AT WHAT AGE SHOULD MY CHILD BE SEEN BY DR. SMITH?
The American Association of Orthodontists recommends that your child be evaluated by age seven. Early detection of some orthodontic problems is important in order to take early corrective action and avoid more difficult treatment later. For most patients, however, treatment is initiated during adolescence between the ages of 10-12.

WHAT ARE THE BENEFITS OF ORTHODONTIC TREATMENT FOR MY CHILD?
The benefits of timely orthodontic treatment for your child may include the following:

• Improve your child's psychological self-image and self-confidence
• Improve speech and the ability to chew food efficiently
• Influence growth of the jaws in a positive manner
• Reduce appearance-consciousness during critical developmental years
• Preserve or gain space for erupting permanent teeth
• Improve access for oral hygiene to prevent the development of cavities and gum disease
• Reduce tooth wear by reducing clenching and/or grinding
• Reduce the tendency for progressive shifting of teeth
• Reduce potential for damage to jaw joints
• Reduce or eliminate the need to extract permanent teeth
• Lower the risk of injury to protruded front teeth
• Correct harmful oral habits
• Improve the width of the dental arches
• Reduce the likelihood of impacted permanent teeth
• Guide permanent teeth into more favorable positions
• Improve lip closure and reduce lip strain
• Take advantage of cooperation before the late teenage years

If you notice a problem with your child's teeth or if your dentist recommends you bring them to an orthodontist, it is in your child’s best interest to make the appointment. If no orthodontic action is taken, treatment options become limited, more difficult, and the long-term stability may be compromised. In addition, it may lead to extractions, oral surgery and increased costs.

Everyone wants and deserves a beautiful smile, and everyone should have a healthy one. We can be reached at 739-3900 to inquire further about the process.

HOW DO I KNOW IF MY CHILD IS IN NEED OF ORTHODONTIC TREATMENT?
It is usually difficult for you to determine if treatment is necessary because there are many problems that can occur even though the front teeth look straight. Also, there are some problems that look intimidating and complex which will resolve on their own. Asking your general dentist is a good reference, but we are your best resource since orthodontics is a specialty and it is all that we do. At Tollgate Orthodontics, your child's initial exam is complimentary and we would be more than happy to see your child and make any necessary recommendations.

WHAT ARE THE EARLY SIGNS OF ORTHODONTIC PROBLEMS?
Although determining if treatment is necessary is difficult for you to assess, the following symptoms may help in prompting you to seek our orthodontic advice. Ask your child to open their mouth and let you look at their teeth. If you see any signs of crooked teeth, gaps between your child's teeth or overlapping teeth, your child may need orthodontic treatment. Ask your child to bite all the way down, but keeping their lips open so you can see their teeth. Do the front top teeth line up with the bottom? Do the top teeth protrude out away from the bottom teeth? Do the top front teeth cover more than 50% of the bottom teeth? Are the top teeth behind the bottom teeth? All these are indicators for potential orthodontic treatment. Look at the alignment of your child's jaw. Does the jaw shift off center when your child bites down? If you see any misalignment, shifting or asymmetry of the jaw, your child may have a skeletal problem that requires orthodontic intervention.
These are some of the more obvious symptoms of orthodontic problems.

WHAT CAUSES A MALOCCLUSION OR FACIAL IRREGULARITY?
Malocclusions are inherited (genetic) or acquired (resulting from events after birth).
Inherited problems include:

• A discrepancy between the size of the jaws and the size of the teeth, resulting in crowding or spacing
• Extra or missing teeth
• Jaw growth problems; when one jaw grows more or less than the opposing jaw
• Cleft palate and other jaw or face irregularities

Acquired problems include:

• Premature loss of primary or permanent teeth
• Dental disease
• Thumb or finger sucking
• Tongue thrusting
• Breathing problems caused by enlarged tonsils and/or adenoids?

WHY SHOULD I BE CONCERNED ABOUT A BAD BITE OR MISFIT OF MY CHILD’S TEETH?
Bad bites can be detrimental to a patient's dental health by possibly causing premature wear on the teeth, asymmetrical jaw growth, difficulty in oral hygiene, or a malfunctioning bite. Orthodontics will align your child's teeth for optimum function, hygiene, appearance, and long-term stability.

WILL ADDITIONAL JAW GROWTH ALLOW FOR SELF-CORRECTION OF CROWDED TEETH OR OTHER BITE PROBLEMS?
Typically, this does not occur for the front teeth. In most children, the available space decreases as larger permanent teeth erupt. The jaws do, however, grow in the back to allow for the eruption of the 12-year molars and wisdom teeth.

