Dr. Daniel M. Eves, D.M.D, M.S.
Specialists in Orthodontics for Children and Adults

Check out Tollgate Orthodontics on Yelp

500 Toll Gate Road
Warwick, RI 02886

20 Clinton Avenue
Jamestown, RI 02835

Rhode Island Orthodontics Frequently Asked Questions

Questions about Orthodontics for Children

Questions about Orthodontics for Adults

General Information about Orthodontics

Questions about Orthodontics for Children

1. Why should children receive an orthodontic screening before all of the permanent teeth erupt?

By age 7, a sufficient amount of permanent teeth has erupted and enough jaw growth has occurred, enabling the orthodontist to identify current and future orthodontic problems. Generally, by this age, the first permanent incisors and molars have erupted. Crowding, crossbites, and developing protrusions can be accessed as well as finger and thumb-sucking habits.

An early orthodontic exam may be necessary if the following signs or habits are present:

  • Crowding
  • Mouth breathing
  • Thumb or finger sucking
  • Early or late loss of baby teeth
  • Difficulty biting or chewing
  • Jaws that makes sounds or shift
  • Teeth that meet abnormally or not at all
  • Teeth and jaws not in proportion with the rest of the face
  • Biting the cheek or roof of the mouth

An orthodontic exam between the ages of 7-12 allows the orthodontist to identify and assess problems, if any, determine if treatment is necessary as well as the best time to initiate treatment.

2. What are the advantages of early treatment?

Early treatment enables the orthodontist to:

  • Guide jaw growth and development
  • Guide the permanent teeth into the right positions
  • Regulate the width of the upper and lower dental arches
  • Reduce the risk of injuries to protruded front teeth
  • Correct oral habits, like finger and thumb-sucking
  • Enhance appearance, thus boosting self-esteem
  • Possibly make future orthodontic treatment simpler and reduce treatment time
  • Decrease the possibility of impacted permanent teeth
  • Save or gain space for erupting permanent teeth

3. What is a space maintainer?

The baby molar teeth hold the space for the permanent teeth to erupt. When a baby molar tooth is lost, a space maintainer is placed between the teeth to hold the space for the permanent teeth.

4. Why are baby teeth sometimes extracted?

Sometimes baby teeth must be extracted to enable severely crowded permanent teeth to erupt at a normal time and in a reasonably normal position. Severely crowded teeth may be an indication that some unerupted permanent teeth (usually canine teeth) will be impacted or not erupt in a highly favorable position. Removal of the baby teeth can dramatically improve severe crowding.

5. Can a child’s growth affect orthodontic treatment?

Absolutely! Orthodontic treatment and growth can correlate each other. Protrusion of the upper front teeth ahead of the lower front teeth is a commonly treated orthodontic problem. This problem often develops because the lower jaw is shorter than the upper jaw. Early treatment consists of orthodontic appliances designed to help the lower jaw catch up with the upper jaw. This may eliminate abnormal swallowing. It is easier to treat severe jaw discrepancies while a child is still growing. If the condition remains untreated during slow or no jaw growth, corrective surgery may be necessary. Young girls with jaw length discrepancies should be evaluated no later than age 10. Young boys should see an orthodontist no later than age 12.

6. What appliances are used to correct problems with jaw growth?

Jaw growth discrepancies are corrected through dentofacial orthopedics. Common orthopedic appliances used to treat the problem include:

  • Functional Appliances-These appliances are designed to hold the lower jaw forward and guide the eruption of the permanent teeth into a more favorable bite, while encouraging the upper and lower jaw to grow in proportion with one another.
  • Palatal Expansion Appliance-If a child’s upper jaw it too narrow for the teeth to fit appropriately with the lower teeth, known as a crossbite, a palatal expansion appliance can be affixed to the upper back teeth to enlarge the width of the upper jaw.

Following an examination, Dr. Eves can determine what appliance is best suited to fit your child’s case, as well as when it should be used. Typically one appliance can successfully treat a given problem. Patient compliance is essential to ensure successful treatment.

7. Can my child play sports while wearing braces?

Absolutely! We recommend your child wear a mouthguard when participating in any contact sport. Dr. Eves can suggest a suitable mouthguard for your child.

8. Can my child continue playing their musical instrument while in braces?

Yes. Although a period of adjustment is necessary, braces do not interfere with the playing of musical instruments.

