Patient Corner

Hygiene

ORAL HYGIENE

Food particles and plaque naturally accumulate on the teeth and on braces. This process could lead to tooth decay and/or gum disease. Proper oral hygiene is vital to prevent these problems from occurring during your orthodontic treatment. The extra effort you give to keep your teeth, braces and gums clean and healthy will result in a much better orthodontic outcome.

Brushing
Flossing
Interdental Toothbrush
Mouth Rinse
Topical Fluoride
Cleaning a Removable Appliance

BRUSHING

Dr. Smith recommends that you use a soft bristled toothbrush with moderate force and a toothpaste that contains fluoride. Place the toothbrush at an angle so that you feel the bristles under your gum line and use small circular motions. Completely clean each surface of every tooth in your mouth, including the areas above, below and between each brace. Each surface of every tooth should be scrubbed with 10 strokes of the toothbrush. This should take 2-3 minutes.

Dr. Smith recommends that you brush at least 4 times per day: after breakfast, after lunch (or as soon as you get home from school), after supper and at bedtime. Your toothbrush will wear out faster because of your appliances, so be sure to replace it whenever the bristles start to fray.

1. Use a soft toothbrush with a small amount of toothpaste. Completely clean each surface of every tooth in your mouth, including the areas above, below and between each brace.	2. Use circular, vibrating motions around the gum line. Scrub each surface of every tooth with 10 strokes of the toothbrush. This should take 2-3 minutes.
3. Brush every tooth slowly. Brush the upper teeth down.	4. Brush the lower teeth up. Also brush your tongue and the roof of your mouth

Remember that a toothbrush might not reach the areas under the archwire properly. Proper oral hygiene also involves flossing and the use of an interdental toothbrush (Proxabrush), an antiseptic mouth rinse (Peroxyl) and a topical fluoride (Phos-Flur)!
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FLOSSING

Dental floss is a nylon thread that is used to remove food particles and plaque from between the teeth. Flossing is more difficult when you have braces on your teeth. A floss threader may be needed to get the floss under the archwire. Dr. Smith will provide these for you (note: floss threaders are reusable). Use a piece of floss about 12 inches long. Use the floss threader to get the floss under the wire. Slide the floss up and down along the tooth surface. When the tooth is clean the floss will "squeak" as you slide it up and down along the tooth surface. Be very careful to not pull with too much force on your archwire.

Flossing is important and should be done every day. The best time to floss is before bedtime after brushing to remove the plaque missed by brushing. This process will take more time than flossing without braces. If your gums are not healthy, they may bleed the first few days you floss. Remember that consistent brushing and flossing will result in a great orthodontic smile!
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1. Carefully pull waxed floss between wire and braces.

2. Floss carefully around the gum area.

INTERDENTAL TOOTHBRUSH

An interdental toothbrush (Proxabrush) is another aid you may find useful to keep your teeth, braces and gums clean and healthy. It can be used to clean under orthodontic wires and around braces. Use this device slowly so you do not damage your braces.
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ANTISEPTIC MOUTH RINSE (PEROXYL)

Peroxyl is an antiseptic dental rinse (active ingredient: hydrogen peroxide 1.5%) used in orthodontics to control minor gum inflammation and irritations from orthodontic appliances. It is also used to cleanse canker sores and minor wounds or other irritations of the mouth and gums such as mouth burns, cheek bites and toothbrush abrasions. Its oxygenating action removes debris allowing natural healing to occur.

Dr. Smith recommends that you rinse with half a capful (two (2) teaspoons) around in the mouth for at least one (1) minute, then spit out. Use up to four (4) times daily after meals and at bedtime while wearing orthodontic appliances.
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TOPICAL FLUORIDE (PHOS-FLUR)

Phos-Flur is a topical fluoride gel (active ingredient: 1.1% sodium fluoride) used in orthodontics as a dental caries preventive. It is not a substitute for tooth paste. Its action is twofold: to re-mineralize tooth enamel which has been exposed to bacterial acids and to act as an antibacterial agent.

