. One end of the spectrum (the cosmetic side) would be a perfect bite and very crooked teeth. The other end (the function end) would be a poorly formed bite (over or under) with straight or crooked teeth. Which is worse, you ask? The end affecting function is actually worse. Bad bites or malocclusions as we call them in the biz are more harmful in the long run. You can have beautiful, straight teeth but if the bite is off you risk problems such as early tooth loss, jaw problems, damage to the tooth surfaces, uneven wear etc. On the other hand, if the bite is perfect and the teeth are crooked, while less attractive, is actually more of a hygiene problem. Brushing is more difficult for these folks but if diligent, the job can get done. Poor hygiene for anyone is a whole different topic and bad all the way around. That will come in a later entry. Anyway, back to the bite situation. Many factors can contribute to a bad bite. These include: overbite, underbite, crossbite, open bite, thumb sucking habit, tongue thrust, jaw size discrepancies and the list goes on.

Another very important question to consider: How do I chose an orthodontist?

Now, believe me, I know times are tough and braces are expensive. However, I implore you, do NOT shop for price. Nothing good can come of this. The old adage, "You get what you pay for.", certainly applies in this situation.  Different practices have different fees. This is a given. You must consider the following: Board Certified Orthodontic Specialists is paramount. AND, you have to make sure that the orthodontists are actually the ones doing the work. Huge! Another big consideration should be the friendliness of the staff. A great office and clinical staff means that the office is run well. Bad staff=Bad office in my humble opinion. Third consideration, flexible payment schedules and insurance billing. You should be able to work this treatment into your family budget and not have to take out a 2nd mortgage to do it.

The most important thing of all is that you and your child feel comfortable and cared for at the office. Your child should understand their treatment and feel free to ask questions. The more they understand and take responsibility for, the better patient they will be and a happier parent you will be. Then, it's all good.

We're Back!

Hello friends! As you can see the blog has a new fabulous look which resembles our website, More Than A Smile . I have also added a Facebook and Twitter link directly on this blog post page.

We will be doing tons more blogs, facebook posts, twitters--all the social media stuff to keep you engaged and interested in what we have to say. I even just started a YouTube channel! That should be interesting....I am so anxious to share our patients experiences and stories with you and I think the patients will be happy too!

Follow us on Facebook (Drs. Patrignani and Kohout) and Twitter (@amazingbraces).

Wishing  you and yours a wonderful Thanksgiving!

Relevant

Do you remember the song from the Fresh Prince of Bel-Air? It was called, "Parents Just Don't Understand"? That's what I'm writing about today. I hope to broaden your understanding on a few things today.

I know that when our kids have braces it is the first experience we, as parents, have with braces too. Some of us have had braces in our earlier years but many of us haven't and the process has changed so much it barely counts if  you did have braces. It's fine to not understand, it's more than fine to ask questions but please keep your dental/orthodontic opinions in check. I've noticed when a patient gets braces, suddenly everyone is an 'orthodontist"--family members, friends, even dentists are throwing in their two cents. You have to understand that I get the most interesting phone calls--this is where this stems from.

Here are some points to help you in your understanding:

1. Your child will never be done with braces after 1 month of treatment.
2. Your appointments will not take 2 seconds.
3. Your child will still become a productive member of society if they miss an hour of school.
4. Your child is not in agony after an adjustment.
5. Your child actually did do something to break their braces, whether or not it was on purpose.
6. Braces and wires do not spontaneously break or fly off the teeth.
7. Impacted teeth will not correct themselves.
8. A retainer doesn't fix barely anything.
9. Your Dentist most likely doesn't know that much about orthodontics, even if he or she is the best Dentist on  Earth. That's why they referred you to an Orthodontist.
10. It's very possible that your child does not brush their teeth often enough or well enough.
11. Nobody is being mean to your child--if they aren't following instructions repeatedly they will be spoken to. It's for their own good. If they aren't responsible for their own treatment, who will be?

Information is POWER! When you understand what is going on with anything, it gives you the power to react appropriately and with good judgment.

Here's another truth--your child can do something wrong. They aren't perfect and that's ok. It seems that everyone in the world just wants to make life easier for their kids and not have children deal with consequences. Nobody wants to think that anything is the child's fault. What's up with that? When we were kids, we got in trouble. If we did something at school, it wasn't the teacher's fault, it was our fault. For some of us, we were even scared of our parents, teachers and coaches. We wanted to please them because we knew if we didn't there would be consequences. That's how we turned out to be good people. That's how we learned lessons on responsibility and accountability.

Post #2
Time to beat the dead horse. It just so happens that this week we have had two instances of mothers calling us up to report that we have made their children cry and they now have a fear of coming here because they have been "yelled at". First off, no one got yelled at. Secondly, what your child perceived as yelling was actually an honest and frank discussion about your child not doing what they need to do. Thirdly, headgear does not wear itself and braces do not spontaneously break off before every visit. Fourthly, for this honest and frank discussion to occur it means the non-compliance and non-cooperation is out of control. We give kids every opportunity to step up before "the talk" happens.

How exactly do you, as parents, expect us to get the job done if you do not support us? I have written in excess about how orthodontic treatment is largely in the hands of the patient. Headgear, elastics, eating the right foods, keeping your hands out of your mouth--these are all things we can't control--but your kid can and has to in order to get the braces off. I can't think of another medical/dental procedure on Earth that takes so much patient participation. There is no way around it.

Back to the question...how would you have us handle your children who aren't exactly doing what they are supposed to do? Do we let it go until we are treating them for years just spinning our wheels while we waste our time and yours? Do we ask them really nicely and say please? Or should we let them know the consequences of their actions--cause and effect--and reinforce that they are responsible for their treatment, not Mom or Dad? How about if we deliver the message in a calm but serious manner?

