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.

10 Extra Tips for Wearing Invisalign

Wearing Invisalign aligners to straighten teeth is the easiest way to go through orthodontic treatment without the pain and embarrassment of wearing braces or the worry of food stuck between the brackets. 

Currently, there are 1.4 million people who have been treated with Invisalign world-wide. Since Invisalign aligners are removable, they can be removed quickly for eating, brushing, flossing, photo sessions, important presentations or special occasions, such as weddings, graduations and reunions. 

Below are 10 tips that can be beneficial to you while wearing your Invisalign aligners:

1. Brush your teeth often. Frequent brushing can help you remove most food and plaque to keep your teeth and gums feeling clean. Brushing can eliminate most external stains from food and drinks, such as tea, coffee, ketchup or food coloring that will lead to yellow teeth. Brushing often is the first step to having clean, white teeth.
2. Floss your teeth daily. With Invisalign, flossing is as routine and simple as not going through any orthodontic treatment. Daily flossing will cut down food build-up around the gum pockets to reduce the risk of gum inflammation or gingivitis.
3. Eliminate nail biting habits. Like Brittney Spears, a few of us may have this tenacious nail-biting habit that is hard to get rid of. Wearing aligners is the fastest way to help you kick the habit. You will notice that, with plastic around your teeth, you can hardly bite into your nails.
4. Insert new aligners at night. Studies show that patients report a feeling of tightness during the first day or two of wearing a new set of aligners. When you insert a new set of aligners at night, there are two benefits. First, you sleep through the discomfort of new pressure and feel less sensitivity. Second, after eight hours of sleep, your teeth already moved. By the morning, the aligners are easier to remove than when you first placed them in your mouth at night.
5. Take a pain reliever during the first two nights of wearing new aligners. Since most people feel slight pressure during the first two nights of new aligners, taking pain reliever medication, such as Ibuprofen or Tylenol, will eliminate any discomfort.
6. Remove aligners from back to front. It is easier to lift the aligners off on the back area of the mouth first, on both right and left sides. Then peel the front aligner off. If you do the opposite and try to push the front out first, it can be very tight since there is more retention on the front teeth.
7. Remove aligners when the mouth is warm. Invisalign aligners are made out of a special plastic material. Plastic is more pliable in warm temperatures. If you take a sip of warm water or just slightly open your mouth for a few minutes to breath warm air into your aligners, you can lift them off easily. This is especially helpful if you have very short nails or no nails at all. On the contrary, if you take a cold drink of water and try to take the aligners out, the aligner can be very stiff and it is harder to lift off.
8. Whiten your teeth while wearing Invisalign. One of the many benefits of wearing aligners is that you can use whitening gels, such as over-the counter products or from your general dentist's dispensary, to whiten your teeth. Although there are attachments bonded on your teeth while wearing Invisalign, most whitening gels can get beneath the attachments. If there are many large attachments, you may need an extra round of teeth whitening after the end of Invisalign treatment to lighten these spots. In general, whitening 1-2 times a year is generally safe with over-the-counter products. However, if your teeth feel sensitive to cold or heat, then you should consult with your dentist first.
9. Reduce teeth clenching at night. For those who tend to grind and clench your teeth a lot night, wearing Invisalign aligners will cut out enamel wear and reduce the soreness that your teeth feel in the morning after heavy grinding. Since you are changing to new aligners every two weeks, any scratches to your aligners are better than dealing with worn enamel. Aligners make an excellent alternative to a mouth guard.
10. Enjoy a night out. If you ever feel burned out from going through orthodontic treatment, you can remove the aligners for a few hours to enjoy a special night out. Overall, you need to wear your aligners an average of 22 hours a day for your treatment to be successful.

At Care Orthodontics, Dr. Nancy Phan and team hope that you find these tips helpful while wearing Invisalign. If you have any questions or need a complimentary consultation regard orthodontic treatment or Invisalign treatment, please give us a call at our San Jose office to schedule an appointment. 

