Patient Education

In the pursuit of a straighter, more confident smile, individuals today are presented with many different treatment options. From traditional metal braces to innovative aligner treatments, the landscape of orthodontic care has evolved significantly. Among these choices, two prominent paths emerge: seeking treatment from an orthodontic specialist, seeking treatment from a general dentist performing orthodontic specialty work, or opting for direct-to-consumer aligner products when patients are. While both avenues promise results, the distinction between them is substantial and warrants careful consideration. In this blog post I will go into some of the critical differences between these two approaches.

or the purposes of this blog, a Direct-to Consumer aligner company is one where you taking impressions of your own teeth and send it in to get aligners for your teeth without the intervention of a dental professional or you visit a "Scan Shop" where a representative will take some type of model of your teeth and you will be sent aligners to straighten your teeth.

At Strouse Orthodontics, I design every aligner treatment plan that we provide our patients. First comes a complete diagnosis of your face, your jaws, and your teeth, the presentation of treatment options, and a final custom treatment plan to address your specific situation.

Aligner design requires an understanding of 1) the patient’s final goals, 2) the sequence and speed of tooth movements, 3) the biomechanics(how the teeth move) that must be built in the prescription to achieve the desired results, and 4) the additional features that are required for difficult tooth movements. Most direct-to-consumer aligners as designed by computer algorithms and then approved by “dental professionals.” Although there may be a dentist’s name on the aligner packaging, he or she had nothing to do with designing your aligners. General dentists(non orthodontic specialists) often do the same, doing little to no analysis or modifications to a patients treatment plan. There are several issues that can occur with a Direct-to Consumer Orthodontic plan.

No Visits

A huge selling point for DTC aligners is that no orthodontic visits are necessary. However, this is also the biggest red flag. You won’t see a orthodontist or even a dental professional at any point in the process. It may not seem like it, but moving your teeth into more optimal positions will impact your entire mouth. Even in simple cases, straightening the teeth will affect the health of your teeth as well as the gums, bones and roots. An orthodontist is trained to ensure all of these are healthy before and during the treatment process to produce safe movement of the teeth.

No Attachments

With Direct To Consumer "Orthodontics" no attachments are placed on the teeth. This is because there is no involvement of a dental professional. Due to the shapes of teeth, as well as the tooth movement being completed, there may be a need for tooth-colored attachments made of dental composite be attached to your teeth. Patients are not able to bond attachments to their own teeth. While there are some tooth movements can be occur without them, there are many tooth movements that may not be able to be predictably achieved without attachments.

Your Teeth Might Not Move the Way They Should
It is important that the teeth move the way the the orthodontist is intending over the course of treatment. If there are problems with how the teeth are movement for any reason(lack of attachments, wrong staging of tooth movements, wrong speed of tooth movement, poor compliance with aligner wear), with a Direct To Consumer Company, there is no way to have your progress evaluated. With an orthodontic specialist, you will be able to have your progress evaluated and be given instructions for how to handle a problem that arises during treatment.

No Rubber Bands

Both braces and aligners can both be straighten the top and bottom teeth individually. When modifications with the bite are needed in the bite however, orthodontists typically prescribe rubber bands connected between the top and bottom teeth to make these changes. Direct-to-consumer companies do not utilize rubber bands with their treatment. Furthermore, they typically have consumers sign a waiver that they understand that the aligners from their company will not improve their bite. This is similar with orthodontic treatment with a general dentist. While they are able to prescribe rubber band wear, they often lack the orthodontic knowledge to correct more advanced malocclusions, sometimes without informing the patient there are any bite issues present at all.

By seeing a specialist in orthodontics for orthodontic care(braces, Invisalign), you can feel confident that an expert is prescribing, planning and monitoring your care. An orthodontist will be able to monitor your teeth, discuss treatment goals, review various options for treatment and be able to provide the necessary in office adjustments that are not possible with a Direct-to-Consumer aligner company. You only get one set of teeth. Trust your smile to an orthodontic specialist.

As you delve into the world of orthodontic treatment, understanding the financial aspects is just as crucial as understanding the clinical ones. While the cost of treatment can vary significantly based on the complexity of your case and other factors, it’s essential to consider additional factors that may affect your out-of-pocket expenses.

Insurance Coverage and Financing: Navigating Your Benefits and Making Treatment Affordable

For many patients, insurance coverage and financing options play a significant role in making orthodontic treatment more accessible.

Insurance Coverage: Some dental insurance plans offer orthodontic coverage, which can help offset a portion of the expenses. However, it’s important to note that coverage levels and limitations vary widely among insurance providers and individual plans.

