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.

Wisdom Teeth Evaluation and Removal

wisdom teeth removal

It is commonly thought that having your wisdom teeth removed by an oral surgeon is done in order to prevent crowding of your teeth. While that is one reason and possible benefit of having them removed that is not the only reason wisdom teeth removal should be considered. If wisdom teeth partially come in and stop, an infection may develop. If wisdom teeth do fully come in and they are very close to the second molars, periodontal disease is a possibility due to the difficulty in brushing and flossing the teeth well.

As with all dental and orthodontic treatment plans there is not a single one size fits all approach. That is why it is important to have your wisdom teeth evaluated by your orthodontist and an oral surgeon. Dr. Reagin assesses the placement and growth of your wisdom teeth, before and during your orthodontic treatment. He evaluates how your wisdom teeth may impact your teeth alignment and bite.  Evaluation is done through an oral exam and a series of x-rays to determine the teeth’s current location and growth pattern.

Evaluation of wisdom teeth is not a one time event, it is something that will need to be done regularly as long as you have them. The position of the teeth and direction of growth often changes as you age, so what is true when you are 15 may not be the same when you are 18 or 30.

In the majority of cases wisdom teeth removal is recommend prior to the age of 24 due to the positives outweighing the negatives. Typically removal is done between 17 and 20. Bone density increases and roots are fully established after the age of 24, making the surgery have more risks associated with it. Waiting until you are over the age of 24 often doubles your recovery time and potential complications, such as nerve damage, sinus exposure, infection and jaw fracture are much more likely. In healthy patients between 17 and 24 there are few complications and the recovery is minimal.

It is highly likely that if Dr. Reagin or an oral surgeon sees the potential for a future problem removal my be recommended, even if there isn’t a problem now. If you have questions about your wisdom teeth, ask Dr. Reagin at your next visit!

Should you See an Orthodontist or a Dentist

Britt for 1205

When it comes to caring for your oral health there are various types of doctors and surgeons available. People are often confused as to what each doctor does. Many people think orthodontists only straighten teeth, but even if your teeth are straight you may have jaw and bite concerns. Today we want to answer the question, “Should you see an orthodontist or a dentist?”

Dentists are important when it comes to our dental health. They regularly clean your teeth and watch for signs in your oral health that can be a symptom of a larger problem. They also discover any cavities through x-rays and exams early if you are going to your twice a year check-ups. A cavity that is left untreated can cause a lot of damage and no one wants that.

Your dentist should also recommend that you see an orthodontist at age seven to be evaluated for orthodontic treatment. Age seven is important because an orthodontist can evaluate a child to see if early intervention is needed to allow for the best possible smile as your child grows.  An Orthodontist is important at this point versus a dentist because an orthodontist has had additional education specifically to identify and treat aligning your teeth and jaw.

Want to know more about why you should see an orthodontist for bite concerns or straightening your teeth?  The American Association of Orthodontists has a great video describing just what an orthodontist is.

What Is Invisalign and Is It For You

invisalign

You have probably heard of Invisalign, but do you know what it is?

Invisalign is a series of custom made aligners used to gradually and gently move your teeth into place. Typically aligners are changed approximately every two weeks. You will receive several sets of custom made aligners at each of your visits, which occur every four to six weeks.

The are many advantages of Invisalign for adults and teens. They are clear, so the go virtually unnoticed. You can remove them when you eat and brush your teeth. This means your diet is not limited by them nor does your dental hygiene routine need to change at all. You can brush and floss just as you always have. There is also a huge benefit to individuals that play musical instruments, especially woodwinds. It is easier to play the instrument with Invisaglin and there is no possibility of cutting your lip with Invisalign as there is with traditional metal braces.

Not everyone is a candidate for Invisalign. The best way to determine if it is right for you is to visit Dr. Reagin for a free consultation. If Invisalign is an option, he will develop a personalized treatment plan for you. Oh and another benefit of Invisalign over traditional braces is you will most likely get to use iTero for your impressions over the goop in the trays! That is certainly one for the plus column! Call us today!

