When will my braces come off?

At Care Orthodontics we're frequently asked, "When will my braces come off?" The short answer is, "When your bite looks perfect." The long answer is that it depends on many factors.

The biological response rate of each individual is different. Some people's teeth move faster than others. Then there are factors like the severity of the bite as well as the compliance of the individual toward attendance, wearing appliances and taking care of the braces.
Despite certain factors that you cannot control, there are things you can do to avoid setbacks and speed up your treatment time. Below is a list of things that you can do to keep your treatment on track:

1. Keep your appointments. Missing appointments will delay treatment length. At each adjustment visit, treatment plans need to be renewed and monitored. Canceled or postponed appointments will delay treatment time.
2. Show up to appointments on time. When you are late, there is often not enough time do all the procedures that were planned.
3. Watch what you eat and avoid hard foods. While wearing braces, you need to follow the diet restrictions that your orthodontist recommends. You must avoid eating hard and sticky foods, such as gum, caramel candies ice chips, apples and carrots because they will cause the brackets to come off. Loose brackets will delay treatment completion.
4. Wear your rubber bands. If your treatment requires you to wear rubber bands, you have to comply and wear elastics full time in order to finish your treatment on target. If you do not wear the rubber bands as recommended, your bite will not finish beautifully.
5. Wear your orthodontic appliances. As with rubber bands, you may be required to wear appliances, such as bite plate, expander, headgear or facemask. You need to wear these appliances daily and follow the instructions that are given to achieve optimal results. 
6. Wear your mouth guard during sports activities. To protect your lips and gums, and avoid damage to your orthodontic appliances, wear a mouth guard during sports activities. By avoiding emergency visits and unexpected procedures, your treatment will progress quickly.
7. Brush and floss daily. Whether or not you are wearing braces, you need to brush your teeth. However, while wearing braces, it is even more important to brush and floss thoroughly to avoid cavities and periodontal problems. With braces, there are more surfaces for food, plaque and bacteria to bind to. Dr. Phan recommends five minutes of brushing three times a day and after each meal to avoid cavities, gingivitis and bad breath. The rate of teeth movement drops significantly in the presence of plaque, bacteria and swollen gums. Thus, clean teeth means more efficient tooth movement.
8. See your general dentist two to three times a year. Many times, parents mistakenly think that their child does not need to see a general dentist during braces treatment. However, the opposite is true. Orthodontists and general dentists have different sets of exams, x-rays and treatment plans. For example, your general dentist takes specific x-rays and performs specific exams to check for cavities, deep pockets and bone and gum attachment. If you don't have frequent cleanings, your gums will swell up and bleed, and this effects the rate of tooth movement. Since teeth move slower in the presence of gingivitis and gum disease, by maintaining healthy teeth and gums, you can finish orthodontic treatment more quickly.

If you follow these guidelines, you will be on your way to completing your treatment efficiently. You will avoid setbacks that can delay your orthodontic treatment. Meanwhile, Dr. Phan and her team will do their best to correct your teeth and bite, and finish the treatment quickly.

Our goal is to give you a radiant smile in the shortest treatment time! Visit our website at www.CareOrthodontics.com.

When is a good age for my child to start braces?

This article answers some commonly asked questions that parents have about when their child should see a dentist or seek orthodontic treatment.

When is a good age for my child to see a dentist?

Age one.

The American Academy of Pediatric Dentistry (AAPD) recommends that a child go to the dentist by age one or within six months after the first tooth erupts. At six months of age, the two lower front teeth begin to erupt. Around age one, your dentist can evaluate the condition of your child's teeth and give recommendations on daily oral hygiene and routine dental care.

When is a good age for my child to see an orthodontist?

Age seven.

The American Association of Orthodontists (AAO) recommends that a child see an orthodontist by age seven. At that age, the orthodontist can evaluate your child's jaw and facial growth patterns, as well as tooth development and bite. Around age seven, your orthodontist can evaluate any dental malocclusion and give recommendations on the best time to start orthodontic treatment. Your orthodontist can help you monitor the eruption of your child's permanent teeth and jaw development.

When is a good age for my child to start orthodontic treatment?

It depends.

Orthodontic treatment varies from child to child. Some children may not need any orthodontic treatment until age 11 or 12. These children may have good jaw and facial growth and only need orthodontic treatment to correct the teeth and occlusion. Other children may need early orthodontic treatment to change the jaw features.

Genetics may dictate a non-favorable jaw relationship, and these children may need interceptive treatment, such as jaw expansion. This jaw modification during growth creates space and reduces the chances of needing jaw surgery later on. Early orthodontic treatment, when required, is usually recommended around age 7 to 10.

A review on development of permanent teeth:

At age six, lower permanent incisors grow in. At age seven, the first back permanent molars grow in. Sequentially other teeth such as canines and premolars erupt in both the lower and upper jaws. When permanent teeth start to grow in, this is a good time to schedule a consultation with an orthodontist.

