So What is Two-Phase Treatment?

reagin orthodontics

It’s been 20 years since you’ve had braces and you remember spending the beginning or all of your teen years wearing them. Now your dentist is telling you at age seven your child needs to be evaluated by an orthodontist. Then the orthodontist tells you your child needs two-phase treatment and it needs to begin now. That leaves you with some questions.

So what is two-phase treatment?

According to the American Association of Orthodontists’ website, “Two-phase orthodontic treatment consists of two separate times when a child receives orthodontic treatment. A first phase of treatment is done while the child still has many or most of their primary or “baby” teeth. A second phase takes place when the child has most or all of their permanent teeth. Braces may or may not be used during a first phase of treatment (or) other appliances (the name used for braces and other devices for orthodontic correction) may be used.”

Phase One is less about straightening teeth than preventing a problem from happening, correcting a developing problem or modifying jaw growth for optimal bite and teeth positioning.

Phase Two is more about aesthetics. Straightening and aligning teeth so every tooth has an exact location for a beautiful smile, correcting the position of teeth and jaw to work optimally and to provide a pleasing face and profile.

So is two-phase treatment really necessary? Two-phase treatment works in conjunction with a child’s natural growth and development. When phase one is done during the growth phase it can correct problems that may result in surgery if the treatment is delayed.

There is no one-size-fits-all treatment plan for everyone. It is important that you make an appointment with Dr. Reagin for an evaluation. At the consultation Dr. Reagin will let you know if is time to begin treatment and he may be able to let you know if he thinks two-phase treatment is in your child’s future.

Help, I Have A Braces Emergency!

braces emergency

You are having a great evening with you friends and suddenly something doesn’t feel right with your braces. What do you do now? Believe it or not there are lots of things you can do to temporarily relieve any discomfort you may be having until you can get to the office.

Poking Wire – Use an eraser from a pencil to push the wire down so it isn’t poking into your cheek, gums or lips. Then cover it with wax so it won’t hurt you again until you can see Dr. Reagin.

Loose Bracket or Band – If the bracket or band is still attached do not pull it off. Put wax over it and call the office. If the bracket comes completely off wrap it in a tissue.

Loose Wire – Using a tweezer, try to put your wire back into place. If doing this and using wax doesn’t help, as a last resort use a small fingernail clipper to clip the wire behind the last tooth to which it is securely fastened. If your discomfort continues, place wax on it.

Loose or Damaged Appliance – If you appliance is bothering you, use wax to cover the part that is bothering you.

It is important that even if you have relieved the pain from a loose wire or bracket that you call and make an appointment as soon as possible. Delaying repair can interfere with the changes Dr. Reagin is making with your treatment. Orthodontic emergencies that require immediate attention are trauma to your mouth or face or loose teeth. Please do not hesitate to call the office if one of these things happens or if you feel you have an emergency.

Steps to Preventing Tooth Decay

Adult Braces

You have your braces on and you are looking forward to your beautiful smile that is in the not so distant future! You are dreaming of straight teeth and a bright smile! Dr. Reagin and the staff at Reagin Orthodontics will do the work on your straightening your teeth and bite, but you play an integral role in the bright part of your smile.

Caring for your teeth and preventing tooth decay with braces does take a little bit of extra effort. It is not insurmountable though!  Here are Dr. Reagin’s recommendations for healthy teeth and gums:

1-  Brush morning and night and after every meal.

2- Use a cone shaped brush called a proxa brush to get to hard to reach areas that your toothbrush cannot reach. Some orthodontic toothbrushes have a regular head on one end and a proxa brush on the other.

2- Floss with special flossers made just for braces wearers. These will allow you to get around the wires and pick up anything that may have been missed.

3- Use a fluoride rinse

4 – Avoid overindulging in sweets.

5- Continue to visit your dentist for regular check-ups.

If you do these five things you should have a great smile that you will want to show off when you braces are removed!

What is the Ideal Age to Begin Orthodontic Treatment?

Brit Reagin

There is not a one-size-fits-all answer to this question. Some children need to enter treatment in elementary school, while others are well into middle school before intervention is ideal. Interesting though is that there is a one-size-fits-all-answer as to when a child should first be evaluated by an orthodontist. An evaluation should take place at age seven, according to The American Association of Orthodontists.

The first adult molars are often coming in around age seven and evaluation at that time can assess if there is something that may become a problem down the road and steps can be taken early to prevent the problem from developing.  A child’s bite can be examined and potential crowding can be seen at this point. If treatment is not recommended at the initial evaluation, Dr. Reagin will recommend when a child should be seen again for continued monitoring.

Advantages of early evaluation and possible treatment are:

Creating room for crowded, erupting teeth

Creating facial symmetry through influencing jaw growth

Reducing the risk of trauma to protruding front teeth

Preserving space for unerupted teeth

Reducing the need for tooth removal

Reducing treatment time with braces

Correcting bite problems that can lead to chewing difficulties, speech impediments and likelihood of chipping teeth.

