| Frequently
Asked Questions |
Can
I Have Just Retainers?
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Most
orthodontic problems are too severe, or are the wrong type of problem,
to treat with just retainers (retainers are removable devices made
of plastic and wire, which slip over the teeth, and can move the
teeth a little).
Besides having limited capabilities, most retainers, being removable,
do not get worn enough hours per day to accomplish much tooth movement.
Braces are usually a more realistic solution.
Nevertheless, retainers are quite suitable for minor irregularities
of the teeth and can be worn at night only and still be effective. |
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Types
of Braces Available
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There
are different kinds of braces available. There are inside behind-the-teeth
braces, and ordinary (on-front-of-the-teeth) braces. Braces that
fit on the outside of the teeth are either clear
or
metal (either silver or gold). Braces that fit behind the teeth
are silver metal.
Most orthodontists
prefer braces that fit on the outside of the teeth because they
are more comfortable for the patient and easier for the orthodontist
to adjust. Clear outside braces are very satisfactory in situations
where appearance is particularly important (such as working adults).
However, clear braces customarily cost more.
For patients
willing to wear metal outside braces, the choices are silver or
gold, and there is no cost difference. For patients only willing
to wear inside braces, the cost is substantially more.
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How
Braces Work
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Braces work
by putting pressure on the teeth, which causes the bone holding
the teeth to remodel (changing the bone’s shape), allowing
the teeth to move. Brackets are glued onto the teeth to serve
as attachments to the teeth, and a flexible straight wire is tied
to the brackets.
 
Tying
the straight wire to the crooked teeth distorts or bends the wire.
The elasticity of the wire makes the wire try to return to its
original shape. This is the source of the pressure that moves
the teeth.
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The
Best Age for Braces
|
Baby teeth usually
do not have braces put on them. Permanent teeth begin to grow
in at age 6. All children should be examined by an orthodontist
at age 7.
The most common
age for braces is between ages 10-13, because this is usually
when the last baby teeth fall out and the permanent teeth grow
in.
Some children
need to be treated earlier, especially if they have underdevelopment
of either jaw. Such children are likely to have two stages of
treatment; one early, to correct the jaw problem, and another
at age 10-13 to straighten the teeth.
The early treatment
will usually involve only a few permanent teeth, and the later
treatment will usually include all the permanent teeth (except
the wisdom teeth, which usually grow in closer to adulthood).
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Adult
Braces
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Most adults
don’t realize they do not have to have a "metal
mouth" in order to straighten their teeth, and get the smile
they desire.
Clear braces
have made orthodontic treatment possible for adults in literally
every profession. Even high-profile celebrities can have braces
if they want, because they can wear the "behind-the-teeth"
invisible braces (just like Cher or Phyllis Diller).
Adult teeth
move much the same way as children’s teeth, and even though
adults do not have growth to help them, tremendous remodeling
of the jaw is still possible, with a significant improvement in
smile appearance.
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Cosmetic
Braces (No Metal Mouth)
|
Frequently,
people who have had clear braces have reported to us that coworkers
did not notice they had braces at all! They do not detract from
one’s appearance. In fact, there are literally hundreds of
thousands of people, mostly adults, wearing clear braces today.
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How
Long for Braces?
|
Some
treatments are less than a year, some take 3 years or more. Most
take around 2 years. The time depends on the difficulty - the number
of problems to be corrected - and the diligence with which the patient
participates in the treatment. This includes keeping appointments,
avoiding breakage of the braces, wearing elastics (rubber bands)
on the braces, and other factors. |
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Cost
for Braces
|
In our geographic
area (Southern California), the main cost component of orthodontic
treatment is the salaries of the skilled staff assisting the orthodontist.
The cost of living in the Los Angeles’ South Bay requires
us to charge between $3,000 and $5,500 for the average two-year
treatment. Simpler and shorter treatments fall in the lower end
of this range. Early treatment (called Stage One) is usually between
$2,000 and $3,000. The fee is usually set at the first appointment.
Clear braces
are $325 extra per jaw.
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What
is Invisalign?
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Invisalign is
a method of straightening teeth using see-through plastic aligners
over the teeth. Models of the crooked teeth are scanned into a
computer. The computer technician moves the teeth a tiny amount
inside the computer program, and the computer then guides the
manufacture of a new model with the teeth in this slightly revised
position. A plastic overlay aligner is made on that new model.
This procedure is repeated many times, so that a numbered series
of aligners are made, each moving the teeth a tiny amount beyond
where they were in the last aligner, until they are straight.
It may take between ten and forty aligners, depending on the beginning
crookedness of the teeth. Each aligner is worn two weeks, and
then the next one is begun. Patients are given several at a time.
They are removed for eating and brushing.
Can Anybody
Get Invisalign?
Although originally
intended for adults who wanted to improve their smile but who
were unwilling to wear braces, Invisalign is also available for
older teenagers whose teeth have fully grown in.
