Ask Dr. Straight Orthodontic Blog

Charlie, In my opinion there are times when you ha...

2010-03-03T12:36:19.809-05:00

Charlie,
In my opinion there are times when you have to have teeth removed. This does not mean that your face is going to ruined or your profile "dished in". In fact, I have seen many extraction cases where the profile and facial harmony has been vastly improved because teeth were removed.
Your orthodontist is extremely careful when it comes to having teeth removed and will have looked at a number of factors to insure that your facial balance is maintained or improved.
Speak to your orthodontist about your concerns and I am sure he will calm your fears.
Keep smiling!

Hi i have to get 4 premolars out to straighten my ...

2010-03-01T12:21:21.464-05:00

Hi i have to get 4 premolars out to straighten my bottom teeth and push back a moderately sticking out mouth,but because i have a small chin and high cheekbones i am afraid in case i could end up with a receded chin ,flat profile or saggy or slimmer face after treatment,i have read of these things happening to people on the web,will my orthodontist know by my face if any of the above could happen , any information will be great ,thanks.

Awfabee, It sounds like one of two things has occu...

2010-01-15T11:52:30.796-05:00

Awfabee,
It sounds like one of two things has occurred: either your daughter's case is more of a challenge than originally thought or your orthodontist has become a SureSmile provider and has chosen your daughter as one of his "in progress" cases. Either way it is a good thing! You are getting the benefits of the Suresmile technique for free. Don't be concerned that he may be "practicing" on your daughter. The wires, brackets and orthodontics are the same. He/She now has the advantage of a computer aided diagnosis, treatment planning and wires to help your daughter attain the result that you and your orthodontist want. So rest assured this is a good thing and you are getting it for free.

Question: After 14 months of "standard" treatment,...

2010-01-14T08:55:12.458-05:00

Question: After 14 months of "standard" treatment, our orthodontist has determined that our daughter's teeth are behind schedule, and wants to switch to Suresmile at no charge to us. In your opinion, is this a reasonable development? My concern is that the orthodontist might be using our daughter as "practise" with a new technology.

Kishore, In the US, in states that I am aware of, ...

2009-11-30T14:46:43.716-05:00

Kishore,
In the US, in states that I am aware of, the assistants have to pass a test certifying that they are able and qualified to perform certain orthodontic tasks. You would have to check the state dental laws to determine which tasks your assistants are allowed to perform.
As an orthodontist, I rely heavily on my chairside assistants to perform certain tasks. And they are quite capable at doing this. But they are not diagnosing and they are not treatment planning the case. They also are not determing the next stage of treament or what needs to be done at your appointment. In the two minutes that your orthodontist sits down and looks at your teeth, he/she is able to determine what needs to be done, how treatment is progressing and what instructions to give.
If you think of the orthodontist as the architect and the assistant as the laborer it will make more sense.

Hi Doc, Firstly love the new posts, I have been t...

2009-11-30T10:03:24.169-05:00

Hi Doc,
Firstly love the new posts, I have been telling my 'braced' friends about your blog and lot of them seem to love your sense of humour.
On an another note I wanted to ask you about the validity and skill level of these "orthodontic assistants" who work on my teeth more than my ortho, I mean $6000 and I get less than 2 minutes with my ortho and rest with these assistants. Is this common practice ? What diffrentiates the ortho from his/her assistants if they are capable of carrying over more 95% of the treatment? Its just that I chose this ortho because he seemed experienced and not because he is well staffed.

Dr. Malsharaf, It is not that I am against the Dam...

2009-10-31T14:31:12.785-04:00

Dr. Malsharaf,
It is not that I am against the Damon bracket as much as I am concerned with companies promoting qualities of a product with little or no evidence-based proof. Personally I see no reason to spend 3-4 times more on a bracket that is not significantly better than a standard twin bracket.

I am glad that you have the opportunity in your residency to use different types of techniques and brackets. You can decide first hand what you like, what you don't and what you want in a technique that provides the best care for your patients.

Is the technique more effective than other techniques? Is breakage and oral hygiene a problem? How is patient comfort? Are the treatment results adequate or superior? How labor intensive is it for you and your chairsides?
These are just some of the questions that you have to ask yourself.

Regarding the thesis, retrospective studies are just that. They deal with past results. I would like to see you do some type of clinical study. Let me think on that one....

Dr Staright I would like to ask couple of question...

2009-10-30T17:26:56.288-04:00

Dr Staright I would like to ask couple of questions please... the first one is that I know that you are against damon technique can you elaborate more on this as you know I am a resident so quiet new in the field but I am going to bond a patient with damon brackets soon to get the experience ..as it is a controversial technique if I can say it in that way I wanted to know from a person who is against it rather than a person who is with it...
my second question is that as you know that I am a resident and need to submit a research in a year and a half... well I come from the UAE where we lack dental research esp ortho oriented and I wanted to do a subject that would benefit the society... the region lacks statistical numbers of any kind so retrospective study would be a great choice but I wanted an interesting subject ...from your experience what would be a good subject that would be a benefit for us the UAE and would be interesting and publishable at the end...I would be greatful if anyone help ;(

Thanx Ameila for your kind words and as dr starigh...

