A Guide through Orthodontic Treatment
Brace Fitting
Depending   on   the   brace   type,   the   braces   are   either   bonded   to   your   teeth   using   a   resin cement   cured   with   a   blue   light   or   fitted   (in   the   case   of   a   removable   brace).   If   you   are having   Invisalign   you   will   usually   need   attachments   to   be   bonded   to   the   teeth.   These can   be   placed   at   the   beginning   of   treatment,   or   a   few   weeks   later   should   you   want   to take   some   time   to   become   accustomed   to   the   brace.   I   also   explain   how   to   care   for the braces and what to do in case of problems or breakages. Applying   and   wearing   braces   shouldn’t   be   painful,   but   regardless   of   the   brace   type,   as the   teeth   are   slowly   moving,   the   teeth   do   become   tender.   You'll   particularly   notice   this when   you   bite   into   harder   foods   and   you   might   find   yourself   cutting   up   food   with   a knife   and   fork   that   you   would   normally   have   just   bitten   through.   The   teeth   are   at   their most   tender   1-7   days   following   bond   up   and   then   for   a   few   days   after   each   follow   up appointment   in   which   I   have   adjusted   the   brace.   In   the   case   of   invisalign,   you’ll   notice it   after   you   change   to   each   new   set   of   aligners.   You   may   find   taking   a   painkiller   makes it easier for the first few days. One   quick   tip   if   you’re   wearing   any   sort   of   metal   brace   is   to   feel   round   the   brace   with your   tongue   to   check   for   any   sharp   bits   before   you   leave   your   appointment.   Sharp bits   can   normally   be   cut   off,   bent   round   or   some   light   cured   silicon   glue   applied   for   a smooth   finish.   This   is   a   lot   easier   to   do   when   you’re   still   sitting   in   the   chair   than   to arrange another appointment.
Wearing Braces
The   overriding   theme   when   wearing   braces   is   discipline.   Discipline   in   what   you   eat, cleaning   your   teeth   regularly   and   attending   appointments   throughout   treatment.   In the   case   of   invisalign,   you   need   to   wear   your   aligners   22   hours   a   day   and   switch   to the   next   set   when   prescribed.   It   is   also   important   to   maintain   regular   checks   with   your own dentist as they will continue to check the health of your teeth. Diet   is   very   important   whilst   wearing   any   type   of   brace.   Avoiding   sugary   snacks   and drinks   and   sticking   to   drinking   water   is   the   safest   option   to   avoid   permanent   white marks   (decalcification)   appearing   on   the   teeth   around   the   braces.   The   white   marks are the beginning of decay and may fade a little once the braces are removed. Oral    hygiene    is    particularly    important    during    orthodontic    treatment    because    the brace   will   trap   food   which   can   then   promote   decay.   In   addition   to   brushing   your   teeth morning   and   night,   brushing   after   every   snack   and   meal   will   reduce   the   risk   of   decay and gum disease. Using   some   of   the   following   will   help   you   to   maintain   your   teeth   and   gums   while wearing a brace:
Use   an   electric   toothbrush,   and   know   how   to   use   it   correctly .   The   rotation oscillation   electric   toothbrushes ,   of   which   the   Oral   B   3D   electric   toothbrush   is an   example   have   been   shown   to   be   slightly   better   at   cleaning   teeth   than   other side    to    side    motion    electric    toothbrushes.    Both    Braun    and    Philips    sell orthodontic   toothbrush   heads   for   their   electric   toothbrushes   which   can   help but    are    not    essential.    Remember    to    replace    the    toothbrush    or    electric toothbrush   head   as   soon   as   it   no   longer   holds   its   shape.   This   will   be   sooner   if using your brush on fixed braces.
Disclosing    tablets    can    help    highlight    areas    that    are missed during normal brushing.
Interdental    (TePe)    brushes    are    ideal    for brace    wearers    to    clean    around    the    braces and   between   the   teeth.   Make   sure   you   replace them when the bristles become worn.
Dental   floss   is   good,   but   you   have   to   be   careful.   Watch this   youtube   video    for   how   to   do   it   properly.   Whether   you   go for    waxed,    non-waxed    or    tape    -    choose    what    you're comfortable    with.    Oral-B    also    do    a    floss    specifically    for braces.
