FAQ

Many adults “finally get their teeth done” when their kids go in for orthodontic treatment. It’s more common than you think! Several ArchWired.com readers have an entire family in braces!

Getting braces put on your teeth does not hurt, and does not require Novocain injections or anything painful. For a full description of the process, read Braces Basics: When the Braces Go On.

The average cost for a full set of braces in a typical two-year treatment is about $5,000 US. The cost varies depending on where you live. Major metropolitan areas tend to be slightly higher in cost than rural areas. Generally, metal braces cost less than ceramic ones. Invisalign treatment can be just as costly as traditional braces, and sometimes is even slightly more expensive. Beware of paying in full for your braces treatment in advance. The orthodontist or dentist may give you a discount for paying in advance, but that often leads to problems down the road. In some cases, unethical dentists have unexpectedly closed their practices, leaving patients in the lurch. It is best to get a payment plan from the dentist, or see about a financing plan such as Care Credit.

Also, do your homework before committing to companies that send Invisalign-type clear aligners to you by mail (such as Smile Direct Club, Candid, SmileLove and others). Do your research. See what others’ experiences have been with these types of companies, especially if their results didn’t turn out as planned.

Many people in the U.S. have dental insurance through their employers or as individuals/families. This insurance usually covers orthodontic treatment for children up to age 18, but does not cover adult orthodontics — or only covers it up to a certain dollar amount. If your plan covers adult braces, consider yourself in the lucky minority. I can’t speak for dental plans offered overseas, as I know very little about them, and some are government-run (such as the NHS in the United Kingdom).

Remember, most insurance plans and discount dental plans do not cover treatment that is already in progress. So, if you are going to sign up for a dental plan or insurance plan, do it before any treatment begins. Also, beware of any waiting periods your dental plan may enforce. Jaw surgery or tooth extraction is sometimes covered under your medical plan, so be sure to look into this, too.

There are dental discount programs (which are not technically insurance). Be sure to carefully calculate the price of your orthodontic treatment before signing up for these sort of plans, because you could wind up spending more in premiums than the braces cost without this type of “insurance!”

To help find an orthodontist near you, it’s best to get personal recommendations. Ask friends who have braces (or whose kids have braces). If your insurance covers orthodontics, see if it is limited to specific dentists/orthodontists. Or, post a query on ArchWired’s Metal Mouth Message Board; our readers are all over the US and around the world, and are very helpful!

Dental plans come and go; some are better than others. Please read the fine print carefully before you sign up for anything and check with the Better Business Bureau. If you don’t have dental insurance, you can sign up for a discount dental plan. A discount dental plan is not insurance — it is a cooperative of dental professionals who have contracted with a company to offer their services at a discounted rate. Many are available, offered by different companies. You can search for discount dental plans on Google or DentalPlans.com. Or, ask a trusted insurance agent or your own dentist.

If you don’t have dental insurance and can’t afford a a discount dental plan, there is still an alternative. If there is a dental school in your area, call them and ask if they have a clinic. Often orthodontists and dentists in training will practice on patients in the school clinic, under the watchful eye of experienced teachers who are themselves dentists and orthodontists. This service is offered to the public at a minimal cost.

It depends on your specific case. Invisalign braces are usually not recommended for very complicated cases, or cases that involve extractions. Only a qualified dental professional who has examined your mouth can decide whether Invisalign is right for you. If you are very concerned about your appearance with braces, another thing to consider is lingual braces, which are behind the teeth (such as iBraces). An orthodontist must take special training to do lingual braces — not every orthodontist does them.

An orthodontist is a dentist who has taken several years of extra training beyond the basic dental degree. Here is what the American Association of Orthodontists (AAO) says:

“It takes many years to become an orthodontist. As in medicine, the educational requirements are demanding.

First, an orthodontist must complete college.

Next is a three- to four-year graduate program at a dental school in a university or other institution accredited by the American Dental Association (ADA).

Finally, there are at least two or three years of advanced specialty education in an ADA-accredited orthodontic residency program. The program is difficult. It includes advanced knowledge in biomedical, behavioral and basic sciences. The orthodontic resident learns the complex skills required to both manage tooth movement (orthodontics) and guide facial development (dentofacial orthopedics).

Only dentists who have successfully completed this advanced specialty education may call themselves orthodontists.”