Dr. Smith recommends that you apply a thin ribbon of Phos-Flur Gel to the teeth with a toothbrush for at least one (1) minute at bedtime, then spit out. Drinking and eating are not recommended for thirty (30) minutes after using Phos-Flur, since doing so will dilute or rinse away the active ingredient.
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CLEANING A REMOVABLE APPLIANCE

All orthodontic appliances tend to accumulate food particles and plaque just like teeth do. Every time you brush your teeth, brush your removable appliance. Once a day you should soak your appliance in a glass of room temperature tap water with a denture-cleaning tablet, such as Polident or Efferdent. This will help prevent plaque buildup and oral infections and will keep your appliance tasting better.
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Serving the Providence, Rhode Island area including Cranston, Coventry,
East Greenwich, Johnston, North Kingstown, Warwick, and West Warwick areas

500 Tollgate Road, Warwick, Rhode Island (RI) 02886 • 401.739.3900 fax 401.739.8626

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Diet

EATING HABITS

For most situations, common sense will tell you what to avoid. Hard foods, sticky foods and foods high in sugar must be avoided. Hard foods can break or damage wires and brackets. Sticky foods can get caught between brackets and wires. Minimize sugary foods; they cause tooth decay and related problems. Nail biting, pencil and pen chewing, and chewing on foreign objects should be avoided. .

Absolutely No:
Sticky Foods (sugarless or otherwise): Gum Caramels Sugar Daddies Starbursts Caramel Apples Sugar Babies Licorice Toffee Tootsie Rolls etc.	Hard Foods: Jolly Ranchers Jaw Breakers Lolli-pops Nuts Bagels Apples (unless cut up) Pizza Crusts Carrots (uncooked, unless cut up) Doritos Pretzels etc.
To Minimize Sugar Intake:
Eat Less: Candy Ice Cream Cake Cookies Pie	Drink Less: Soda Drinks with sugar

Check your braces occasionally for anything loose or bent. If a brace comes loose or you break a wire, please call our office so that we can arrange an appointment long enough to repair it. Be as specific as possible with the receptionist. If you lose your rubber bands, call us so we can mail you some more or drop by the office and pick some up.

BRUSHING

You will notice that it is much harder to keep your teeth clean with braces. Food collects around the braces and between your teeth, and can only be removed by brushing and flossing. If plaque remains on the teeth for any length of time, it will leave a permanent white scar on the tooth surface. Brushing after meals should become part of your daily schedule.
Click here for brushing and flossing instructions.

SORE TEETH

After braces are placed in the mouth it is normal for the teeth to be sore for about 1 to 3 days. Tylenol or Advil will help relieve this discomfort. Some irritation to the cheeks and/or lips is normal, but if you feel anything sharp poking you or any sores developing, please call our office at 401-739-3900.

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Managing Discomfort

EMERGENCIES:

It is Dr. Smith's desire that you never have an orthodontic emergency and, in reality, orthodontic emergencies are relatively rare. However, in the event that something does occur where you need emergency care our office is on call 24 hours per day, every day of the year. Please call the office if an emergency occurs during office hours @ 739-3900. If an emergency occurs after business hours, please call the office @ 739-3900 and our answering service will direct you to a telephone number where we can be reached.

Pain in the Teeth
Pain in the Gums
Temporomandibular Joint (TMJ) Pain
Sore Places in the Cheeks
Sore Places on the Lips
Sore Places on the Tongue
Loose Brace or Bonded Appliance (e.g., palatal expander)
Loose Archwire
Loose or Broken Retainers or Removable Appliances
Swallowed Parts
Wax
Swollen Gums
Unusual Movement of Your Teeth
Allergies

PAIN IN THE TEETH

Sore teeth during orthodontic treatment is normal and results from the forces placed on the teeth to move them. You or your child are most likely to experience sore teeth for 1 to 3 days after the braces are first placed and occasionally after a routine orthodontic visit. An anti-inflammatory medication such as ibuprofen (e.g., Advil, Motrin) is very good at reducing the soreness. Also, avoid hard or chewy foods while your teeth are sore. If you experience intense pain or if the soreness persists longer than you think is normal, please call Dr. Smith.
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PAIN

IN THE GUMS

Pain in the gums during orthodontic treatment is not normal. One possible cause is food trapped under a brace or beneath the gum line. Rinse your mouth several times per day with warm salt water and/or a mouthwash, such as Peroxyl. Brush your teeth and gums with a soft toothbrush and use dental floss and/or an interdental toothbrush (Proxabrush) to dislodge the food. If you experience severe pain or if the pain lasts longer than a few days, please call Dr. Smith.

