Treatment

Brushing
You will notice that it requires more time to keep your teeth clean with braces. Food tends to get stuck in the brackets and between your teeth, and can only be removed by brushing and flossing. Floss every day. In order to get the floss under your wires, use floss threaders. If plaque remains on the teeth for any length of time, it will leave a permanent white scar on the surface. Brushing after meals should become part of your daily schedule. Make sure to use the special fluoride gel prescribed by your orthodontist every day. It will not only prevent cavities, but also help prevent decalcification around the brackets of your braces.

Eating Habits
A healthy diet means a healthy body, healthy teeth, and a better result for your orthodontia. Please do not eat hard foods: nuts, ice, crisp taco shells, whole apples and carrots (cut them into pieces first), hard French bread crust and rolls, spareribs, corn on the cob (cut the corn off the cob before eating), and popcorn. These foods risk breaking brackets and wires. Also beware of nail biting and pen or pencil chewing habits, since these can damage your braces. Do not eat sticky foods: taffy, caramels, bubble gum, sticky candy of any sort. A small piece of sugarless gum occasionally is acceptable. Use common sense about most foods.

Foods to avoid while wearing braces:

• Gummy Bears

• Chewing Cracked Ice

• Chewing Hard Bread Crust

• Hard Pretzels

• Hard Pizza Crust

• Apples (unless peeled and cut into bite sized pieces)

• Carrots (unless cut in strips)

• Popcorn

• Frozen Candy Bars

• Nuts

• Hard Candies

• Sticky Candies

• Meat on the Bone

• Beef Jerky

• Celery

• Granola Bars

• Corn on the Cobb

• Bubble Gum

• Tootsie Roll / Bit-O-Honey

• Crunchy Chips

Elastics
Elastics (rubber bands) exert the proper force that creates the right amount of pressure to move teeth. In order for this force to remain constant, elastics must be worn all the time and changed once a day. Any time missed in wearing your elastics will only make your treatment take longer, so remember these things:

• You are responsible for placing the elastics on your braces between appointments. Make sure to wear them as instructed. Remove them only when brushing your teeth, gums and braces after meals. Then put your elastics back on immediately.

• Always carry a few elastics with you, so if one breaks you can replace it right away. If your supply is low, call the office and we will mail you an additional supply of elastics.

• If you forget to insert your elastics one day, do not double up the next day, just follow your regular instructions.

• Elastics become worn out. When they lose their elasticity, they do not provide the proper pressure on your teeth and jaws. It is very important to change them as directed, even when they are not broken.

• If your elastics break frequently, a wire or band loosens, or a hook breaks off call our office immediately. Do not wait until your next appointment. These problems need to be corrected as soon as possible.

Removable Appliances
The removable appliance is carefully designed to move or to hold your teeth. It is important that it is worn according to instructions and brought to each appointment.
You must wear your appliance at all times, even while you are asleep. It may be removed while eating, swimming, or playing vigorous sports activities.
Avoid flipping your appliance with your tongue. This can cause damage to your teeth or breakage of your appliance.
Your new appliance may make your teeth sore for a day or two, especially after an adjustment. If you have a sore spot on you gums, call our office so that we can adjust the appliance.
Clean your appliance by brushing it daily with toothpaste. Denture cleaner (e.g., Efferdent, Fixodent or Polident) can also be used for a more thorough cleaning. If you are wearing a bonded wire retainer behind your front teeth, be extra careful to clean the wire and the area around it. Flossing should be done every day.
Never wrap your appliance in a paper napkin or tissue and set it down on the table. You or someone else may accidentally throw it away. Do not put it in your pocket when playing or you may break or lose it. Whenever it is not in your mouth, it should be placed in its plastic appliance case.
Keep your appliance away from dogs or cats, as they love to chew on the

Spacers
Spacers or separators are small blue doughnut shaped elastic rings. They are placed between your teeth to create enough space for fitting bands comfortably. They will be removed the day you get your bands on. You can still brush as normal, but you can not floss between where the spacers are. Please check everyday to make sure that you have the same number of spacers as the day they were placed.
At first it will feel like you have a piece of food caught between your teeth. After a few hours you may feel soreness that may increase discomfort and last a few days. You can take whatever you would to treat a headache to ease the discomfort. You can still eat everyting you normally would, but remember to stay away from sticky and chewy foods. These types of food will make your spacers fall out. If a spacer falls out please call the office to have it replaced.