My personal opinion leans toward orthodontists. Here’s why:

Some dentists incorporate orthodontics into their practices. They have probably completed some extra coursework in tooth movement management and facial development. Some dentists who practice orthodontics have completed more coursework than others. Don’t feel shy about asking a dentist about his orthodontic qualifications — what extra training he has completed, and how many orthodontic patients he has seen. Just because a dentist says he or she “can do braces for you” doesn’t mean that they have all the training necessary to successfully handle complicated treatments. Some dentists confer with their their orthodontic colleagues to ensure that they’re doing things optimally. If you have minor orthodontic problems, your dentist might be able to handle your case. Complicated cases are probably best handled by an orthodontist who has more training.

If you’re considering getting braces, you should probably get at least one opinion from an orthodontist to ensure that you are getting the correct type of treatment.

You can get as many orthodontic consultations as you want. In a consultation, an orthodontist looks at the alignment of your teeth and your facial aesthetics and gives you a general opinion of what he or she would do to correct your problems.

Usually the consultations are free or of minimal cost. While an orthodontist can look at your teeth and give you a general opinion, he or she can’t put together a comprehensive treatment plan for you until teeth molds and panoramic x-rays have been done.

There is usually no one right way to correct orthodontic problems — there are many ways, and different orthodontists may give you different opinions. That is why it’s a good idea to consult with two or three orthodontist before you start treatment, especially if they recommend extractions, headgear, or jaw surgery.

Just like any medical or dental procedure, there are some risks involved in orthodontic treatment, no matter your age.  The forces involved in braces can cause some amount of trauma to the dental tissues and structures. However, most adults successfully complete their treatment without any major complications. Orthodontists often give their patients a booklet outlining some of the risks that may be involved and make them sign a waiver that they understand these risks, which include:

• Root resorption – The structure of the tooth’s root may break down, causing its destruction.

• Gum recession – The loss of gum tissue around the tooth, which in severe cases can expose the tooth’s root. The “triangle” of gum tissue surrounding some teeth may also recede.

• Allergic reactions – If you are already allergic to nickel or latex, tell your orthodontist. There are alternative brackets and bands which are nickel and latex free. You may be sensitive to these substances and not realize it until you get braces. If you develop unusual swelling or tenderness in your gums during your treatment, or any sort of hives or rash on your face and mouth, allergy may be the culprit.

Occlusion is another word for your bite — how the teeth in your top and bottom jaw meet with each other. Mal comes from the Latin root meaning “bad.” So, a malocclusion means a bad bite — a bite with problems. It means that your top teeth do not line up properly with your bottom teeth.

Malocclusion (literally “bad bite”) is most often caused by hereditary factors such as an abnormal relationship between the size of the teeth and the size of the jaws. Malocclusion may also result from missing teeth or habits such as thumb sucking or tongue thrusting.

Malocclusions are classified based on the relationship of the maxillary (upper jaw) and mandibular (lower jaw) first permanent molars.

There are three basic classes of malocclusion, Class I, Class II, and Class III:

Class I malocclusion involves crowding, spacing, or overlapping of the teeth. In this classification the upper jaw is in a normal relationship to the lower jaw; that is, neither jaw protrudes.

Class II malocclusion occurs when the bottom jaw is in a more posterior (backward) position than normal. The top teeth appear to protrude out over the lower teeth. One example of this type of malocclusion is often referred to as “buck” teeth.

Class III malocclusion occurs when the lower jaw is in a more anterior (forward) position than normal. The lower teeth protrude out beyond the upper teeth. This is often the most difficult type of malocclusion to correct.

The most common types of bite problems are:

• Overbite. Patients with overbites appear “bucktoothed” and have a receding chin. The lower front teeth are positioned too far behind the upper front teeth. This condition can result from a horizontal overdevelopment of the upper jaw or an underdevelopment of the lower jaw or a combination of both.

• Underbite. Patients with underbites have a strong jaw with a chin that juts straight out. The lower front teeth are positioned in front of the upper front teeth. This condition is caused by the horizontal underdevelopment of the upper jaw, the horizontal overdevelopment of the lower jaw, or most frequently a combination of both.
• Crossbite. This occurs when the upper teeth are biting inside the lower teeth. This is frequently the result of a narrow upper jaw. Crossbites also occur because of a mismatch in jaw size and position between the upper and lower jaw. Some crossbites also lead to asymmetry of the lower jaw by causing the jaw to be abnormally deflected to one side when closing the teeth together. Proper diagnosis determines how and when a crossbite needs correction.
• Open bite. This occurs when the upper front teeth cannot meet or overlap the lower front teeth even though the back teeth have closed together. Sometimes this this makes eating difficult. Open bites are caused by the overdevelopment of the back portion of the upper jaw in a vertical direction. As the back portion of the upper jaw grows vertically downward, the lower jaw will open in a clockwise direction. This explains why open bite patients have a long facial appearance.