What fries me even more is that if a Sports Coach spoke to them about something that they needed to do, no one would be jumping down that coach's throat. I would go so far as to say that you would take the coach's side. I am pretty much thinking that a Coach doesn't really have to ask things twice. I am also guessing that if you were paying thousands of dollars for your kid to be on that team that they would be compliant. I am starting to think that I need to speak to a Coach and learn from them.They seem to have the system down pat.

Ok, all right, I have kids. I get it. They don't listen and it is really tiring to keep asking the same things over and over. But there has to come a point (hopefully sooner rather than later) where you back us and get serious about getting your child to comply. I am not going to tell you how to do this but I bet you can come up with something.

Thankfully, this is not the prevailing attitude. Most kids are very compliant and cooperative and everyone certainly has an accidental breakage at some point or another. And that's ok. No biggie. Your children should never be afraid to go to their orthodontist's office--it is usually a pretty friendly place. We try really hard in our office to keep it a fun and friendly atmosphere but just as in parenting, sometimes you have to be the parent and not the friend.

Let's try to afford our children the same opportunities to learn as we had because we all want the best for our kids.

Messages

Many medical/dental practices have some sort of set up on their phone systems for times when the offices are closed. The information that is left usually includes emergency contact information, regular business hours and the like.  Some offices accept voice mails, some do not. The offices that don't accept voice mails are the smart ones. My office doesn't fall into that category.

Unfortunately, I don't think our phone system allows us to turn off the voice mail option. I wish it did. When we are closed there is really no reason not to call back during regular hours. I know that you think you are helping by leaving a long detailed message but you aren't. I lose interest in those messages after about 10 seconds. Since everyone seems to be hell bent on leaving a message there is a correct way and an incorrect way to do it.

The correct way is to state your name, your phone number (slowly) and the subject of your call. For example, "My name is Ann Smith, 555-5555 and I have a billing question." That's it. That's all we need.

The incorrect way is to call from your hands free cell phone device so there is the maximum amount of background noise and to speak at the speed of light when leaving your phone number and/or name--if you do leave the name or number. Sometimes this small but important piece of information is left out. There is also no need to leave the entire story of your question/problem/comment on the voice mail as the person who listens to it may not be the one who returns the call. The information will need to be repeated anyway to understand what you are talking about in most cases. The worst is when people call and leave messages and then you can't get a hold of them again and you play voice mail tag. Just call when we are open or better yet, shoot me an email.

We have had as many as 40 voice mails to listen to on a Monday morning. As you can imagine, it takes a while to listen to all of them. Thankfully, I personally do not have to listen to them on Mondays unless someone else is on vacation. When I do listen to them, I get who it is and a phone number and hopefully, a topic then I delete the message. I don't listen to the whole thing. I can't. It literally fills me with rage when I have to listen to them. Overkill on the emotions I know but I spend a big part of the day with a phone growing out of my head--I don't like to do things that add to that time. Sometimes my ears actually hurt from the phone.

While on the subject--why do people not identify themselves immediately? Whether it is a live phone call or a voice mail the first words out of someone's mouth should be their name. Truthfully, this seems to be a female shortcoming. Men tend to identify themselves more. What's up with that? I think I know what it is but that's for another time.

I know most people probably feel that their message is REALLY important and it is important but it is not unique. I can usually guess the problem within 5 words of the message and know what to do to remedy it immediately. I don't need the whole story.

The moral of the story is to remember that someone has to listen to the messages that you leave. Please identify yourself and be clear and to the point. Our ears will really appreciate it!

Arbitrary

Arbitrary. That is what a patient's father just told me our fees were. Arbitrary. He said, "How did you come up with this fee? Seems awfully arbitrary."

I explained to him that our Doctors have been doing this for the better part of 30 years. They can see what needs to be done by looking in a patient's mouth alone. We absolutely, without fail, gather the proper diagnostic tools (x-rays, intra-oral photos and impressions) to confirm what they found but 99.9% of the time they are dead on. There are very few surprises for them. They have treated thousands of patients over the years. There is pretty much nothing new anymore.

AND if the dad was so interested about our willy nilly ways--why didn't he show up here the first time with his kid? Instead, he just took up another chunk of the Doctor's time to have things explained to him. So A--he didn't believe what his wife repeated to him about their son and B--he didn't believe what I had told him about figuring out the fees (which I don't set--I just deliver the news). He was just being a pill.

It's funny because one of our Doctors just had a knee replacement. He was just saying that  he chose the surgeon partly because he had already done 4500 knees. He and his team are experts, right? They have seen every possible knee scenario. Guess what? Our Doctors have successfully treated probably double or even triple that amount of patients. I think it is more than fair to say that they know what they are looking at. Yet--folks are always with the suspicions about fees.

Just for the record--fees are determined based on the estimated length of time it will take to complete the treatment. We are not toiling away on a calculator for each patient. The Doctors figure out a treatment time--24 months, 30 months, 36 months--and the fee is based on that. Certain things take a certain amount of time. It just is what it is. A not too complicated case will take 18 or 24 months. Something more complicated can take 30 and really complicated will take at least 36 months. An estimated treatment time of 36 months will never be done in 12 months--never. They just know these things. Trust, people, trust.

Also for the record--if a patient were a miracle patient and did finish early (which did happen once in all the years I have been here) we refunded the difference. But, if a patient takes 42 months instead of 36 months, just because that can happen sometimes, we don't charge more.

As you can see, this whole topic just angers me. I just can't stand when people are basically accusing us of being greedy. It devalues everything that this profession is about and the work that the Doctors have done to become experts in their field.