Treatment for Kids

What age is best for first orthodontic screening?

January 5th, 2020

If you have school age children, determining the age of the first orthodontic visit may be confusing. You may see some first graders in braces and you may be wondering: "Why in the world are they wearing braces already? As a parent, am I missing something?"

It is very common for parents to ask me:

What is the best age to bring my child for their first orthodontic screening?

In my opinion, I believe the best time for a first visit is around their 8th birthday. At this age, children have a mix of both adult and baby teeth, and we can start to foresee how their teeth and jaws will line up in the future. Specifically, I am looking for:
- Cross bites (top jaw is too small)
- Excessive crowding or spacing of the teeth
- Overbites and underbites (mismatch of upper and lower jaw size)
- Missing teeth, late erupting teeth, extra teeth, abnormally shaped teeth
- Environmental factors (thumb sucking habits, mouth breathing, etc.)

While there are many things I am looking for at this age, it does not necessarily mean that I will treat them at this age. In fact, for most kids under the age of 11, I recommend waiting.  While every orthodontist is different, I prefer a conservative approach and I firmly believe "less is more" when it comes to orthodontic treatment.

Why do I take this approach? For many bites, we have studies that show we can get the same result if we treat in one stage instead of two. This not only saves time and money in orthodontic treatment, but it gives your kid the chance to be a kid without having braces from age 8 until 13. Additionally, we have to consider these are their adult teeth - they need to have them forever! Hygiene is very important, and I want to give every kid the chance to keep their teeth clean and cavity-free if possible.

Does this mean I wait in all cases? Not at all! It is true - some cases I do recommend a 2 step approach with early orthodontic intervention at age 8-10 years old. Often times, this is for bone growth issues that are best addressed at that age, or for teeth alignment issues that if left untreated will make for a more difficult treatment in the future. If this is the case, I try to do an early treatment for as little time as possible to help correct the problem. Then we can wait and approach the rest as a pre-teen or teenagerI sincerely look at every child as if they were my own, and if there is a situation that I would treat my son or daughter, then I let you know.

I take pride in our conservative approach to early treatment. Best of all, we do not charge anything for an initial screening - our first appointment is entirely free, and you do not need a referral from your dentist to check us out. Feel free to reach out anytime with questions - I am here to help : )

-Dr. Zach

9 Common Questions about Orthodontics

December 15th, 2019

We receive lots of questions every week from people interesting straightening their teeth to improve their smile and to create a healthy bite. Here are a few of our most popular questions and answers : )

  1. What is an orthodontist, and how is he/she different than my regular dentist?
    An orthodontist is a dental specialist who focuses only on treatment with braces, clear aligners (Invisalign), and retainers. An orthodontist has pursued 2-3 years of additional training beyond dental school in order to specialize in the growth and development of facial structures.
  2. What problems does an orthodontist fix?
    Common orthodontic problems include crowding or spacing of teeth, uneven smile, impacted or unerupted teeth, and improper jaw alignment.
  3. Will getting braces or orthodontic treatment hurt?
    Generally, there is a short period of discomfort for a couple of days in your teeth, gums, and cheeks as you mouth gets adjusted to the braces. Dr. Zach will discuss with you or your parents the best way to manage this discomfort.
  4. What is the best age to see Dr. Zach for a consultation?
    In general, anyone wishing to improve his or her smile can schedule an exam at any age, from children to adults! Most full orthodontic treatments will begin around age 11-13 to coincide with the start of adolescence and the loss of remaining baby teeth. However, some problems can still develop before this age and require a form of early treatment as early as age 7.
  5. How do I take care of my braces?
    Excellent brushing and flossing habits are necessary to take care of your braces and teeth. Also, you will need to follow our instructions on how to avoid any broken appliances and problems.
  6. How long will I have wear braces or Invisalign clear aligners?
    Treatment times will vary on an individual basis depending on your goals and how challenging the tooth movements will be. Treatment times can range from 6 months to 30 months, and the most common treatments average about 18-20 months for a beautiful smile.
  7. Do I still see my regular dentist every 6 months?
    Yes! It is absolutely necessary to see your general dentist every 6 months for regular check-ups and cleanings. The health of your teeth is our number one priority, and your dentist is essential in the maintenance of your teeth before, during, and after treatment.
  8. Will I have problems playing sports or musical instruments?
    Although there is an initial adjustment period, you should not have problems participating in your normal activities with braces. We recommend wearing a mouth guard during contact sports.
  9. Will I have to wear a retainer at the end of treatment?
    Yes, at the conclusion of orthodontic treatment, a retainer is required to maintain the result and keep your smile beautiful.

Still have more questions? Feel free to contact us here or call/text us anytime : ) We are happy to help!

Missing Teeth, Impacted Canines, and Your Family Tree

August 24th, 2019

Teeth genetics are weird. There is so much variation in size, shape, and color teeth. There is also a lot of variation when it comes to timing of when baby teeth are lost. We are all so different from one another, with a few exceptions: our teeth are very much like those of our parents and siblings.