2009-10-30T17:18:20.199-04:00

Thanx Ameila for your kind words and as dr staright commented that we will continue on his legacy...

a, I am going to assume that you really mean "over...

2009-10-29T10:23:30.802-04:00

a,
I am going to assume that you really mean "overjet". That is the amount your upper front teeth "jet over" your lower front teeth and not how deep your bite is. Overjet is a horizontal measurement and overbite is a vertical measurement.
If your upper front teeth were crowded it is very likely that they moved forward as they straightened out. If the lowers were not that crowded then you would see that overjet increase. To complicate it a bit, if the upper arch was too far forward to begin with (and your teeth were inclined back which would have masked the jaw relationship to your eyes)then the overjet would become very visible to you. The rest of your treatment would then be correcting your bite into a Class I relationship. Straightening your teeth is the easy part while correcting your bite is the challenge.
You trusted your orthodontist when you started treatment. Continue to do so. Ask him if it was your teeth that were out of position, your jaws or a combination of the two. He can then explain it to you more fully.
Take care and keep smiling.

Hi doc. Can I ask you something? It goes like this...

2009-10-28T21:07:24.474-04:00

Hi doc. Can I ask you something? It goes like this...

A year ago I started to wear braces because some of my teeth were "out of place". I also had a barely noticeable overbite (maybe 1mm? LOL). Today, after 1 year, my teeth are perfectly aligned! I'm so happy. BUT the problem is that the small overbite got WAY WORSE! My orthodontist says that it is a normal process blabla, but I just can't believe him, since that with each passing month is getting worse. Could you tell me if it is true? Is the increasing of the over bite a natural process when your teeth are being aligned? Please help me, I don't want my face to look ridiculous!

Thanks.

Khrystal, Your face can change with orthodontic tr...

2009-10-26T16:17:17.739-04:00

Khrystal,
Your face can change with orthodontic treatment and you might be able to see a difference quicker than your orthodontist. In fact, you might swear there is a difference and it is not that apparent to him. I have had patients very sensitive to their appearance and I could see no significant difference.
If your teeth were flaring out then the only way to bring them back or upright them is to either expand laterally, move teeth back bodily or extract. I think you will find that when your treatment is completed and you see the before and the after you will be happy. Don't judge the "construction of the building" until it is completed. There are many steps between the start and finish.
Concerning the clicking in your jaw, that is a whole different thing. I will tell you that extractions and orthodontic treatment have nothing to do with it. It is a multi-factoral entity. My first response would be to make sure that you are not bruxing or clenching your jaws a lot. Check yourself during the day and see if you're teeth are clenched together.
Take care, be patient and I think you will be pleased with your new look.

I had extractions for my braces in August. 3 premo...

2009-10-21T16:22:12.657-04:00

I had extractions for my braces in August. 3 premolars. My arches were rounding out ok except I had a problem with the bottom incisors flaring out. The ortho told me extraction is the only way. Well I had them done and something weird happened. My face changed shape. Can that happen so fast? I was told it wouldnt. It is much more narrow especially at my jaw and the ortho doesnt seem to care. In addition since I had the extractions the clicking in my jaw got worse.

Kev, It is difficult to answer your question with ...

2009-10-21T07:53:13.064-04:00

Kev,
It is difficult to answer your question with the limited info I have on the position of your teeth and being not privy to your records. But yes, if there is space on the upper arch between the fron teeth, powerchain can be used to decrease the overjet. Having said that, please realize that your front teeth are not supposed to be edge to edge on closing. There should be a slight vertical and horizontal overlap. Some patients don't realize that you want a little overjet.
I hope this eases your concerns and good luck.

Amelia, Yes, we shall carry on his legacy. I thin...

2009-10-20T21:28:39.103-04:00

Amelia,
Yes, we shall carry on his legacy. I think that the current demand for evidence-based treatment is testament to his life.
On a lighter note, I thank you for your kind words and remain in touch through this blog. :)

There's a huge problem with patients not getting s...

2009-10-20T20:00:00.177-04:00

There's a huge problem with patients not getting successful treatment, largely from the majority of doctors who are less-experienced providers. This goes not only for results, but problems with bad impressions, mutliple impressions, attachments falling off, improper IPR, not doing IPR, not moving teeth properly, etc etc. This in turn tarnishes Invisalign's reputation, even though, when used in the appropriate way, aligners can produce excellent results. My view is that they are banking on experienced users providing good outcomes, and expecting an increase in numbers due to public acceptance. There is a lot of negative press about Invisalign on forums, Yahoo questions, Ask Google, etc.

While I agree that legislative bodies and dental boards should decide upon qualifications, unfortunately, Align is a public company and can offer their product to whomever they wish.

An interesting aside is that at the last Canadian Association meeting, educators decided to stop teaching Invisalign in their programs in response to the proficiency. Unfortunately, it is the ortho residents who will suffer by not being able to learn about this treatment modality.

Fortunate enough to have been trained by "Dr. G" a...

