ortho 1.10

Separators or Spacers

Separators have been placed between your teeth in order to move them apart slightly so that orthodontic bands (the metal rings around the back teeth) may be placed at your next appointment. Separators are removed prior to placement of the orthodontic bands.

If the separators become loose before your next appointment, please call our office in order to see if they need to be replaced. You should make every effort to keep the separators in place by avoiding sticky foods like chewing gum, and avoiding flossing in the areas with the separators (this will be one of the few times we ever tell you NOT to floss).

The tenderness associated with the separators usually diminishes after a few days. In the meantime, whatever medication you usually take for a headache (Advil, Tylenol, or aspirin) can be used to take care of any discomfort.

Palatal Expander
A Palatal Expander is designed specifically to expand and widen your upper jaw.

Any interference with your speech due to the appliance usually resolves over time. Sometimes activating the expander causes some slight pressure near the nose or out toward the cheek bones. This sensation usually subsides within 30 minutes. Advil or Tylenol may be needed for the first 3 nights.

To activate the expander:

Place the key into the key hole in the center screw and gently push the key toward the back of the mouth which will turn the center screw.

If the key has been moved all the way to the back of the mouth, the next hole should be visible in the front. When one hole is visible, turning the key so that you can see the next hole is considered one “turn” or “activation”.

Please do not pull the key forward to remove it. If that happens, you “undo” the expansion.

Because the hole is difficult to see, the activation usually needs to be done by someone other than the patient. We recommend some place with good lighting (like a bathroom) or a flashlight for the best visibility.

Turn the appliance once per day for as many days as the doctors’ instruct. We will schedule an appointment to see you evaluate your progress and determine if any more turns are necessary.

The expander may cause the separation of the two front teeth. This is normal and space may closes on its own when the key turning is stopped. Otherwise, the space will eventually be closed with braces.

After the expansion is completed, the patient will continue to wear the appliance for a period of time to allow the bones to get used to the new position.
Headgear is used in treatment of patients whose upper teeth are ahead of the lower teeth, and guides the growth of the teeth and jaws.

It is important to wear the headgear 12-14 hours per day, every day, with the majority or time while sleeping. In order to comfortably “work up to” those ideal hours, follow this schedule:

DAY 1: 4 hours
DAY 2: 6 hours
DAY 3-7: 8 hours (including all night, while sleeping)
DAY 8: 12+ hours

At this point, the 12+ hours should be maintained daily until instructed otherwise.

NOTE: The hours the headgear is worn do not have to be consecutive.

To place the headgear:

Placing the headgear in your mouth should be done carefully.

Attach the elastic strap to the hook on one side of the headgear.

Using the side that is attached to the strap, place the headgear into the tube attached to the band in back of your mouth. The bumps or loops on the headgear should point down.

Insert the other side of the headgear into the tube on the band on the other side of the mouth.

Hold the headgear in front of the mouth with one hand while using the other hand to attach the elastic strap to the hook on the other side of the headgear.
Bring your headgear to every appointment so we can check and adjust it. Each headgear is custom fitted and adjusted. You should not change yours in any way. Please call us if you feel it’s not fitting correctly.

It is normal if your teeth are tender for the first few days the headgear is worn. This tenderness will disappear as you and your teeth get used to the pressure. Wear the headgear consistently and do not remove it frequently.

Please remove the headgear before engaging in physical activity. Wearing the headgear while playing sports or wrestling may injure you or others.

Be careful when removing the headgear. If the headgear does not easily slip out when you try to remove it, stop! Go to a mirror and gently remove it. Twisting and forceful pulling may bend the headgear or loosen the bands.

The elastic strap is hand washable. Hang to dry (do not place in a dryer).
Elastics or “Rubber Bands”
Elastics, or “rubber bands”, are used to help improve the fit and bite of the upper and lower teeth. How well the rubber bands work, and therefore how quickly your teeth fit together appropriately, is determined by how well you wear the rubber bands.

The rubber bands should be worn every day, 7 days a week.

They can be removed to eat. After you eat, you should throw away the old rubber bands and place new ones. Since a rubber band is not as effective after being in the mouth for more than 12 hours, please try to change them 3-4 times per day.

The rubber bands need to be worn exactly the way we showed you. Wearing them in a way other than shown can result in tooth movement different than intended, and even opposite of what we want. If you are not sure how you’re supposed to be wearing them, ask us.

Advil or Tylenol may be used if the rubber bands cause the teeth to be sore.

Occasionally, wearing rubber bands can cause the jaw joints to become sore or start making noises when you open and close your mouth. If that happens, call our office and we will make an appointment to see what is going on with your jaw joints.