8 Ways to Kick the Nail Biting Habit

Nail biting is a “nervous disorder” that is scientifically described as onychophagia. It is usually triggered by stress, excitement, boredom or nervousness. Between 30% to 65% of children and 15% of adults bite their nails at one time or another. More than 75% of these people stop the habit after age 35, except for a few with OCD (Obsessive Compulsive Disorder).

There are several reasons to stop biting your nails:

• It's unsanitary. Nails harbor bacteria below the nail beds and you swallow these bacteria while biting your nails. Bacteria and viruses passed from your fingers to your face and mouth can make you vulnerable to infection.
• It's unattractive and socially unacceptable. In addition to having a negative appearance, it causes damage to your health. Nail biting leads to ragged and unattractive nails. It also causes nail bleeding and damage to nail beds.
• It can cause stomach problems. When you bite your nails, you transfer bacteria between your mouth and your nails. Swallowing bacteria and broken nail bits can lead to stomach problems.
• It wears down teeth. Pressure from nail biting wears down your teeth over time. In addition, biting pressure leads to crooked teeth. It causes gum redness and irritation. Overall, nail biting can lead to permanent damage to your teeth, gums and nails.
• It can delay your orthodontic treatment and cost you money. Nail biting leads to frequent broken brackets or chipped teeth, which costs you more to fix the dental problem and delays orthodontic treatment.

Here are eight recommended ways to kick the nail biting habit:

1. Keep nails short so there is less nail to bite.
2. Coat your nail with bitter-tasting nail polish. Try fake nail products such as acrylics, wraps, gels and press-on nails.
3. Wear bandages on your nails or gloves on your hands. It may seem a bit awkward at first, but this can be an effective tool.
4. Wear a mouth guard, a clear retainer, or an Invisalign aligner to prevent you from biting your nails.
5. Wear a rubber band around your wrist and snap it every time you have an urge to gnaw on your nails.
6. Take up a new habit in order to kick old habits. Understanding when and why you bite your nails is the first step to making a conscious effort to kick the habit. Then find a way to distract yourself when you have an urge to bite your nails, such as humming, finger tapping, chewing gum, knitting, crocheting, nail care, decoration, doing art projects with clay or plaster, etc.   Outdoor activities such as running, playing basketball, tennis, etc. will also keep you occupied and distracted from the urge to gnaw on your nails.
7. Get support from those around you. Share the news with a friend or family member to encourage and remind you to stop.
8. If you can't find a suitable distraction or habit to help you stop biting your nails, you might try addressing the problem therapeutically. There are options such as behavior therapy or online support groups. You could also find a "quit buddy" to help you on your journey to a bite-free existence.

View How to Stop Biting Your Nails on Howcast

At Care Orthodontics, Dr. Nancy Phan and team care for your oral health as well as your overall health. We hope you find these tips helpful to kick any nail biting habits that you may have.

Sources and Citations:

1. http://www.webmd.com/healthy-beauty/stop-nail-biting-tips
2. http://www.psychologytoday.com/blog/making-habits-breaking-habits/201301/how-stop-biting-your-nails
3. http://www.rd.com/health/beauty/14-tips-for-strong-and-healthy-nails/
4. http://www.wikihow.com/Stop-Biting-Your-Nails

How to handle an orthodontic emergency?

Luckily in orthodontics there are not many true emergencies. Common problems are minor issues such as loose wire and brackets. The best thing to avoid any orthodontic emergency is prevention. Diet and food selection can the keys for patients wearing braces. While in orthodontic treatment, patients in braces should avoid hard and sticky foods, and should cut food up into small pieces, and take small bites. These daily habits will prevent loose brackets and broken wires. Patients in Invisalign treatment may have a few composite attachments and occasionally experience them coming off. Attachments can be replaced at the following visit.

There are 2 types of orthodontic emergencies. They are categorized as major and minor emergencies. 

Major orthodontic emergencies:

Major emergencies are any direct injuries to the face, mouth, jaw or teeth. Patients with these problems should be seen by a medical professional such as physician or dentist right away. You may need x-rays or advanced imaging to determine the extent of your injury. If the injury affects the orthodontic appliances, the appliances may need to be removed, replaced or adjusted right away.