When left untreated, orthodontic problems usually become progressively worse. Orthodontic treatment to correct bite problems is often less costly than the additional dental care required to treat the more serious problems that can develop later in life.

WHAT IS PHASE I (EARLY/INTERCEPTIVE) TREATMENT?
Phase I or Interceptive Treatment usually starts while the child has most of their baby teeth and a few of their permanent front incisors. This stage in development is usually about the age of seven (7) to ten (10). The goal of Phase I treatment is to intercept a moderate or severe orthodontic problem early in order to reduce it's severity. In most cases where early orthodontic treatment is recommended, the immediate treatment objective will be one of the following:

• to correct jaw disproportion before aligning teeth
• to prevent injury to protruded front teeth
• to manage crowding and prevent permanent tooth extraction, whenever possible
• to eliminate damaging oral habits
• to improve a child's psychological self-image and self-esteem/self-confidence

With these problems, timely treatment takes advantage of the early growth spurt and turns a difficult orthodontic problem into a more manageable one. This helps reduce the need for extractions or surgery and delivers better long-term results and treatment options.

DOES EVERYONE NEED A PHASE I TREATMENT?
Absolutely not! Only certain bites require early intervention. All others can, and should, wait until most or all their permanent teeth erupt.

CAN I WAIT ON PHASE I/INTERCEPTIVE ORTHODONTIC TREATMENT UNTIL MY CHILD IS OLDER?
This is not recommended. If your child needs Phase I treatment this usually means that he or she has a difficult problem that requires attention now. If no orthodontic action is taken, treatment options become limited, more difficult, and the long-term stability may be compromised. In addition, it may lead to extractions, oral surgery and increased costs.

IS IT REQUIRED THAT I BE REFERRED BY MY FAMILY DENTIST TO SCHEDULE AN APPOINTMENT WITH DR. SMITH?
No. Many patients who have concerns about their health and appearance and want to be evaluated as to the need for orthodontic care take the initiative themselves to schedule an initial examination.

HOW DO I SCHEDULE AN APPOINTMENT FOR AN INITIAL EXAM?
If you think you or your child would benefit from orthodontic treatment, simply call our office at 739-3900 and we will be happy to schedule an appointment for you. During the call to schedule your appointment, our administrative staff will gather some very basic information regarding you and your child.

IS THERE A COST FOR THE INITIAL EXAMINATION?
No. There is no cost for the initial examination.

WHAT WILL HAPPEN AT THE INITIAL EXAMINATION APPOINTMENT?
Dr. Smith will conduct a thorough examination of the patient's mouth to determine if there is a need for orthodontic treatment. He will be looking to determine if there is enough room to accommodate all of the teeth, if the top teeth are lined up correctly with the bottom teeth, if any teeth are crooked or not growing in the right position and if there are missing or extra teeth? He will also be asking the patient if they are experiencing any breathing problems, have they had any finger or tongue habits and have they experienced any jaw joint problems?

WHAT WILL I LEARN FROM THE INITIAL EXAMINATION?
There are five important questions that will be answered during the initial examination:

• Is there an orthodontic problem and, if so, what is it?
• What must be done to correct the problem?
• Will any permanent teeth need to be removed?
• How long will the treatment take to complete?
• How much will the treatment cost?

In addition to these, Dr. Smith will take the time to answer any other questions a patient or parent may have.

WHAT ORTHODONTIC RECORDS ARE ESSENTIAL TO PROPERLY DIAGNOSE AND TREAT EACH PATIENT’S INDIVIDUAL ORTHODONTIC PROBLEM AND CONSTRUCT A TREATMENT PLAN?
ORTHODONTIC RECORDS
Orthodontic records include a panoramic x-ray, a cephalometric x-ray, models of the teeth, three (3) facial photographs and six (6) intraoral photographs. Pre-treatment orthodontic records are essential for Dr. Smith to properly diagnose and treatment plan each patient's individual orthodontic problem and treatment needs. Some orthodontic records may be taken again during the course of treatment or after the completion of treatment.

Panoramic X-rays

Cephalometric X-rays

Impressions

Facial Photographs

Intraoral Photographs

PANORAMIC X-RAY
A panoramic x-ray enables Dr. Smith to see the roots of the teeth and the position of any unerupted teeth. Any missing or extra teeth will be identified on this x-ray. Panoramic x-rays are an excellent way to determine the best time to begin your child’s orthodontic treatment.