If you notice that you are running low on rubber bands, call our office. You can either come by to pick up some more or we can mail them to you.
Retainer can be either removable or cemented in place behind the teeth.

For Removable Retainers:

Wear the retainer as instructed by the doctor. Usually, the retainer is worn 24 hours a day immediately after the braces are removed. Only take them out when eating, brushing and flossing, or when playing contact sports. This means all day and all night.

Brush your retainer with toothpaste and water when you brush your teeth (which should be at least twice per day). Calculus is a hard white substance that can build up on the retainer. If it does, soak the retainer in 1 cup of vinegar for 4 to 8 hours and then brush as usual with toothpaste and water. NEVER soak your retainer in ANYTHING except vinegar or some type of denture cleanser!

If your retainer is not in your mouth it should be in the case we provided. NEVER wrap your retainer in a napkin or place it in your pocket, because it can be easily broken, thrown away, or lost.

Do not bite the retainer into place, or “click” the retainer in and out of your mouth with your tongue. This can either bend the wire or break the plastic.

Do not immerse the retainer in hot water, as plastic will distort and the retainer may no longer fit.

Dogs and cats love to chew on retainers! Keep them out of reach of your pet’s mouth.

If a retainer is broken, irritates the mouth, does not fit, or is lost, call our office immediately.

The cost of your first retainer was covered in the orthodontic treatment fee, however; if we need to make you a new one there is a replacement fee per retainer. If you break the retainer, please save the pieces and bring them with you. Sometimes they can be repaired for a lesser fee. PLEASE KEEP IN MIND that we will need to see you twice for any repair or replacement, as a new impression has to be made to either repair or replace a broken retainer.
For Cemented or “Permanent Wire” Retainer
Your permanent retainer is cemented to the tongue side of your front teeth and is not removable. It is designed to last many years with proper care.
Please remember that it is a delicate appliance and certain precautions need to be taken while eating:

Avoid hard or sticky foods. Many of the foods you have been avoiding with braces on, you will still need to avoid.

Things like fresh vegetables and fruit should be cut up into smaller pieces. This is so you can chew them with your back teeth and avoid biting them with your front teeth.

Do not poke the retainer or chew on pens or pencils. They can break the retainer or knock it loose.
If you notice that the retainer is loose, please contact our office as soon as possible. We want your teeth to remain straight, but if the retainer is loose, your teeth could move. Additionally, a loose retainer makes it easier to get cavities underneath the retainer. Please brush your teeth and retainer thoroughly. You will need to use a floss threader to get the floss under the retainer wire. Just make sure you are careful and do not pull “up” on the retainer with the floss, as this could distort or loosen it.


Orthodontics is not just for children. In fact, 1 in every 5 patients in orthodontic treatment is an adult. No one is too old for orthodontic treatment.

Adults seek orthodontic treatment for many of the same reasons as children. Some adults may have had orthodontic problems as children but were unable to correct them until now. Others who had treatment as children may need further treatment as adults due to relapse or limitations in initial treatment.

Benefits of Treatment
Adults can benefit from orthodontic treatment in many ways. These include:

Align the teeth to create a more esthetic and beautiful smile

Correct relapse after previous orthodontic treatment

Improve the ability to brush and floss, especially for crowded or overlapping lower front teeth, to prevent gum disease

Create a better or more comfortable bite and ability to chew

Address missing teeth

Close spaces between the teeth

Reduce excessive wear on the teeth

Jaw surgery to correct discrepancy between the upper and lower jaws.
Appearance of Braces
Many adults are concerned with the appearance of the braces. For more simple or uncomplicated correction, clear removable appliances (“invisible aligners”) can be used. For more involved correction, we have the option of clear brackets (which you can view on this web site: http://www.3MUnitek.com/Clarity) or even gold brackets.

Orthodontic treatment does not hurt more for adults than children. Adults undergoing orthodontic treatment report the same level of soreness as children (although adults are more willing to tell us about the soreness).

Typically, the teeth are most sore 12-24 hours after and orthodontic adjustment, and will disappear within 3 to 7 days. Modern appliances are smaller and more comfortable, and modern techniques and materials put less pressure on the teeth while moving the teeth more rapidly and efficiently.
Cost. The cost for adult orthodontic treatment is determined the same way as child or adolescent treatment, based on the severity of the problem, the complexity of the correction, and the length of time to correct.

Many adults are surprised to find that the same insurance that gives them a benefit for their children also allow for adult treatment. We can help determine if your insurance has a benefit for adult treatment.