9. Why does orthodontic treatment sometimes last longer than expected?

Following an initial evaluation, we can only provide an estimate of the treatment time. Growth rates vary among patients. Thus, each patient responds to treatment in their own way. Dr. Eves will continue with treatment until the specific goals discussed are achieved. Patient cooperation is significant. Patients who take care of their appliances, and wear rubber bands or other appliances as instructed, will most likely complete treatment on time, and receive excellent results.

10. Why are retainers necessary after orthodontic treatment?

Once braces are removed, teeth can shift out of their new positions if they are not stabilized. Retainers are designed to hold teeth in their corrected positions, until the gums and bones adapt to the changes. Wearing retainers as instructed ensures excellent results that will last a lifetime.

11. Will my child’s tooth alignment change later in life?

Studies indicate that teeth may shift as people age. This unpredictable pattern of gradual shifting, know as maturational change, may slow down after the early 20s, but in some cases, will continue to some degree throughout life, Even children whose teeth align correctly, may experience orthodontic problems as an adult. Crowding of the lower front teeth is the most common maturational change. Proper retainer wear following orthodontic treatment stabilizes the bite. Long-term nighttime wear can prevent maturational shifting.

12. Should wisdom teeth (third molars) be removed?

In about three out of four instances, where teeth have been extracted during orthodontic treatment, wisdom teeth should be removed when the patient reaches their mid-to-late teens. However, research has shown that wisdom teeth do not cause or contribute to crowding of the lower incisor teeth, which can develop progressively in the late teens and beyond. In conjunction with your family dentist and oral surgeon, Dr. Eves can determine what is right for your child.

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Questions about Orthodontics for Adults

1. Am I too old to have orthodontic treatment?

Absolutely not! Orthodontics can improve your smile at any age. Approximately 25% of our orthodontic patients are adults. We offer several advanced braces to effectively move adult teeth. According to the American Association of Orthodontists, nearly 1,000,000 adults in the United States and Canada are currently receiving orthodontic treatment.

2. How does adult orthodontic treatment differ?

Adults are no longer growing, and may have experienced some breakdown or loss of teeth or bone. If this is the case, orthodontic treatment may be only a portion of the patient’s treatment plan. Overall treatment may be coordinated between our orthodontist Dr. Eves, a periodontist, oral surgeon, an endodontist and the general dentist. This ensures that the patient’s case is managed well and complements every area of their treatment needs. The following conditions can cause adult orthodontic treatment to differ from children and adolescent treatment:

  • Worn, damaged or missing teeth-Teeth that are worn, damaged or missing can complicate treatment, but can also make treatment necessary. Teeth may progressively wear and move into locations where they can only be restored following orthodontic treatment. Teeth that are damaged or broken may not even look good or function appropriately even following treatment, unless they are restored by a dentist. Missing teeth that are not replaced often causes gradual tipping and drifting of other teeth, which worsens alignment, increases the chance for periodontal problems and further complicates treatment.
  • No jaw growth-While children can benefit from orthopedic growth appliances to manage jaw growth, adults may need surgery if the problem is severe. For instance, if an adult’s lower jaw is much shorter than the upper jaw, a severe bite problem can occur. Braces alone may not correct this problem. Jaw surgery may be necessary to bring the lower teeth forward, thus lengthening the lower jaw, and bringing the lower teeth forward into the correct bite. Other cases of jaw-width or jaw length discrepancies may also require surgery if orthodontics alone cannot correct the bite.
  • Gum or bone loss-Adults are more likely to experience loss or damage of the gum and bone. This may require treatment from the dentist or periodontist prior to, during and/or after orthodontic treatment. Loss of bone can limit the amount and direction of tooth movement that is desirable.

3. My general dentist said I need to have some missing teeth replaced, but I need orthodontic treatment first, why?

When teeth are lost, it is common for the remaining teeth to tip, drift or shift, thus resulting in poor alignment and uneven spacing that cannot be adequately restored until missing teeth are replaced. Tipped teeth typically need to be straightened so they can stand up to normal biting pressures in the future.

Your general dentist may recommend orthodontic treatment, so he or she can treat you in the best way possible, to improve the health of your smile. Many complex restorations, such as crowns, implants and bridges are better accomplished when the remaining teeth are aligned properly.