Waterpiks    are    a    little    messy,    but    great    for    initial cleaning    prior    to    brushing    especially    with    lingual braces. See a YouTube video on how to use one here .
Toothpaste.   Almost   any   toothpaste   will   do   -   as   long as it has 1,450ppm of fluoride .
Fluoride   mouthwash.   A   daily   fluoride   mouthwash    (0.05%   Sodium   Fluoride   or 225ppm   Fluoride)   has   been   shown   to   reduce   the   risk   of   white   marks   appearing on   the   teeth.   It   should   be   used   once   daily   at   a   time   other   than   brushing   and   so I would recommend you do this when you get in from school.
Orthodontic   silicone   wax   or   a   silicon based    glue    can    be    applied    to    your brace   in   the   case   of   rubbing   against your    lips    -    if    you’re    wearing    a    labial brace,   or   against   your   tongue   if   you’re wearing   a   lingual   brace.   I   advise   drying the   brace   with   a   cotton   bud   prior   to applying   the   wax   as   it   will   stick   better.   I include   a   box   of   gishy   goo   in   my   starter pack for private patients.
Mouthguards              are              highly recommended   if   you   participate   in   any activity   where   you   might   get   your   teeth knocked.   Getting   your   teeth   knocked   is particularly     bad     if     you’re     wearing braces    because    your    treatment    may then   need   to   be   completely   stopped   or delayed    and    there    is    always    a    long term   risk   of   losing   the   knocked   tooth.   I can    make    you    a    custom    mouthguard that    fits    snugly    around    your    brace. There’s   also   a   wide   range   of   standard mouthguards   available   which   generally don’t    fit    so    well,    but    wearing    one    is certainly far better than not.
Metal   and   ceramic   braces   are   relatively   fragile.   Avoid   eating   hard   foods   such   as   nuts or   tough   foods   such   as   crusty   bread   as   these   may   dislodge   the   brackets   or   bands   or damage   the   wires.   Hard   fruit   and   vegetables   are   better   cut   into   small   pieces   before eating.   Obviously   if   you’re   wearing   invisalign   aligners,   remember   to   take   them   out prior to eating and put them straight back in afterwards. A    common    question    is    whether    speech    is    affected.    The    answer    is    not    normally, however,   if   I've   fitted   a   palatal   expander   appliance   to   the   roof   of   your   mouth,   or   you have   a   removable   brace,   lingual   brace   or   even   invisalign,   your   speech   may   be   a   little difficult for up to 4 weeks. Lastly,   having   a   brace   does   make   some   people   more   prone   to   ulcers   -   particularly   if there’s   rubbing   between   the   lips   and   the   brace.   Ulcers   generally   heal   within   a   week, but do use the wax to stop the rubbing.
Follow Up Appointments
Treatment   with   fixed   braces   typically   takes   12-24   months,   during   which   you   will   need to visit me every 6-10 weeks depending on where you are in your treatment. If   you’re   wearing   a   metal   brace   (Labial   or   Lingual),   I   will   typically   adjust   it   at   each appointment. The main adjustments I do are the following:
Change   the   wire   that   runs   through the     brackets.     As     you     go     through treatment     the     wire     interlacing     the brackets   is   exchanged   for   larger   wires. Typically,   I   will   do   this   4-5   times.   As   the wires   get   larger,   the   amount   of   torque on     the     bracket     increases.     Due     to accuracy   of   the   interplay   between   the wire   and   bracket   if   you   break   the   brace in   the   latter   stages   when   the   wires   are bigger,   it   can   be   difficult   to   maintain your    treatment    progress    as    we    may have   to   drop   down   to   a   smaller   wire. Repeated   breakages   will   mean   I   may not   be   able   to   achieve   everything   we wanted to.
Apply   Quick   Ligatures.   You   may   think   I   have   missed   a   colour   on   one   of   your brackets   but   as   Quick   Ligatures   are   made   of   metal   they   are   often   difficult   to see   as   they   blend   in   with   the   bracket.   These   are   tied   to   the   wire   in   the   bracket to   help   straighten   particularly   misplaced   teeth   and   allow   greater   sliding   of   the main wire through the bracket.