Samples of major emergencies:

• Lacerated lips and oral tissues due to contact sports - go to an emergency room for evaluation and treatment.
• Fractures of teeth and jaw due to facial injury - go to an emergency room for further imaging and treatment.
• Infected teeth that cause bleeding, swelling or pain associated with the mouth - call your dentist for further diagnoses and treatment.

Minor emergencies:

While these are not true emergencies, they require some home care remedies and the problem can be fixed at the next office visit or subsequent visits.

Samples of minor emergencies:

• Loose wire - if it is not pokey, leave it alone and wait until the next orthodontic visit. If it is pokey, then cut the pokey end with a clean nail clipper or bend the pokey end until comfortable using the eraser end of a pencil or a cotton swab.
• Loose brackets, loose bands, lose elastic band - chew food on the opposite side and wait until the next orthodontic visit.
• Loose appliances - if the entire appliance is loose, remove it and bring it to the next orthodontic visit for re-insertion. If only one side is loose, then call for an early appointment for removal and re-insertion.
• General soreness or canker sore - place wax on brackets that face the canker sore, stay away from foods that are too spicy or salty, and chew food on the opposite site until canker sores disappear. Canker sores usually heal and disappear within 5-7 days.
• Headgear or facemask that does not fit - stop wearing the appliance temporary and bring the appliance to the next orthodontic visit for re-fitting.
• Broke your retainer or lost your retainer - call our office to order a new one.

Any of those above issues can happen due to normal shifting while wearing your braces. Eating hard or sticky food can exacerbate the problems. Vigorous brushing can also contribute. Wide yawning or sharp opening of mouth while wearing rubber bands can cause brackets to come loose. Chewing gums or chewing on pens or pencils can cause appliances or brackets to loosen. These problems do not require immediate fixing; however, they will need repairs at subsequent office visits.

The on-the-spot remedy for those loose brackets or wires is wax to alleviate discomfort. Pokey wires can be moved with a cotton swab or clipped off with a clean nail clipper. Soreness and small abrasions in the mouth are normal due to new adjustments to orthodontic appliances. Rinse your mouth with salt water solution comprised of a cup of 8oz warm water and one teaspoon of salt, 3 times daily, for 2-3 days until better.

We have a lot of instructions on our website at www.CareOrthodontics.com to help you handle minor issues. We have instructions for emergency care under ‘Braces San Jose' > 'Emergency care’ tab. We have videos on how to handle common issues under ‘Orthodontic videos' > 'Instructions videos’ tab.

Whenever in doubt, be sure to contact our office to schedule an appointment with Dr. Phan at Care Orthodontics. We are always available for instructions, care and comfort. Our mission is to help you achieve the most beautiful smile with personal attention and care!

Why are retainers important after orthodontic treatment?

The most important reason for wearing retainers is to prevent your teeth from shifting back to their original position. The second reason is to maintain the shape of your jaw, and the third reason is to reduce jaw clenching and grinding.

After completing your orthodontic treatment at Care Orthodontics, Dr. Nancy Phan and team will recommend that you wear retainers. Retainers will hold your teeth, gums and bones in placed until they are stabilized and are less likely to relapse.

There are 3 kinds of retainers. Today, Dr. Phan will share with you the pros and cons and each type:

Hawley retainers:  They are the most common type of retainers and are made out of wire and acrylic. They are removable and are custom made from the impression of your teeth.

• Pros:  These retainers are most durable. They can last up to 15-20 years as long as they are well maintained, kept in their retainer cases, and being worn daily. They can be repaired to accommodate a new crown, a big restoration or even an implant crown or bridge. They allow the person to brush and floss easily.
• Cons:  They require a short adjustment time initially. When first worn this type of retainer may alter your speech a little. Your mouth may salivate a little more until your tongue adjusts to function with these retainers in the mouth.

Clear retainers:  They are removable and transparent. They are custom-made from the entire arch and can be used to hold teeth or to produce minor movements. They are commonly used in Invisalign treatment to move teeth.