4. I’ve had crooked teeth for years. How can orthodontics benefit me now?

If orthodontic treatment is indicated, it can be a positive step for adults who have endured problems for a long time. Orthodontics can restore proper function. Teeth that function better typically look better. A beautiful, healthy smile can boost a patient’s self-esteem at any age.

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General Information about Orthodontics

1. What is orthodontics

Orthodontics is the branch of dentistry focused on the diagnosis, prevention and treatment of dental and facial abnormalities. “Malocclusion” is the technical term for these problems. Malocclusion means “bad bite.” The profession of orthodontics requires expertise in the design, application, and control of corrective appliances, including braces. These appliances are designed to bring teeth, lips and jaws into proper position, and to attain facial balance.

2. What is an orthodontist?

All orthodontists are dentists, but only roughly six percent of dentists are orthodontists. Orthodontists have the training to diagnose, prevent and treat dental and facial abnormalities. Orthodontists must attend college, and then complete a four-year graduate dental program at a university dental school or another institution credited by the Commission on Dental Accreditation of the American Dental Association (ADA). Orthodontists must then complete an additional two-to-three year residency program in orthodontics, which must be accredited by the ADA. During this residency, the orthodontist learns the skills necessary to control tooth movement and guide facial development.

3. Who can have orthodontic treatment?

Adults and children can benefit from orthodontic care, because healthy teeth can be moved at an age. The American Association of Orthodontists recommends all chidren have their first orthodontic screening no later than age 7. Some orthodontic problems are easier to correct when treated early. Postponing treatment until facial growth is nearly complete, or until all the permanent teeth have erupted can make treatment more difficult.

4. What causes bad bites?

Generally, most malocclusions are hereditary, but some are acquired. Inherited problems include crowding, too much space between teeth, missing or extra teeth, and a broad range of teeth, facial and jaw irregularities.

Acquired bad bites can occur as a result of accidents, thumb, finger or pacifier sucking, dental disease, airway obstruction by the adenoids and tonsils, or premature loss of baby teeth and permanent teeth. Whether hereditary or acquired, many of these problems have an effect the bite, facial development and appearance.

5. What are the most commonly treated orthodontic problems?

  • Spacing-Spacing between teeth can occur as a result of missing or small teeth, or a dental arch that is very wide. Persons with excessive spacing most commonly complain about poor appearance.
  • Crossbite-Crossbites of the back and front teeth are often corrected early to resolved biting and chewing difficulties. The most common type of crossbite is when the upper teeth sit inside the lower teeth.
  • Lower jaw protrusion or Underbite-This occurs when the lower jaw is longer than the upper jaw, causing the lower front teeth to protrude ahead of the upper front teeth, resulting in a crossbite. Jaw growth and tooth development must be closely monitored.
  • Overjet or protruding upper teeth-Upper front teeth extending beyond the lower front teeth are susceptible to injury, and may be a sign of uneven jaw growth and a poor bite of the back teeth. Generally, protruded upper teeth are linked to a lower jaw that is short in relation to the upper jaw. Overjet can also occur as a result of thumb or finger sucking.
  • Openbite-This type of bite is characterized by upper and lower front teeth that do not touch when biting; causing all the chewing pressure to be placed on the back teeth. An openbite makes chewing difficult and can significantly impact tooth wear.
  • Deep overbite-This type of bite occurs when the lower front teeth bite too close or into the gum tissue behind the upper teeth. If the lower front teeth bite into the roof of the mouth, or in the tissue behind the upper front teeth, considerable bone damage and discomfort can occur. A deep overbite can also cause excessive wear of the front teeth.

6. Why is orthodontic treatment important?

Crooked and crowded teeth are difficult to clean, and could contribute to conditions that cause tooth decay and ultimately periodontal disease and tooth loss. Other orthodontic problems can contribute to abnormal tooth wear, impede proper chewing, cause excessive stress on the gum tissue and supporting bone, or affect jaw joint alignment. These conditions may cause neck or facial pain or chronic headaches.

If orthodontic problems are not treated, they become worse. Treatment by an orthodontist to correct the problem early on is often less expensive than additional dental procedures needed to treat more serious problems that could develop later on.

