Do-it-Yourself Orthodontics!!!

November 1st, 2018

Welcome back everyone.  While there are still so many topics to discuss, I wanted to briefly touch on one of the newest, and worrisome, fads today in Orthodontics.  

Most likely you have read/heard about Direct-to-Consumer (D2C) companies.  To make sure everyone is on the same page, I will briefly explain.  D2C companies are those that market their goods and services directly to the public.  There are no middlemen (think stores), and as such they are able to reduce their costs AND therefore sell their products more cheaply.  

For this reason D2Cs have exploded in popularity.  Chances are you have heard of (if not bought from) some of the most successful D2C companies.  Do the names Casper (mattresses), Warby Parker (glasses) and Dollar Shave Club sound familiar?  For the record I have purchased items from some of these companies and am thrilled with their products.  Alright, now that we are all caught up…

Dentistry and orthodontics are not immune from the D2C trend.  These companies specifically market do-it-yourself (DIY) treatments.  There are dental labs that will produce snoring appliances, removable dentures, and different versions of veneers to make someone’s smile appear whiter and brighter.  Those are all treatments that have the potential to permanently change teeth, bone and gum tissue!  Even in orthodontics there are now a few companies advertising to produce clear aligners (trays) to straighten teeth!  

The American Dental Association (ADA) and American Association of Orthodontics (AAO) have both released statements regarding these D2C companies.  Obviously consumers, when using D2Cs, are bypassing the doctor’s essential role in diagnosing and treatment planning.  What could possibly go wrong with this scenario? 

Well, apparently many things have gone wrong and now the American Dental Association (ADA) is working with the FDA on helping consumers report their problems.  Check out the article here.   

In our own practice we have re-treated 5 people in the past year who have tried their luck with DIY orthodontics.  Also, one of our colleagues recently posted a video of a patient who was seeking his orthodontic expertise to correct a DIY treatment gone bad.  I was going to include it but it was recently taken down because the D2C company is suing him!  Go figure.  

Obviously we discourage anyone from pursuing DIY dental or orthodontic treatments.  Without proper oversight, these seemingly “simple” and “easy” treatments can lead to irreversible harm at worst, or simply a very expensive re-treatment at best.  Unfortunately I don’t believe we can now close Pandora’s box.  DIY treatments will remain, especially as their marketing budgets swell and consumers remain largely uneducated on the necessity of doctor-based care.  

So, why write something like this?  Well maybe you will share it with someone who is thinking about DIY orthodontics.  If nothing else perhaps it will persuade them to dig a little deeper with their research.  Consumer education is everything, and hopefully this helps.   

What I did on Vacation

July 13th, 2018

Dr. Nate here today.  So, here we are in the middle of Summer...We sincerely hope everyone has had a great start to their Summer activities!  Our whole family just got back from our yearly beach vacation, and while we were there I was finally able to catch up on the latest Orthodontic news. 

My last post focused on a supposed revolutionary vibration device designed to make Orthodontic treatment go faster.  If you want to re-visit that, click here.  I had concluded that there was no substantial evidence this system would make teeth move faster.  And now I have some semblance of vindication...

There is an Orthodontist in England named Kevin O’Brien who writes a very good blog about Orthodontics.  He is a professor of Orthodontics and a talented writer who has made quite the name for himself, even in the US.  In his most recent post (which is here) he mentioned that the British government, namely the Advertising Standards Authority (ASA), forced the company promoting their Orthodontic vibrating device to remove their ads for a very serious reason.  Instead of summarizing, I will pull the important quote.

“The ad must not appear again in its current form.  We told OrthoAccel Technologies Inc. not to make claims that their AcceleDent device could move teeth faster and reduce the pain for brace wearers unless they held adequate evidence to support such claims.”

When I finished Dr. O’Brien’s post, and then read the full ASA document, I could hardly believe it!  And then I became frustrated for two reasons.  First, the same standards haven’t been applied here in the US.  Treatments without excellent research results should not be presented to the public through advertisements!  Secondly, as a supposed learned specialty within Dentistry, Orthodontists should be able to discern good quality research from poor research.  That is our responsibility to the public...don’t treat patients with something that doesn’t work!