Why you shouldn't wait to seek orthodontic treatment:

Most parents wait until they think their child needs braces. Then they make an appointment. However, waiting is not a good solution. You can miss out on many available treatment options that are more effective while the jaw is still growing, or before all the permanent teeth are in place. For example, without adequate space, many permanent teeth may fail to come in. The longer you wait, the denser the bone quality and the more slowly teeth erupt.

Waiting can make the face look worse. Since genetic make-up already dictates how the face will grow, you should seek an orthodontic consultation at the first signs of possible problems. Waiting will not reverse growth patterns - they will need orthodontic intervention eventually, and the longer you wait the harder it will be. In addition, older children are less compliant to follow treatment regimens than younger children. Preteens and teens are less willing to wear headgear, expanders, a facemask or rubber bands. They may want braces off quickly before treatment is fully completed.

An early orthodontic evaluation will also allow you more flexibility, not just with treatment planning, but also with financial planning.

At Care Orthodontics, Dr. Nancy Phan provides complimentary consultations and follow-up visits. At these visits, she will check your child's bite and make specific recommendations on when and what needs to be done.

In the follow-up visits, she monitors teeth that are delayed in eruption and verifies any factors that contribute to a bad occlusion. Depending on the diagnosis, she will give you recommendations on whether to pursue orthodontics now or in the future.

Dr. Nancy Phan has been providing orthodontic treatment for children and adults in San Jose and the surrounding Bay areas for over ten years. Schedule a complimentary consultation for your child by calling our office at (408) 971-2885. Check out our website for other beneficial information and educational videos at www.CareOrthodontics.com.

Should I buy an electric toothbrush?

Can an electric toothbrush brush your teeth better than a manual toothbrush? No. As long as you can do a good job of brushing and removing all plaque on the teeth and around your gums, then either toothbrush can help you accomplish this goal.

Can an electric toothbrush brush your teeth faster than a manual toothbrush? Absolutely.

Is it worthwhile to spend $70 on an electric toothbrush? Yes. If you can afford to buy one, it will save you time and effort. You just need to hold the angle of the toothbrush correctly and it will do the job for you.

Comparing electric tooth brushing with manual brushing:

If the ultimate goal of brushing is to remove plaque and bacteria then either method can work as long as the end goal was accomplished – that is the removal of plaque. Research has found that electric toothbrushes are no more effective than manual toothbrushes, assuming that the people used a manual toothbrush effectively. [Source: Manual versus powered brushing]

Research has concluded that the way brushing is done and the amount of time spent is more important than the choice of brushes. [Source: Meta Analysis]

Special features of an electric toothbrush:

Did you know the first electric toothbrush was invented in 1954 in Switzerland by Dr. Philippe-Guy Woog? It was created for patients with limited motor skills and for patients in braces. [Source: Wikipedia]

Here are a few reasons why you should spend $70 on an electric toothbrush:

1. An electric toothbrush can have two types of action: vibration or rotation-oscillation. A vibrating toothbrush is similar to manual brushing, however, at a faster rate. A rotational oscillation toothbrush alternately rotates in one direction and then the opposite direction. They can both deliver around 20,000 to 50,000 strokes per minute compared to 100-300 strokes per minute with manual brushing.

2. An electric toothbrush is classified based on speed, such as power brush, sonic brush or ultrasonic brush. If it is below 1000 oscillations per minute, it is a power brush. If it is below 20,000 oscillations per minute, it is a sonic brush. If it is above 20,000 oscillations per minute, it is classified as an ultrasonic brush. An ultrasonic toothbrush emits vibration in high frequency and low amplitude to break up plaque and bio film on teeth surfaces as well as up to 5mm below gum level.

3. An electric toothbrush comes with a small head to get to hard-to-reach surfaces, such as behind the last molars and around inside surfaces of the teeth.

4. An electric toothbrush can come with a bigger handle to make it easier for young children and adults with arthritis to operate.

5. An electric toothbrush is rechargeable so it can deliver the same force after it is fully charged.

6. An electric toothbrush has a 30-second beeping feature for each quadrant and a two-minute timer for entire mouth brushing.

Don't forget to change the brush head every 3-6 months or when the brush bristles are visibly worn out. If you decide to keep using a manual toothbrush, you can do so, just make sure you spend at least 2 to 3 minutes to brush, reach all surfaces including gum-line level to adequately remove plaque, and get in between the brackets. Brush and floss daily.

Dr. Nancy Phan and the team at Care Orthodontics in San Jose, CA love to see you with a beautiful and radiant smile. Please check out our website www.CareOrthodontics.com for more information about Invisalign or braces.

Resources:

1.http://en.wikipedia.org/wiki/Electric_toothbrush

2. Robinson PG, Deacon SA, Deery C, Heanue M, Walmsley AD, Worthington HV, Glenny AM, Shaw WC (2009). "Manual versus powered tooth brushing for oral health"  Cochrane Database Syst Rev (1): CD002281. doi: 10.1002/14651858.CD002281.pub2.  PMID 15846633 -  Meta-analysis of studies of the effectiveness of electric toothbrushes.