The most visible benefit of undergoing orthodontic treatment is the improved appearance and self-esteem that comes from a straight, beautiful smile! It is commonly observed and reported that improved appearance can help a person’s academic, professional and personal success, and that one of the most significant factors of appearance is a wide, bright smile. Having a beautiful smile can help a patient look and feel better about themselves, which can have a significant impact on every aspect of their life.

7. How much does orthodontic treatment cost?

The cost of treatment can vary, depending on the severity of the patient’s condition and the type of treatment. Orthodontic treatment is an excellent investment in an individual’s overall dental, medical and psychological health and well being. Because of this, we believe financial considerations should not be an obstacle to obtaining this important health service. Being sensitive to the fact that different patients have different needs in fulfilling their financial obligations, we provide a variety of affordable payment options. We will thoroughly discuss fees and payment options with you before any treatment begins.

8. How long does orthodontic treatment take?

Typically, active orthodontic treatment lasts one to two years. Early treatment can be completed within a few months. Actual treatment time depends on patient compliance, the growth of the patient’s face and mouth, and the severity of the condition. Mild cases generally require less treatment time. Some patients respond to treatment faster than others. Patient compliance with the use of rubber bands and other appliances is essential for completing treatment as scheduled.

Although orthodontic requires a time commitment, the benefits are healthy teeth, a properly aligned jaw and a beautiful smile. Teeth and jaws that are aligned properly look better and function well, contribute to overall physical health and can boost self-esteem.

9. How is treatment completed?

Dr. Eves will prescribe and design braces or appliances that are customized for the specific treatment plan. Braces may be fixed or removable, and made of metal or ceramic. Braces gradually move teeth into the proper alignment by placing a constant, gentle force on teeth and the supporting bone.

Orthodontic appliances, such as the herbst appliance and palatal expander are utilized to guide the jaw growth and development of children and teenagers.

10. Are less noticeable braces available?

Orthodontics is more popular than ever. This popularity is due to the overwhelming success of improved treatments and technology. Today’s braces and wires are smaller, less noticeable and more efficient than those of the past. Braces can be tooth-colored or metal, depending on the patient's preference. In our office, we use Damon® Braces (Damon Clear, Damon Q), which are smaller and more efficient than traditional braces. For patients with minor orthodontic concerns, we offer Invisalign®, a series of virtually invisible, removable aligners, which gradually straighten teeth without metal or wires.

11. How have innovative “high-tech” wires changed orthodontics?

Stainless steel wires are no longer the only wires being used. Currently, many of the wires used are made of “space-age” materials that apply a fixed, gentle pressure on teeth; making orthodontic treatment faster and more comfortable. These wires are made of alloys of titanium, nickel, copper and cobalt. Some are heat-activated. Initially NASA engineered nickel-titanium alloy to automatically stimulate the antennae or solar panels of a spacecraft orbiting into the sun’s rays. These advanced wires also significantly reduce the number of appointments required during treatment.

12. Are braces painful?

Compared to traditional braces, most patients experience mild discomfort after Damon braces are placed. After braces are placed, teeth may be sore and biting pressures may be tender for a few days. Pain medications commonly taken for a headache can reduce discomfort. Following braces placement, the cheeks and lips may also become irritated for one to weeks as they toughen and adjust to the surface of the braces. In general, most patients experience mild, temporary discomfort after Damon braces are placed.

13. How can I best take care of my braces during treatment?

Avoid hard and sticky foods. Do not chew on pencils, pens or fingernails. Chewing on hard objects can damage braces, which can prolong treatment time and require extra office visits.

Practicing proper oral hygiene each day will ensure that the teeth and gums remain healthy during treatment. Patients who do not clean their teeth properly may need to visit the dentist more often for a professional cleaning.

We will teach patients the proper oral hygiene techniques to preserve the health of their gums, teeth and braces during treatment. We teach patients and/or parents how often to brush and floss, and if needed, recommend other cleaning aids that may help the patient maintain good dental health.

14. How important is patient compliance during treatment?

Successful requires a mutual effort by Dr. Eves and the patient. To ensure optimal results are achieved, the patient must clean their teeth daily, wear elastics and other appliances as instructed, attend all scheduled appointments, and take care of braces and/or appliances. Damaged appliances can prolong treatment time and affect the overall outcome of treatment.

To preserve the health of teeth and gums, patients must continue to visit their general dentist for professional cleanings. Adult patients with a history or concerns about gum disease may also need to see a periodontist during treatment.

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