If you have made it this far, you should know that I fully understand that this rant has been more cathartic for me than entertaining for you.  Selfish?  Of course.  But my (and Dr. Theresa’s and Dr. Nick’s) standards are very high when it comes to treatment decisions.  Ask us why we do this treatment, and not that one.  We will be glad to tell you, and show you the research backing it up.  

New technology is great, but not always effective.  That is an important distinction. 

Some beach vacation...

Good Vibrations

March 28th, 2018

Dr. Nate here today and I wanted to discuss a new trend in Orthodontics.

Every profession chases their own ‘Holy Grail.’  It is the target at which progress attempts to hit.  Orthodontics is no different…but what IS our target?

Speed.  And more speed.  In fact, this is the most common question we hear…”How long do I have to be in braces?”  It is an appropriate question too.  Families want to get the maximum benefit with the minimum treatment time.  That not only helps the patient in terms of the final smile, but also minimizes the biggest risk of Orthodontics (think oral hygiene here).   

The quest for faster treatments has had many targets.  For example, bracket designs have been changed umpteen times and wires have been modified in both materials and sizes.  The result after roughly 75 years of tinkering…a slow, but definite decrease in treatment time.  Recently, however, speed has plateaued with traditional appliances.  More novel concepts are being developed and brought to market.

One popular product is focused on making teeth move faster with vibration.  They make a powerful assertion…use their device for 20 minutes a day and teeth will move up to 50% faster!  Amazing, right? 

But, as with anything else in the medical and dental worlds, research results are the ultimate proof of success.  As of me typing this on a very early Saturday morning there are 4 published articles on this topic.  Any guesses as to the consensus???

Three out of the four articles show absolutely no increase in tooth movement when using this vibrating device.  The one article with a positive increase (0.37mm) in tooth movement per month is barely more than the width of a human hair (0.2mm).  This apparent outlier actually has other very serious problems with their statistical analysis, and if that sounds like an interesting conversation to have let me know…

So, what is the point of all of this?  If you made it this far, here you go.  If you picture Orthodontics as a biological process (which it is), bone and bone cells are the arbiter of treatment time.  Logically, do bone cells “care” that they are being vibrated?  And is their response going to be to make the teeth move faster?  The research clearly states that the answer to both of those questions is a resounding NO. 

We obsess over the best research to determine whether new treatments are going to make a difference to our patients.  If we use it, then we can easily back up WHY.  If we don’t, well make your own conclusions.  Speed is undoubtedly important, but we NEVER compromise the quality of our treatments.  And the smiles are all the better for it. 

Dr. Nate Writes a Poem...

December 13th, 2017

As I sit down every Tuesday night to brainstorm over the week's blog post, I find my mind easily wanders.  And, most of the time that is a unwelcome distraction.  However, last night I went quickly from Christmas.  The reason is obvious, but what came next was very serendipitous (or, at least, amusing).  So, without any more ado let me present my Orthodontic interpretation of "The Night Before Christmas."  Enjoy...


‘Twas the night before Christmas, when all through the house,

Not a creature was stirring, not even for floss;

The rubber bands were all set in their mouths with care,

In the hope that Dr. Nick soon would be there.

The children were nestled all snug in their beds,

While visions of braces danced in their heads,

And Mom with her Invisalign, and I in my cap,

Had just settled down for a long winter’s nap-

When out on the lawn there arose such a clatter,

I sprang from the bed to see what was the matter.

Away down the hall I flew like a kite,

Tore open the door, and threw on the light. 

The moon on the surface of the new fallen snow,

Gave the luster of white teeth to objects below;

When, what to my wondering eyes should appear,

But a miniature sleigh, and eight tiny reindeer.

With a little old driver, so spry and so quick,

I knew in a moment it must be Dr. Nick!

More rapid than a plane his reindeer they came,

And he whistled, and shouted, and called them by name.

“Now! Brushin', now! Flossin', now! Fixin', and Pliers,

On! Molars, on! Cuspids, on! Incisors, and Wires.”