3. Deery C, Heanue M, Deacon S, Robinson PG, Walmsley AD, Worthington H, Shaw W, Glenny AM (March 2004). "The effectiveness of manual versus powered toothbrushes for dental health: a systematic review". J Dent 32 (3): 197- 211.  doi: 10.1016/j.jdent.2003.11.006.  PMID 15001285

5 commonly asked questions regarding Invisalign

Orthodontic treatment has come a long way since the advancement of technology and material options. Unlike the old days when the only option to straighten your smile was to wear a mouth full of bulky bands and brackets, today's braces are thinner, smaller and more aesthetically designed. In addition, there are other treatment options that can hide the look of braces, such as lingual braces and Invisalign.

Invisalign is a popular option to correct crooked teeth and crooked smiles with minimal discomfort. Today it is estimated that nearly two million adults and teenagers wear Invisalign aligners.

Below are five commonly asked questions regarding Invisalign:

1. Are they really invisible?

Yes. Since the aligners are crystal clear and they are trimmed to the gum margins, they appear "invisible" to onlookers.

2. Are they less painful to move teeth than braces?

Yes. First, since the aligners are smooth, round and flexible, as opposed to raised corners and shapes in metal or ceramic brackets, they are more comfortable to the mouth. Secondly, since teeth are moved with mild, gentle and continuous force, they are less painful. Any discomfort associated with moving teeth is limited to just day one and two of wearing new aligners. Most patients rate the discomfort level at 1 or 2 out of 10 on the scale of tolerance.

3. Does Invisalign work as well as braces?

Yes. At the molecular level, bone biology works the same whether the teeth are moved through Invisalign force or braces force. The principle is that bone cells have to break down and regenerate to allow bone around the teeth to soften so the tooth can move. With Invisalign, plastic materials are programmed to push teeth. With braces, fixed wires and brackets are used to push and pull teeth. Although one treatment method uses removable products and the other method uses fixed appliances, both methods should render a nice, straight, beautiful smile.

As with an artist and painting, the artist's experiences and skills dictate whether or not the painting looks good in the end. With Invisalign treatment, an experienced orthodontist leverages his or her expertise, knowledge of teeth movement, mechanical force principles and force mechanics to design and create a beautiful smile.

4. Is wearing Invisalign better for your teeth?

Yes, Invisalign aligners allow easier brushing and flossing than wearing braces. Wearing aligners also allows some protection from bruxism and teeth grinding at night. Since aligner materials are more clear and invisible, they are more discrete and more socially acceptable for patients, especially adults and teenagers. Patients can eat any kind of food without having to cut it into small pieces or avoid hard foods. Invisalign is a great choice, especially for adults who want to straighten their teeth but minimize the risks of gingivitis and periodontal diseases.

5. Do they cost more than braces?

While cost of treatment varies from patient to patient depending on the level of treatment and needs, the cost for Invisalign and braces are very similar. In general, Invisalign and traditional braces may vary by a few hundred dollars, which makes Invisalign a good alternative to braces.

For more information about Invisalign or Invisalign Teen, schedule an initial consultation with Dr. Nancy Phan. She can answer your questions and concerns. The consultation is complimentary. You can visit us at www.CareOrthodontics.com.

5 Ways to clean your retainers and aligners and keep them smelling fresh

If you wear retainers or Invisalign aligners, you need to clean them and keep them smelling fresh. 

Here are five ways to keep them clean:

1. Mechanical Cleaning 

The most reliable way is daily mechanical cleaning using a toothbrush and storing your retainers in an open lid case during the day, when you are not wearing them. Dry air will wick away any odor to leave the retainers dry and fresh for the next night’s wear.

2. Baking Soda

A second way is using baking soda. You can soak your retainers in a solution of 1 part baking soda, 3 parts water for 20 minutes. Baking soda neutralizes any acidic content in plaque and biofilm that normally surface on retainers. It also deodorizes the smell. After soaking, make sure you brush the retainers or aligners with water to get rid of minerals and build-ups.

3. Mouthwash Solution

A third way is soaking in mouthwash solution. You can soak retainers or aligners in mouthwash for 20 minutes or less. It is best to use alcohol-free mouthwash since the alcohol can degrade the plastic material of retainers overtime. Since most mouthwash solution such as Listerine contains alcohol, you should brush your retainers first, then soak your retainers just a short period to achieve a fresh scent.

4. Retainer Cleaning Products

The fourth way is using over-the-counter retainer cleaning products. Samples of retainer cleaning tablets are Retainer Brite, SonicBrite, DentaSoak, and Efferdent. Other products that also work effectively are retainer cleaning gel, spraying foam, retainer wipe, and retainer spray. They all have deodorizing effects to give a fresh-smelling scent. You need to follow the manufacturer's instructions on the box.

