Patient education

Thumbs, Fingers, and Pacifiers: Kick the Habit

September 6th, 2020

All of us are born with the innate sucking reflex. It is needed to survive as an infant and helps us eat as babies. As we develop, some babies will use a thumb, finger, or a pacifier as a comforting mechanism. However, at some point, this habit can start to cause harm to the developing teeth and bones of the mouth.

At what age do kids need to stop sucking thumbs or using pacifiers?
- Depending on how much sucking pressure your child uses on his thumb or pacifier, you may start to see changes as soon as age 2-4 years old. You may notice flaring of the front teeth and changes to the shape of the smile. Typically, these changes can self-correct if the child is done with the habit by age 6 before the adult teeth start to erupt.

Why do we need to break the habit?
- The habit can permanently change shape of bones of the mouth and permanently change the shape of the smile.  Some long-term habits can cause irreversible changes that cannot be fixed with orthodontic treatment alone. Additionally, it will create issues that can make orthodontic treatment more time-consuming, more complex, and more expensive.

How can we start to break a pacifier habit?
Typically a thumb habit is more challenging to break than a pacifier habit because you cannot take a thumb away : ) In most cases, you will start this process at a younger age while the child is still a toddler, and in many cases they will stop on their own. Avoid harsh words or punishment as this is not effective for this age group. Praise progress and use rewards charts to help encourage them to quit. Beware - in some cases, a new thumb or finger habit may emerge!

How can we start to break a thumb habit?
- Be conservative at first! If your child in pre-school or early elementary school, start by talking about it. Kids must be on board to quit; if they do not want to quit, conservative approaches may not be successful, and you may have to revisit it again after waiting a few months. The earlier you start the conversation, the better of you are since the upper front adult teeth will come in around age 6-7. I recommend starting out with simple reminders such as wearing a Band-Aid on the thumb or finger.

My kid is now on board - what can we do to help him quit his thumb habit?
- While they may relapse at times to find comfort, you may need to use additional items to help kick the habit. You can try a baseball batting glove, thin winter glove, or sock over the hand at night time. You can loosely add medical tape around the wrist to make it more difficult to remove, but please be sure it is not too tight. Another product is Mavala Stop which is a sour tasting nail polish to serve as a reminder. Always remember - couple the reminders with a tracking and reward system to celebrate the small wins. Praise will help keep the kids motivated - remember they want to make you happy!

What if the conservative habit break measures don't work?
- More aggressive physical reminders in addition to the above may be needed. An Ace bandage wrap around the elbow will make it more difficult to bend the elbow which will restrict their ability to bring their hand towards the mouth. You may also consider a wrist guard thumb habit appliance (TGuard brand) that is fixed to the wrist and plastic around the thumb/fingers

What if everything else does not work - what is our last resort?
- Orthodontic appliances are the last resort. If all else fails and we see the habit is causing significant bone changes, we can make what we call a "habit appliance" and cement it to the molars in the mouth. It is like a metal cage that fits near the roof of the mouth and difficult to remove. Typically, we will keep it in place for 9 months, but no less than 6 months in order to break the habit. If this appliance is needed, many times a palatal expander will be needed afterwards to correct the changes that have occurred due to the habit.

Orthodontists are skilled in helping you and your child with their habit issues. Additionally, we are skilled at correcting the problems that prolonged habits may cause. Be sure to talk to your local orthodontist early about breaking the habit - it will certainly make a difference in the long run!

What are orthodontic tooth separators or spacers?

May 17th, 2020

Orthodontic separators (also known as “spacers”) are small latex-free rubber bands that fit in between two teeth to make space in preparation for fitting an orthodontic band or ring around the tooth. These are commonly placed before a palatal expander is placed.

What can my child expect after the separator or "spacer" is placed?

  1. Mild soreness from the spacer is expected – use over the counter pain medications as needed.
  2. Pressure or feeling of something stuck between the teeth is normal.
  3. If the spacer falls out a few days before the next appointment, that usually means enough space has been made.

Tips:

  1. Do not try to remove the spacers at home – this may delay fitting the orthodontic band or appliance at the next appointment
  2. Avoid sticky and chewy foods that may dislodge the spacer
  3. Brush the area normally but do not floss the area with the spacers

If the spacer falls out before your next appointment, the ring around the tooth should still fit in most cases so there is no need to come in for a separate appointment. If you have any questions or concerns about the spacer, please call our office, as we are happy to help!

Re-opening office after temporary closure: Updates and what to expect at your visit

May 8th, 2020

After being temporarily closed for a long 8 weeks, we are ready to make you smile again! We had to postpone hundreds of appointments, so we have a long road ahead to catch up. Rest assured, we will get there!

As we move forward with some new guidelines, we ask for patience and understanding. The new guidelines are for everyone's benefit in order to have a safe environment for care as well as to provide an efficient way to get everyone back on track.