According to readers of ArchWired’s Metal Mouth Message Board, most people begin see changes in their teeth in the first 2 to 6 weeks of treatment. In some cases, you may begin to see movement within the first week. Be patient, and soon enough you will get the smile of your dreams!

Of course you’re self-conscious because it is YOUR mouth, but frankly most people don’t give a hoot. Your braces are a conversation piece for about 3 minutes; after that, nobody pays much attention. Really. And most people don’t think you look geeky. In fact, they probably think you look cute, or applaud that you are doing something positive to improve your appearance and your dental health. Whenever you become self-conscious about your braces, think about how great you’ll look after they come off!

FYI, here are the results of a poll of ArchWired.com readers on this very subject, conducted in January, 2004. The poll may be a little old, but the attitudes haven’t really changed. In fact, since that poll was conducted, it has become even more common to see adults wearing dental braces.

Changing orthodontists mid-treatment can be tricky. Most orthodontists work on a “pay as you go” plan. In other words, you pay a certain amount of money at the outset of treatment (for the molds, consultations, and having the braces installed). Then, each month, you pay a percentage of the rest of your balance. So, if you move away from your orthodontist, be sure to tell him/her ASAP so that you will not be charged extra. You orthodontist will probably “pro-rate” your balance or refund some of your money. You should also request your dental records, or ask your orthodontist to forward them to your new doc.

However, you may wind up paying a few hundred dollars more to your new orthodontist. After all, this new doc has never seen you before, and you are a new patient to him. Hopefully, changing orthodontists mid-treatment won’t raise your costs too much.

In any event, this is a good argument for NOT PAYING THE ENTIRE BALANCE UP FRONT. Personally, I think that paying it all up-front is a really bad idea, even if it saves you money. For example, there was a story in the news a few years ago about an unscrupulous dentist who took full payment from his patients — and then closed his practice! Some of them had to pay the full amount (in excess of $5,000) again to the new orthodontist, and some just couldn’t afford the unexpected expense and had to stop their treatment. The odds are that your dentist would not do this to you — but even under the best circumstances, nobody knows what the future holds, so I think that “pay as you go” is safest option. For more details on this subject, read Braces and Moving.

It depends on your specific case. When we are young and our jaws are still growing, dentists/orthodontists can work with our growth to straighten the teeth without extraction.

But once we are adults, dentists are limited to what is already in place. If your orthodontist recommends extraction, it may be wise to get at least one more (if not two more) opinions before going through with the procedure — once the teeth are gone, they’re gone! Your teeth and jaw help to shape your face. Changing the underlying structure will result in some changes in your facial appearance. You should discuss this with your orthodontist. There are newer types of bracket systems that apply lighter forces and may be able to correct your problems without extractions, such as Damon Brackets. You may want to ask your orthodontist about it.

Sometimes however, depending on your unique case, extraction may be the only way to successfully straighten your teeth and correct your bite. For more information about extractions, see Getting Teeth Extracted for Braces.

That depends on your body’s unique physiology. Gaps in teeth on the lower jaw tend to close slower than on the upper jaw. It can take anywhere from a few months to a year to close extraction gaps. Orthodontists have a variety of techniques to help close gaps faster. If your treatment isn’t going at the pace you would like, talk to your orthodontist about what options are available.

Yes, you do, to some extent. At first your teeth will hurt and you won’t be able to bite into hard foods, big sandwiches, or anything too chewy or crunchy. It is best to stick to soft foods until your teeth begin to feel better — usually in a few weeks. You will also need to change the way that you chew your food, because your teeth will hurt and you will be chewing differently. Read Soft Food Suggestions for information to help you cope.

That depends on your case. Orthodontics isn’t just about making your teeth straight or making them look better. Most dentists and orthodontists take a lot of things into consideration when recommending treatment, such as:

• how the top and bottom teeth meet with each other (i.e., your bite)

• how well you can chew your food

• whether you have a tongue thrust problem

• whether extraction or surgery will be necessary to correct your problems

• whether you will need any appliances in your treatment, such as a palate expander or headgear (yes, some adults do wear headgear)

So you see, it isn’t just a matter of making your teeth look pretty. There are lot of other factors to take into consideration. This is why you sometimes need a full set of braces, even if you think that you only need them on top or bottom. Of course, some people are lucky. Their bites are good and perhaps they only need a bit of straightening. People in this position often can get braces only on top or bottom.

Both ceramic and metal of braces work well to move your teeth and give you the smile that you want. There are some differences between them, such as:

Durability – Ceramic braces are susceptible to chipping and cracking, so they may not be the best choice for people who play contact sports. In many cases, ceramic braces are put on the upper teeth and metal braces on the lower teeth. This is because more pressure is usually applied to the lower teeth, and metal braces can withstand that extra pressure better than ceramic braces.