5. Castile Oil

The final way is soaking in Castile oil [Source: Wikihow]. Castile oil is made out of coconut oil and olive oil, so it is organically safe and free of harmful chemicals. You can purchase a bottle of peppermint Castile liquid soap at the body cleanser section at Walmart or order online for about $5 to $10. Castile soap contains a main ingredient called Castile oil.

You can also substitute with peppermint oil to give it a very pleasant smell. Squirt 2 tablespoons of Castile liquid soap or peppermint Castile liquid soap in a cup of warm water and soak your retainers or aligners for 15 minutes. After you take them out and rinse them with water, you will have very clean and peppermint-smelling retainers [Source: AskTheDentist].

If you find this post helpful, let us know. You can find other useful information and articles at our website, www.CareOrthodontics.com. Dr. Nancy Phan and the team love to give you a beautiful and radiant smile.

What is a bad bite?

A bad bite refers to the misalignment of teeth. When teeth do not come together correctly, they are termed bad bite, or "malocclusion."

What causes a bad bite?

It is often caused by genetics, environmental factors, oral habits or multifactorials. For example, you may have an overjet, commonly known in lay term as "over bite," where your front teeth stick out. With this bite, your lower lip, caught behind the upper teeth, wedges both top and bottom teeth and makes the upper teeth stick out further. If you have a tongue habit, your tongue can push your front teeth out further. The misalignment of your teeth and jaw can make the bite worse over time.

3 types of bad bite:

In orthodontics, there are 3 main types of bad bite. There are also subdivision bites but for simplicity, lets discuss the 3 main ones. They are categorized based on how the top and bottom jaws relate to each other.

• Class I bite is referred to both upper and lower jaws being proportionate in length. There is no issue with the jaw; instead, the bite problem is associated with the teeth. The teeth are either not straight or they can be crowded, spaced, rotated, overlapped, twisted or tipped.
• Class II bite refers to a long upper jaw or a short lower jaw. The jaw position affects the appearance of the front incisors. With a Class II bite, the upper front teeth fit far outside the lower front teeth. 
• Class III bite refers to a long lower jaw or a short upper jaw. Often the upper jaw grows too short and the lower jaw grows too long. With a Class III bite, the lower front teeth fit far outside the upper front teeth.

Who should correct a bad bite?

A bad bite should be corrected by an orthodontist. Orthodontists are dental specialists who have undergone an additional 2-3 years of specialized study in the field of malocclusions to correct and treat bite and jaw problems. They are trained to diagnose all problems associated with the teeth, the jaw, the airway, the facial musculature, and temporal mandibular joints. Some bite problems may need both orthodontics and surgical interventions. Although your general dentist may offer orthodontic treatment, he or she does not have the added training and may not be able to correct complex orthodontic cases.

Dr. Nancy Phan is an orthodontist and has been practicing orthodontics exclusively for over 10 years. When you schedule an orthodontic consultation, she will go over your bite problem and suggest treatment options. Orthodontic records can be taken at that time to further collect data, diagnose problems, analyze details and establish a treatment plan. Once a treatment plan is completed, treatment will then be rendered.

When you have a bad bite, you need more than tooth alignment. You need correction of teeth, bite, jaw and facial alignment to achieve that harmonious and beautiful smile! You can check our website www.CareOrthodontics.com for other beneficial information.

Does my child need early orthodontic treatment?

Even though our office offers complimentary orthodontic consultations to children, some parents do not take advantage of this offer. Some parents say, “Why early treatment when my child can wait?” or “Would it cost me more to do early treatment?” These are valid questions, until you know the reasons for early treatment and significant benefits that come with it.

Many orthodontic problems may be diagnosed and treated early to prevent further complications. The American Association of Orthodontists recommends an orthodontic evaluation at age 7. Dr. Phan recommends that children be screened for any bite or jaw growth problems between ages 7-9.

Screening does mean your child always requires orthodontic treatment. Screening allows you to recognize the severity of an orthodontic problem, if there is any. In our office, 20-25% of children benefit from early treatment. The remaining 75-80% do not require early treatment.

Early orthodontic treatment may also be referred to as Phase I treatment, interventional orthodontic treatment, interceptive orthodontic treatment, or limited orthodontic treatment. These terms indicate early correction of a bite problem.

What are examples of early bite problems?

• Severe over bite – where the lower teeth cause cuts on the upper gum
• Severe over jet – where the upper jaw and teeth stick out too far, risking enamel fracture
• Under bite issues- where the lower jaw sticks out too far
• Cross bite issues – where the upper and lower jaws misalign, leading to uneven facial growth
• Mouth breathing habit – causing dry mouth and inflamed gums
• Thumb and finger sucking habit – causing open bite
• Speech impediment – affecting language development
• Early loss of baby teeth – delayed eruption of permanent teeth
• Difficulty chewing or biting – affecting digestion and well-being
• Super crowded teeth – affecting eruption of permanent teeth
• Uneven bite – affecting facial appearance and self-image

Why do they need correction?  