Here is what you need to know:

APPOINTMENTS AND SCHEDULING:
- PLEASE WAIT FOR OUR OFFICE TO CONTACT YOU FOR AN APPOINTMENT. We have a long list of people to contact, and this will make for more efficient scheduling by our team.
- COMFORT/URGENT APPOINTMENTS: These appointments will still only be seen on an as-needed basis for significant pain or bleeding. For now, broken brackets are not considered urgent comfort appointments. Need advice - click here!
- RETAINER CHECKS: All retainer check appointments will be postponed until the fall with exception of certain cases that Dr. Zach sees necessary; if you have retainer concerns, please call us and we can still schedule an appointment
- GROWTH CHECKS: Growth check appointments will be seen on a case-by-case basis; in many cases, they will be postponed until the fall; if you have concerns and would like to be seen sooner, please call us and we can still schedule an appointment

BEFORE YOUR VISIT:
- PLEASE BRUSH YOUR TEETH THOROUGHLY RIGHT BEFORE YOUR APPPOINTMENT and do not come in with excessive food or debris on your teeth/braces. Our tooth brushing station is closed and is now a designated station for our patients to wash their hands.
- EVERYONE WHO ENTERS OUR BUILDING MUST HAVE A MASK (both patient and parents). Please come prepared.

YOUR VISIT:
- FOR ALL MINORS (18 and younger), a parent must be at the appointment to sign a questionnaire regarding COVID symptoms and exposure. If you cannot come, you must contact our office prior to the appointment for the form and send a SIGNED COPY with your child. Unfortunately, we cannot make any exceptions to this rule.
- PLEASE ARRIVE ON-TIME. We have staggered arrival times to limit the number of people in our building at any given time. Arriving too early will likely lead to waiting, and late arrivals may need to be rescheduled.
- When you arrive, REMAIN IN YOUR CAR AND CALL our office to let us know you have arrived. We will let you know when to come in.
- For any minor patient, ONE parent/guardian should come in to sign a questionnaire form regarding COVID symptoms and exposure. Absolutely no other individuals will be allowed. We encourage that parents return to their car after signing our questionnaire.
- DO NOT COME IF YOU ARE FEELING ILL. Any question indicating recent exposure to COVID-19 or anyone with signs/symptoms will be asked to leave immediately and will not be able to return for at least the specified 14-day self-quarantine requirement.
- THE PATIENT’S TEMPERATURE WILL BE TAKEN using a touchless thermometer. If the temperature is > 100 degrees F, you will be asked to leave immediately and will not be able to return for at least the specified 14-day self-quarantine requirement.
- PLEASE MAINTAIN 6-FOOT SOCIAL DISTANCING guidelines while in the office and seated in the waiting room. Reception furniture has been limited to accommodate this guideline.
- Patients will be asked to wash or sanitize their hands before and after their appointment.
- Patients will be asked to rinse with Colgate Peroxyl mouth rinse at their chair where an assistant will suction.
- We ask for understanding as we try to address all of your needs at your visit. Individuals with multiple broken brackets or issues may not have everything completed during the visit due to strict scheduling times. If you anticipate you or child needs more time for these issues, let us know beforehand.

AFTER THE VISIT:
- DO NOT DRIVE HOME RIGHT AWAY - WE NEED TO SCHEDULE YOUR NEXT VISIT! For child patients, one of our team members will call you to update you on progress and schedule the next appointment. We will not be scheduling at our front desk at this time.
- ADULT PATIENTS – you will be scheduled while seated in the chair.

OUR NEW PROTOCOLS:
- HOURS: Our office hours are now Monday to Friday 8:00am to 4:00pm until further notice. We have extended our clinic hours to space out appointments, catch up on overdue treatment, and allow for extensive cleaning of our office twice per day. We will notify you once normal hours of operation resume in the future.
- BARRIERS: You will notice clear barriers at our front desk as well as in our consult room. Additionally, we have placed barriers between our chairs in the clinic (which are 7 feet apart). We will continue to operate our medical grade HEPA filter in our treatment area (this has been present prior to the pandemic).
- CLEANING: Office cleaning will take place in the morning, midday, and evening.
- RECEPTION ROOM: Furniture has been limited and no magazines or books are available. We encourage non-patients (parents/guardians) to wait in the car or outside.

TEAMWORK:
- OUR TEAM IS SCREENED ON A DAILY BASIS with a questionnaire, and temperature is taken daily. Any team member with COVID symptoms or a fever >100 degree F will be required to go home.
- OUR TEAM HAS BEEN THOROUGHLY TRAINED on the new protocols. Please be patient as things may take more time at first as we are adapting to our new protocols.

Our priority has always been delivering the absolute best orthodontic in a safe and timely manner - that still remains our top priority. We are still committed to this community for the long haul, so while some things will be different about our office in the short-term, our mission has not changed!

Questions or concerns should be addressed by calling or emailing our office - we are here for you. We understand this may be the first time many of you are leaving your home in 8 weeks, so please do not hesitate to let us know how we can make you feel safe and secure. See you soon!

  • Dr. Zach
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