Teeth abnormalities are pretty common in the general public, and many people are affected by them. For example, approximately 30% of people are missing at least one tooth. This is most commonly a wisdom tooth. Also, approximately 2-3% of the population has an impacted canine, where the canine is stuck in the bone and does not want to come in. It is more common on the left side than the right side (how weird!) and it is more common in girls than boys (sorry ladies!).

As a parent, it is important to keep this in mind. Are you missing an adult tooth, or was your brother or sister missing a tooth? Do you still have a baby tooth in your mouth? Do you remember having braces to fix an impacted canine? Your kids will be more at risk for similar problems. Impacted canine teeth can damage other adult teeth, and missing teeth can be a dental problem in the future if not addressed early.

So what do you do? It's simple - get a screening early. I recommend having an orthodontic  screening at age 8 to evaluate for these conditions early. We take a panoramic x-ray that looks at all of the developing teeth so that we can see if any of these problems may occur. Most orthodontists do not charge for this screening, and it basically informational to help you understand your child's current or future needs.

Is it OK to have a screening even if you didn't have these problems? Yes - definitely! You may not know that grandma or great-uncle was missing 4 adult teeth. Additionally, we are screening for more than just missing teeth. We look for crowding issues, spacing issues, overbites, underbites, cross bites, and much more.

At the end of the day, please do not lose sleep over any of these issues. Genetics is out of your control, but we are here to help however we can. We can correct impacted teeth, missing teeth, and bite issues in many different ways with braces and Invisalign®. Feel free to reach out with any question : )

Take care and love your smile!
Dr. Zach

Sleep Issues in Children – Read before your child’s next physical exam

February 3rd, 2019


When you hear the words sleep apnea, you probably don’t think much about kids. However, sleep apnea affects 2-3% of kids, and the symptoms are subtler than they are in adults. Children with sleep apnea may appear totally normal at a physical exam, but there are some signs to watch out for. This list is not all-inclusive, nor does it mean that any one of these indicates a problem. However, if some of these describe your child, it may be a good idea to consult with your family doctor about the possibility that sleep may a problem.

  • Snoring – No child should snore – period. An occasional load breath may be heard, but your child should not be snoring or breathing loudly at night on a regular basis. Snoring in children goes hand-in-hand with sleep apnea, and this should definitely be brought the attention of your family doctor.
  • Teeth grinding – Grinding teeth at night may be a defense mechanism for the body. If your child is struggling with proper airflow at nighttime (due to a collapsed airway, tonsils, adenoids, allergies, etc.), pushing the lower jaw forward often helps open the airway to allow a better passage of air down the throat. This protective measure for the body is helpful for breathing, but can really cause long lasting harmful effects on the teeth.
  • Bedwetting – Typically, by around the age of 5, most kids will be able to sleep without wetting the bed. An accident here or there is much different than an older child who is wetting the bed frequently. Although this can be due to other medical conditions, bedwetting can be linked to sleep disorders as the body fails to awaken when the bladder is full.
  • Mouth breathing – While humans are able to breathe through both the nose and the mouth, we are technically “obligate nasal breathers” as a species, meaning we are supposed to breathe through our nose. Deviated septum, allergies, and other nasal airway obstructions can make it difficult to breathe through the nose. Mouth breathing can affect the development of the face, jaws, and teeth position, often times leading to orthodontic treatment to normalize the effects of letting the mouth hang open all the time.
  • ADHD – Sleep issues may contribute to problems relating to attention span. When some kids don’t get enough sleep, they actually act opposite of what we would expect – they actually become hyperactive rather than tired. Additionally, they may be irritable, unfocused, and easily distracted, and these consequences can have a very negative effect on school performance. Studies have shown that 1/3 kids with ADHD also snore while sleeping.
  • Morning headaches – If your child’s airway is partially blocked while sleeping, the amount of oxygen in the blood will be reduced. This reduction in oxygen level may lead to headaches, specifically in the morning after waking from a poor night’s sleep.
  • Sleepwalking and sleep talking – Typically if these are observed, they are usually shortly after going to bed and associated with “confused arousal.” This means that something startles the child awake, but they are still subconscious and may not be fully awake. This arousal may be from other medical conditions, but it may also be from airway obstruction that causes sleepwalking and/or sleep talking.

The bottom line is this – sleep is obviously important for all of us, but many kids with sleep issues are not being identified. As an orthodontist, I am a specialist in facial growth and development, and my job is to simply screen for some of these issues. I can fix some of the side effects on the teeth and jaws, but ultimately a physician (sleep specialist or ENT physician) needs to put all the pieces together to make a diagnosis. So, if you see these issues at home, or your dentist or orthodontist has mentioned some of them to you, make sure to follow up with your physician. Improving your child’s sleep very well could change their life, so the sooner we do it, the better : )

- Dr. Zach

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