Are There Limitations
with Invisalign?
Presently, Invisalign
is used to straighten mildly crooked teeth. It is not suggested
for large overbites (top teeth too forward), underbites (top teeth
too backward), and severe crowding or open bites (front top teeth
do not come together with lower front teeth).
What does Invisalign
Cost?
Fees
are similar to fees for braces, or somewhat higher. Insurance
will cover Invisalign the same way it covers braces.
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Financial
Arrangements
|
Fees
may be paid in various ways:
If
payment is made in full at the beginning of treatment, a discount
is usually given, depending on the total treatment fee and the
method of payment.
If
terms are requested, we can usually extend no-interest 12-month
terms, with an initial payment of one-third or more.
If
longer terms are needed, we can recommend a low fee lender, who
can allow 36 months or more of equal payments (depending on credit
worthiness).
We
accept MasterCard, VISA, Discover and American Express.
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Orthodontic
Insurance
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Insurance to
cover the cost of braces is usually available through one’s
employer, as part of dental insurance. There is one major difference,
however. Unlike regular dental insurance, orthodontic insurance
usually pays only 50%, with a lifetime maximum or cap.
The maximum
orthodontic benefit depends on the policy, but we have seen benefits
of $500, $750, $1,000, $1,500 and $2,000. Sometimes the coverage
is for children only and excludes adults, so this should be investigated
by the prospective patient or parent.
There is another
type of "coverage," different than insurance, called
a "plan," which is offered by many insurance companies.
While it does not pay the cost of braces, it provides lower fees
for treatment. This is because the insurance company has obtained
agreement with preferred provider orthodontists for a lower than
usual fee schedule. In cases like this, the insurance company
usually pays nothing to the orthodontist, but the patient has
the benefit of a lower fee, as if the insurance company had paid
a portion of the normal fee.
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Why
Treat Children Early?
Baby
Molars Lost Too Early
Baby
Canines Lost Too Early |
Whenever
possible, treatment should begin when a child’s baby teeth
are gone and the permanent teeth have grown in. However, situations
can occur that the child’s jaws are so small that the permanent
teeth cannot grow in, or
the jaws are positioned incorrectly enough that the jaws will not
grow symmetrically or in balance.
In
these cases, the orthodontist may begin treatment early, usually
with specific limited objectives, such as to get the jaws in balance
or to create enough room for the teeth to grow in properly. After
an objective like this is achieved, it is best to stop the early
treatment, utilize retainers, and wait for the permanent teeth to
grow in. At this point the second stage of treatment would begin. |
Closing
Spaces
|
Unsightly spaces
between teeth can cause embarrassment and reduce a person’s
tendency to smile. Spaces can sometimes be closed with retainers,
but more often it requires braces. Some spaces occur because teeth
are too small, so sometimes teeth can be widened with porcelain
bonding. Some spaces occur because teeth are missing; in which
case replacement teeth (such as a bridge or an implant) are needed.
However, braces may be needed to rearrange or realign the teeth
before restoration is done.
Spaces can also
occur when the teeth drift due to loss of bone. In this case,
braces and retainers may be used to reduce the spaces and then
hold them closed.
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Overlapping
Teeth
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Overlapping
teeth are one of the most common reasons people get braces. Overlapping
teeth look bad; sometimes it even looks like one tooth is missing
due to shadows and stains. Often the gums around overlapping teeth
are shrunken or swollen, and consequently are hard to brush and
floss. Rarely is there sufficient space for the overlapped teeth
to be straightened with retainers. |
Crooked
Teeth
|
One
of the major causes of low self-confidence and inhibited smiling
is crooked teeth. Teeth can be turned, tipped, too long or short,
overlapping, above or behind other teeth; in short, there are many
ways for a smile to look wrong. Straightening can relieve all these
problems, and usually requires braces. |
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Teeth
Whitening
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Most
people’s teeth get darker as they age. Sometimes people just
have dark teeth. We all realize that whiter teeth can make people
look younger. Dentistry has an effective way to lighten the teeth
using a low concentration bleach gel. The dentist makes a model
of the teeth and makes a thin transparent rubber mold of the teeth.
The mold is trimmed to fit the teeth, the bleaching gel is inserted
into the mold and the mold is worn on the teeth for a few hours
several days in a row. After 2 weeks or so, the teeth have generally
lightened by several shades, and the effects are fairly permanent.
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What
Makes a Nice Smile?
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Here are some
of the technical aspects of a good smile, which is the goal of
the orthodontist.
The teeth should
be straight.
The upper teeth should show their entire length.
The upper gums should not show.
The upper teeth should taper back gradually on the sides so the
back teeth contribute to the width of the smile in the corners
of the mouth.
The upper teeth biting edges should be aligned on a line parallel
to the lower lip when smiling.
These are the ingredients of a nice smile, and are the guidelines
used in orthodontic treatment planning.
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