• Pros:  These retainers are very esthetic and they are very thin so they are very easy to wear. Most people do not need any adjustment time. Your speech is not affected. In addition, this kind of retainer can be used as a mouth guard to prevent enamel wearing down during grinding.
• Cons:  Their average life time may be 3-10 years depend on the amount of teeth grinding or clenching. Patients who experience heavy clenching and grinding may wear out clear retainers quickly and require a replacement set.

Bonded retainers. They are fixed, non-removable and cemented directly in the back of upper and lower six front teeth.

• Pros:  These retainers stay in the mouth 24-7 unless there is any breakage. For people who forget to wear retainers, for whom teeth have shifted easily, or who prefer to leave retainers in the mouth all the time, this type of retainer is indicated. 
• Cons:  These retainers require the most daily care and maintenance. You need thorough brushing and a special flossing device to keep stains and food away from these retainers. You need to avoid incorrect biting or flossing to prevent bonding breakage. Bonded retainers are not life-time permanent retainers. The bonding can break off and cause your teeth to shift. Broken bonded retainers will need to be repaired or replaced by an orthodontist. In patients who have periodontal diseases such as loss of bony attachment around teeth or have loose teeth, bonded retainers can break easily and require frequent repairs.   

If you have any question about retainers, you can contact us for a consultation appointment at (408) 971-2885 with Dr. Nancy Phan. You can also check our website at www.CareOrthodontics.com for other useful information and tips.

8 Benefits of Invisalign Treatment for Teens and Adults

Most people recognize the Invisalign brand name and have heard that it can help adjust your teeth. However, do you know all the benefits that Invisalign can bring?

Invisalign is an orthodontic system that uses transparent, removable aligners to move teeth. Almost everyone who has healthy, permanent teeth can benefit from Invisalign treatment. Aligners can straighten teeth without metal brackets. They can be removed daily for eating, brushing, flossing and any social events. In addition, there are other benefits that are specific to teenagers and adults.

Benefits to teenagers:

1. Invisalign Teen protects teeth during contact sports. At Care Orthodontics we recommend wearing a mouth guard for all contact sports or gymnastics. It absorbs shock from any object that can shatter teeth and lacerate lips. For teenagers who are in braces, a custom fit mouth guard is expensive to fabricate and is difficult to fit over braces. With Invisalign, aligners already wrapped around the teeth to provide some protection. For heavy sports, aligners can be removed and a normal mouth guard can be worn without the added expense of a specialized mouth guard.
2.  Invisalign protects lip irritation for anyone playing "wind-musical instruments" such as clarinet, saxophone, trumpet, horns, etc... Unlike braces, Invisalign has no raised metal brackets or sharp corners to cause scratches, canker sores or inflammation. Teenagers can remove aligners while practicing and playing in a band. Since aligner material is very thin, it is an ideal dental device for music lovers. 
3. Invisalign trains kids to be more responsible. Since Invisalign requires kids to wear aligners full time with an average of 22 hours per day, kids are treated like an adult and asked to be responsible for their treatment. Surprisingly, I find that kids enjoy their responsibility when being challenged on a daily basis. They comply better when they see their teeth becoming straighter. They are motivated to wear the aligners because they can see the changing results.
4.  Invisalign saves time. I understand that kids are busy with many school activities such as academics, sports, and after-hour curriculum, while parents are busy with work and commuting. Going to an orthodontic office and waiting to be seen for a monthly adjustment is a chore that both parents and kids are glad to eliminate. Invisalign offers a perfect alternative because they require a fewer number of office visits. There are no monthly adjustment, no dental emergencies such as loose bands, brackets or pokey wires, and no alteration in diet or flossing. For busy teenagers, Invisalign saves time and makes treatment a convenience.