TEMPOROMANDIBULAR JOINT

(TMJ) PAIN

Pops, clicks and discomfort are sometimes felt in the TMJ(s) ("jaw joint(s)") while undergoing orthodontic treatment. These symptoms are usually transient because the teeth and jaw structures are moving into better alignment as orthodontic treatment progresses. Please note, if the pain in the TMJ(s) is persistent or severe, call Dr. Smith. You or your child may need to be seen for an extra visit.
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SORE PLACES IN THE CHEEKS
Braces and some other orthodontic appliances can sometimes irritate the inside of the cheek, especially during the first few days following the placement of braces. A sore spot may develop due to the orthodontic brackets or wires. To help the sore spot heal, place wax on the part of the brace adjacent to the sore spot. Please refer to the topic "Wax" in the Emergencies section for complete instructions on the use of wax. If the wax does not help or if the sore spot seems to get worse, please call Dr. Smith.
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SORE PLACES ON THE LIPS
During the first week of wearing your braces, your lips may be irritated from the brackets on your front teeth. If a sore spot develops on your lip, cover the part of your brace adjacent to the sore spot with wax and lubricate your lips with Vaseline or Chap Stick. Please refer to the topic "Wax" in the Emergencies section for complete instructions on the use of wax. If these steps do not help or if the sore spot seems to get worse, please call Dr. Smith.
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SORE PLACES ON THE TONGUE
Some of your orthodontic appliances may have parts that are on the surfaces of your teeth toward the tongue. This is called the lingual surface. These parts may irritate the tongue for several days as you get used to your braces. To help the sore spot heal and to let your tongue get used to your braces, place wax on the the brace that is causing the sore spot. Please refer to the topic "Wax" in the Emergencies section for complete instructions on the use of wax. If the wax does not seem to help or if the sore spot gets worse, please call Dr. Smith.

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LOOSE BRACE OR BONDED APPLIANCE (E.G., PALATAL EXPANDER)
In most cases, a loose brace will remain attached to the archwire and is not cause for an emergency visit. Sometimes the brace may move or slide back and forth on the archwire. Tweezers can be used to reposition the brace if it flips around the wire. If tissue irritation occurs, cover the loose brace with orthodontic wax to help the sore area heal. Please refer to the topic "Wax" in the Emergencies section for complete instructions on the use of wax. Note: loose braces cannot support the use of elastics. If a bonded appliance (e.g., a palatal expander) comes loose, it can cause irritation and soreness in the soft tissues.A loose orthodontic appliance will not move the teeth to their proper positions. This can result in a delay in treatment progress. Do not try to fix these problems yourself. It is important to call Dr. Smith to inquire about scheduling an appointment to repair the loose appliance.
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LOOSE OR IRRITATING WIRE
If the main wire has come out of the brace or tube on a back molar tooth, attempt to reinsert the wire with a pair of needle nosed pliers or tweezers. If the wire is not sticking you, place a piece of wax over the area. If the wire is sticking you and wax does not help, the wire can be cut with a small wire cutter or nail clipper close to the back of the last brace. This is a last resort until you can see us for an adjustment

.An archwire that is not attached to a brace will not be moving the tooth as it is supposed to. This can result in a delay in treatment progress.A loose archwire needs to be repaired.

If a wire causes irritation, push the wire away from the area using the eraser end of a pencil or a cotton swab. If the wire cannot be tucked away, cover the end of the wire with a small piece of wax, a cotton ball, or a piece of sugarless gum, until you can see us for an adjustment.Please call Dr. Smith to schedule an earlier appointment.
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LOOSE OR BROKEN RETAINERS OR REMOVEABLE DEVICES
The metal or plastic parts of retainers or removable appliances may break or get bent. This can cause them to function improperly. In these situations, it may be necessary to stop wearing the appliance. Call Dr. Smith. It may be necessary to schedule an earlier appointment to adjust or repair the appliance.
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SWALLOWED PARTS
If you swallow part of your orthodontic appliance, such as a brace or rubber band, it will pass through your system and be harmless, unless you experience difficulty breathing. If you experience difficulty breathing, seek immediate medical help. Get to the nearest medical facility, whether it is Dr. Smith's office or an emergency room.
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WAX
Orthodontic wax is used to cover loose or broken parts of your braces, hooks, newly placed braces, and other orthodontic appliances that may cause soft tissue irritation or sore spots. To use your wax, take a small piece about the size of a pea. Shape it into a ball with your fingers and apply the wax directly to the part of the braces causing the sore spot. Press it around the part and smooth it with your fingers. Please continue to brush even while using wax. Wax is harmless and can be applied to your braces as often as is needed. If you swallow wax it will not harm you!

