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Early orthodontic treatment

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A common misunderstanding is that orthodontic treatment can only commence when all adult teeth have erupted. Early treatment is sometimes required before this, and is aimed at treating functional issues with developing bites and occasionally for psycho-social reasons (e.g. teasing at school due to the appearance of the child’s teeth). Your dentist is usually the first person to detect such problems and may recommend an early referral to an orthodontist for your child to undergo an assessment. Usually early treatment occurs any time after eruption of the front adult teeth and first adult molars (from age 6 onward) up until eruption of the adult teeth (approximately age 12). It is uncommon for treatment to be required earlier than this. Some problems that are best treated early to avoid significant dental issues in the future are listed below: Protrusive upper front teeth: If the upper teeth stick out over the lower teeth to a significant degree, they are more susceptible to trauma. This is particularly so if a patient cannot close their lips over their front teeth or for children engaging in contact sports. Deep bite: Upper teeth cover the lower teeth more than they should, which can cause increased wear to the enamel of the front teeth and sometimes damage to upper gum tissue. Under bite: Lower teeth are forward of the upper teeth. This may be the result of a jaw growth discrepancy and/or tooth problem. Open bite: Upper and lower front teeth do not come together. This is often the result of a finger/thumb sucking habit. Crowding: Jaws are too narrow or teeth are too large causing crowded or misaligned teeth. Spacing: Teeth are too small or jaws are too large causing space between the teeth. Sometimes teeth also fail to develop which can lead to increased spacing of the teeth. Space maintenance: If a baby molar tooth is lost early (e.g. due to decay), it is often necessary to hold the space with a space maintainer for the developing adult tooth to erupt into the arch. Crossbite: Upper teeth are inside the lower teeth, causing wear to the teeth and possible asymmetrical growth of the lower jaw. Malpositioned teeth: Teeth erupting into the wrong position can sometimes cause damage to adjacent teeth as they erupt. It is important to detect this problem early to facilitate treatment to allow for normal dental development. Impacted teeth/delayed eruption: If teeth have not erupted at the usual age or there is a significant delay between corresponding teeth erupting on different sides of the mouth, investigation is required. Teeth can sometimes become ‘stuck’, which is often the result of an extra tooth growing, previous trauma to the baby teeth affecting root development, or incorrect position. If you have concerns that your child may have any of the above issues, it is recommended to speak with your dentist or arrange for a consultation with your local orthodontist. They can then determine if early treatment is required or whether treatment can wait until the child is in the adult dentition. Written by Yvette Ding.

Indirect bonding

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Orthodontists have traditionally placed braces on the teeth one at a time, in a process known as direct bonding.  Although this technique is widely practised, a more efficient and comfortable method, known as indirect bonding, is often used at Sable and Pepicelli Orthodontists. In order to place the braces indirectly, our orthodontic therapist will start by taking impressions of your upper and lower teeth. From these impressions, our laboratory technician creates a set of plaster models. Your orthodontist will then carefully and accurately position the braces on the models, without you even being in the clinic! Once the braces are in place, soft custom trays are placed over the models which allow the braces to then come away from the plaster, within the trays. On the day that you have your braces fitted (usually one to two weeks after the impressions), our orthodontic therapist will clean and prepare your teeth.  Once the teeth are ready, the orthodontist will fit the custom trays containing all of the braces, and then set the glue.  After the glue is set, the custom trays will be removed, and your braces will be on! Lastly, you will have your upper and lower wires inserted, and then you will be ready to begin your orthodontic journey! Written by Sher Fong.

What is the best age to visit the orthodontist?