“To the top of the porch! To the top of the wall!

Now scrub away! Scrub away! Scrub away all!”

As plaque leaves before our appointments we try,

When they meet the doctors with eyes to the sky.

So up to the house-top the reindeer they flew,

With a sleigh full of brushing supplies—And Dr. Nick too:

And then in a twinkling, I heard on the roof

The prancing and pawing of each little hoof. 

As I drew in my head, and was turning around,

Down the chimney Dr. Nick came with a bound:

He was so dapper dressed, from his head to his foot,

But his clothes were all tarnished with ashes and soot;

A bundle of gloves and tools flung on his back,

And he looked like our doctor as he opened his pack:

His eyes—how they twinkled!  His dimples how merry,

His cheeks were like roses, his nose like a cherry.

His smile was drawn all up like a bow,

And his teeth were like pearls as white as snow;

His spectacles were held high and light on his nose,

With his white doctor's coat down to his toes. 

He had a thin face, and the kindest of eyes

They twinkled when he smiled, like he'd won a prize.

He was skinny and fit, a right jolly old elf. 

And I laugh’d when I saw him in spite of myself.

A wink of his eye and a twist of his head

Soon gave to know I had nothing to dread.

He spoke not a word, but went straight to work,

And fix’d all our smiles; then turn’d with a jerk.

And laying his finger aside with his nose

And giving a nod, up the chimney he rose.

He sprung to his sleigh, to his team gave a whistle,

And away they all flew, like a down of a thistle:

But I heard him exclaim, ere he drove out of sight-

Happy Christmas to all, and to all smile bright!

Netflix Loves Teeth-Part Deux

December 6th, 2017

Dr. Nate here again today on the blog. Last week I left everyone in suspense regarding Part Deux of Netflix’s hit show Stranger Things and their connections to the dental world. If you didn’t read last week’s post, head back to our blog to catch up!

Now, in full disclosure I didn’t notice this other dental connection myself. It came across my email from a friend/colleague in Missouri. What’s cool about this connection is it’s much more specific to Orthodontics than General Dentistry.

Recall last week I wrote about Dustin’s (real-life Gaten Matarazzo) genetic condition called Cleidocranial Dysplasia. It requires significant dental work, which Dustin frequently referenced in this second season by calling his new teeth ‘pearls.’ The second connection to Orthodontics is actually a t-shirt!

In one of the episodes, Dustin is wearing a t-shirt that reads “Brace Yourself for the Future!” It is from an Orthodontist in Springfield, MO named Dr. Wes Allai. When he first opened his practice in 1982, he made these shirts to hand out to his community. They are cool in the way the rest of Stranger Things is cool…very 1980’s. The graphics and the wording all point to something very familiar to those of us who did grow up in the 80s.

I found a recent interview with Dr. Allai and he said he doesn’t know how one of his shirts made its way onto the set of Stranger Things. He stopped making them over 30 years ago! But, being a true business man he is now offering the same shirts through Etsy.

And, yes, I did already buy one…

Netflix Loves Teeth-Part 1

November 29th, 2017

Dr. Nate back at the blog.  For those keeping tabs, it has been a while since we last posted an entry.  And, to get comfortable with writing again I am going to start off with a topic that has gained considerable attention recently through the pop media. 

I assume most everyone has heard of, if not seen, the Netflix show Stranger Things.  There are NO spoilers ahead I promise...

One of the main characters is a young boy named Dustin, played by Gaten Matarazzo.  He is quite an actor, and his character is very funny and sweet.  Gaten has a genetic condition called Cleidocranial Dysplasia, and the show has incorporated his real-life condition to Dustin.  In fact, now that the show has made its way through 2 seasons (roughly 20 episodes), the writers have referenced Gaten’s condition multiple times. 

So, what exactly is Cleidocranial Dysplasia?  It is a genetic condition that affects mostly the development of bones and teeth.  As we are Orthodontists, I am going to focus on the teeth.  The condition most often leads to an absence of permanent teeth, as well as slow eruption of the permanent teeth that are present.  It is definitely a condition that requires meticulous planning and collaboration between the General Dentist and Orthodontist to ensure the patient has both an amazing smile but also a functional bite that will last a lifetime. 