NOTE: If you happen to run out of wax, sugar free gum can serve as a good alternative.
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SWOLLEN GUMS
It is very important to keep your teeth and gums healthy during orthodontic treatment. Poor oral hygiene may result in swollen and bleeding gum tissue. Gentle and thorough brushing, rinsing with warm salt water and mouthwash (e.g., Peroxyl) will help return the gums to a healthy state. Also, use dental floss to remove any food or debris that may have become trapped under the gum line. Orthodontic tooth movement may also cause swollen gums. If the steps above do not help the situation, please call Dr. Smith.
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UNUSUAL MOVEMENT IN YOUR MOUTH
Your braces are designed to move your teeth in all 3 dimensions. Occasionally a tooth may appear to be moving in the wrong direction. Dr. Smith would advise you to be patient for a few days. Usually this happens at the beginning of treatment. However, undesired tooth movement can occur when part of your braces are broken or damaged. If you think this is the case, please call Dr. Smith. It may be necessary to schedule an earlier appointment to adjust or repair the appliance.
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ALLERGIES
Allergic reactions during orthodontic treatment are very uncommon, but they can occur. Some patients may be allergic to the metal in some appliances or to the latex gloves worn by Dr. Smith and his staff. If unusual or unexplained symptoms such as swelling or redness in your mouth, or a skin rash appear, please call Dr. Smith for advice.
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Glossary

he following Glossary of Orthodontic Terms is provided to assist our patients in understanding more about the process, terms, and technical issues related to Orthodontics.