Apply    Elastics.    These    are    used    to move    your    teeth    in    order    to    improve how   your   upper   and   lower   teeth   bite together.
Apply   a   power   chain.   These   are   used in   addition   to   the   wire   running   across the   brace   to   provide   extra   tension   to close    spaces    between    teeth.    Closing spaces    will    usually    happen    after    the teeth    have    been    straightened    and    so there   will   be   a   period   where   you   still have   gaps   between   your   teeth   if   you have had teeth removed.
If   you’re   wearing   Invisalign   braces,   the   follow   up   appointments   will   be   to   monitor   the progress of the treatment and make adjustments as required. Regardless   of   your   type   of   brace,   you   may   need   some   interproximal   reduction   (IPR). This   is   where   a   small   amount   of   the   tooth   enamel   is   sanded   off   the   sides   of   crowded teeth   in   order   to   create   space   and   hence   allow   the   teeth   to   line   up.   While   historically this    has    raised    concerns    about    a    range    of    potential    side    effects    including    tooth sensitivity   and   propensity   for   decay,   when   done   sensibly   and   properly   by   a   specialist orthodontist, these concerns have now been dismissed .
copyright 2016 Orthodontics by Eva
Tel: 01962 865560
Email: eva@orthodonticsbyeva.co.uk
Dr Eva Lewin
St James Dental Practice
7 St James Terrace, Winchester, SO22 4PP
copyright 2016 Orthodontics by Eva
A Guide through Orthodontic Treatment
Brace Fitting
Depending   on   the   brace   type,   the   braces are    either    bonded    to    your    teeth    using    a resin    cement    cured    with    a    blue    light    or fitted   (in   the   case   of   a   removable   brace).   If you    are    having    Invisalign    you    will    usually need    attachments    to    be    bonded    to    the teeth.   These   can   be   placed   at   the   beginning of   treatment,   or   a   few   weeks   later   should you    want    to    take    some    time    to    become accustomed   to   the   brace.   I   also   explain   how to   care   for   the   braces   and   what   to   do   in case of problems or breakages. Applying   and   wearing   braces   shouldn’t   be painful,   but   regardless   of   the   brace   type,   as the   teeth   are   slowly   moving,   the   teeth   do become   tender.   You'll   particularly   notice   this when   you   bite   into   harder   foods   and   you might   find   yourself   cutting   up   food   with   a knife   and   fork   that   you   would   normally   have just   bitten   through.   The   teeth   are   at   their most   tender   1-7   days   following   bond   up   and then   for   a   few   days   after   each   follow   up appointment   in   which   I   have   adjusted   the brace.   In   the   case   of   invisalign,   you’ll   notice it    after    you    change    to    each    new    set    of aligners.    You    may    find    taking    a    painkiller makes it easier for the first few days. One   quick   tip   if   you’re   wearing   any   sort   of metal   brace   is   to   feel   round   the   brace   with your    tongue    to    check    for    any    sharp    bits before   you   leave   your   appointment.   Sharp bits   can   normally   be   cut   off,   bent   round   or some   light   cured   silicon   glue   applied   for   a smooth   finish.   This   is   a   lot   easier   to   do   when you’re    still    sitting    in    the    chair    than    to arrange another appointment.