Treatment Time – Metal braces usually move your teeth slightly faster than ceramic.

Cost – Ceramic braces are usually more expensive than metal braces.

Visibility – Although many types of metal braces are much smaller when compared to the past, they aren’t transparent or tooth-colored. Ceramic braces can be virtually invisible from a distance, or even in photos.

All the pros and cons of ceramic versus metal braces are outlined in What Type of Braces are Best?

Yes, at first they do. For me, it felt like I had been hit in the teeth with a baseball — but everyone’s experience is different. Your teeth will ache to some extent and your gums will probably get sore in specific places. This is because your teeth are not used to the pressure, and your cheeks are not used to the metal or ceramic rubbing against them.

After wearing braces for a few weeks, the pain and discomfort begin to diminish. You can use dental wax and topical anesthetic to help create a barrier between the braces and any sores that develop on your gums (the sores usually heal within a few weeks). You can also use a lip protector.

In a few months, pain is less of an issue, and it goes away. You sometimes even forget that you’re wearing braces! Your teeth may also hurt again for several days after your monthly adjustment, but by then you’re used to it and it doesn’t bother you as much.

There is no age limit for braces. As long as you have good periodontal health, braces can be used to straighten your teeth and correct your bite. More people over age 30 are getting braces today than ever before. Most ArchWired.com readers are between the ages of 25 to 55! However, if you have been on a Bisphosphonate drug for osteoporosis (such as Fosamax or Boniva) you need to talk to your orthodontist or dentist first. Read this article to find out why this is very important.

You  can use a regular soft toothbrush when you have braces, but most orthodontists recommend an orthodontic-cut toothbrush, where the bristles in the middle are lower than the bristles on the edges and cut into a “v” shape.  This is often called a “v-trim” toothbrush. They are difficult to find in stores, but your orthodontist will usually have some to give you. DentaKit carries a particularly good v-trim manual toothbrush and several soft toothbrushes which are good for sensitive gums. You can also use any electric toothbrush, such as a Sonicare or Oral-B Braun. These do an especially good job of cleaning your teeth.

To floss your teeth, you don’t necessarily need special floss. You can use any type of floss with a plastic threader needle such as BridgeAid or those made by DenTek . The plastic threader helps you bring the floss under the arch wire for each bracket.

To make things easier, there are also several types of “threader floss” which is a length of floss that has a built-in stiff threader end. Some popular brands of threader floss are ProxySoft (formerly Thornton 3-in-1 Floss), SuperFloss and Oral-B Glide Threader Floss. An enterprising orthodontic patient even invented a tool he calls “FlossFish” to help you floss under your brackets with any type of regular dental floss. Many of these flossing tools, and others such as GumChucks OrthoGami and Plackers OrthoPik Flossers can be found at DentaKit.com or many online drugstores.

You might also want to get a small spiral dental brush (sometimes called an “interproximal brush” or a “proxi-brush”) or a rubber-tipped stimulator to help clean food debris out from between the brackets before you brush.  There are many types of these on the market, including those made by DenTek (in a variety of widths), and ones with longer handles, such as those made by Tepe. DentaKit.com also carries a good variety of these interproximal brushes.

A WaterPik water flosser or a device like Oral Breeze’s QuickBreeze (which attaches to your sink faucet) or ShowerBreeze (which attaches in your shower) are also helpful. On the go, you might find a portable battery-powered WaterPik helpful. In fact, they even make a mini travel version of the WaterPik for travel called the Sidekick. It plugs into the wall socket and hold more water than the battery-operated model, so it’s ideal for long trips. My husband, who has periodontal problems, uses the Sidekick when he travels and he likes it a lot.

Wax helps to create a barrier between the bracket and the inside of your cheeks and lips. It helps prevent the bracket from irritating your cheeks or gums. At first you will probably use a lot of dental wax, but as your get used to your braces and the insides of your cheeks “toughen up” you may wind up using less.

To use dental wax, break off a tiny bit of wax from the container, smoosh it with your fingers a bit to mold it, then place it directly on the bracket that is causing the irritation, as shown in this photo. Dental wax is non-toxic, so it’s ok if you swallow it. Wax tends to break down over time, so you’ll probably have to apply more after eating a meal. Take off the wax before you brush your teeth, or it will gunk up your toothbrush.