Before beginning treatment, it’s advisable to review your insurance policy to understand the extent of your orthodontic coverage. Your orthodontist’s office can also assist you in navigating your benefits and determining how they apply to your treatment plan. While insurance coverage can help reduce costs, it’s essential to be aware of any deductibles, copayments, or exclusions that may apply.

Financing Options: For patients concerned about the financial aspect of orthodontic treatment, many orthodontic practices offer flexible financing options to make treatment more accessible. Interest-free financing plans allow you to spread the cost of treatment over manageable monthly payments, making it easier to fit orthodontic care into your budget.

Orthodontic financing plans typically offer competitive terms and can be customized to suit your individual needs. By taking advantage of these financing options, you can focus on achieving your dream smile without worrying about the upfront financial burden.

Consultation: Your First Step

Before diving into the specifics of cost, the first step in your orthodontic journey is a consultation with a qualified orthodontist. During this initial appointment, the orthodontist will conduct a thorough examination of your teeth, jaws, and overall oral health to assess your individual needs.

The consultation allows the orthodontist to develop a personalized treatment plan tailored to address your specific concerns. It also provides an opportunity to discuss your treatment goals, ask any questions you may have, and address any financial considerations.

Understanding Phase One Orthodontics

Phase one orthodontics, also known as early or interceptive orthodontic treatment, is aimed at addressing orthodontic issues in children at a younger age, typically between the ages of 7 and 10. This early intervention helps guide the growth and development of the jaws, creating a more favorable environment for the eruption of permanent teeth and correcting certain bite problems.

The cost of phase one orthodontics can vary depending on the complexity of the treatment and the specific needs of the child. While it typically ranges between $2000 and $4500, it’s essential to consult with your orthodontist to get an accurate estimate based on your child’s individual case.

Comprehensive Orthodontic Treatment

Comprehensive orthodontic treatment, often referred to as full treatment, is typically initiated when all permanent teeth have erupted, usually around the ages of 11 to 13. This phase of treatment focuses on achieving optimal alignment of the teeth and bite, resulting in a straighter, healthier smile.

The cost of comprehensive orthodontic treatment also varies depending on factors such as the complexity of the case, the type of braces or aligners used, and the duration of treatment. On average, comprehensive treatment ranges between $5000 and $7000. However, it’s important to remember that this is just a general estimate, and the actual cost may differ based on individual circumstances.

Conclusion

Orthodontic treatment is a valuable investment in your oral health and overall well-being. While cost is undoubtedly a consideration, it’s essential to prioritize quality care and the expertise of a qualified orthodontist. Your orthodontist will work with you to develop a personalized treatment plan that meets your needs and fits your budget, ensuring you achieve the smile you’ve always wanted. Don’t hesitate to discuss any questions or concerns you may have about the financial aspects of treatment. With the right guidance and support, you can achieve the smile you’ve always wanted while staying within your budget. Remember, the first step is scheduling a consultation to discuss your options and get started on your journey to a confident, beautiful smile.

In orthodontics, the quest for a beautiful harmonic smile often involves various intricate techniques and methods. While braces or Invisalign can make the teeth straighter, in most cases, an orthodontic specialist has many variables to consider and a complex diagnosis and treatment planning is done behind the scenes. Some of these considerations involve a patients skeletal pattern, analysis of several radiographs, the patients facial profile and balance, symmetry, as well as the macro and micro esthetics of the teeth.

This post will focus on the last point. The macro esthetics encompass the relationships of the teeth to the face, lips and gums and the micro esthetics involve the individual tooth size, shapes and shades. There are many misconceptions about interproximal reduction, many of which come from General Dentists who have the best intentions, but are ill-informed, as well as social media. It is important to remember that Orthodontists are specialists in tooth movement and what is needed to obtain the best smile and proper bite relationship.

The size and shape of the teeth play as large role in the appearance of the smile as anything that an orthodontist does with braces or Invisalign. If the teeth have irregular size or shape sometimes the teeth themselves need to be altered in order to obtain an ideal bite as well as an optimal esthetic result. Interproximal reduction, or IPR, is a technique that can be utilized in order to obtain the best orthodontic outcome.