GLOSSARY OF ORTHODONTIC TERMS Please click on the words to get a detailed description.
A point	first-order	occlusal dysfunction
acromegaly	fixation	occlusal index
acrylic	fixed appliance	occlusal plane
activation	fixed appliance	occlusion
activation site	flush terminal plane	occlusoapical
activator	FMA	onplant
Adams clasp	FMIA	open bite
adolescent dentition	force	OR
adult dentition	franchise dentistry	orbitale
alveolar arch	Fränkel appliance	ortho
alveolar bone	free-way space	orthodontic (orthopedic)
alveolar process	frenectomy	orthodontic appliance
American Association of Orthodontists	frenum	orthodontic attachment
anchorage	friction	orthodontic displacement
Angle classification of malocclusion	frontal cephalometric radiograph	orthodontic force
ankylosis	full treatment	orthodontics/dentofacial orthopedics
anodontia	functional appliance	orthodontist
ANS	functional appliance	orthognathic
antegonial notch	functional jaw orthopedics	orthognathic surgery
anterior cranial base	functional matrix	orthopedic
anterior guidance	functional occlusion	orthopedic appliance
anterior nasal spine	gable bends, tent bends	osseous
anteroposterior	gemination	ostectomy
anthropometry	genial	osteotomy
apical base	genioplasty	overbite
appliance	gingiva	overjet
AR	gingival attachment	palatal bar
arch	gingival display	palate
arch form	gingival graft	palpation
arch length	gingival recession	panoramic radiograph
arch length deficiency	gingivitis	papilla (interdental)
archwire	glenoid fossa	periapical
articulare	gnathion	periodontal ligament
axis of rotation	gnathology	periodontal membrane (or ligament)
B point	GO	periodontal pocket
balancing side	gonial angle	periodontics
band (orthodontic)	graft	periodontium
basal bone	grinding	permanent dentition
basal dysplasia	growth forecast (or prediction)	pharynx
basion	growth potential	PNS
Begg appliance	growth site	PO
Bennett movement	growth spurt	POG
beta-titanium	guidance, developmental	pogonion
bimaxillary dentoalveolar protrusion	guide plane	point A
bimaxillary protrusion	gummy smile	point B
Bimler appliance	habit	porion
bionator	habit therapy	positioner (tooth positioner)
biteblock	habitual occlusion	posterior nasal spine
biteplate	hand-wrist x-ray	postural rest position
Board Certification	hard palate	PPO (Preferred Provider Organization)
bodily movement	Hawley appliance	preangulated bracket
Bolton analysis	Hawley retainer	preventive orthodontic treatment
Bolton point	headcap	primary dentition
Bolton Point	headfilm	proclination
bonding	headgear	prognathic
brachycephalic	Health Maintenance Organization (HMO)	pronasale
brachyfacial (brachyprosopic)	helix	prosthion
bracket	Herbst appliance	protraction
bruxism	high angle malocclusion	protrusion
buccal	high-pull headgear	proximal segment
buccoversion	hinge axis	pulp (dental)
capitation dentistry	Hooke's law	pure rotation
cast (dental)	hooks	quadhelix
center of resistance	hyperdivergent	R point
center of rotation	hyperplasia	R point (registration point)
centric occlusion	hypertrophy	radiograph
centric relation	hypodivergent	radiographic imaging
cephalogram	hypodontia	ramus
cephalometer	hypoplasia	rapid palatal or rapid maxillary expansion (RPE, RME)
cephalometric analysis	iatrogenic	rare earth screens
cephalometric landmarks	ideal occlusion	reciprocal anchorage
cephalometric radiograph	idiopathic	reference frame
ceramic brackets	imaging	removable appliance
cervical appliance	imbrication	replantation
chin cap	immobilization	reproximation (slenderizing)
Class I malocclusion	impaction (surgical)	resection
Class II malocclusion	impaction (tooth)	resilience
Class II, Division 1	implant	resorption
Class II, Division 2	impression	rest position
Class III malocclusion	incisal	retainer
cleft lip	inclination	retention
cleft palate	inclined plane	retraction
clenching	index of malocclusion	retrognathic
clicking	indirect bonding	retroinclination
closed bite	indirect bonding	retrusion
closing loop	Individual Practice Association (IPA)	reverse-pull or protraction headgear
College of Diplomates of the American Board of Orthodontics	inelastic deformation	ribbon arch appliance
comprehensive orthodontic therapy	infection control	rigid fixation
compressive deformation	informed consent	Risk Retention Group
computer-assisted tomography (CATscan)	infradentale	roentgenogram
computerized cephalometrics	infraocclusion	roentgenography
computerized digital imaging	intensifying screen	root
condylar displacement	interceptive orthodontics	root movement
condylar growth	interdental spacing	root resection
condylar guidance	interdigitation	root resorption
condyle	intermaxillary	rotation
condylion	intermaxillary anchorage	sagittal split osteotemy
continuous arch wire	intermaxillary elastic traction	second order bends
continuous orthodontic force	intermittent force	second order movement
cosmetic orthodontics	internal derangement	second-order clearance