Now the great thing about Stranger Things is that they have discussed Gaten/Dustin’s condition in a way that has empowered other kids with Cleidocranial Dysplasia. To check for yourself, Google Dustin’s name with Stranger Things. You will find many articles that talk about how Gaten has helped other kids be more open about their condition!

In our practice we have been honored to take care of kids with Cleidocranial Dysplasia, as well as other Craniofacial conditions.  Being able to help these kids to smile confidently is a tremendous privilege!

Lastly, there is actually one other connection with Orthodontics and Stranger Things, but that will have to wait until next week...

It's good to be back!

Stubborn Teeth!

June 14th, 2017

Dr. Theresa here today to write about an intriguing subject: impacted teeth.  For the sake of simplicity, I will only focus on one of the most commonly impacted teeth, Maxillary (upper) canines.  Canines are commonly referred to as the “i-teeth.”  An impacted tooth means it has finished developing, but is unable to erupt.

What makes the upper canines become impacted?  There are multiple theories, and none of them have been officially proven.  So we will discuss the most realistic ones.

First, the size of the teeth could be larger than the space available in the jaw (simply called ‘crowding.’)  When this happens, there is not enough space for the canine to erupt into the mouth which inevitably traps the canine in the bone.

Second, the baby canine tooth does not fall out at the appropriate time.  If the baby canine remains in the mouth too long then the permanent canine does not have a chance to erupt into the mouth.  Remember, there is a ‘normal’ permanent tooth eruption sequence (more on that below).

Third, the canine can develop sideways (horizontal), but no one has a reasonable explanation as to why.

Lastly, the development of one of the adjacent teeth can affect the upper canine eruption path.  Usually this would be the Lateral Incisor (one of your front teeth), and in the cases with impacted canines the incisor would be peg shaped and smaller than ideal.  I put this theory in because we have seen a recent string of patients with extremely small upper incisors whose canines are impacted.

Is there a way to avoid canine impaction?  In most cases yes there is, but it does require an orthodontic visit around age 7.  For those avid readers of our blog (all 6 of you—thank you by the way!), we had a post about the ideal time to visit the orthodontist.  Here is the link.  So what are we, as orthodontists, looking for?

We begin by making sure there is progress with losing baby teeth and gaining permanent teeth.  We also take a special X-ray to determine the canine location.  The X-ray also assesses the development of all teeth, and whether the baby teeth are inhibiting normal permanent tooth eruption.  In regards to the upper canines, they normally erupt into the mouth around age 11.

If the baby canines are not loose by age 10 AND you haven’t seen an orthodontist, it is our recommendation that you discuss the situation with your dentist.  We are also happy to take a look at any time.

As previously mentioned, early intervention can prevent or decrease the severity of an impacted canine.  The goal of early intervention is to guide the proper tooth eruption, and to ultimately make any treatment as comfortable as possible.

We hope that everyone has a great start to their Summer!

The Story of Retainers

May 3rd, 2017

Dr. Nate here this week to explain why you need a retainer after braces. Simply: teeth move. It doesn't even matter whether you've had orthodontic treatment or not. As long as you are alive, your teeth will shift over time. There are two main reasons why teeth move...

Let's first start with physiology. Teeth are surrounded by bone, but that bone is subject to the forces of biting (occlusion). So while teeth feel firmly attached to your head, they are part of a mini-earthquake every time you bite down. This constant change can cause teeth to shift with time.

As for the second reason, I have to start with some orthodontic research. Adults who had braces back in the early 80's will tell us that they were told long ago that retainers didn't need to be worn forever. And they are correct.

But, just as anything else in medicine and dentistry, our treatments are based in the best AVAILABLE research. And up until 1985 orthodontists were recommending retainers be worn for "a few years."