Interproximal reduction is a simple procedure in which the size and shape of the teeth are adjusted using precise diamond embedded instruments in which minute amounts of enamel are removed. This is typically done in between the teeth where they touch one another, known as the contact point. There are several reasons why this is done:

• Tooth Size Discrepancy: The set of upper and lower teeth are like a puzzle and the individual teeth have ideal sizes in order to fit together properly. If the upper teeth are too big or the bottom teeth are too narrow in comparison, a patient will present with upper crowding, an excess overbite or spacing of the lower teeth. On the other hand, if the top teeth are too small or the lower teeth are too wide, there will be spaces on the top or crowding on the bottom. Through extensive orthodontic research, it was discovered that there are ideal proportions of the upper and lower teeth. If the upper and lower teeth do not match due to the tooth size, it is known as a "Tooth Size Discrepancy". On occasion, reduction of the upper or lower teeth is a solution.
• This is a quick, safe and pain free procedure. Tooth enamel can be as much as 2.5 millimeters thick and Interproximal reduction typically involves no more than 0.2-0.4 millimeters. After IPR, there is plenty of excess enamel to keep the teeth healthy and strong, which has be shown in countless orthodontic research. IPR does not increase the risk of cavities. Research has shown that dentists are less comfortable performing IPR routinely and orthodontists who are more likely to have researched the long term effects of IPR on the teeth are more comfortable performing the procedure. Because of this, dentists will often inform patients and their families that IPR is unsafe, will damage the teeth or other statements that are incorrect, and not backed by scientific research.

• Anatomy: Sometimes the shape of the teeth is such that an esthetic improve can be made by removing some excess enamel in order to improve the shape of the teeth or how to teeth connect to each other in order to obtain a more esthetic final result.

• Black Triangles: Sometimes due to the shape of the teeth, how they connect to each other or due to gum recession, the appearance of what are known as black triangles occur. It is noticed as triangluar "spaces" close to the gum-line. While there are not actually spaces between the teeth, if the teeth are only touching at the tips and not up to the gums, a dark triangle will apear. On occasion, IPR can reshape these teeth and reduce the size and appearance of the black triangle once the space is closed.

• Crowding: Another reason for using IPR is due to crowding of the teeth. Significant amounts of space can be created by removing very small amounts of enamel in between some of the teeth. If there is crowding between the teeth, but not enough crowding for the removal of permanent teeth, IPR can be used to create enough space for all of the teeth. In addition to create space, IPR also creates flat surfaces between the teeth which helps improve the stability of teeth to keep them straight after orthodontic treatment is completed.
• Conclusion and Considerations: IPR is a safe procedure and extensive research shows that there is no increased decay after IPR, there is improved stability of the orthodontic results after IPR due to the improved contacts, and there is no increase in sensitivity when the amount of enamel removed is within proper limits.

The author, Dr. Eric Strouse DMD MDS is a specialist in orthodontics in the practice of orthodontics in Spring Hill and Lecanto, Florida. He was trained at Muhlenberg College for his Bachelors Degree where he competed on the track and field team. He completed his dental training at the University of Connecticut School of Dental Medicine, earning a Doctorate of Medicine in Dentistry(DMD). He completed a one year General Practice Residency at St. Luke's Hospital in Allentown, PA and his specialty training in Orthodontics and Dentofacial Orthopedics at Rutgers University where he also completed a Masters in Dental Science. Dr. Strouse has been published in several Dental and Orthodontic Journals. Dr. Strouse is an expert in two-phase orthodontic treatment, phase 1 interceptive treatment, extraction and non-extraction treatment, Invisalign clear aligners, and multiple bracket systems(custom braces, self ligating braces, conventional braces). This blog is for informational purposes only.

Some very common statements I hear as an orthodontist from patients are "my wisdom teeth got removed and cause my teeth to shift" or "When my wisdom teeth came in my teeth started to shift". While it is a commonly held belief that the wisdom teeth are related to crowding, they are not related. The thought that wisdom teeth cause crowding or make your teeth crooked is somewhat of an old wives tale and is not true. So why do teeth because crowded after braces or Invisalign?

Teeth become crooked after orthodontic treatment for a few reasons. The main reason is lack of retainer wear. Research has shown that orthodontic retainers are the only way to keep the teeth in their new position after treatment and keep tooth movement to a minimum. Without retainers, the teeth will begin to shift and become crooked. Just like anything else in the body, teeth change over time, and maintenance is necessary. Keeping the teeth straight after braces requires wearing retainers for as long as you want them to stay straight.

Another factor that over time can lead to shifting of teeth is what is known as late mandibular growth. Put simply, there is a very small amount of lower jaw growth that happens in the late teens and twenties that puts a slight force on the lower teeth pushing them forward and upward very slightly into the back of the top teeth. Over time, this extra force or pressure can cause crowding of previously straight teeth.

Research at the University of Iowa showed that wisdom teeth can not exert pressure on the front teeth to cause them to become crooked. The way this was discovered was by using sensors that compared the pressure with wisdom teeth and without wisdom teeth. What they found was that there was no difference. Research also compared the amounts of crowding in children after braces with and without their wisdom teeth. There was no difference in the amounts of crowding, suggesting that wisdom teeth do not play any factor in crowding, or shifting of the teeth after orthodontics.

