For Our Patients

Braces

Congratulations! You have become a new patient with braces! Braces are a system of many components which all work together to achieve tooth alignment and bite correction.

There are a few things a new patient with braces needs to know…

It will take from 5-10 days to get accustomed to your braces. The initial soreness will last 1-3 days following each adjustment.
As your teeth move, wires will sometimes begin to protrude from the band in the back of your mouth. Call the office for an appointment to have the wire clipped.
Brackets will break away from your tooth if you eat hard, sticky or crunchy foods. * Please avoid these types of foods. If a bracket breaks, please call our office to schedule a rebonding as soon as possible. If a bracket or band breaks away from your tooth, your tooth will be at risk of moving out of alignment and your treatment time may increase.
Oral hygiene is very important while you are in braces. A patient with braces must brush 3-4 times a day. Please also floss once a day. You will be provided with all the tools required to keep your braces shining!! Beware of decalcification. Decalcification is what occurs when plaque lays on your teeth and damages your enamel. It appears as bright white marks or squares on your teeth after

Foods to avoid when you have braces:

Hard Candy such as: Jolly Ranchers and Lifesavers.

Sticky foods such as: Caramel, Gum, Taffy, Starbursts, Airheads, Skittles

Crunchy foods such as: Doritos, Pizza Crust, Hard Pretzels, Crunchy Potato Chips, Nuts, Ice

**Avoid soda as the acid and carbonation in soda may erode the glue that is used to adhere your braces to your teeth.

**Avoid chewing on pens, pencils, ice, and fingernails.

Facemask

Today you have been given a facemask to wear during a portion of your treatment. During treatment, a facemask is used to generate a force to aid in the movement of upper jaw and/or the upper teeth. Facemask appliances are often used in conjunction with either a removable or permanent bite opening appliance.

Wear your facemask as directed by Drs. Bloom and Reddy. When the facemask is worn one day and left off the next, the tooth movement does not continue as rapidly, and often no change takes place.
The more you wear your facemask, the faster your teeth/jaws will move. Treatment can be seriously delayed by lack of cooperation with facemask wear.
There is often initial discomfort when facemask is first worn. Your teeth may feel sore for the first few nights. The discomfort will dissipate within a few days.
Wear your facemask for 10 –12 hours per day cumulatively.
Never wear your facemask while your out of the house. A facemask is to be worn only during quiet times.
Your facemask does not have to be on continuously. You may put it on after school, take it off for dinner then put it back on for bed time. The majority of your wear occurs over night.
You may have to work up to 10– 12 hours per day. Start out just wearing it after school, then work up to all night. You should accomplish 10 –12 hours per day within a week of receiving your facemask
Check your facemask attachments every night. If a band or hook is loose do not wear your headgear that night and promptly call our office for a repair appointment.

Just remember, the more you wear your facemask, the faster it works and the faster you will finish.

Headgear

(Cervical, High pull, Facemask or Reverse Headgear)

Today you have been given headgear to wear during a portion of your treatment. During treatment, headgear is used to generate a force to aid in the movement of upper jaw and/or the upper teeth. The type of headgear is based on a patient’s skeletal malocclusion.

Wear your headgear consistently, as directed by Drs. Bloom and Reddy. When the headgear is worn one day and left off the next, the tooth movement does not continue as rapidly and often no change takes place.
The more you wear your headgear, the faster your teeth/jaws will move. Treatment can be seriously delayed by lack of cooperation with headgear wear.
There is often initial discomfort when headgear is first worn. Your teeth may feel sore for the first few nights. The discomfort will dissipate within a few days.
Wear your headgear for 10 –12 hours per day cumulatively.
Never wear your headgear while your out of the house. Headgear is to be worn only during quiet times.
Your headgear does not have to be on continuously. You may put it on after school, take it off for dinner then put it back on for bed time. The majority of your wear occurs over night.
You may have to work up to 10– 12 hours per day. Start out just wearing it after school, then work up to all night. You should accomplish 10 –12 hours per day within a week of receiving your headgear.
Check your headgear attachments every night. If a band or hook is loose do not wear your headgear that night and promptly call our office for a repair appointment .

Just remember, the more you wear your headgear,
the faster it works and the faster you will finish.

Note: If you are a side or stomach sleeper and find sleeping with headgear uncomfortable, you might check out www.openspaces.com, which advertises an “open spaces pillow” for patients with headgear.

Herbst Appliance

One of the most common problems orthodontists treat is the discrepancy that occurs when the upper teeth protrude beyond the lower teeth, this is referred to as overjet. Sometimes this means that the upper teeth are too far forward and have to be brought back to meet the lower teeth. But, often the discrepancy lies with the lower jaw that has grown insufficiently. This results in poor skeletal balance between the upper and lower jaws. When the lower jaw is too short an overjet results. The Herbst appliance has been designed to treat this condition and is most effective when used during the pubertal growth spurt. This typically occurs between the ages of 10-14 years old. The appliance must remain in place for a period of 12-15 months for advancement and stability.

