John B. Harrison, DDS,MSC

There are several varieties of cross bites that have different considerations, it can be a single tooth front or back with front usually more serious because it pits a stronger bigger upper tooth against a smaller weaker lower in traumatic occlusion causing bone and gum breakdown, it can be an entire segment of posterior teeth unilaterally or bilaterally, usually meaning the upper arch is too narrow for the lower because of mouth breathing and low tongue posture. Sometimes a cross bite causes the jaw to deflect to an unnatural position and function which is harmful to the jaw joint. Basically, a cross bite indicates an imbalance and disharmony of function. On rare occasions, a cross bite is harmless, but the sooner, the better as far as age is concerned for correction. I would not want my grandkids to have any type of cross bite at age 6 when the permanent first molars and incisors erupt.

I think you are wondering about a space between your upper front teeth, called a diastema. It can be closed with clear aligners as well as braces, but in order to keep the space closed, you will need a fixed bonded retainer.

With an adult, there are no stages or phases of braces like with younger growing patients. Your treatment will all be done start to finish with one stage. Then retention begins if you want to call it a stage which will require you to wear a retainer at night as long as you want straight teeth. Don't underestimate the importance of retention and years of holding teeth.
Hope that help your understanding.

Dr. Harrison

The root canal procedure would have nothing to do with the bio mechanics of tooth movement, unless there were a large area of bone destruction (infection) at the root tip which you would want to heal first. A post-op X-ray would show healing so as soon as verified and you are comfortable and asymptomatic with the treated tooth, begin your orthodontic treatment. I am glad you decided on root canal treatment rather than removal of the tooth, but how soon depends on the severity of the infection, it could be OK right away or need 6-8 weeks for bone healing. Whoever did your root canal will give you the best answer.

Dr. Harrison

Great question and I know it is important to you. My thought is that you would rather not have them in on a date night and you do not want to eat in them so I really don't think it is a problem to some days only getting 18 hours of wear time. I know this happens plenty of times where the 22 hours/day is not achieved yet progress does not suffer unless patients are very careless with wear time. I would love to get feed back on this question from personal experience because I honestly don't know what difference it makes. I am sure social media of Invisalign users would love to give you their advice, but I think you are the best judge of what is best for you.
Hope your nice teeth will benefit you in many ways.

Dr. Harrison

Congratulations on considering braces at 42, no sense waiting until you are 72. Healthy teeth can be improved at any age if it is important to you and there will be benefit to your oral health both aesthetically and functionally.

The better question is what is better for your particular situation which an orthodontist can help you decide. There are special situations where Clear tray aligners might be the better option and others where fixed appliances have an advantage. The obligation of an orthodontist is to have the best possible outcome for their patients, but also meet the preference of patients.

Ceramic brackets have been around a long time and do not break easily unless there is direct traumatic blow. They are glass, but durable. Mouth guards are essential in sports to protect both teeth and brackets, but you are not likely to be wearing a mouth guard should an unforeseen accident occur. If a broken piece is swallowed, there is no way to locate it with an X-ray, but bigger and worse things are swallowed accidentally without a high probability of harm. It is important for the lower ceramic brackets not to contact the upper teeth or they will break or, worse yet, wear the enamel off the inside of upper teeth. Most adults prefer aesthetic attachments and the breakage risk is very low.

Sometimes it is very necessary, especially on non growing adults with limited bone support for all the teeth or when a tooth is completely blocked out. we cannot violate the bone and gum support of each tooth. you might want to have the braces installed before the removal on the same day. Not a lot of people have room for 32 beautifully aligned teeth.

First, for conventional braces, I think a Water Pic is essential for much improved oral hygiene. However, brushes, floss, interproximal cleaners and fluoride rinses all have their place regardless of fixed appliances or clear aligners. The smaller and softer the brush, the better, and trays should be cleaned with soap and water with a small brush that gets down into the
tooth indentations. Power brushes with small heads that clean one tooth at a time are will win you over if used correctly. Clear trays and retainers should not be soaked in mouthwash. All that said, it is the person attached to the handle that determines how well the mouth is cleaned. A 10X lighted make up mirror is worth its weight in gold if you examine your teeth after brushing. Disclosing tablets help train you to do a better job because you can see where you missed. Excellent oral hygiene is critical with any kind of appliance placed in the mouth.