Adults and Braces

Adult Braces

Do you wish your smile was a little different each time you look in the mirror? Did you have braces as a teenager, but as you’ve gotten older you notice your teeth are not as straight as they used to be? Maybe you never had braces and you would like to do something about some crooked teeth or your bite now as an adult. With all the options available, other than traditional metal braces, adults in orthodontic treatment are much more common than they used to be.

If you are considering making a change, the first step is a consultation with an orthodontist. This will determine the treatment plan needed and the various options that can provide you with your best possible smile. Dr. Reagin at Reagin Orthodontics offers a free consultation to all new patients. At the consultation Dr. Reagin will talk with you about your concerns and how you would like your smile to look. He and his staff will also take a series of x-rays and photographs before making recommendations for your treatment plan and the options available to you.

Traditional metal braces are still an option in most cases, but if that is not the path you want to take there may be another option for you. Ceramic brackets blend with the color of your teeth to make your braces less noticeable. Incognito braces are placed on the back of your teeth so no one will notice you are wearing them. Invisalign is a series of custom-made clear aligners that typically go completely unnoticed by everyone!

Each person is unique in their treatment plan and which tools are the best for them. Dr. Reagin will discuss with you all the options that will get you the best result possible!

Is Nail Biting Bad for You?

nail biting

The short answer is yes. At some point in your life you have probably heard someone say “Stop biting your nails. It is not good for you.” Maybe it was said to you or someone you know. Did it make you wonder why it wasn’t good for you to bite your nails?

Before we talk about how it is bad for your teeth, let’s just talk about germs. Your hands hold a lot of germs. You touch things all day long and since biting your nails is often a habit you do without realizing you are doing it, you put those dirty hands in your mouth. When you think about it that way, it can turn your stomach a bit! You have the potential to pick up germs and viruses that can make you sick or expose your mouth and body to unnecessary risk.

It is also actually bad for your teeth. Nail biting is often done with your front teeth which are not intended for chewing and grinding hard materials, your back teeth are. Constant chewing on your nails can wear down your tooth enamel and even make your teeth uneven.

The Academy of General Dentistry also says that biting nails often leads to jaw clenching and grinding. This can lead to TMJ down the road which is condition where the jaw pops, can even lock and cause a considerable amount of pain. The Academy of General Dentistry has also done research that shows nail biters spend up to $4000 more on dental care in their lifetime than non-nail biters.

We know stopping the habit can be hard since it is often a reaction to stress or anxiety that the nail biter often doesn’t realize they are doing. Of course you can try to break the habit by painting clear polish on your nails or using a special product for the cessation of nail biting. Both products have an unpleasant taste which will hopefully make the nail biter want to stop. Another option is to replace it with something else that is not harmful to you. You could twirl a pencil, string or turn a coin in your hand to replace the nervous habit.

If you have tried these things and they haven’t worked or you know you or your child is a nail biter and a teeth grinder talk with Dr. Reagin. Mouth guards can be made that reduce the grinding at night and worn at other times of the day can prevent you from biting your nails.

Whichever path you choose it is just important to start trying to break the habit and improve your dental and overall health.

Why Early Intervention?

Brit Reagin

In the 1990’s The American Association of Orthodontics began recommending orthodontic consultations for children at age seven because most children have lost several baby teeth by this point and permanent teeth are beginning to come in. At age seven, potential problems can be identified and steps can be taken to minimize the development of bigger problems down the road.

There are multiple reasons early treatment or early intervention may be recommended. A child’s jaw is still growing at the age of seven and should there be crowding, space can be made by expanding the palate to provide room for the permanent teeth to move into place. This can prevent multiple extractions and crooked teeth in years to come. Expanding a child’s palate can also assist with a misaligned bite.

During early treatment, traditional braces may also be used on front teeth to correct protruding or crooked teeth, as well as, assist in guiding erupting teeth into place. Wondering what other reasons early treatment may be recommended for your child?

  • Various bite concerns – open, deep or cross bites
  • Spacing
  • Teeth not emerging in the right sequence
  • Missing teeth

Early treatment will not be recommended for everyone. The best way to find out what is needed for your child is to schedule a consultation with a reputable orthodontist for an evaluation once your child is seven years old. Regain Orthodontics offers free consultations to all new patients and Dr. Regain will recommend a plan to start immediately or a time frame for your child to return to be reevaluated.