Dr. Patel hasundergone additional training to better serve the special needs of adults. She has focused her training on jaw surgery and implants and coordinated treatment with general dentists to address missing teeth and gum disease.

At what age should a child have an orthodontic examination?
The American Association of Orthodontists recommends that most children should have an orthodontic screening by age 7. This allows Dr. Patel to evaluate if orthodontic treatment will be required and the best time for the patient to be treated. Many of the dentists in our community have been trained to identify orthodontic problems early, and may refer you to Dr. Patel earlier than age 7.

Why are children being evaluated at such an early age?
Early diagnosis and treatment can guide erupting teeth into a more favorable position, preserve space for permanent teeth, and reduce the likelihood of fracturing protruded front teeth.

If early treatment is indicated, Dr. Patel can guide the growth of the jaw and guide incoming permanent teeth. Early treatment can also regulate the width of the upper and lower dental arches, gain space for permanent teeth, avoid the need for permanent tooth extractions, reduce the likelihood of impacted permanent teeth, correct thumb-sucking, and eliminate abnormal swallowing or speech problems. In other words, early treatment can simplify later treatment

In addition to better-looking teeth, what are some other benefits of orthodontic treatment?
Braces can improve function of the bite and teeth, improve ability to clean the teeth, prevent wear on the teeth, and increase the longevity of natural teeth.

Does early treatment benefit all children?
Early treatment does not necessarily benefit all children. Certain types of orthodontic problems can be more easily and efficiently corrected in the teen years when all the permanent teeth have erupted, while still other orthodontic problems should not be addressed until growth is more advanced or completed. Dr. Younger and Dr. Groesbeck develop a plan for treatment based on each individual child’s needs.

If a child has treatment early, will this prevent the need for braces as an adolescent?
Early treatment can begin the correction of significant problems, prevent more severe problems from developing, and simplify future treatment. Because all of the permanent teeth have not yet erupted when early treatment is performed, all the permanent teeth have not been corrected. Typically, a second comprehensive phase of treatment in the teen years, after all the permanent teeth have erupted, completes the correction.

Do we still need to see our family dentists if we’re already seeing Dr. Patel?
Patients with braces and other orthodontic appliances require more effort to keep their teeth and gums clean. Because Dr. Patel want to insure the highest level of dental health, they will require you to see your family dentist for regular check-ups and cleanings.

Eating With Braces
What can you eat? Let’s talk about what you shouldn’t eat! For the first day or so, stick to soft foods. Avoid tough meats, hard breads, and raw vegetables. But you’ll need to protect your orthodontic appliances when you eat for as long as you’re wearing braces.


Chewy foods: bagels, hard rolls, licorice, gummy bears
Crunchy foods: popcorn, ice, chips
Sticky foods: caramels, gum
Hard foods: nuts, candy
Foods you have to bite into: corn on the cob, apples, carrots, etc. must be cut into smaller bites before eating
Chewing on hard things (for example, pens, pencils or fingernails) can damage the braces. Damaged braces will cause treatment to take longer.
General Soreness
When you get your braces on, you may feel general soreness in your mouth and teeth may be tender to biting pressures for three to five days. If the tenderness is severe, take ibuprofen or whatever you normally take for headache or similar pain. The lips, cheeks and tongue may also become irritated for one to two weeks as they toughen and become accustomed to the surface of the braces. You can put wax on the braces to lessen this. We’ll show you how!

Loosening of Teeth
This is to be expected throughout treatment. Don’t worry! It’s normal. Teeth must loosen first so they can be moved. The teeth will again become rigidly fixed in their new — corrected — positions.

Care of Appliances
It’s more important than ever to brush and floss regularly when you have braces, so the teeth and gums are healthy after orthodontic treatment. Patients who do not keep their teeth clean may require more frequent visits to the dentist for a professional cleaning. Adults who have a history of gum disease should also see a periodontist during orthodontic treatment.

If you play sports, it’s important that you consult us for special precautions. A protective mouthguard is advised for playing contact sports. In case of any accident involving the face, check your mouth and the appliances immediately. If teeth are loosened or the appliances damaged, phone at once for an appointment. In the meantime, treat your discomfort as you would treat any general soreness.

Initial Examination Visit
Our Treatment Coordinator will greet you, introduce you to our office, and become familiar with your orthodontic needs and expectations. In order to make this visit as productive as possible, we will take radiographs and photos. Then, Dr. Patel will conduct a thorough clinical examination and go over the findings with you, using the radiographs and photos as reference.

The purpose of the initial examination is to answer:
1. What sort of problem is present, if any?
2. When is the proper time for treatment?
3. How much will the treatment cost?
4. How long will treatment take?
5. What type of treatment is indicated?

