Metal Mouth Message Board

Hi everybody,

My name is Dr. Graham Jones and I am an orthodontist here willing to help answer any questions you might have. I've spent quite a bit of time reading the posts on this board and I'm so impressed with everyone's enthusiasm for improving their smiles and learning more about the ortho process. I wasn't able to afford ortho until I was in college, so I understand a bit about post-adolescent life in braces. Also, my wife is currently braced up, so I get to hear about ortho life from her on a daily basis.

I received my orthodontic training at St Louis University and I currently practice in the Seattle area. I am starting up an office of my own in Monroe, WA and I work part time as an orthodontist at a couple of offices locally. I have worked as a hygienist and general dentist in the area, which I still do a bit as my ortho practice grows. Working in the dental field outside of ortho has been fun for me as I get to answer a lot of questions from people who are in braces or considering making the jump.

My orthodontic training is failry recent, so I am familiar with many of the current philosophies and treatments. I consider myself not too far toward any "extreme" in orthodontics, but pretty familiar with a wide array of treatments.

I am happy to help answer any questions anyone may have as sincerely as I can. If I don't know the answer, I'll let you know that, too! I promise not to push my own agenda, but to provide as much helpful information as I can. I am happy to contribute to this forum, if it would be beneficial at all.

Thanks for having me, what a great website!
-Graham Jones, DDS, MSD
jonesfamilyortho.com

Everyone please welcome Dr. Jones! Thanks for joining us!

WELCOME!

WELCOME! Thank you in advance for your willingness to share your knowledge with this very appreciative group! I look forward to hearing your opinions.

Andi

Welcome Dr. Jones! I'm sure we'll all really appreciate your professional advice.

On a side note, I seriously considered getting ortho treatment at SLU, but they could never fit me in!

Thanks everybody for the welcome! I'll try to sift through the topics and see if there is anything helpful I can add. You are all so good at answering each other's questions, I don't want to barge in. If there are questions that you would like for me specifically to take a crack at, let me know!
Thanks.

Dr. Jones, there are plenty of questions to keep you busy when you're not hard at work!

Welcome!

One of the questions that gets discussed regularly around here is "which type of bracket is the best?" or one of its corollaries like "is the Damon bracket better than other types". Perhaps you could let us know your feelings on this topic.

Betty Bat
senior member (well, I'm senior in age anyway - age 55)
upper braces off April, 2007 - Essix retainer
lower braces off September, 2007 - Hawley retainer
getting dental implants October, 2007

My dentist didn't inform me that extracting teeth would narrow my arch. I'm now unhappy with my narrow smile. Is there anything that can be done at this point? I'm 36 months into treatment with almost all gaps closed.

Hi jonesortho and welcome! We're glad to have you here and I'll look forward to reading posts from you.

Hi DavidT: You might wish to start a new thread with your question - it is much more likely that people will see it so they can hopefully be of help.

The bracket question, huh?
Well, my 2 cents on this is similar to what I've seen on this forum with a bit of my own personal soap box. The bracket is an attachment that is placed on the tooth that allows the wire to work on the tooth; that's all a bracket is. The wire is what does the work. There are lots of fancy bracket designs out there with different modifications. They are all worthless without a proper understanding of what the wire is going to do once it is placed in the bracket. Some of the best orthodontists on earth, who get the most beautiful results use the cheapest, most simple brackets out there. The opposite can also be true. Many orthodontists are moving toward self-ligating brackets (like Damon, Innovation, Smart-Clip, etc.). To me this is more of a practice management decision than it is a treatment decision. I have used nearly all of the self ligating brackets that are available, just to see how I liked them. I can tell you that they do not change how the teeth move or how your smile looks in the end. Research backs this up, too. Self ligating brackets may allow for longer intervals between appointments (because colored o-rings don't have to be changed) and it makes appointments quicker (for the same reason), but to me, that's about it. I use self ligating brackets in my practice, but I do not believe that I am offering any better treatment because of them than I would offer with a standard bracket of any shape or size.
The problem I have is with the marketing that has gone into some of these brackets....one in particular that I'll leave unnamed. The company in question is marketing their bracket in such a way that it makes it seem as though orthodontists who are not using their product are somehow selling their patients short. They offer a nice product that many terrific orthodontists are using with much success, but it is in no way able to provide superior results to any other bracket available. The company has put together a slick marketing campaign that has reached the general public. That is putting some pressure on orthodontists to have this particular bracket available, even if we are not big fans of the bracket. I could discuss this ad nauseum, but my take home point is: find a good orthodontist who comes recommended by someone you trust, make sure that you trust the orthodontist, and don't worry about what bracket style, prescription, etc he or she uses, because the bracket will not determine the result. If anyone would like to discuss this more with me, I'm happy to do so, but I don't want to use your forum as my soap box.

As far as extractions narrowing the arch. This is a common misconception. There are 2 well done research studies that have looked at this, both done by a fantastic orthodontist named Tony Gianelly. Here are the references:
Angle Orthod. 2003 Aug;73(4):354-8 --this one is available for free online at http://www.angle.org/anglonline/?reques ... &page=0354

Am J Orthod Dentofacial Orthop. 2003 Jan;123(1):25-8 --this one is only available to subscribers, but here is a brief summary of the study.

An undocumented criticism of extraction treatment is that it results in narrower dental arches when compared with nonextraction therapy. Anterior and posterior arch widths of the maxillary and mandibular arches of 25 patients treated by 4 first-premolar extraction and 25 patients treated without extractions were measured on posttreatment study models and compared statistically to determine whether the dental arches were narrower after extraction treatment, to test the accuracy of this view. Measurements were made in the canine and the molar regions from the most labial aspect of the buccal surfaces of the canines and the molars. In both groups, anterior and posterior arch widths were the same except for the mandibular intercanine dimension, which was 0.94 mm larger (P <.01) in the extraction group. This indicates that extraction treatment does not result in narrower dental arches than nonextraction treatment.

I would ask whoever is telling you that extraction narrows the smile to provide you with some tangible evidence that this is true. There are some authors and websites I've found that claim this to be true, but offer no evidence to back their claims up.
I would also discuss your unhappiness with your smile with your current orthodontist, it may be that the adjustments he or she has planned in "fine tuning" your smile may make you much happier with your smile. A lot of these tunings are done toward the end of treatment, after the spaces are closed. You may be surprised how different things look as your orthodontist "finishes" your smile.



Hope that helps with the discussion!

Thanks for discussing the bracket question. That was a good, comprehensive response and it is appreciated!

Thanks!

As I have already spent 4 years in braces and I am an adult, I have been worrying of late about Root Resorption.

Anyway, I spoke to my ortho yesterday and she said that my gums look healthy and I clean my teeth well so I need not worry about this. Though she did admit when I asked that she couldnt be sure without an xray.

What she did say however, was that, now my brace is 'anchoring' my teeth and only 1 or 2 teeth are in the process of actually being moved. She said a brace which is not moving, but anchoring is actually a good thing and will help protect my teeth.

Would appreciate if you could confirm (or discount) her theory.

Thanks in advance

Just wanted to thank you Dr. Jones !

It is awesome to have here again an orthodontist. I hope you didn't see too many
mistakes in the answers we, pro patients, post here.