What to expect..

During the first few weeks, your mouth will feel unusually full and speaking will be awkward. If you practice reading out loud, your speech will quickly return to normal. You may also experience a rather brief period of excessive salivation, this too will subside.
Eat soft foods until you get accustomed to the feel of your appliance. As you get used to your Herbst, your diet will return to normal. This generally occurs within 1-2 weeks.
Should you experience muscle soreness, apply moist heat for periods of 20 minutes each day. A mild pain reliever such as Acetaminophen or Ibuprofen can also provide relief . Should you require a pain reliever please always be sure to follow the recommended dosing instructions.

Herbst Restrictions

Avoid foods that are hard or sticky such as ice, hard candy, gum, taffy. crunchy chips, hard pretzels and any food that requires excessive chewing such as beef jerky and tough pizza crust.
Avoid Soda - The carbonation will dissolve the band cement.
Avoid shifting your jaw from side to side, this will cause the joints on the side of the appliance to separate from the bands and will require a new appliance to be made.
Do not play with the appliance with your fingers or unhook the appliance on purpose. If the arms and sleeves come apart, gently open your mouth wide, reinsert the arms into the sleeves and gently close your mouth.
Inspect the appliance each night. If a band or any other attachment is loose, please notify us immediately. Do not wait until your next appointment. If your appointment is that same day, you must notify our office ahead of time as this will require a longer time allotment.

Informed Consent: Herbst Supplement: It is important for patients to understand that the Herbst appliance is utilized to avoid more serious methods of correcting significant skeletal overjet such as, extractions and /or orthognathic surgery. A small possibility of relapse with the final results of the Herbst appliance does exist. In which case extractions or surgery may become necessary to fully correct the skeletal malocclusion. It is also suspected that patients with significant overjet ( 6mm or more) are more prone to TMJ dysfunction which is mentioned in your full informed consent.

Transpalatal Arch

(also for Lower Lingual Holding Arch)

The transpalatal arch is an inactive banded appliance used to maintain space and arch length. It is not an active appliance so the adjustment time should be minimal. It is important to maintain good oral hygiene and follow the same food restrictions with this appliance as with any other banded appliance.

Taking care of your appliance

Brush your entire mouth, your appliance should be clear of any food debris. If your TPA/LLHA is cleaned properly it will be shiny. Floss daily.
Check each band every night. If a band is loose, contact our office promptly for a repair. * Do not wait for your next appointment as relapse can occur. More time is required for the repair of the appliance. Please call ahead if you are experiencing problems.
Please avoid hard, sticky or chewy foods. These include taffy, gum, hard pretzels and popcorn as these foods will damage the appliances. It is important to also limit the amount of carbonated beverage's you drink to 1-2 cans per week. Carbonated beverage’s will deteriorate the dental cement used to adhere the bands to your teeth.
If you have any questions or concerns please contact the office.

Retainer Instructions

Your teeth will move if you don’t wear your retainers.

Please wear your retainers at all times, except when eating, brushing and playing active sports or swimming. If your retainers are lost or broken, notify Drs. Bloom and Reddy promptly to arrange for replacements. Retainers are worn 24 hours a day for the first year. Your retainers will be worn at night-time for the second year. You will gradually reduce your retainer wear to a couple of nights a week, after wisdom teeth are addressed. Retainer wear is a lifetime effort.

Brush your retainer with water or mouthwash at least once a day. An ultrasonic retainer cleaner may also be used periodically to remove tarter and calculus build up. Denture cleaner may also be used, however, never soak your retainer for more than 10 minutes, as they can distort and oxidize causing the retainer wires to break prematurely.
Plastic retainers can be ruined by heat. Never put a retainer in boiling water, a dishwasher, or on the dashboard of a car.
Plastic retainers can be damaged by soaking them in mouthwash.
Keep retainers beyond the reach of pets and young children. Dogs and cats like to chew on retainers.
Retainers can be broken if placed in a pocket or back pack.
There is a charge to replace retainers, so please be careful.
Retainers are likely to be thrown away if they are wrapped in a napkin or placed on a food tray.
Like contact lenses, eye glasses and other personal items, retainers can wear out over time. Retainer wear is a lifetime effort. Replacing a worn out retainer is a wise investment in protecting your smile and the long term stability of your teeth. It is important to keep your retainer in your case when the retainer is not in use, clean your case regularly.

Palatal Expander

(also for Pendex)


Expander		Pendex

Some patients have a very narrow upper jaw accompanied by a high palate. This can cause crowding of the upper teeth, cross bites and restrict breathing through your nose. In these cases, we may choose to widen the upper jaw with a palatal expander.