While everything in the body changes over the course of time, when it comes to maintaining the position of the teeth, the most important thing is to continue wearing your retainers for as long as you want the teeth to remain straight. The wisdom teeth do not play a role in cause the teeth to shift.

Our office and the American Association of Orthodontists (AAO) recommends children get their first check-up with an orthodontist either at the first recognition of an orthodontic problem or at age 7. It is important not to rely on your general dentist(the dentist that does your checkups and cleanings) to properly evaluate for orthodontic concerns.

Around that age, children have a mix of baby (primary) and permanent teeth. An examination at this age gives the child orthodontist a wealth of information. If a problem exists, or if one is developing, your orthodontist is able to advise you on which treatment is recommended, when it should begin, and estimate its length. "Waiting for the baby teeth to fall out" without being evaluated and monitored by an orthodontist is a mistake that can lead to serious issues down the road.

If your child is younger than 7, and you notice something that appears “off,” it’s not necessary to wait until your child turns 7 or until you get a recommendation from your dentist. You should take your child to an orthodontist the moment you notice an issue, regardless of age. No referral needed to set up an appointment for an orthodontic evaluation. At Strouse Orthodontics, as well as most orthodontic offices, initial consultations are complimentary. Orthodontists care about the well being and orthodontic health of your family and will be able to advise if any treatment is needed.

What Happens at the First Exam? Generally five questions will be answered

1. Is there an orthodontic problem, and if so, what is it?
2. What are the options to correct the problem?
3. Is there a possibility any teeth need to be removed?
4. How long is the recommended treatment expected to take?
5. How much will the recommended treatment cost?

Frequently Asked Questions

Won't my child's teeth become straighter as they grow?

Unfortunately, a common misconception is that a child's teeth will naturally align as they age. However, the reality is quite different. The space available for permanent front teeth does not expand with growth. In fact, after the eruption of the permanent molars around age 12, there's often less room for the front teeth, potentially resulting in orthodontic issues like protrusion or misalignment. Furthermore, untreated orthodontic problems tend to exacerbate over time and can pose greater challenges as a child matures.

Should I wait for our Dentist to refer my child to an orthodontist?

No. Parents are usually the first to realize something is off about their child's teeth or jaws. If you have any concerns please contact our office to schedule an initial consultation.

Where did my child's orthodontic problems come from?

Most orthodontic problems are genetic. Some are “acquired,” developing over time by sucking the thumb or fingers, mouth breathing, dental disease, abnormal swallowing, poor dental hygiene, or early or late loss of baby teeth, accidents and poor nutrition. Regardless of the cause, an orthodontist will likely be able to treat the condition.

Embarking on the journey towards a straighter, more aligned smile through orthodontics with braces or Invisalign is an exciting and transformative experience. As you enter the world of braces or Invisalign, it is crucial to remember that your orthodontist is just one part of your oral health care team. In this post I will explore why regular dental checkups are essential even when you're undergoing orthodontic treatment.

Oral Health Assessment

While the orthodontist is focusing on straightening teeth and correcting bite issues, your dentist plays a crucial role in ensuring your overall oral health. Regular dental checkups provide a comprehensive assessment of your gums, tongue, cheeks, and the overall health of your mouth. This helps in identifying and addressing any potential issues before they escalate.

Monitoring Oral Hygiene

Maintaining good oral hygiene can be challenging with braces or aligners. The presence of orthodontic appliances creates additional nooks and crannies where food particles and plaque can accumulate. Your dentist will monitor your oral hygiene practices and provide guidance on effective cleaning techniques to prevent cavities and gum problems. It is especially crucial to maintain professional cleanings during orthodontic treatment.

Early Detection of Dental Issues

Dental problems don't take a break during orthodontic treatment. In fact, the presence of braces or aligners can sometimes make it more challenging to detect certain issues. Regular dental checkups enable early detection of problems such as cavities, gum disease, or signs of teeth grinding. Timely intervention can prevent these issues from interfering with your orthodontic progress.

Coordination between Orthodontist and Dentist

Collaboration between your orthodontist and dentist is key to achieving optimal oral health. Your dentist and orthodontist work together to address specific issues, such as restorations after orthodontics, tooth extraction, impacted teeth, or any concerns related to your overall oral health. This coordinated effort ensures that your orthodontic treatment aligns seamlessly with your broader dental care plan.

Conclusion: In conclusion, seeing your dentist regularly during orthodontic treatment is not only advisable but crucial for maintaining overall oral health. The collaboration between your orthodontist and dentist ensures that you receive comprehensive care, addressing both the specific goals of your orthodontic treatment and the broader aspects of oral health. Remember, a beautiful smile is not just about straight teeth – it's also about a healthy and well-maintained mouth.