Wearing Braces
The   overriding   theme   when   wearing   braces is    discipline.    Discipline    in    what    you    eat, cleaning   your   teeth   regularly   and   attending appointments   throughout   treatment.   In   the case   of   invisalign,   you   need   to   wear   your aligners   22   hours   a   day   and   switch   to   the next     set     when     prescribed.     It     is     also important   to   maintain   regular   checks   with your   own   dentist   as   they   will   continue   to check the health of your teeth. Diet   is   very   important   whilst   wearing   any type   of   brace.   Avoiding   sugary   snacks   and drinks   and   sticking   to   drinking   water   is   the safest    option    to    avoid    permanent    white marks    (decalcification)    appearing    on    the teeth   around   the   braces.   The   white   marks are   the   beginning   of   decay   and   may   fade   a little once the braces are removed. Oral     hygiene     is     particularly     important during   orthodontic   treatment   because   the brace   will   trap   food   which   can   then   promote decay.    In    addition    to    brushing    your    teeth morning    and    night,    brushing    after    every snack   and   meal   will   reduce   the   risk   of   decay and gum disease. Using   some   of   the   following   will   help   you   to maintain     your     teeth     and     gums     while wearing a brace:
Use    an    electric    toothbrush,    and    know how     to     use     it     correctly .     The     rotation oscillation    electric    toothbrushes ,    of    which the    Oral    B    3D    electric    toothbrush    is    an example    have    been    shown    to    be    slightly better   at   cleaning   teeth   than   other   side   to side     motion     electric     toothbrushes.     Both Braun       and       Philips       sell       orthodontic toothbrush       heads       for       their       electric toothbrushes    which    can    help    but    are    not essential.      Remember      to      replace      the toothbrush   or   electric   toothbrush   head   as soon   as   it   no   longer   holds   its   shape.   This   will be    sooner    if    using    your    brush    on    fixed braces.
Disclosing    tablets    can    help    highlight areas     that     are     missed     during     normal brushing.
Interdental   (TePe)   brushes   are   ideal   for brace   wearers   to   clean   around   the   braces and    between    the    teeth.    Make    sure    you replace    them    when    the    bristles    become worn.
Dental   floss   is   good,   but   you   have   to   be careful.   Watch   this   youtube   video    for   how   to do   it   properly.   Whether   you   go   for   waxed, non-waxed    or    tape    -choose    what    you're comfortable    with.    Oral-B    also    do    a    floss specifically for braces.
Waterpiks   are   a   little   messy,   but   great for     initial     cleaning     prior     to     brushing especially     with     lingual     braces.     See     a YouTube video on how to use one here .
Toothpaste.   Almost   any   toothpaste   will do - as long as it has 1,450ppm of fluoride .
Fluoride    mouthwash.    A    daily    fluoride mouthwash      (0.05%     Sodium     Fluoride     or 225ppm     Fluoride)     has     been     shown     to reduce   the   risk   of   white   marks   appearing on   the   teeth.   It   should   be   used   once   daily   at a   time   other   than   brushing   and   so   I   would recommend    you    do    this    when    you    get    in from school.
Orthodontic    silicone    wax    or    a    silicon based   glue   can   be   applied   to   your   brace   in the   case   of   rubbing   against   your   lips   -   if you’re    wearing    a    labial    brace,    or    against your    tongue    if    you’re    wearing    a    lingual brace.    I    advise    drying    the    brace    with    a cotton   bud   prior   to   applying   the   wax   as   it will   stick   better.   I   include   a   box   of   gishy   goo in my starter pack for private patients.
Mouthguards   are   highly   recommended if   you   participate   in   any   activity   where   you might   get   your   teeth   knocked.   Getting   your teeth   knocked   is   particularly   bad   if   you’re wearing    braces    because    your    treatment may   then   need   to   be   completely   stopped   or delayed   and   there   is   always   a   long   term   risk of   losing   the   knocked   tooth.   I   can   make   you a     custom     mouthguard     that     fits     snugly around    your    brace.    There’s    also    a    wide range    of    standard    mouthguards    available which     generally     don’t     fit     so     well,     but wearing one is certainly far better than not.
Metal    and    ceramic    braces    are    relatively fragile.    Avoid    eating    hard    foods    such    as nuts   or   tough   foods   such   as   crusty   bread   as these   may   dislodge   the   brackets   or   bands or     damage     the     wires.     Hard     fruit     and vegetables   are   better   cut   into   small   pieces before   eating.   Obviously   if   you’re   wearing invisalign   aligners,   remember   to   take   them out   prior   to   eating   and   put   them   straight back in afterwards. A   common   question   is   whether   speech   is affected.     The     answer     is     not     normally, however,    if    I've    fitted    a    palatal    expander appliance   to   the   roof   of   your   mouth,   or   you have   a   removable   brace,   lingual   brace   or even   invisalign,   your   speech   may   be   a   little difficult for up to 4 weeks. Lastly,    having    a    brace    does    make    some people   more   prone   to   ulcers   -   particularly   if there’s    rubbing    between    the    lips    and    the brace.   Ulcers   generally   heal   within   a   week, but do use the wax to stop the rubbing.