Early treatment is not necessary in every case, but establishing a relationship with an orthodontist and beginning a regular evaluation schedule can ensure that treatment will begin at the optimal time to make the most difference in a child’s bite and smile.

Dr. Reagin provides a free consultation to all new patients. Call the office today and make an appointment for you child.

February is Dental Health Month

how to brush your teeth

The American Dental Association spreads the word about dental health during the month of February, focusing on pre-schoolers and kindergartners. It is important to teach children how to care for their teeth at an early age in order for it to become a life long habit.

Everyone whether you wear braces or not should brush their teeth at least twice a day – in the morning and before bed for 2 minutes each time. If at all possible it is better if you can add in a third brushing after lunch. The sooner you brush after eating the less time food has to sit and grow bacteria. It is also important to floss after brushing to catch any particles that may have been missed by your toothbrush.

Braces wearers should brush after each time they eat. There are a lot more places for food particles to hide and get stuck in braces. There are special flossers for braces wearers to make sure all spaces are reached. These flossers look like a little Christmas tree and allow you to get under and around all the wires.

Reagin Orthodontics promotes dental hygiene month by sending out our own personal tooth fairy to visit schools and talk to children about their teeth and how to care for them! She has been visiting area schools for the past two weeks and we can’t wait to share some photos with you at the end of the month. In the meantime, visit our Facebook page to see a few and add an extra brushing into today!

Give the Gift of a New Smile

valentines day

Are you trying to figure out a perfect Valentine’s Day Gift for your sweetheart? The best gifts are the ones someone would never purchase for themselves, but you know they would love. You’ve probably done a spa day or a golf trip before for that very reason. So what could you possibly dream up that would surprise them? How about giving them the gift of a beautiful smile?

Has your Valentine always wanted to change their smile? Maybe they didn’t have braces when they were younger or maybe they did, but there are some things that still bother them about their teeth. Valentine’s Day is a great time to give the gift of a new smile because it shows you were listening to what matters to your special someone and you are truly giving from the heart.

You can even give yourself the gift of a new smile for Valentine’s Day! People buy themselves boxes of chocolates and flowers, why not do something for yourself that you keep putting off?

Reagin Orthodontics offers a free consultation to every new patient, so what are you waiting for? Sometimes the phone call is the hardest! Take the leap for yourself or someone else and schedule an appointment. At the consultation Dr. Reagin will take x-rays, do an exam and discuss what each person is looking for in their new smile. He will talk to the patient about their options and in some cases treatment can even start that day! So go on call us today, we promise you won’t regret doing something this wonderful for your Valentine or yourself!

The Truth About Bottled Water and Your Teeth

fluoride and your teeth

Let’s face it bottled water is part of all of our lives and there are certainly some benefits for it! Having the option to buy bottled water at a gas station or convenience mart on a road trip is a great improvement over only having sodas or juices as our choices. Believe it or not that option has only been prevalent since the 1990’s. In 1987 the average American drank six gallons of bottled water a year. In 2010 the average American drank 28 gallons of bottled water a year!

All this bottled water has had an effect on tooth decay as well. The majority of store bought waters do not contain fluoride, while most tap water does. When fluoride was added to water in the 1950’s there was 29% reduction in tooth decay among four to 17 year olds.  According to Dr. Burton Edestein, president of the Children’s Dental Health Project in Washington, D.C. and a professor of dentistry and health policy and management at New York City’s Columbia University in 2012, 1 in 10 two year olds, 1 in 5 three year olds, 1 in 3 four year olds and nearly half of all 5 year olds had tooth decay. Leading most researchers to believe that it is a direct effect of the reduction in fluoride consumed by our nation’s children.

So how can we help our children get the fluoride they need for strong healthy teeth? If the tap water at your house has fluoride you can simply drink tap water. If you prefer filtering your household water to eliminate possible contaminants choose a filter that does not eliminate fluoride, such as this one. You can also choose fluoride fortified foods when available and use a toothpaste approved by the American Dental Association .

Children’s teeth absorb the most fluoride, but continuing to get fluoride throughout your life will help keep your teeth strong and healthy for years to come. So take time to consider your fluoride intake and ensure that you and your children are receiving an adequate amount!

What is a Maxillary Expander?

Palatal expander, expander, maxillary expander are all names for the same orthodontic appliance. Have you heard your child's friends talk about needing one of these? Are you wondering if your child will too? A maxillary expander is used to widen a child's arch before the growth plate in the roof of the mouth is fused. These devices are used to correct a posterior crossbite or alleviate extreme crowding.

The device looks more intimidating than it actually is. It is attached to the the back teeth and a screw is inserted each night to turn it ever so slightly.  Over the course of several weeks the palate is expanded in order to correct the problems.