• In a growing child, every effort should be made to help the maxilla and mandible grow at similar speeds. Uneven jaw growth leads to an unfavorable facial profile and requires jaw surgery later in adulthood.
• By manipulating jaw dimension in a growing child, it is possible to reverse the genetic causes of this trait.
• By aligning the jaws, it is possible to achieve a more balanced and symmetrical face.
• By correcting deviated jaw growth, it is possible to reverse facial asymmetry.
• By stopping dysfunctional habits, such as finger sucking or tongue thrusting, it is possible to prevent speech, mastication, and bite problems.
• By creating space, it is possible to prevent impaction of permanent teeth.
• By correcting a malocclusion, it is possible to avoid psychological impacts caused by school bullies or child teasing.

What are the benefits of early treatment? 

Early intervention eliminates harmful oral habits, creates space for ease of permanent teeth eruption, reduces the extra pain associated with surgical requirements, and reduces the risk of jaw surgery in adulthood. Early treatment plays an important role in the prevention of serious bite problems, guides jaw alignment, develops final occlusion, and improves facial aesthetics.

Early detection of jaw and bite problems provides a great opportunity for effective treatment planning, financial planning, and simple treatment. When indicated, early treatment, also known as Phase I treatment, reduces the severity, treatment length and treatment cost of Phase II treatment. Many times, a more severe orthodontic problem can be corrected using a fixed or removable orthodontic appliance.

Call for a consultation.

You can schedule a consultation for your child to evaluate their bite and receive the best advice to care for your child’s smile by calling our office at (408) 971-2885. Please visit our website, www.CareOrthodontics.com, for other beneficial information.

Treatment options for sleep apnea

What is sleep apnea?

Sleep apnea is a condition when your breathing stops during your sleep, sometimes occurring 20-30 times per hour. Each time you stop breathing, the lack of oxygen available to supply to the brain causes you to wake up to restart the breathing process. The continuous process of wake-sleep, wake-sleep cycles prevent you from achieving deep sleep and causes you to feel constant drowsiness and fatigue during the day.

What are the risk factors?

Sleep apnea can occur with any age and gender. However, it is more common in males over age 40. There is higher risk for individuals with obesity, smoking, drinking, and family history.

Should it be treated?

Sleep apnea should be treated immediately. If left untreated, it can lead to high blood pressure, risk of heart failure, and stroke. It interferes with sedation and surgical recovery. Due to unintentionally falling asleep during the day, it negatively affects work and school. It also leads to higher risk of injury while operating heavy machinery.

How is sleep apnea treated?

Treatment for sleep apnea depends on the severity and type of apnea. Basic treatments involve behavior management, such as instructing patients to lose weight, stop smoking, stop drinking, and sleep on their side instead of their back.

Intervention treatment may include an oxygen machine. A medical device called a CPAP machine (Continuous Positive Airway Pressure) is commonly used to treat moderate to severe sleep apnea. It delivers a continuous stream of oxygen to the patient, and has been proven to lower blood pressure and reduce heart problems [Source: WebMD].

Many people find that the machine works effectively at delivering air flow. However, the drawbacks include wearing a face mask that can be cumbersome and uncomfortable, and the mask can cause sore spots and irritation to the skin. The machine can be noisy, which can wake a person up at night. It is also an expensive machine. Some patients find themselves waking up at night to take the oxygen mask off.

An alternative treatment is oral appliance therapy. The oral device works best for mild and moderate cases of sleep apnea and avoids the drawbacks of an uncomfortable machine. The treatment involves fabricating and fitting a custom-made appliance to position the mouth open and unobstructed in order to maintain an open airway. This appliance is fabricated by an orthodontist and is used to prevent throat blockages. The oral appliance must fit comfortably so that it does not cause sore spots and the person can breathe comfortably.

In some severe cases, surgical treatment may be required to permanently change the position of the jaw. The mandible can be advanced to open the airway. The maxilla can be widened with a palatal expander in order to widen airway spaces.

If you or someone you love suffers from sleep apnea, talk to your physician to be referred to a sleep apnea specialist. The specialist may conduct a sleep study to diagnose the extent of the problem and recommend the appropriate treatment. If you are diagnosed with obstructive sleep apnea (OSA), you can schedule a consultation with an orthodontist to see if oral appliance therapy may be helpful to treat your sleep apnea. We can custom create an oral device for you to help open your airway and improve breathing.

If you find this blog helpful, let us know. Dr. Nancy Phan and the team at Care Orthodontics want you to have a beautiful and healthy smile. We create beautiful smiles with Care!

Sources and Citations:

1. http://www.progressivebraces.com/sleep-apnea-appliance-snore-appliance
2. http://www.dentistryiq.com/articles/2013/11/using-oral-and-dental-devices-to-treat-snoring-and-sleep-apnea.html
3. http://www.webmd.com/sleep-disorders/sleep-apnea/continuous-positive-airway-pressure-cpap-for-obstructive-sleep-apnea

What is the difference between snoring and sleep apnea?