Follow Up Appointments
Treatment   with   fixed   braces   typically   takes 12-24   months,   during   which   you   will   need   to visit    me    every    6-10    weeks    depending    on where you are in your treatment. If   you’re   wearing   a   metal   brace   (Labial   or Lingual),    I    will    typically    adjust    it    at    each appointment.    The    main    adjustments    I    do are the following:
Change   the   wire   that   runs   through   the brackets.   As   you   go   through   treatment   the wire   interlacing   the   brackets   is   exchanged for   larger   wires.   Typically,   I   will   do   this   4-5 times.   As   the   wires   get   larger,   the   amount   of torque    on    the    bracket    increases.    Due    to accuracy   of   the   interplay   between   the   wire and   bracket   if   you   break   the   brace   in   the latter   stages   when   the   wires   are   bigger,   it can   be   difficult   to   maintain   your   treatment progress   as   we   may   have   to   drop   down   to   a smaller   wire.   Repeated   breakages   will   mean I   may   not   be   able   to   achieve   everything   we wanted to.
Apply   Quick   Ligatures.   You   may   think   I have    missed    a    colour    on    one    of    your brackets   but   as   Quick   Ligatures   are   made of   metal   they   are   often   difficult   to   see   as they   blend   in   with   the   bracket.   These   are tied    to    the    wire    in    the    bracket    to    help straighten   particularly   misplaced   teeth   and allow     greater     sliding     of     the     main     wire through the bracket.
Apply   Elastics.   These   are   used   to   move your    teeth    in    order    to    improve    how    your upper and lower teeth bite together.
Apply   a   power   chain.   These   are   used   in addition    to    the    wire    running    across    the brace    to    provide    extra    tension    to    close spaces   between   teeth.   Closing   spaces   will usually   happen   after   the   teeth   have   been straightened   and   so   there   will   be   a   period where    you    still    have    gaps    between    your teeth if you have had teeth removed.
If    you’re    wearing    Invisalign    braces,    the follow   up   appointments   will   be   to   monitor the    progress    of    the    treatment    and    make adjustments as required. Regardless   of   your   type   of   brace,   you   may need    some    interproximal    reduction    (IPR). This   is   where   a   small   amount   of   the   tooth enamel   is   sanded   off   the   sides   of   crowded teeth   in   order   to   create   space   and   hence allow   the   teeth   to   line   up.   While   historically this   has   raised   concerns   about   a   range   of potential      side      effects      including      tooth sensitivity   and   propensity   for   decay,   when done   sensibly   and   properly   by   a   specialist orthodontist,     these     concerns     have     now been dismissed .
copyright 2016 Orthodontics by Eva
A Guide through Orthodontic Treatment
Brace Fitting
Depending   on   the   brace   type,   the   braces   are   either   bonded to   your   teeth   using   a   resin   cement   cured   with   a   blue   light   or fitted   (in   the   case   of   a   removable   brace).   If   you   are   having Invisalign   you   will   usually   need   attachments   to   be   bonded   to the    teeth.    These    can    be    placed    at    the    beginning    of treatment,   or   a   few   weeks   later   should   you   want   to   take some    time    to    become    accustomed    to    the    brace.    I    also explain   how   to   care   for   the   braces   and   what   to   do   in   case   of problems or breakages. Applying    and    wearing    braces    shouldn’t    be    painful,    but regardless   of   the   brace   type,   as   the   teeth   are   slowly   moving, the   teeth   do   become   tender.   You'll   particularly   notice   this when   you   bite   into   harder   foods   and   you   might   find   yourself cutting    up    food    with    a    knife    and    fork    that    you    would normally   have   just   bitten   through.   The   teeth   are   at   their most   tender   1-7   days   following   bond   up   and   then   for   a   few days    after    each    follow    up    appointment    in    which    I    have adjusted   the   brace.   In   the   case   of   invisalign,   you’ll   notice   it after   you   change   to   each   new   set   of   aligners.   You   may   find taking a painkiller makes it easier for the first few days. One   quick   tip   if   you’re   wearing   any   sort   of   metal   brace   is   to feel   round   the   brace   with   your   tongue   to   check   for   any sharp   bits   before   you   leave   your   appointment.   Sharp   bits can   normally   be   cut   off,   bent   round   or   some   light   cured silicon   glue   applied   for   a   smooth   finish.   This   is   a   lot   easier   to do    when    you’re    still    sitting    in    the    chair    than    to    arrange another appointment.