Dr. John Harrison

Options for sensitive teeth are no different regardless of treatment procedures. For the most part sensitive teeth can be desensitized by your dentist who can determine the cause. New crowns or fillings may cause temporary sensitivity,a split or cracked tooth will always be sensitive until it is removed. Some sensitive teeth need endodontic treatment which removes the life support system of the tooth while others may be sensitive
because of gum recession and root exposure which is cured by fluoride varnish or rubbing in Sensodyne toothpaste into the exposed root area. Orthodontic treatment might make your teeth tender to chewing after an
adjustment but I would not call that sensitivity.

Dr. Harrison

There are two sides to the question. Some might think that clear tray aligners are invisible,In fact, one manufacture has a trade name Invisalign, another Clear Correct, another Clear Choice as well as other brand names for clear tray aligners. A growing number of orthodontists make their own aligners with 3D scans and 3D printers or use local dental labs to fabricate clear trays. All of these are more or less invisible from a social distance and are a consideration for your choice of treatment. The other side of "invisible" are lingual braces which are brackets attached to the inside of teeth which have come in and out of favor with orthodontists due to constant improvements in design and technique. They truly cannot be seen unless open mouth close inspection of the patient showing them off to friends. The learning curve for lingual (tongue side) braces is somewhat difficult due to the restricted space for wire activation, different instruments and wire bending. The required training, more difficult technique, and more expensive instrumentation result in higher well deserved fees. Both efforts at hiding the hardware of braces result in higher fees than conventional traditional braces. A third option is clear conventional. a tooth colored bracket on the outside of teeth replacing the
metal look which is aesthetic, not so noticeable or as costly. Listen. Learn, then decide what is best for you. Not all orthodontists do lingual braces, so you need to find someone experienced in that technique and who can show you results of cases similar to yours.

No one alive is too old to improve a deviation from nature's normal if that is an informed decision and you have the desire and motivation to change. You always have the choice to decline advice and accept yourself as is. Teeth and or jaws have to be moved to correct excessive overbite. Being a non growing adult at 23, some situations require surgical intervention
along with some form of braces. Surgical correction without orthodontic finishing is not a good idea, but surgery may not be necessary. Discuss what is necessary with your orthodontist or get another evaluation, but base your decision on what you think is best for you in light of professional explanation.You can also wait however long you want if now is not a good time for treatment.

Dr. John Harrison

You need to discuss your options with an orthodontists who will give you enough information for you to make an informed decision. Your options are traditional braces, either clear or metal, attached to the outside of each tooth, or lingual braces attached to the inside of each tooth, or clear tray aligners which are successive sets worn full time except for eating and changed out at two-week intervals. All systems have advantages and disadvantages depending on the tooth movement necessary, discipline and compliance of each patient. Your success with any of these options depends.

8 years of age is an ideal time to evaluate for orthodontic treatment because the lower and upper 4 permanent incisors should be in place and the first permanent molars should be in proper occlusion bite relationship. There then has to be enough room for the unerupted permanent teeth to come in at their appropriate time. If everything is idea then the overbite both horizontal and vertical should be normal. If horizontal overbite or vertical overbite are greater than normal, braces can correct the problem. It will not correct itself. The question then becomes, when is the best time to initiate treatment, early at 8 or waiting until more permanent teeth have erupted? Both have their advantages and disadvantages, and it is a question best discussed with an orthodontist who can determine what is best for your child. Early treatment can be a real advantage in normalizing problems, but it usually needs to be followed by finishing treatment after the permanent teeth fully erupt (excluding wisdom teeth).

Any type of aligner treatment that is managed by an orthodontist should succeed in giving you a desired result if you value an attractive smile and healthy mouth. Of all the things you wear your smile is the most valuable. Orthodontic fees are fair and not overpriced if you are pleased with the result and long term benefit.

Many orthodontists want more hours than just sleeping, especially early in retention, but all night is a minimum for many years if you want to maintain your nice result. Your orthodontist can best advise you based on the initial condition and his/her experience.

Faster is not always better, some tooth movements are complex and require more time than others. Accuracy,precision and fine tuning are dependent on the orthodontist skill with any appliance and patient cooperation. There are several developments in orthodontics that claim to accelerate treatment time regardless of the type of braces. Your orthodontist can advise you regarding a reasonable treatment time.

We like patients to change rubber bands twice a day, however, once a day is probably more universal. The force of elastics degenerates over time so replacement is necessary.

We take a lot of pride in cavity free orthodontic treatment because of the importance we place on oral hygiene and the protection of teeth. Cavities should not occur with diligent care, but it is possible to get decay anywhere in the mouth that is not kept clean regardless of braces.