In 1985, an orthodontist named Rolph Behrents published a paper called "Growth in the Aging Craniofacial Skeleton" that definitively showed that faces continue to grow throughout a lifetime. Now understand that this growth is minimal, say 1mm over a 10 year period. But believe me when I say this paper was revolutionary in terms of dictating future orthodontic treatments, especially in the area of retainers.

Why would a small amount facial growth affect tooth position? Dr. Behrents showed that facial growth isn't symmetrical between the upper and lower jaws. Instead the lower jaw grows more than the upper jaw. This tends to put stress on the lower front teeth, and causes them to crowd. This is why adults most often notice that their lower teeth have moved more than the upper jaw counterparts. Again, this is an insidiously slow process. But it is one that over 10 years will cause you to notice that your teeth have moved. So, how do we combat this?


At the end of orthodontic treatment, we give our patients retainers. In a future blog post, we will discuss the different retainer types. These retainers do exactly what they say. They retain position. Our instructions are clear-wear your retainers as long as you want your teeth to stay straight.

If you've had orthodontic treatment in the past, and have lost or stopped wearing your retainers, we would recommend that you find a way to get new ones. It is a simple solution that could help you avoid more complicated problems later.

Confident Smiles!

April 26th, 2017

Dr. Nate here on a continuation from last week’s blog post on adult Orthodontics.

As Orthodontists, we are experts on crafting wonderfully balanced smile esthetics.  While the reasons for wanting an improved smile are as unique as every patient we see, there is a common underlying theme.


What can increased self-confidence do for adults?

Lets start with the professional world.  We have so many adult patients that want to improve their smiles for their careers.  The reason…there is a ton of research that talks about how important a confident smile is to the interview process, and to potential customers.

The smile is consistently the number 2 focal point of a person’s eyes when they are introduced.

Anyone know what the number 1 facial focal-point is?  Feel free to answer in the comments section.  But back to the point…

And there are many, many more scenarios where that new smile is desirable.

What if you are getting married soon, and want that perfect smile for your pictures?  Or, what if you are a mother who hasn’t treated yourself in lord-knows-how-long?  Wait, isn’t Mother’s Day coming up?????

These are just a small sample of reasons our adult patients have sought out our practice.

We offer so many treatment options, including truly esthetic methods such as Invisalign.  Our incredible team is able to accommodate any schedule and any timeline.

So, give us a call and come meet your new smile!

Adults have Something to Smile About!

April 12th, 2017

Dr. Nate at the computer today.

It is a common misconception that, as Orthodontists, we only see kids for braces.

The majority of our patients are under the age of 19, but a rapidly growing number of adults are now either adding their smile to their bucket list or correcting treatment they had as a child.

The increasing adult orthodontics trend is being seen nationwide.

Different surveys put the number between 20-25%, and those numbers are at least a few years old.

So, why do an increasing number of adults care about their smiles?

The cynical person would answer that it is a symptom of our superficial society.  Our experience treating hundreds of adults has shown that nothing could be further from reality.  Besides… who wants to be around that person anyways?  They probably never smile!

Adults often renew their smiles through orthodontic treatment because of a relapse from previous treatment when they were teenagers.

In fact, if you are an adult who has had orthodontic treatment when you were a child, ask yourself this question… Do you know where your retainer is right now?  That’s what I thought (wink-wink).

We’ll cover the importance of retainers in a future blog post, but teeth WILL shift with time (regardless if you have had previous orthodontics).

The saying should go... Just like you will always need air to breath, your teeth will always be on the move!  #teethmove

But the largest percentage of our adult patients are completely new to orthodontics.  They never had braces as a child so…. What brings them in?

The most common answer?

“I want a fantastic smile” …and that is great!

Indulge me for a minute.  What do you see when you hear the term 'smile?'

Perhaps you picture your actual smile, but I would venture to guess you think of a memory that makes you smile.

In fact, more often it’s having a new reason to smile that leads adults to discover orthodontic treatment…

We call this the Smile-Emotion-Connection.

There is a true emotional attachment with your smile and as a result, your happiness. That is partly why adults want their kids to have orthodontics, a 'beautiful smile' lasts forever in those memories.