CEPHALOMETRIC X-RAY
Cephalometric x-rays are used by Dr. Smith to make angular and linear measurements of a patient's hard and soft tissue utilizing various landmarks. Examples include the angles of the teeth in relation to the skull and jaw structures and the assessment of the facial profile. Each patient's measurements are compared to normal values



IMPRESSIONS
Impressions are molds of your child’s teeth that are used to make plaster study models. Dr. Smith uses the models to help in treatment planning. Impressions are almost always made before and after orthodontic treatment. Orthodontic appliances such as expanders and retainers are made on models of your child’s teeth.



FACIAL PHOTOGRAPHS
Facial photographs enable Dr. Smith to identify and analyze various features of your child’s face and smile. Facial asymmetries, "gummy" smiles and profile imbalances are identified using facial photographs. These pre-treatment photographs also provide a way to assess the progress of treatment.



INTRAORAL PHOTOGRAPHS
Photographs of your child's teeth are used, along with study models, to help Dr. Smith accurately evaluate the malocclusion. These photographs are extremely valuable to assess the progress of treatment.



WILL I HAVE TO HAVE ANY TEETH REMOVED FOR BRACES?
Because today's technology has resulted in advanced orthodontic procedures, the need for removing teeth has been greatly reduced. However, removing teeth is sometimes needed to get the best orthodontic result. Straight teeth and a balanced facial profile are always the goal.

WILL MY CHILD NEED AN EXPANDER?
At the completion of the initial examination, Dr. Smith will determine whether a patient will require an expander or not.

WHAT IS PHASE ONE (EARLY) TREATMENT? WHAT IS THE LENGTH OR DURATION OF PHASE ONE/EARLY TREATMENT?
Phase One treatment is usually initiated for children between the ages of seven (7) and ten (10). The objectives of Phase One treatment include the correction of harmful habits (e.g., thumb/finger sucking, tongue thrusting), the correction of skeletal relationships ("crossbites, overbites, underbites, open bites," etc.) between the upper and lower jaws, the development of space to accommodate the permanent teeth, and improvement in a child's psychological self-image and self-esteem, both very important during their formative years. Generally, Phase I/Early Treatment lasts from 4 to 16 months, or longer, depending on the age of the patient, the severity of the problem, the patient's cooperation, and the degree of movement possible.

IF MY CHILD HAS EARLY TREATMENT, WILL ADDITIONAL TREATMENT BE NECESSARY?
In most cases, yes. After the permanent teeth have erupted, treatment is usually necessary to complete the work that was started in the earlier phase. The objective of continued treatment is to place the permanent teeth in positions of optimal function, comfort, esthetics and long-term stability.

HOW MUCH WILL BRACES COST? ARE FINANCING OPTIONS AVAILABLE? HOW DOES MY INSURANCE WORK?
It is impossible to give an exact cost for treatment until Dr. Smith has actually examined your child. The exact cost and financial options will be discussed at the initial examination. We have many financing options available to meet most needs and we will be happy to review them with you. We do file insurance on your behalf. We also offer a courtesy (discount) for fees paid in full within the first three months of treatment. Proper orthodontic treatment to correct a problem is often less costly than the additional dental care required to treat the more serious problems that can develop in later years.

HOW OFTEN WILL MY CHILD HAVE APPOINTMENTS?
Appointments are scheduled according to each individual patient's needs. With the latest technology, most patients in braces today will be seen every eight-to-ten (8-10) weeks. If there are specific situations that require more frequent monitoring, appointments may be scheduled more often.

CAN MY CHILD HAVE ALL HIS/HER APPOINTMENTS AFTER SCHOOL?
This is a very common question. Unfortunately, we cannot schedule all appointments for all student-patients for after school hours. However, because most appointments are scheduled eight-to-ten (8-10) weeks apart, most patients miss very little school because of orthodontic appointments. We reference all of the area school calendars at the front desk and try very hard to help in all possible ways to assist patient scheduling.

CAN I DROP MY CHILD OFF FOR AN APPOINTMENT?
We are very understanding of busy schedules and working parent's desires to run errands while their child is at our office. If you have a cell phone and provide us with the number, we can reach you by page or phone when it is time to return. On some occasions, Dr. Smith may want to speak with parents when you return. So please, we request that parents check in with the front desk staff as they schedule their next appointment.

HOW DO BRACES WORK?
Braces are bonded (cemented or adhered) directly to each tooth and arch wires connect all the braces. Unlike what most people think, it is the arch wire that does the work -- the braces merely serve as handles! The wires use a gentle, continuous pressure to move teeth into their proper positions. Much like moving a stick through sand, as the tooth moves, bone gives way on one side and fills in on the other side. It is truly amazing! Elastics (“rubber bands”) are sometimes worn to help the wires do their job to align the upper teeth with the lower teeth.