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We often have parents ask us “what age should I bring my child in to be seen by the orthodontist – they’re only 8, is that too young?”. Quite the contrary – around 8 years old is the ideal age to first see us. By that age, some of the permanent/adult teeth are beginning to erupt and it is possible to identify unfavourable growth patterns (e.g. crossbites, deep bites etc.), address bad habits (e.g. thumb sucking) or assist front teeth in erupting correctly. Moreover, it provides a good reference point to allow the orthodontist to monitor growth and dental development over time. Often your orthodontist may be able to simply review your child on a regular basis, with the view to treat them when all of their permanent teeth are through. Conversely, early intervention is sometimes required to correct dental problems. Early treatment may not necessarily prevent the need for comprehensive treatment in the future, however, it may simplify later treatment or decrease the length of time spent in care. Additionally, it may help to avoid premature damage or wear to teeth that have erupted unfavourably. Written by Campbell Watson.  

What is a TAD/Mini-Screw?

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In orthodontics, a mini-screw or temporary anchorage device (TAD) is a small metal implant that acts as a fixed anchorage point to help with more complex orthodontic tooth movement. TAD’s are typically used to aid closure of large spaces, move multiple teeth at the same time, assist with movement of teeth that wouldn’t be otherwise possible with braces alone and/or hold teeth in a fixed position if required. Their small and clever design makes the mini-screw a simple and effective tool to treat difficult cases in a time efficient manner and is well tolerated by patients.    

Thumb Sucking

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Children often suck their thumbs, fingers, dummies, blankets or toys, as this provides comfort and security. Most children will stop sucking their thumb or fingers naturally between the ages of 2 to 4 years old.  As children start to interact with others in a social environment, this habit may also stop due to peer pressure.  Some children however, develop a habit that they are unable to break, as it is often a source of comfort during periods of stress, anxiety and worry. If the child continues to suck their thumb or fingers when the adult teeth erupt into the mouth (at around the age of 6 or 7), growth of the jaws can be affected and this can result in significant misalignment of the teeth.  Orthodontic treatment will then be required to correct the problems caused by their sucking habit. Common orthodontic problems caused by prolonged thumb sucking Open bite: the teeth do not meet together at the front. Protrusive bite: the upper front teeth are positioned forward relative to the lower front teeth. These teeth are then at risk of trauma. Crossbite: the upper jaw is narrow compared to the lower jaw due to contraction of the cheek muscles used for the sucking motion. Lisp: it may become difficult to pronounce certain sounds due to the teeth being pushed out of place. Trauma to thumbs and fingers: the thumbs or fingers may become swollen and develop sores or calluses. Methods to stop the thumb sucking habit  Identify and remove the cause(s) of the stress and anxiety for the child Encourage and offer rewards for breaking the habit Tape the thumb or finger at night with sports tape, to bring the habit into the child’s awareness when sleeping Use unpleasant tasting nail paint If all of the above methods are not successful in breaking the habit, then a Thumb Sucking Appliance can be used.  This orthodontic appliance is cemented onto the back teeth and consists of a smooth metal crib positioned on the roof of the mouth, behind the upper front teeth.  This acts as a physical reminder for the child not to suck their thumb. Thumb sucking habits can be difficult for a child to break.  However this problem is better corrected earlier rather than later, and before the adult teeth start erupting into the mouth.  If you are having difficulty getting your child to break the habit, please don’t hesitate to contact us. Written by Jennifer Wu.

What can I expect after I have my braces put on? Will it hurt?

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The most common question we hear from patients is will braces hurt?  Rest assured that the process of putting the braces onto your teeth does not hurt – we simply glue to brackets to the teeth.  However, it is normal to experience some discomfort and pressure on the teeth about 4 hours after the wires have been placed as the teeth begin to move. This mild discomfort generally lasts less than a week and you can take regular analgesics to relieve any pain.  To further minimise any discomfort, we also recommend that you eat soft foods such as pasta, rice and soup as you are getting used to the braces. After the braces have been put on, you may also find it harder to talk and that you salivate more.  This is all normal and everything will improve over the next few days as you practice talking with the braces on. Sometimes the braces can rub against the inside of your lips and cheeks and cause irritation or sore sports.  To prevent this, you can apply orthodontic wax over the brackets.  If you have any mouth ulcers, it is useful to rinse with warm salt-water to help them heal. An important thing to remember with braces is that any discomfort that you experience is only temporary and can be easily managed.  Most importantly, you can always contact the clinic if you are unsure of anything or need any further support. Written by Sher Fong.