Patients sometimes report feeling pressure on their teeth, in their noses or under their eyes. They sometimes get a headache due to the pressure. Over-the-counter medications such as Advil and Tylenol can help with any discomfort that is felt.

Only your orthodontist can determine if you need a maxillary expander. Dr. Reagin will take a series of x-rays and do an exam to determine if one is needed in your treatment plan. They are not necessary in all treatment plans and using one when there is not a problem, will create a problem.

Wondering what they look like and what a typical child has to say about how it feels. We filmed one of our patients, Hughston Reagin, after he had his expander placed.  See what it looks like and what Dr. Reagin’s oldest son has to say about it!

Herbst Appliance & Airways

What do you need to know about the Herbst appliance?

Using a cephalometric x-ray (the one that takes images from the side of the head (see fig 1), an orthodontist can properly diagnose whether the orthodontic issue is skeletal or dental in nature. If the issue is skeletal, the only way to properly address and correct such is by way of a growth modification appliance such as the Herbst. This growth modification should be performed at an “ideal” time to be effective. If done too early, it will not last. If done too late, it will not be effective and jaw surgery will be required to correct the problem.
Therefore, if an orthodontist has diagnosed your child’s orthodontic issue as being skeletal in nature, treatment with rubber bands will not provide a solution.

Benefits of the Herbst?

Upper airway narrowing is connected to several breathing problems which include obstructive sleep apnea. Upper airway narrowing most commonly occurs in the space directly behind the tongue called the oropharynx. A small or narrow oropharynx is often linked to a retrusive (posterior) lower jaw position. It is worth noting that approximately 25% of the children that visit an orthodontist have a lower jaw that is positioned too far posteriorly which puts them at risk for either having or developing airway problems later in life.
In the simplest of terms, the Herbst appliance positions the lower jaw into a more forward position. In clinical research, Iwasaki verified that orthodontic treatment with a Herbst appliance can significantly enlarge the oropharynx, thereby opening the upper airway and minimizing the risk of developing airway issues later in life (see figure 2). Further research by Shutz showed that the Herbst appliance, used in conjunction with expansion of the upper jaw, will increase the volume of the pharyngeal airway and relieve the symptoms of obstructive sleep apnea. Lastly, Pancherz showed thorough additional clinical research that the Herbst appliance is most effective when used near the pubertal growth spurt. It is for the reason that the American Association of Orthodontists recommends that all children have a screening, performed by an orthodontist, at age 7.

Therefore, as one can glean, proper diagnose and efficient timing of treatment is essential to effectively treat a child with orthodontic issues of a skeletal nature using growth modification. The answer of “what should we do” in such a case that one orthodontist has recommended a Herbst while a second recommends rubber bands comes squarely down to the doctors’ diagnosis. If, in fact, the problem is skeletal, rubber bands are not a viable solution.

Dr. K Britt Reagin has been educated in orthodontic and dento-facial orthopedics and can monitor your child using radiographs to determine if and when your child will benefit the most from growth modification such as the Herbst.

herbst1
Figure 1. An example of a cephalometric x ray used by orthodontist to determine if your orthodontic problem is dental or skeletal in nature. This radiograph can also be used to determine if you child is near the pubertal growth spurt.

herbst2
Figure 2. Courtesy of Iwasaki. A. Shows a child with an obstructed airway prior to growth modification. B. Shows the same patient after the Herbst appliance. Notice then enlargement of the red cavity which is the airway.

How Do You Care For Your Braces

brushing with braces

Congrats! You have your braces and you are on your way to a great smile! At first your mouth may be a little sore and eating softer foods is advised. Once the tenderness is gone you can get back to eating most of your favorite foods. You just need to make a couple of adjustments.

If you love crunchy foods such as apples and carrots, it is best to cut them into smaller pieces and avoid biting into them with your front teeth. Using your front teeth on hard foods can cause a wire or bracket to break. Sweets can still be enjoyed occasionally, but don’t overindulge because sugar from sweets and sodas can get trapped under the brackets and cause tooth decay. Sticky and chewy foods such as caramel and taffy are best avoided altogether because they can be very difficult to remove from your braces. Those are the only changes you need to make in your diet! That doesn’t sound too hard does it?

Now what about brushing your teeth with braces? Brushing is very important and you will need to do this more often than you did before braces. Dr. Reagin recommends you brush after every meal and snack to avoid food particles and sugar from getting trapped in your braces and causing problems down the road. Carry a travel toothbrush with you in your book bag, gym bag or purse so you can brush your teeth at school or wherever you are after eating. If you cannot brush make sure to rinse your mouth thoroughly with water.

At least once a day, preferably at night, you need to floss with special flossers called a floss threader. These allow you to get between your teeth and around the brackets and wires to ensure that there are no food particles remaining that you missed with brushing.

Not brushing and flossing well can cause tooth decay, gum disease and even staining of the teeth under the braces. These things are easy to prevent with adding a couple of steps to your daily routine. It is well worth it in the long run!