What is snoring?

Snoring occurs when you make hoarse sounds during sleep. It is caused by the vibration of the soft palate. It presents due to narrowing and laxity of airway tissues. Snoring does not restrict the airway and it does not cause sleep disturbances.

Studies estimate that 30% to 50% of the U.S. population experience snoring. Light snoring can be a minor annoyance. Excessive, loud and habitual snoring can disturb your loved one. Snoring does not cause breathing or sleep disturbances. However, it can progress into upper airway resistance syndrome, which causes sleep disturbances and becomes sleep apnea. Snoring can be a sign of sleep apnea. Snoring can increase a person's risk for stroke. [Source: Lee et al.]

In summary, as long as there is no airway restriction, then the term “snoring” is used. It is important that you recognize the differences between snoring and sleep apnea.

What is sleep apnea?

Sleep apnea is a condition when your breathing stops during your sleep, sometimes occurring 20-30 times per hour. Each time you stop breathing, the lack of oxygen supply available to the brain causes you to wake up in order to restart the breathing process. The continuous process of wake-sleep, wake-sleep cycles prevent you from achieving deep sleep and causes you to feel constant drowsiness and fatigue during the day.

Sleep apnea is defined as restriction of the airway passage for a minimum time leading to oxygen saturation drop. Apnea is a complete or almost complete blockage of the airway for a certain time.

What are the signs of sleep apnea?

Snoring is one symptom of sleep apnea. However, snoring does not always indicate sleep apnea. It may be a social inconvenience but may not cause cessation of breathing, and may not require immediate treatment. Currently, 1.2 million Americans suffer from sleep apnea.

To diagnose sleep apnea, look for these symptoms:

• Choking or gasping that follows loud snores at night
• Breathing cessation episodes
• The need to wake up frequently with shortness of breath
• Sore throat and dry mouth after waking
• Insomnia or difficult sleeping
• Headaches, drowsiness, and irritability upon waking in the morning
• Falling asleep unintentionally during the day

What are the different types of sleep apnea?

The types of sleep apnea are usually diagnosed by a sleep apnea specialist in a sleep lab.

There are 3 types of sleep apnea:

1. Obstructive sleep apnea (OSA) is the common type. It occurs due to a physical blockage, typically caused by the tongue, uvula and soft palate, which collapse and block the airway in the back of the throat.
2. Central sleep apnea (CSA) is a less common type. It occurs due to lack of proper signals from the brain sent to the breathing muscles.
3. Complex sleep apnea is a less common type. It is a combination of obstructive and central sleep apnea. [Source: Dental IQ]

 

Medical and dental conditions associated with sleep apnea

• People who have high blood pressure, frequent heartburn and hypothyroidism have high associations with sleep apnea.
• People who have heavy clenching, grinding, bruxing, temporal mandibular joint symptoms and frequent headaches have high associations with sleep apnea. [Source: Health checklist]

If you have these conditions, along with disruptive sleep patterns, you should see your physician to get diagnosed with sleep study tests to rule out sleep apnea.

Should it be treated?

A light snoring can be a minor annoyance to your spouse or family member but may not need treatment. Severe snoring can be a sign of sleep apnea and should be diagnosed and treated. Sleep apnea should be treated immediately. If left untreated, sleep apnea can lead to high blood pressure, risk of heart failure, and stroke. It interferes with sedation and surgical recovery. Due to unintentionally falling asleep during the day, it negatively affects work and school. It also leads to a higher risk of injury while operating heavy machinery.

In the next post, Dr. Nancy Phan will discuss different treatment options for sleep apnea.

If you find this blog helpful, let us know. Dr. Nancy Phan and the team at Care Orthodontics want you to have a beautiful and healthy smile. We create beautiful smiles with Care!

1. http://www.dentistryiq.com/articles/2013/11/using-oral-and-dental-devices-to-treat-snoring-and-sleep-apnea.htm
2. Lee SA, Amis TC, Byth K, et al. Heavy snoring as a cause of carotid artery atherosclerosis. Sleep 2008, 31:1207-1213
3. Bruce, Dan. Health history checklist for sleep-related breathing disorders. Dental Economics 03 2015, 80-84

3 effective methods to clean your retainers and Invisalign aligners

If you are wearing removable retainers such as Hawley, or clear retainers or aligners, you may notice they get white build-up. At first, the build-up may be soft and sticky due to plaque build-up. With time, this sticky layer turns into crusty, white build-up that is difficult to brush away.

Just as calculus builds up on teeth, caused by minerals in saliva, calculus deposits can form on retainers. With time, it is very hard to remove. Aside from the unattractive look, dirty retainers also smell like rotten fruit. Thus, it is important to keep retainers and aligners clean.