Dental silicone, such as Ortho-Sil is a little different. It lasts longer than regular dental wax. Your brackets must be extremely dry when you apply dental silicone, or it will not stick to them. Some people love dental silicone and some prefer regular wax. If you have never used OrthoSil, ask your orthodontist for a small packet, or  just a small amount to try before buying a large quantity. There is also another product called OrthoDots, which is dental silicone formulated with a special adhesive that works when wet.

Usually your dentist/orthodontist gives you some dental wax after you get your braces put on. Most pharmacies (both online and local) carry dental wax. DentaKit.com also carries silicone dental wax, as well as several types of lip protectors which are alternatives to wax.

First, rinse with warm water a couple of times to dislodge any food particles. You can also use a rubber-tipped gum massager to dislodge any particularly stubborn particles that are badly stuck in your brackets. Now you can use a small amount of toothpaste and brush your teeth.

It is best to use circular, vibrating motions around the gum line. Angle your toothbrush above and below the brackets. Scrub each surface of every tooth with 10 strokes of the toothbrush. This should take several minutes — be as thorough as possible. Don’t forget to also clean the surfaces of the molars and to also brush your tongue!

It’s best not to use a whitening toothpaste until after your braces come off. If you use a whitening toothpaste on a daily basis, the teeth underneath the brackets may not be as white as the rest of your teeth when your braces come off!

Flossing braces is a little tricky at first. You must thread the floss under the arch wire between each tooth, floss under the gumline, then remove it. Repeat for each tooth. At first it will take about 15 minutes to floss all of your teeth, but with practice you will get faster and more efficient at doing it. It is important to floss EVERY NIGHT. Even if you use a Waterpik device or interproximal brushes, you should still floss. Braces are notorious for hiding tiny pieces of food you could have sworn were rinsed away!

You can use any type of floss that is comfortable. Most people attach the floss to a plastic needle called a Floss Threader, or use floss that has a stiff end, such as Oral-B Glide Threader Floss. There are also other types of flossing tools you can try, such as GumChucks Orthogami, FlossFish, and Plackers Orthpick Flossers. All of these products are available at DentaKit.com and in some in pharmacies.

Most people who have braces carry a little dental kit to help them in such situations. A dental kit should contain a dental pick, some floss and floss threaders, a toothbrush, and some toothpaste. A travel cup is also a good idea. It is easy to put one together yourself.

All these items are compactly offered in a product called DentaKit Braces Survival Kit, which is pictured here. This is a product that I created a few months after getting my braces. I needed a kit like this and couldn’t find one anywhere, so I created one!  Like most people, I started out by putting some stuff in a baggie, and then a small cosmetic bag. One of the advantages of the DentaKit product is that everything is held securely in the pockets, making it easy and convenient to use.

All the tools included in the kit are designed to help you clean your braces. Thousands of orthodontic patients worldwide have bought this kit and tell me that they consider it a valuable tool in helping to keep their teeth and braces clean. It includes everything you need to clean your braces “on the go,” including a unique leak-proof pop-up folding cup, and extra pockets to put lip gloss, Chapstick, or hand wipes.

Elastics help fine-tune the alignment of your teeth and your bite. There are many different ways that you can wear elastics for specific reasons. You should wear the elastics the number of hours that your dentist recommends to help your treatment progress properly. (Wearing them “double time” or “double strength” to make up for time you spent without them is NOT advisable — that could harm your teeth). Most people take elastics out before a meal, brush, then replace them after a meal. For more information, read All About Orthodontic Elastics.

Yes, you can. It’s probably best to have the braces on for a few months before snorkeling or scuba diving, so you can get used to the extra hardware in your mouth. For an ArchWired reader’s perspective on the subject, read Braces and Snorkeling/Scuba.

The brackets themselves usually do not stain. It’s the elastic ligatures that hold the arch wire to the bracket that stains. These are changed at each adjustment, when you get fresh clean ones. So, if your ligatures or power chains stain, you’ll only have to live with it for a short time. For more information, read Help! Did I Stain My Braces? 

Yes and no. All of the companies that make clear plastic aligners base their treatment on the same principles as Align Technologies (the company that created Invisalign, the first clear aligner). However, there are some differences. Invisalign’s material and methodology is patented, so other companies can’t copy the exact material or the exact methods that Invisalign uses. Therefore, other companies make their aligners out of similar materials and use a similar type of tooth movement technology. In addition, some brands don’t treat the entire mouth; only the six front top and six front bottom teeth. Be sure to ask a lot of questions about the type of invisible aligner treatment you are getting, so that you are properly informed about what sort of outcome to expect.

This is more common than you think. The teeth are actually more dynamic than you’d expect. Sometimes, when wisdom teeth erupt, your bite can change in adulthood. A large percentage of adults in braces are in them (or need them) for a second time!