A pendex is also a palatal expander accompanied by a secondary component to move the molars toward the back of the mouth for a more favorable bite relationship.

How this appliance works

The expander works by slowly and gently separating the palatal suture. This suture runs down the center of the roof mouth. In young patients this suture is soft and can be stretched to allow for a true skeletal widening.
The expansion generally takes place over a period of 2-6 weeks, then the appliance is stabilized for 6-9 months. During this period new bone grows to fill into the expanded arch.
A space will likely form between the front teeth. This is a sign that the appliance is working and the space will close again naturally. The expander may cause some initial discomfort and some feeling of pressure and tingling as the arch expands.

Taking care of your appliance

To activate your appliance you will turn it ____________.
To do this insert the key into the hole in the middle of the appliance. Push the hole towards the back of the mouth (follow the arrows on the appliance). Once the turn feels complete be careful to remove it in the finished position. If you have successfully turned the appliance you will see a new hole in the front of the mechanism.
Avoid hard, sticky and chewy foods such as gum, hard candy and crunchy chips.
Avoid Soda as the carbonation will dissolve the glue used to bond your expander to your teeth.
Brush your entire mouth, your expander should be clear of any food debris. If your expander is cleaned properly it will be shiny. Floss daily.
A syringe is provided for cleaning the roof of the mouth, please do so every night with a mix of water and Listerine.
Check each band every night, if a band is loose contact our office promptly for a repair. *Do not activate your appliance.* Do not wait for your next appointment as relapse can occur. More time is require for appliance repair, please call ahead if you are experiencing problems.
During your activation period it is essential that the patient be seen every 2—5 weeks as instructed by the doctor to ensure proper management of the appliance. If you can not make your scheduled appointment, cease activation until a new appointment can be acquired.
If you have any questions or concerns please contact the office.

Separators

(AKA Spacers)

Teeth normally contact each other tightly. In order to fit your bands properly, we need space between the teeth. Small rubber modules or metal springs are the two types of spacers we use. They act gently over several days to move certain teeth slightly apart to allow us to accurately place the bands at your next appointment.

Instructions

You will experience some discomfort for the first few days after spacers are placed, take a pain reliever to alleviate your symptoms. If a pain reliever is necessary please always be sure to follow the manufacturers dosing instructions.
You may also want to reduce your diet to softer foods until the soreness dissipates.
You may brush your teeth normally around the separators, but do not floss or use toothpicks in the separated areas.
IMPORTANT- If you loose a separator, please call our office so that it can be replaced.

If you have any questions regarding the management of the separators, or any other aspect of your treatment, please don’t hesitate to call our office.

Tongue Exercises

Take the tip of your tongue and place it in the dipped in portion of the palate.
Bite down; close your lips together; and with your tongue still on the palate, swallow. Try to keep the tip of your tongue in the target area.
Repeat 10 times, 3-4 times a day.

Try holding a tic-tac or lifesaver on the roof of your mouth to make it more FUN!!

Tongue Guard

(tongue exercise instructions)

You have been given a tongue guard today. This appliance is used to help break the tongue thrusting habit and can also be used for digit habits such as thumb or finger sucking. Tongue thrusting and digit habits have a detrimental affect on the front teeth and sometimes affects skeletal development of the upper jaw. Tongue thrusting can potentially shorten the roots of the front teeth and open the bite in the front of the mouth. Digit habits can cause a narrowing of the upper jaw, leading to protrusion of the front teeth and crossbites of the back teeth.

How does a tongue guard work?

The tongue guard is designed specifically for each individual patient. A gate is designed to obstruct the tongue from contacting with the front teeth, thus allowing the teeth to drop into a more favorable position. The ultimate goal of the tongue guard is to retrain the tongue to use a proper swallowing pattern. To increase the likelihood of this we also encourage our patients to practice tongue exercises.

Tongue Exercises

Take the tip of your tongue and place it in the dipped in portion of the palate.
Bite down , close your lips together, and with your tongue still on the palate, swallow. Try to keep the tip of your tongue in the target area.
Repeat ten times, 3-4 times a day.

Taking care of your new appliance

Please avoid hard, sticky, chewy foods, such as taffy, gum and hard pretzels.
Limit the amount of carbonated beverages you drink to 1-2 cans per week. The carbonation deteriorates the dental cement used to adhere the bands to your teeth and will cause the appliance to become loose.
Brush your teeth and the appliance 3 time a day. The metal of the appliance should appear shiny if it is cleaned properly.
Floss daily. If you experience any inflammation or pain please contact our office.
If the appliance becomes loose please contact our office. Do not wait for your next appointment, call ahead to allow us to schedule you for the required appointment time.