Below are 3 methods of cleaning retainers: 

1. Brush your retainers manually
2. Soak your retainers in a sonic cleansing system
3. Soak your retainers in homemade solutions

 

1. Brush your retainers manually

This method is the cheapest, most reliable, and most effective way of cleaning retainers and aligners. Every morning, a minimum of once a day, manually brush your retainers with liquid hand soap and a toothbrush. Use a denture toothbrush that has stiff bristles to help get rid of the white plaque. Then rinse with warm water. Store retainers or aligners in a case with the lid open to air dry and eliminate any damp, salivary smell. Use soap that contains an antibacterial agent to clean plaque. It will also have a deodorizing agent to eliminate the smell.

Make sure to store retainers dry and only if they are clean and free of build-up. If they are dirty and you don't have time to brush them in the morning, then you should store the retainers in a cup of distilled water. Dirty retainers will dry out with a white biofilm and harden into crusty white calculus that is very difficult to clean and remove.

If you are concerned about avoiding chemicals, then use water only to clean the retainers. It may take a little longer to manually scrub the retainer.

You can use toothpaste instead of soap to brush the retainers. However, most toothpaste contains about 20% of abrasives, such as silica compounds, triclosan, polymers, and pyrophosphates. These ingredients are used to polish the teeth, prevent biofilm formation, prevent stains, and prevent tartar formation respectively. These ingredients can create micro scratches on your retainers or make retainers look more dull over time.

 

2. Soak your retainers in cleaning tablets and a sonic cleaner

This method uses a proprietary system of sonic cleaner and tablets. It is convenient and works effectively, however, it is more expensive. You can purchase a portable sonic cleaning kit and cleaning tablets at a drug store or over the internet from websites such as dentalkit.com or smileshop.com.

The sonic cleaners cost from $10 to $50 per unit depending on if they are battery operated or have a power plug with an auto shut-off option. These units basically vibrate to shake off calculus and plaque build-ups. The cleaning tablets cost about $5 per monthly supply. There are many brand names, such as Retainer Brite, SonicBrite, DentaSoak, Efferdent, and Polident. These tablets have antibacterial agents, cleaning agents and deodorizing agents to eliminate the smell and clean retainers. [Source: Wikihow]

 

3. Soak retainers in homemade cleaning solutions

With this method, you will need to create your own ingredient mix. The ingredients can be vinegar, baking soda or hydrogen peroxide.

You can use 5% distilled white vinegar, used for home cooking. Mix 1 part vinegar to 3 parts warm water. Soak your retainers or aligners for 20 minutes. Then clean off with water to dissolve white plaque. Use vinegar sparingly, as long term use can degrade the plastic and change the color of acrylic.

If you have not been cleaning your retainers and the build-up is old, chunky, and crusty, then use 1 part vinegar to 1 part water and soak overnight. Brush off with a stiff brush in the morning. Vinegar works as a dissolving and antibacterial agent. Most of the time, you can get rid of about 75% of crusty calculus. You still need mechanical brushing to scrape of the remaining tenacious hard calculus. By brushing your retainers daily, you prevent hard mineral build-ups as described here.

Baking soda or hydrogen peroxide can be used in substitution for vinegar, also with dilution in water. These ingredients work as an antibacterial agent to neutralize acidic bacteria and clean soft plaque. In general, vinegar still does a better job at removing hard calculus.

If you find this blog helpful, let us know. Dr. Nancy Phan and the team at Care Orthodontics want you to have a healthy and beautiful smile. We love to see you smile!

Am I too old for braces?

From time to time, we have grandparents who are interested in orthodontic treatment after having brought the grandkids into our office. We also have middle-aged adults who would like to get started with treatment or want re-treatment. Nowadays, there are more adults getting braces and Invisalign treatment than decades before. According the American Association of Orthodontists, currently 20% of orthodontic patients are adults, compared to less than 5% over 20 years ago. 

Reasons why it is easier for adults to wear braces these days:

• The metal brackets are thinner and smaller
• The clear, ceramic brackets are thinner, less brittle, less likely to cause stains
• Optional lingual braces are attached to the back of the teeth and are less noticeable
• Invisalign is a good alternative for adults who do not want to wear braces
• Socially, it is more acceptable to wear braces and more people are doing it than ever before

As more people are aware of the benefits of straight and healthy teeth, they are more motivated to obtain treatment. You don't have to live with negative consequences of physically limited oral health due to bad bite, uneven teeth, gingival recessed gum, or trapped plaque. You don't have to suffer the psychological setback of covering your unattractive teeth while smiling, and you don't have to fear that people will judge you negatively due to crooked teeth.

Here are the benefits of receiving orthodontic treatment:

• Less chance of food build-up, stain, and plaque accumulation with aligned teeth
• Less periodontal disease and gum recession when teeth are in proper occlusion
• Less trauma in occlusion when teeth are properly fitted
• It is much easier to brush and floss with straight teeth
• You chew food properly and avoid gastrointestinal problem with correction of improper bite
• You speak better and digest food better with correction of an open bite
• You show more self-confidence when you have a better smile
• When you smile more, you are more approachable to others, make more friends, attract the opposite sex, and perform better at job interviews.