Wearing Braces
The   overriding   theme   when   wearing   braces   is   discipline. Discipline   in   what   you   eat,   cleaning   your   teeth   regularly   and attending   appointments   throughout   treatment.   In   the   case of   invisalign,   you   need   to   wear   your   aligners   22   hours   a   day and    switch    to    the    next    set    when    prescribed.    It    is    also important   to   maintain   regular   checks   with   your   own   dentist as they will continue to check the health of your teeth. Diet   is   very   important   whilst   wearing   any   type   of   brace. Avoiding   sugary   snacks   and   drinks   and   sticking   to   drinking water   is   the   safest   option   to   avoid   permanent   white   marks (decalcification)   appearing   on   the   teeth   around   the   braces. The   white   marks   are   the   beginning   of   decay   and   may   fade a little once the braces are removed. Oral   hygiene   is   particularly   important   during   orthodontic treatment   because   the   brace   will   trap   food   which   can   then promote   decay.   In   addition   to   brushing   your   teeth   morning and   night,   brushing   after   every   snack   and   meal   will   reduce the risk of decay and gum disease. Using   some   of   the   following   will   help   you   to   maintain   your teeth and gums while wearing a brace:
Use    an    electric    toothbrush,    and    know    how    to    use    it correctly .   The   rotation   oscillation   electric   toothbrushes ,   of which   the   Oral   B   3D   electric   toothbrush   is   an   example   have been    shown    to    be    slightly    better    at    cleaning    teeth    than other   side   to   side   motion   electric   toothbrushes.   Both   Braun and    Philips    sell    orthodontic    toothbrush    heads    for    their electric   toothbrushes   which   can   help   but   are   not   essential. Remember   to   replace   the   toothbrush   or   electric   toothbrush head   as   soon   as   it   no   longer   holds   its   shape.   This   will   be sooner if using your brush on fixed braces.
Mid-treatment with upper and lower metal fixed braces to create a space for missing teeth.
Disclosing    tablets    can    help    highlight    areas    that    are missed during normal brushing.
Interdental   (TePe)   brushes   are   ideal   for   brace   wearers   to clean   around   the   braces   and   between   the   teeth.   Make   sure you replace them when the bristles become worn.
Dental   floss   is   good,   but   you   have   to   be   careful.   Watch this   youtube   video    for   how   to   do   it   properly.   Whether   you go    for    waxed,    non-waxed    or    tape    -choose    what    you're comfortable    with.    Oral-B    also    do    a    floss    specifically    for braces.
Waterpiks   are   a   little   messy,   but   great   for   initial   cleaning prior    to    brushing    especially    with    lingual    braces.    See    a YouTube video on how to use one here .
Toothpaste.   Almost   any   toothpaste   will   do   -   as   long   as   it has 1,450ppm of fluoride .
Fluoride   mouthwash.   A   daily   fluoride   mouthwash    (0.05% Sodium   Fluoride   or   225ppm   Fluoride)   has   been   shown   to reduce   the   risk   of   white   marks   appearing   on   the   teeth.   It should   be   used   once   daily   at   a   time   other   than   brushing   and so   I   would   recommend   you   do   this   when   you   get   in   from school.
Orthodontic   silicone   wax   or   a   silicon   based   glue   can   be applied   to   your   brace   in   the   case   of   rubbing   against   your lips   -   if   you’re   wearing   a   labial   brace,   or   against   your   tongue if   you’re   wearing   a   lingual   brace.   I   advise   drying   the   brace with   a   cotton   bud   prior   to   applying   the   wax   as   it   will   stick better.   I   include   a   box   of   gishy   goo   in   my   starter   pack   for private patients.