What’s Next
If treatment is indicated, records can be taken during your initial exam and appointments can be scheduled to begin treatment. Our Treatment Coordinator will also describe for you the subsequent steps to start treatment and answer any questions you have concerning treatment, scheduling, finances, or insurance. When indicated, a separate consultation appointment may be arranged.

There is no charge for the initial examination.

Cost of Treatment and Insurance

Cost of Treatment
The cost of treatment depends on the severity of the orthodontic problem. You will be able to discuss fees and payment options before treatment begins. We have payments options to suit different budgets, including a no-down-payment option. We also accept direct reimbursement from some insurance plans, and file the necessary papers to the insurance company. We work hard to make orthodontic care affordable and feel that cost should not be a barrier.

The Treatment Coordinator will discuss the various payment options available, as well as the insurance process.

If you have insurance we will help you determine the coverage you have available. You are responsible for informing us of any changes in your insurance. As a courtesy, we will file your orthodontic claim with your insurance carrier. Please be aware that payment for treatment is determined by the carrier at the time services are rendered. Preauthorization by phone or paper are not a guarantee of payment. We will help in every way we can in filing your claim and handling insurance questions from our office on your behalf.

Scheduling Appointments
Braces or other appliances are placed at the initial banding appointment. This appointment will take about 1-2 hours, and will be scheduled in the morning when the doctors can focus more attention on this important step. After appliances are in place, regular adjustment appointments will be scheduled every 4-8 weeks. Most adjustment appointments will be 15-30 minutes long. Patients are seen by appointment only. We value your time, and make every effort to be on time. If you cannot keep an appointment, please notify us as soon as possible so someone else can use this valuable appointment time.


What To Do- We feel it is important for you to get in touch with someone in case of an emergency. When the office is open, please call our office and we will schedule an appointment to correct the problem. When the office is closed, please call and listen to the message that will instruct you on how to reach Dr. Messersmith or a staff member.

Unless you are in pain, most orthodontic emergencies can wait until the office reopens. In the meantime, here are some tips to relieve any discomfort.

Sore spot. When you first get braces or an appliance, you may have a sore spot(s) develop. You can put wax on the bracket or wire that is rubbing your cheek until it heals. Your mouth will toughen up after a short while.

Sore teeth. Try the pain reliever that you typically use for a headache or similar discomfort. We generally recommend that you take an analgesic such as acetaminophen (Tylenol) or ibuprofen (Advil, Motrin). This is the protocol only if there are no known allergies to these medications. Rinsing with Peroxyl or a cup of warm water and teaspoon of salt can also be soothing. Soreness can be expected for 3-5 days after an adjustment.

Poking wire. If a wire is poking you, we would like to see you. Please call the office and we will schedule a time to fix the wire. It it is after hours, please call the office and follow the instructions for the emergency number. Someone will meet you at the office to fix the wire poke.

Main wire out of position. If the main wire has come out of the brace or tube on a back molar tooth, attempt to reinsert the wire into the bracket slot with a pair of tweezers. If the wire is not poking you, place a piece of wax over the area. If the wire is poking and wax does not help, please call our office to schedule an appointment to have this repaired. After hours, call the office to get the emergency person�s number so they can meet you at the office and correct the problem.

Broken bracket. If a brace comes loose from a tooth, it usually remains connected to the main wire and is not cause for an emergency visit. Tweezers can be used to reposition the brace if it flips around the wire and becomes a source of irritation. Keep the loose bracket and call our office to schedule a visit to repair the loose brace(s). If it is after hours, please call the office number and get the emergency number. Someone will meet you at the office to clip the wire if you have a wire poke. We will then schedule a repair appointment during regular hours to rebond the bracket.

Herbst appliance. If your appliance comes apart when opening your mouth too wide, slip the rods on the lower part of the Herbst into the tubes of the upper part of the Herbst and close normally. Should your appliance break, keep all pieces and call the office to schedule a repair appointment. If it is after hours, please call the office to get the emergency number.

Loose expander, MARA or Herbst. Please call the office to schedule a repair appointment. If it is after hours, please call the office and get the emergency number so someone can see you.

Trauma to face, teeth or jaws. Please call your family dentist immediately if you have an accident involving your face, teeth or jaws. After you see your dentist, he or she will evaluate, treat or refer you as needed for the best possible care. After you are treated, please call to advise us of your status so we can see you, if needed. If your dentist needs us to see you after they have evaluated and treated you, please call the office to get the emergency number.


View all posts by

Leave a Reply