DO BRACES HURT?
With the latest technology, many of our patients do not report any soreness at all following the majority of their visits! For some visits, however, teeth may be sore for a day or two. In these situations, discomfort can be managed with medications such as ibuprofen (e.g., Advil, Motrin) or acetaminophen (e.g., Tylenol). We often remind our patients that “it does not have to hurt to work! “

CAN MY CHILD RETURN TO SCHOOL THE DAY BRACES ARE PLACED?
Yes. There is no reason to miss school because of an orthodontic appointment.

DO YOU GIVE SHOTS?
No. No shots are necessary in orthodontic treatment.

DO YOU USE RECYCLED BRACES?
Absolutely not! It is our belief that each patient should be provided with their own braces to achieve the very best orthodontic result possible. Dr. Smith would never use worn, used or recycled braces.

CAN MY CHILD PLAY SPORTS AND/OR MUSICAL INSTRUMENTS WHILE IN BRACES?
Yes! We will provide your child with a mouth guard for all sports. If your child plays an instrument such as a trumpet, we will provide you with a "lip protector" that works very well to cushion the lips from the braces. Please inform us when your child needs a mouth guard or lip protector.

DOES MY CHILD NEED TO SEE OUR FAMILY DENTIST WHILE WEARING BRACES?
Yes. Regular check-ups with your family dentist are very important while in braces. Your family dentist will assist in determining how often you should be seen for cleaning appointments while you are in braces.

ARE THERE FOODS MY CHILD CANNOT EAT WHILE WEARING BRACES?
Yes. Once treatment begins, very complete instructions will be provided regarding foods to avoid. Click to View a List of Items to Avoid While Wearing Braces. Many emergency appointments to repair broken or damaged braces can be avoided by carefully following instructions regarding foods.

HOW OFTEN SHOULD I BRUSH MY TEETH WHILE IN BRACES?
Patients should brush their teeth at least four times each day: after breakfast, lunch (or as soon as they get home from school), supper and before going to bed. We will show each patient how to floss their teeth with braces on and will also provide a prescription for a special fluoride gel to help protect the teeth.

> WHAT IS AN EMERGENCY APPOINTMENT? HOW ARE THOSE HANDLED?
If something happens and your child’s braces are causing discomfort or if something is broken, you should call our office (739-3900). In most cases, these issues are simple to resolve and often do not require a special visit.

WHAT IF THE EMERGENCY OCCURS AFTER NORMAL OFFICE HOURS?
Our office is available after normal working hours. Simply call the office and wait for the answering machine to answer. The recorded message will give you the number where we can be reached.

WILL MY CHILD HAVE TO WEAR RETAINERS?
Orthodontics is a process of moving teeth through the bone into their new positions. Once the teeth have been moved into their desired positions, retainers will be placed to maintain the correction. Once stabilization occurs, we encourage our patients to continue to wear their retainers on a nightly basis to maintain their beautiful smile.

CAN ORTHODONTIC CORRECTION OCCUR WHILE A CHILD STILL HAS SOME BABY TEETH?
Yes. However, we do not require braces for every patient who visits our office. Some orthodontic problems are significant enough to require early intervention. However, if a patient is not yet ready for treatment, we will follow that patient's growth and development until the time is appropriate for treatment to begin.

WILL MY CHILD NEED FULL BRACES IF HE/SHE HAS PHASE ONE TREATMENT?
It is best to assume that your child will need full braces even after Phase One treatment. The period of time following Phase One treatment is called the "resting period," during which growth and tooth eruption are closely monitored. Throughout this period, parents and patients will be kept informed as to any future treatment recommendations.

WHAT IS PHASE II TREATMENT?
Phase II treatment usually occurs a couple years following phase I and involves "full" braces. Typically, we are waiting for 12-16 more permanent teeth to erupt before Phase II begins. This most commonly occurs between the ages of 11-13. The goal of Phase II treatment is to achieve an ideal occlusion ("bite") with all of the permanent teeth. Achieving this produces optimal function, esthetics and long-term stability of the teeth.

WHY SHOULD YOU SELECT DR SMITH TO BE YOUR ORTHODONTIST?
Teeth and sometimes entire facial structures are permanently changed by orthodontic treatment. It is very important that the treatment be appropriate and properly completed. Dr. Smith graduated from Georgetown University Dental School and elected to complete three (3) additional years of specialty training to become an orthodontist. It is notable that The Consumer’s Research Council of America, a Washington, D.C. based research organization, selected Dr. Smith as one of the BEST oral health care specialists (orthodontists) in the United States. He is a member of the American Association of Orthodontists, the only certifying organization recognized by The American Dental Association, and has successfully provided orthodontic treatment to several thousand patients since opening his practice in 1990.