Adults are never too old to pursue a fantastic smile…  A smile that can turn back the clock further than daylight savings time and give you one more reason to like what you see in every mirror you pass.

Biologically, the teeth will still move the same (albeit slightly slower...there is always a catch). There are even cutting-edge treatments beyond standard braces that adults can choose from with the help of an Orthodontist who has dedicated his or her life to the art and science of tooth movement.

When it comes to your smile a fraction of a millimeter in any direction can make the difference between a brilliant smile and just unremarkable straight teeth.

So whenever you or someone you love is ready to take the next step, either myself, or one of the many world class Orthodontists around the county, will be patiently waiting with your new smile.

Wisdom Teeth Roulette

April 5th, 2017

Dr. Theresa here this week.   Frequently our teenage patients, and their parents, will ask us, “Do I need to have my wisdom teeth taken out?”  If these ‘wisdom teeth’ are so wise, why do they occasionally need to be removed?

Well, lets start with a little background lesson on teeth.  32 teeth make a full set.  On average, the first permanent molars erupt at age six, and by the early teens 28 teeth are present (including the 12-year molars).  Then, there is a six year hiatus in tooth eruption while the third molars (wisdom teeth) continue to form.  On average, third molars begin to erupt into the mouth at 18 years of age.

Why then do most people NOT have their wisdom teeth?  The problem is the amount of room, or lack thereof, for the wisdom teeth to erupt.  The Maxilla (upper jaw) sometimes has enough room to allow for wisdom tooth eruption, but the Mandible (lower jaw) often does not.  It gets pretty cramped back there!

So, are we as a species shrinking?  In the jaw, yes.  Why?  There are a multitude of theories on this one, but they are beyond the scope of this post.  And none of these theories have been proven correct, so right now everything is speculative.

Does everyone need their wisdom teeth removed?  No.  Our patients are monitored in conjunction with their general dentist to assess the likelihood their wisdom teeth will erupt.  If it looks like their position will inhibit full eruption, or there won’t be enough room for COMPLETE eruption, then we recommend they are removed.  It is as simple as that.

Remember, every patient has an unique set of circumstances.   Therefore some are fortunate enough to be able to keep their wisdom teeth.  Most are not.  The procedure to have them removed is not difficult, and we are lucky to live in an area with many talented professionals that take great care of those patients that need wisdom teeth removed.  So, our advice is to be like Bobby McFerrin.  Google him if you must…

Bracket Busters

March 29th, 2017

Dr. Nate here this week.  Welcome to Spring Break (at least for those not having theirs over Easter...)!  And what is the one thing I know you were eagerly anticipating?  This blog.  You're welcome.

If you have read our blog over its short history, most of the posts deal with answers to commonly asked questions in our practice.  And today's is no different.  What exactly do the brackets do, and is the design important?

As discussed last week, teeth move because of a force applying pressure over time.  The brackets transfer that force from the wire to the teeth.  Without getting stuck in the weeds, that is essentially the answer.  Brackets are a way to help move teeth by holding the wire in place.  So the next logical question then is, does bracket design matter?

If you ask the manufacturers, the answer is yes.  About 15 years ago bracket design was at the forefront of 'new' orthodontic technology (never mind that the designs have largely remained the same since the mid 20th century, even the 'new' ones).  What's that old adage about not know your history...?

Certain companies came out with these new brackets they termed self-ligating.  To not infringe on copyrights, I will not post pictures.  Google self-ligating brackets if you want, but the simplest explanation is a traditional bracket with a garage door that would close around the wire.

What made them so special?  They would move teeth faster, cause less pain, and make treatment times go down.  Basically they would do everything except end world hunger.  Name something you don't like about orthodontics, and self-ligating brackets would do it.  It got kind of nutty, actually.  But did the bracket design matter?

No.  It took about a decade of research, but the conclusion was that all brackets work the same.  And why wouldn't they?  If you think logically orthodontics is a biological/physiological process involving cells, bone, and teeth.  How does a cell in your body know if the bracket is a specific design?  It doesn't.  Orthodontics still comes down to the skill set of the Orthodontist, not the brackets they use.

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