Meet Elaine

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Meet Elaine – our clinical coordinator at Sable and Pepicelli Orthodontists. ELAINE How long have you been working at Sable and Pepicelli Orthodontists? I started working at Sable and Pepicelli Orthodontists in 2014. What is your role at Sable and Pepicelli Orthodontists? Clinical Coordinator Have you ever had braces? Yes I had braces twice, the first time round was in Germany when I was 13 years old however I stopped wearing my retainers after four years and my teeth moved. I then decided to get braces again at Sable and Pepicelli Orthodontists. I will never stop wearing my retainers. Where did you grow up? I was born and raised in a small village of just 10,000 people in Germany called Bad Ems. What is your background? My mother is from Malaysia and my father is from Hong Kong.  My parents moved to Germany for work. I moved to Australia in 2008 after completing my high school education in Germany.  Do you speak any other languages? My first language is German. I am also fluent in English, Cantonese and Mandarin. I am currently taking Japanese language classes and plan to learn French in the future. What is most rewarding about your job as a clinic coordinator at Sable and Pepicelli Orthodontists? I like seeing the practice run smoothly for the doctors and patients. Where is your favourite place to visit and why? I love to visit Germany to see my family and friends. I also love to visit Malaysia for the great food and shopping. What are hobbies? I enjoy taking my Rottweiler dog Stark to the dog park and beach. I also love travelling and eating different cuisines. What is your favourite restaurant? Tetsujin Sushi Train – Melbourne Emporium   Written by Stacey Ottaway.

Orthodontic emergencies

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Orthodontic Emergencies The large majority of our patients make it through treatment with only minor inconveniences. Every now and again though, something can go awry and cause irritation or issue. Here is Yvette’s guide to navigating orthodontic issues and emergencies: Lip and cheek irritation Initially, certain parts of the braces or orthodontic appliances may cause irritation to the lips and cheeks causing ulcers. This will subside as the body becomes used to the braces after a week or two. This can be easily addressed by applying wax to the appliance causing irritation. In conjunction with warm salty mouth rinses the area should heal within a week. Tooth sensitivity Patients will experience a continuous light pressure during treatment. It is possible for some teeth to become sensitive for a couple of days following a visit. This is normal. This will usually subside within 3-4 days and any pain can be managed with regular analgesics. Broken and loose appliances Brackets, wires and bands may become loose during treatment. If this occurs, please contact us immediately and we will organise to see you as soon as possible. However, if something happens to occur on a weekend, you can attempt to gently remove anything that is causing direct discomfort and we will endeavour to see you as soon as possible. With all that said, prevention is the best cure so avoid hard or sticky foods to minimize breakages during treatment. Long wire or shifted wire As the teeth move around and align during the initial phase of treatment it is not uncommon for the excess wire to protrude from the back teeth. This can also occur later in treatment if we are closing spaces. Depending on the amount of wire, this feeling can range from unnoticeable to quite irritating. Orthodontic wax can be used as a temporary measure, but we will need to see you for a more permanent solution. Lost mods, power chains and separators If any of the elastic components come adrift and your appointment is within seven days, there is no urgency to make a special trip in to see us. If however your next visit is more than a week away, we would prefer you call to come in and see us. Loose Forsus spring The Forsus rod can disengage from the spring on wide opening or yawning. If you feel comfortable doing so, you can try to reengage the rod by placing it back in the spring. If that is unsuccessful or you don’t feel comfortable doing that, do not hesitate to call and book an appointment. Broken or lost retainers If you lose or break your retainer, please contact us to make an appointment as soon as possible. Teeth retain the capacity to move throughout your lifetime, so the sooner we can see you the less likely they are to have moved.   Written by Yvette Ding

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