couple	interocclusal clearance	second-order rotation
couple-force ratio	intramaxillary	sectional arch wire
cranial base	intramaxillary anchorage	sella turcica (sella; S)
craniometry	intraoral anchorage	sella tursica
crepitus	intraoral force	sella-nasion(S-N)
crib	intrusion	separation
crossbite	irregularity index	serial extraction
crowding	jaw	sheath
Crozat appliance	jaw relationship	soft palate
curve of spee	J-hook headgear	space maintainer
curve of Wilson	joint symptoms	space regainer
cyst	jumper	specialist
DDS or DMD	jumping the bite	splint
debanding	key ridge	spring-back
debonding	key ridge	stabilizing wire
decompensation	labial	stiffness
deep bite	labial arch or bow	stomatognathic system
deformation	labial root (lingual crown) torque	stomion
dehiscence	labial sulcus	stop
dental arch	labiolingual appliances	straight wire appliance
dental plaque	labioversion	strain
dentofacial deformity	labrale inferior	stress (mechanical)
dentofacial orthopedics	labrale superior	stress-relief
DHMO (dental health maintenance organization)	laminography	stripping of teeth
diagnostic set up	landmarks, cephalometric	subnasale
diastema	lateral cephalometric radiograph	subspinale (Downs Point A)
differential moment	lateral excursion	subtraction radiography
digital image	Le Fort I surgical procedure	succedaneous teeth
digitization	Le Fort II surgical procedure	superelastic
Diplomate	Le Fort III surgical procedure	superimposition
direct bonding	Le Fort surgical procedure	supernumerary teeth
direct reimbursement	leeway space	superoinferior
disclusion	leveling	supramentale (Downs point B)
discrepancy	leveling wire	supraocclusion
displacement	ligature	surgical fixation
distal	light-wire technique	suture
distal segment	limited treatment	symphysis (mental)
distoclusion	lingual	syndrome
distoversion	lingual appliances	technique (appliance)
distraction osteogenesis	lingual arch	telescoping bite
dolichocephalic	lingual retainers	temporomandibular articulation
dolichofacial	lingual root (labial crown) torque	therapeutic diagnosis
down-fracture	lingual version	third order bends
Downs analysis	linguoclusion	third order movement
dysfunction	lip bumper	threshold force
dysplasia	lip incompetence	thumb (or finger) sucking
early orthodontic treatment	long-axis rotation	tie-back
ectopic	long-face syndrome	tinnitus
edge-to-edge occlusion	luxation	TMD
edgewise appliance	macrodontia	TMJ (temporomandibular joint)
elastic	magnetic force	tomograph
elastic deformation	mal-	tongue crib
elastic limit	malar	tongue thrust
elastic range	malocclusion	tooth size discrepancy
elastic strength	mandible	torque
elastics (rubber bands)	mandibular osteotomy	torsiversion
elastomeric ligature	mandibular resection (osteotomy)	torus
emergence	materia alba	toughness
enucleate	maxilla	tracing (cephalometric)
equilibrate	maxillary	traction
eruption	maxillary osteotomy	transitional dentition
etch	maximum force	translation
etiology	mechanotherapy	transposition
excessive force	mediolateral	transseptal fibers
exfoliate	menton	transverse displacement
exostosis	mesial	trauma
expansion	mesial drift	trismus
expansion key	mesioclusion	tuberosity
expansion screw	mesiodens	Tweed triangle
extraction	mesiodistal	twin block appliance
extraoral anchorage	mesognathic	twin bracket
extraoral force or traction	microdontia	ugly duckling stage
extrusion	micrognathia	underbite
facebow	midsagittal plane	undermining resorption
facemask	migration (dental)	universal appliance
facial	mixed dentition	uprighting
facial asymmetry	model (dental)	utility arch
facial concavity	moment	V bends
facial convexity	monobloc	velopharyngeal insufficiency
facial esthetics	mouthguard	velum
facial form	MRI (Magnetic Resonance Imaging)	vertex (anatomy)
facial growth	MS	vertical dimension
facial pattern	MSD	vertical elastic traction
facial proportions	mucosa	vestibular screen
facial type	myalgia	visceral swallowing
faciolingual	myofunctional	Visual Treatment Objective (VTO)
fee for service dentistry	NA	w arch
fenestration	nasion	wear facet
fiberotomy	natural head position	working side
finger spring	neutroclusion	World Federation of Orthodontists (WFO)
finishing	nightguard	x-bite
first order bends	normal occlusion	x-ray
first order movement	obturator	zygoma
first order rotation	occlusal

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STATE OF THE ART CARE

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Schedule Your Complimentary Examination Now.

STATE OF THE ART CARE

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Alan C. Smith, DDS, MSD

Patient Corner

Hygiene

ORAL HYGIENE

BRUSHING

FLOSSING

INTERDENTAL TOOTHBRUSH

ANTISEPTIC MOUTH RINSE (PEROXYL)

TOPICAL FLUORIDE (PHOS-FLUR)

CLEANING A REMOVABLE APPLIANCE

Diet

EATING HABITS

BRUSHING

SORE TEETH

Managing Discomfort

EMERGENCIES:

PAIN IN THE TEETH

PAIN

TEMPOROMANDIBULAR JOINT

Glossary

Account Info