2009-10-20T19:46:27.630-04:00

Fortunate enough to have been trained by "Dr. G" as he was known. An amazingly humble man for what he has done for orthodontics. Definitely a huge loss, but there are a lot of us out there who will try to continue on his passion for evidence-based practice.

On another note, I have really enjoyed your blog. It is fantastically candid, and I found myself literally LOLing reading. Wonder if there would be some way to get in touch?

Hi, I am not sure where to post this question but ...

2009-10-20T14:47:18.880-04:00

Hi, I am not sure where to post this question but here goes. Can an overjet of the upper arch be corrected (just the central incisors) using a powerchain alone?

My bottom teeth were debanded ages ago and only now has the ortho decided to fix the overjet. I am worried that he hasnt many options left now to fix my overjet as there is no where to hook elastics onto if he wanted to use elastics.

I am not impressed with 60 minutes. I have seen t...

2009-10-07T12:18:11.554-04:00

I am not impressed with 60 minutes. I have seen them skew and slant so many subjects and I think this is one of them. My opinion is that there is still a necessity in some cases to extract teeth. Extration frequency is much less than in the past but I think this is due to a better understanding of growth and development, understanding maturation changes in the face and an increased attention to facial esthetics. I don't think it has anything to do with what bracket is used.

I can treat any case with non-extraction but that does not make it correct, stable or esthetically pleasing. Those that never take out teeth are just as wrong as those that take out too many.

By the way, quit smoking now! You will live much healthier and be able to smile with your loved ones for a much longer time.

I often feel guilty to use the disposable toothbru...

2009-10-07T10:28:49.119-04:00

I often feel guilty to use the disposable toothbrush, feesl like such a waste to throw it after just one use, any how doc I am avid reader of your blog and appreciate your input and insight into the world of orthodontics.
Recently while I was at my orthodontist appointment, I saw some one come in for a consult and I guess he needed extractions and based on this video he saw on youtube 60 Minutes - Dr Derek Mahony (http://www.youtube.com/watch?v=SEFTJwTEbpw) it is an extraction vs non-extraction study and he deducted that my ortho is incompetent ! I learned about the site when I met him outside for a smoke. I watched the video and there is a heavy agenda against extractions, how much truth does this video hold ?!

Thank you
Keep them blogs coming, always a great read !

Rita, The brackets have little if anything to do w...

2009-10-05T10:22:40.386-04:00

Rita,
The brackets have little if anything to do with extraction vs non-extraction. It all comes down to the diagnosis made by the orthodontist,their idea of facial esthetics, stability and their educational background. There are many times in the case of "borderline extraction" cases when one practitioner will suggest extractions, one won't and another will do it as a trial non-extraction and see how things develop through treatment.
I would be cautious with anyone that says they never extract teeth just as much as I would be cautious with someone who extracts teeth in the majority of cases. I find that I have to extract in about 20% of my cases. This may vary with different orthodontists.

I would like to leave the question in here since I...

2009-10-05T03:08:45.274-04:00

I would like to leave the question in here since I faced similar problem. I went for a coupne of orthodonts to get a consultation on my case. 1 of them suggested regular metal braces or damon (but possibly without extractions with both systems) and I was fine with this - I was thinking of chosing regular ones. BUT,I visited anothe one who is working only with regular ones, she requested for me to take out 4 teeth and probably all wisdom-teeth also (she claimed another specialist for saying that extractions are nor necessary) because if I wouldn't extract it my teeth at the end would change the angle and move forward. She says she doesn't believe in self-ligating systems as it wasn't proved scientifically. So I'm kind of mixed up right now, I booked a visit for the 3rd specialist but would like to hear your oppinion whether it is possible not to extract teeth (does it really make that bad consequences)? Somehow I do not really want to get rid of 8 of mine and therefore I am considerind Damons only because of that reason.
Thank you for an answer

And so we see qualified orthodontists become less ...

2009-10-04T17:23:48.681-04:00

And so we see qualified orthodontists become less likely to (be able to) offer Invisalign, and it becoming even more the preserve of the general dentist. Also, what's the betting that a number of providers will end up agreeing on Invisliagn for borderline, or inappropriate cases, just to make their numbers ...

On reflection, I think this whole move by Align Tech is not so good as it might, at first blush, have appeared to be.

To walk away from a practitioner they know to be g...

2009-10-04T17:20:28.271-04:00

To walk away from a practitioner they know to be good, for one with whom they lack that type of first-hand experience, over just $225 is just plain silly. (And, as Britt posted, they'll lose more than that in extra gas costs over the course of the treatment anyway!)

However, if comparing treatment plans that are similar, and orthos who each have a great reputation in their community, if one is significantly less expensive than the other, then price does become a consideration. In this situation, if I happened to prefer the ortho who was making the higher price quote, I'd sure as heck try to get them to come down some.

If you ask me all direct marketing to patients of ...

2009-10-04T17:15:10.378-04:00

If you ask me all direct marketing to patients of medical products should be banned. This is especially true for prescription medications, but holds for orthodontic systems as well.