Benefits to adults:

1.   Invisalign is a versatile therapy for adults.  Aligners can be removed to eat, brush, and floss. You don't have to worry about changing your diet or avoiding certain favorite foods as required by braces. You don't have to deal with special brushing or flossing tools. Without brackets, there is less plaque accumulation near the gum line, thus less risk of gum diseases and deep pockets. Adults also experience lighter force with aligners, thus making treatment more enjoyable and less painful. 
2.   Invisalign is a good solution for social settings. Many adults aren't sure if it is worth wearing braces to have straight teeth. They don't want to be noticed for having metal brackets in their mouths or having food stuck between their brackets. Now adults can achieve straight teeth, without the hassle of worrying about metal brackets.
3. Invisalign is a good fit for adults who have busy schedules.  Between works, meetings, picking up and dropping off kids at schools, groceries and meal preparation, adults usually have no time left at the end of the day. With Invisalign, there are virtually no emergencies or loose appliances, discomfort is minimized, and fewer visits to the orthodontist’s office are required. It is the preferred appliance for many busy adults.
4. Invisalign can help with teeth whitening. Patients can buy whitening kits over- the-counter and whiten their teeth while getting their teeth straightened. It is an ideal set-up for a beautiful and healthy smile.

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. Give us a call at (408) 971-2885 or visit us at www.CareOrthodontics.com . 

  

What are the benefits of braces…other than just to straighten teeth?

Everyone wants a naturally straight and beautiful smile. It is no secret that braces can deliver a good smile. However, there are many additional benefits to having braces other than just having straight teeth. You will gain many oral health benefits in addition to the cosmetic ones:

1. Reduce tooth decay and gum disease. Crooked teeth, crowded teeth, overlapped teeth create tight spaces, lead to food traps and difficulty brushing and flossing. Gingivitis and periodontal diseases are different types of gum disease, caused by certain strain of bacteria found in plaque sitting above the gum and deep inside the gum pockets. These bacteria break down bone and tissue attachments to cause teeth mobility and tooth loss. Having straight teeth allows better brushing and flossing, reducing food traps and encouraging healthy gingival and bone.
2. Improve your speech. Your teeth play a significant role in speech. The way your tongue is positioned in relation to your teeth contributes to the formation of sound. When your teeth are too far out forward or backward, they can affect speech and cause lisping, frustration or embarrassment. Aligned teeth allow for more clear and acute speech.
3. Improve your eating. Your top and bottom teeth need to come together evenly to break down food. A person who has an open bite, when the top and bottom front teeth are not aligned, will not be able to bite into a piece of lettuce or into a thin slice of ham with the front teeth. Another person with an overbite or an under-bite will have a hard time chewing food normally. Straight teeth allow better chewing and mastication. 
4. Prevent bone erosion. Bone and gum begin to erode when there are no teeth to support them. Teeth that are far out of alignment can lead to bone and gum erosion, resulted in teeth mobility and teeth sensitivity. With braces, Dr. Nancy Phan can bring poorly fitted teeth back into a healthy range. 
5. Reduce risks of temporal mandibular joint (TMJ) dysfunction. Bad bites can cause stress to the temporal mandibular joint and lead to muscle fatigue, muscle spasm, joint soreness or joint inflammation. By eliminating a bad bite, Dr. Nancy Phan can establish a harmonious occlusion with minimum joint stress. 
6. Improve your digestion. Your teeth play an important role in digestion. Before food gets digested in your stomach, they are first digested by your teeth. When teeth are severely out of line, they do not break down food effectively. With braces, you can achieve more optimal chewing. 
7. Improve your self-esteem. A research by Wakefield and the American Association of Orthodontists revealed that 1/3 of American adults are unhappy with their smile. Bad teeth represent one of the biggest dating turn-offs among men and women. Bad teeth lead to lack of self confidence and lead to missed opportunities on career advancement, social interactions, and a better job interview or a job offering. Having a beautiful smile is the first step to gaining self confidence.

With today's technology, braces are thinner, smaller and far more esthetics than the 1960s -1970s. People can get their teeth corrected with different options such are metal braces, ceramic braces, clear aligners, Invisalign, etc. Healthy teeth can be moved at any age. You are never too old to enjoy a straight and healthy smile!

Call us at 408-971-2885 or check us at www.CareOrthodontics.com to schedule a complimentary consultation for orthodontic treatment. You can enjoy all the benefits of braces discussed in this article.