When Should You Visit an Orthdontist

Dr. Brit Reagin

One of the most common questions we get asked is, “When should my child visit an orthodontist?”  This is a great question, because for most of us the age has changed since we were children. The American Association of Orthodontists recommends your child have a orthodontic consultation by age seven. This is most likely much earlier than when most parents experienced their first trip to the orthodontist!

Why should your child see an orthodontist by the age of seven? Research has shown that there are many issues that can be avoided and corrected while the permanent teeth are still coming in. Early intervention can eliminate some dental problems from developing into a problem later.

In many cases the consultation at age seven will not result in an immediate treatment plan, but allows the orthodontist to do an evaluation and let you know when your child should return for reevaluation. There are some situations that can be vastly changed and improved when treatment at a young age takes place. If any of these are present and you have not seen an orthodontist yet, it is time to consult one. These can lead to bigger problems in years to come.

1-      Finger or thumb sucking

2-      Jaws that look too far forward or too far back

3-      Early or late loss of baby teeth

4-      Difficulty chewing or biting food

5-      Clenching or grinding of teeth.

6-      Difficulty speaking

While early treatment can help with a child’s self-esteem, by correcting crooked or poorly spaced teeth, it most often is to prevent future jaw problems and to make room for permanent teeth that may be having difficulty coming in. Jaw and bite concerns can typically be identified by age seven allowing Dr. Reagin to correct them before they cause on-going or bigger concerns.

Consultations are free and a referral from your pediatrician or dentist is not required for a consultation by Dr. Reagin. If you child is seven or older call our office today! It can give you and your child peace of mind.

Can Sports and Energy Drinks Damage Your Teeth?

Sports Drinks and Teeth

The short answer is yes, they can. Dr. Reagin thinks exercising and taking care of your overall health is important, but wants his patients to think twice about consuming large amounts of sports and energy drinks when exercising. They can damage both your teeth enamel and your waistline with the acid and added sugar each of them contains. Many people think these drinks contain less sugar and acid than traditional sodas, but often that is not true.

While both energy and sports drink can do damage to your teeth because of the high level of acid and sugar in them, energy drinks do twice the amount of damage, according to a study published in 2012 in the journal of General Dentistry. Amounts vary by brand and flavor, but there is no one brand or flavor that is exceedingly better than the others.  Southern Illinois University School of Dentistry analyzed the levels of acidity in nine different energy drinks and 13 different sports drinks to determine each brands composition.

They went further by soaking tooth enamel samples in each sports or energy drink. The samples were soaked for 15 minutes in each drink, and then were soaked for two hours in artificial saliva, for four times a day for five days. The researchers found that enamel damage was evident after just five days.

Most student and adult athletes do not need to consume sports drinks daily when participating in moderate intensity activities. Drinking plenty of water and sports drinks in moderation is often enough. If you do consume sports drinks, you can rinse your mouth with water to help reduce the amount of acid that remains on your teeth.

If you have an increase in cavities or teeth that have become sensitive to touch or temperature change talk to Dr. Reagin or your dentist at your next appointment. These can be the result of damage to your tooth enamel.

Fall Sports and Your Child’s Smile

mouth guards

It’s the first week of September and fall sports have kicked off! Sports physicals are complete, uniforms and shoes have been purchased and you are ready to sit on the sidelines and watch your children in their latest sports endeavors.

There may be one thing that was overlooked though. While some sports require facial and mouth protection not all do, but just because it is not required doesn’t mean it is not a good idea.  Soccer, volleyball, basketball or any sport where there is potential to be hit by a ball or collide with another player can result in damage to soft tissues of the mouth, broken teeth or lost teeth. A mouth guard can prevent many of these injuries from happening.

Dr. Reagin recommends mouth guards for most sports and he provides them to all of his patients. The good new is you don’t have to be a patient of Reagin Orthodontics to make an appointment for a mouth guard. It is a simple phone call and he would be happy to fit you or your child for a custom mouth guard.

Many injuries that could cause long term damage to the mouth and teeth can be prevented by wearing a mouth guard, so call us today!

nterested in finding out more about mouth guards, read this article from our Spring Newsletter.