Should you consider orthodontic treatment at your age?

You are never too old for orthodontic treatment. Even in your 70s or 80s, as long as there is normal bone metabolism and no periodontal disease, tooth movement can occur. However, here are some important differences to consider in adult orthodontics:

• By adulthood, bone growth has stopped. Therefore, there are no opportunities to manipulate jaw growth except for jaw surgery. With severe underbites, overbites, crossbites, or facial asymmetry, a combination of jaw surgery and orthodontic treatment may be necessary.
• Treatment may take longer in adults compared to adolescence. With age, teeth may move a little more slowly due to dense bone. With age, adults are more prone to root resorption and periodontal diseases. Thus, adults need to be more closely monitored and need more frequent cleanings. Adults need gum pockets checked every 4-6 months to ensure healthy periodontal structure.
• Adults often need more inter-discipline care and dental cosmetic treatments along with orthodontic treatment. Procedures such as veneers, porcelain crowns, teeth whitening, gum grafting, etc. are often indicated to restore size, shape, and function of teeth as a result of heavy grinding, bruxism, root-canal treatment, internal staining, or gum recession.

The outcomes are just as good for adults. Even though many adults worry about the age to pursue orthodontic treatment, the majority are satisfied with the end results. They are happy that they invested the time and money in their smile and they can keep their healthy smiles for many more years to come!

At Care Orthodontics, we are here to help. If you have any questions about your bite and would like to consider treatment options, you can schedule an appointment for complimentary consultation with Dr. Nancy Phan at 408-971-2885. You can also find other beneficial information on our website at www.CareOrthodontics.com.

Does my child need a palatal expander?

Some parents are concerned when seeing many crooked teeth in their child’s mouth, and often ask if a palatal expander would be beneficial. The answer is, it depends. A child should be seen by an orthodontist to evaluate the size, shape, and bite of the mouth to determine if an expander is indicated.

What is an expander? It is a custom-fitted dental device that is made by 2 metal halves joined together by a small screw. When turned, the screw opens slowly to widen the width of the upper jaw.

  

When is palatal expander used? A palatal expander can be used on a child or an adult to correct a bad bite, sometimes referred as a "cross-bite." It is also used to widen the maxilla. Anatomically, the upper jaw and roof of mouth are together know as a maxilla. In some individuals the maxilla is narrower than normal and causes the upper teeth to fit abnormally inside the lower teeth when biting down known as a "cross-bite." A cross-bite may restrict the amount of space available for the permanent teeth to erupt. A cross-bite can also cause the lower jaw to shift lopsided when biting down creating facial asymmetry.

In a child, there is a window of opportunity to correct a cross-bite non-surgically. Since the maxilla is made up by 2 pieces of bones connected in the middle by a seam of cartilage, this cartilage is soft and can be stretched by a palatal expander. Once puberty hits, on average round age 12-14; this cartilage hardens into bone. The 2 pieces of maxilla bones fuse together and cease to expand. Any expansion has to be done through surgery.

In adults, jaw expansion works through jaw surgery via a cut through the roof of the jaw, then a palatal expander separates the bones, bone fills in the expansion gap, and finally bone healing occurs 3-4 months later to stabilize the new jaw.

Why is palatal expander used? The expander is used to correct a one-side cross-bite or two-side cross-bites and to widen the roof of the jaw. In a child, the expander fixes the bad bite, prevents unsymmetrical facial growth, prevents uneven wearing of teeth, and gains space to allow ease of eruption of permanent teeth. In adults, using an expander establishes balanced occlusion, prevents uneven enamel wear, and corrects facial asymmetry.

Does it hurt to wear an expander? Insertion of an expander does not hurt except for turning the appliance. One can feel some tight pressure around the base of the nose and the roof of mouth a few minutes after the expander has been turned. An expander does alter speech and swallowing for 1-2 weeks until the tongue adjusts to the new device.

How long is the expander turned? In general the expander is turned for 1 to 2 weeks while being monitored by an orthodontist. After that, the expander is left in the mouth for an average period of 6 months for bones and tissues to adapt.

In summary, a palatal expander is beneficial when indicated. Although it is non-invasive to separate the maxilla bone with an expander, it must be done before puberty. Discovering this type of malocclusion early is one of the many reasons the American Association of Orthodontists recommends a child to see an orthodontist by the age of 7. It is much easier for parents to have a consultation with an orthodontist to survey their child's bite problem, discuss options, and plan the course of treatment early than dealing with complicated options which may require pain and surgical intervention later on.

At Care Orthodontics, we are here to help. Dr. Nancy Phan can provide a complimentary consultation to answer your questions at (408) 971-2885. You can also find other beneficial information on our website at www.CareOrthdontics.com.