Lip Bumper
Lip bumper therapy is used to create space when there is crowding or insufficient room for the permanent teeth in the lower arch. It consists of placing bands (metal rings) around the lower 6-year molars onto which the lip bumper fits. The lip bumper itself is U-shaped plastic tubing used to shield the lip an cheek muscles away from the teeth. This will allow us to maximize the space for the permanent teeth while your child is growing.
Wear your lip bumper 24 hours per day. It should be worn even when brushing your teeth, eating, playing sports, sleeping, and all other activities. It is important to keep the area between the lip bumper and the teeth clean, as well as brushing around your lip bumper and bands to maintain good oral hygiene. Initially, and after each adjustment, your teeth may become sensitive. However this will only last a few days. Any discomfort can be relieved with whatever medication you would take for a headache. It's normal to have a red line inside your lower lip (called the "bumper line") after wearing the lip bumper for a while. This is normal and can be expected. However, if an ulcer that looks like a cold sore or canker sore appears, contact our office for further instructions. Avoid playing with your lip bumper. Otherwise, it may loosen up your bands. If your lip bumper falls out of the tubes when eating or brushing your teeth, you may slip the lip bumper back into the tubes, with loops in the downward position.
You can eat normally. Just remember to follow the list of foods to avoid during treatment. If a band that is cemented to a tooth becomes loose, call for an appointment to have it recemented. Bring the band and all other material with you.

Palatal Expander (Hyrax)
A palatal expander is an orthopedic appliance designed specifically for the upper arch. It is used for the correction of two problems: 1) Narrow upper arch - crowding an insufficient space for permanent teeth 2) Crossbite - the upper teeth fit inside or behind the lower teeth A palatal expander is usually worn for approximately 7 months. This device painlessly expands the palate. New bone fills in, and the palate remains wider.
We would like you to turn your appliances twice a day. The best time to do this is once in the morning and once at night, just before bed. The turning instructions are as follows: 1) Always place your finger through the safetly loop, attached to the key, to prevent the possibility of the key being dropped or swallowed. 2) Place the key firmly into the hole in the front of the appliance. 3) Push the key toward the back of the mouth until the key will go no furthur and the next hole appears in the front of the appliance. 4) Remove the key from the hole by sliding the key down towards the back of the mouth, not forward.
Keeping your expander clean is very important. Brush the appliance when you brush your teeth, including the portion that goes across your palate. Vigorous rinsing is helpful. The use of a waterpik is optional You will be seen approximately once a week for the next 3 to 4 weeks to monitor your progress closely. It is extremely important to keep your appointments, especially during the activation phase. We will be monitoring the progress of the expansion to determine when activation should be discontinued.

Headgear
Headgear therapy is used for one type of early correction. It consists of placing bands (metal rings) around the upper six-year molars to act as anchors onto which the headgear fits. This appliance is used in cases where the upper teeth or jaw are too far forward. The headgear slows the upper jaw in its forward growth and allows the lower jaw to catch up simply by developing at its natural rate during the period of early facial growth.
1) Wear the appliance from 12 to 14 hours per day. 2) Some temporary discomfort may be experienced during the first few nights. Molar teeth may become tender and even a little loose. Falling asleep may be difficult. 3) Once you start headgear treatment, you must keep it continuously. Wear the headgear everyday and all night. Wearing the headgear only while sleeping will NOT produce the necessary and desired improvement. 4) Use the "score card" in your headgear bag to keep account of the number of hours you wear the appliance each day and night. This is IMPORTANT!! 5) Please do not wear your headgear during rough play, sports, school, in the car or when riding your bike. 6) Handle everything carefully, especially when removing or inserting the inner bow. Never -- we repeat NEVER try to pull the headgear off without first unhooking the safety strap which is attached to the outer bow. 7) Protect the bow when not in use by keeping it, with the neck strap, in the bag provided. If the bow is lost or distorted, call us immediately. 8) Remember to follow the list of "Foods to Avoid" during treatment. If a band that is cemented to a tooth becomes loose, call for an appointment to have it recemented. Bring the band and all other material with you.

Retainers
Now that your braces are off and you are enjoying your beautiful new smile, we would like to give you some information about retainers.
Retainers are very important to your orthodontic result and the first year after braces is always the most crucial.

• Until you are advised differently, wear your retainer all the time, except for playing sports and eating.

• Brush the retainers with cold water every time you brush your teeth. Soaking them in mouthwash during dinner will give you that after-dinner mint taste. Occasionally soaking in regular denture cleaner is also a good idea.

• Retainers can easily be broken if they are not in your mouth or in their case. Avoid backpacks, back pockets, tabletops and places where the family pet can reach them.

• If you break your retainer, do not try to fix it yourself. Call our office to get it repaired.

• Be careful not to click your retainer in and out all the time or always be taking it out to show friends. This will cause it to get loose and not fit properly.

• Retainers do not like heat. Avoid hot water, sunlight and do not microwave them (yes, it has been done)

• You may talk funny or salivate more when you first get your retainer. This is normal and will improve with practice and time.

• Remember: retainers are difficult to make and are expensive to replace. Take care of them and keep your recall appointments with us. With proper care, your retainer will serve you well for a very long time.

The Patients responsibility
For best results, please follow these instructions and keep your appointments.

• See your dentist every 6 months.

• Brush your teeth after every meal.

• AVOID eating sweets between meals unless the teeth can be cleaned immediately thereafter.

• AVOID chewing ice, hard or sticky candy, gum, and popcorn, playing with, or dislodging appliances.

• AVOID rough play where you could receive a blow to the face or could catch the appliances upon your clothing and dislodging or breaking them.

• Please notify the office IMMEDIATELY if the appliances are loose, lost or broken.