Mouthguards   are   highly   recommended   if   you   participate in   any   activity   where   you   might   get   your   teeth   knocked. Getting    your    teeth    knocked    is    particularly    bad    if    you’re wearing   braces   because   your   treatment   may   then   need   to be   completely   stopped   or   delayed   and   there   is   always   a long   term   risk   of   losing   the   knocked   tooth.   I   can   make   you   a custom    mouthguard    that    fits    snugly    around    your    brace. There’s     also     a     wide     range     of     standard     mouthguards available   which   generally   don’t   fit   so   well,   but   wearing   one is certainly far better than not.
Metal   and   ceramic   braces   are   relatively   fragile.   Avoid   eating hard    foods    such    as    nuts    or    tough    foods    such    as    crusty bread    as    these    may    dislodge    the    brackets    or    bands    or damage   the   wires.   Hard   fruit   and   vegetables   are   better   cut into   small   pieces   before   eating.   Obviously   if   you’re   wearing invisalign    aligners,    remember    to    take    them    out    prior    to eating and put them straight back in afterwards. A    common    question    is    whether    speech    is    affected.    The answer    is    not    normally,    however,    if    I've    fitted    a    palatal expander   appliance   to   the   roof   of   your   mouth,   or   you   have   a removable    brace,    lingual    brace    or    even    invisalign,    your speech may be a little difficult for up to 4 weeks. Lastly,   having   a   brace   does   make   some   people   more   prone to   ulcers   -   particularly   if   there’s   rubbing   between   the   lips and   the   brace.   Ulcers   generally   heal   within   a   week,   but   do use the wax to stop the rubbing.
Follow Up Appointments
Treatment   with   fixed   braces   typically   takes   12-24   months, during   which   you   will   need   to   visit   me   every   6-10   weeks depending on where you are in your treatment. If   you’re   wearing   a   metal   brace   (Labial   or   Lingual),   I   will typically     adjust     it     at     each     appointment.     The     main adjustments I do are the following:
Change   the   wire   that   runs   through   the   brackets.   As   you go   through   treatment   the   wire   interlacing   the   brackets   is exchanged   for   larger   wires.   Typically,   I   will   do   this   4-5   times. As   the   wires   get   larger,   the   amount   of   torque   on   the   bracket increases.   Due   to   accuracy   of   the   interplay   between   the wire   and   bracket   if   you   break   the   brace   in   the   latter   stages when   the   wires   are   bigger,   it   can   be   difficult   to   maintain your   treatment   progress   as   we   may   have   to   drop   down   to   a smaller   wire.   Repeated   breakages   will   mean   I   may   not   be able to achieve everything we wanted to.
Apply   Quick   Ligatures.   You   may   think   I   have   missed   a colour   on   one   of   your   brackets   but   as   Quick   Ligatures   are made   of   metal   they   are   often   difficult   to   see   as   they   blend in   with   the   bracket.   These   are   tied   to   the   wire   in   the   bracket to   help   straighten   particularly   misplaced   teeth   and   allow greater sliding of the main wire through the bracket.
Apply   Elastics.   These   are   used   to   move   your   teeth   in order    to    improve    how    your    upper    and    lower    teeth    bite together.
Apply   a   power   chain.   These   are   used   in   addition   to   the wire   running   across   the   brace   to   provide   extra   tension   to close    spaces    between    teeth.    Closing    spaces    will    usually happen   after   the   teeth   have   been   straightened   and   so   there will   be   a   period   where   you   still   have   gaps   between   your teeth if you have had teeth removed.
If     you’re     wearing     Invisalign     braces,     the     follow     up appointments    will    be    to    monitor    the    progress    of    the treatment and make adjustments as required. Regardless    of    your    type    of    brace,    you    may    need    some interproximal   reduction   (IPR).   This   is   where   a   small   amount of   the   tooth   enamel   is   sanded   off   the   sides   of   crowded   teeth in   order   to   create   space   and   hence   allow   the   teeth   to   line up.    While    historically    this    has    raised    concerns    about    a range   of   potential   side   effects   including   tooth   sensitivity and   propensity   for   decay,   when   done   sensibly   and   properly by   a   specialist   orthodontist,   these   concerns   have   now   been dismissed .