MARC THOMAS

They should feel the same now as the day that the orthodontist gave them to you. If they feel tighter, that can be a sign that your teeth have shifted and the retainers no longer fit well. It would be unusual for them to get looser with time. The best option would be to follow up with your orthodontist to see if the retainers need to be remade.

Marc D. Thomas DDS

Canyon Ridge Pediatric Dentistry

(303) 841-7900

http://www.canyonridgepediatricdentistry.com/

My guess is that you had a wire retainer bonded to the back of your teeth. If that breaks, the best thing would be to visit the orthodontist as soon as you can. Sometimes it can be sharp or irritating and long term, it can cause your teeth to begin to shift.

Marc D. Thomas, DDS

Yes, in many ways. It will be very important for her to coordinate any dental treatment with the oncologist. If she is treated with radiation or chemotherapy there can be an effect on the adult teeth that are developing. Sometimes the shape can be different or some adult teeth may not develop depending on the dosage and timing of treatment. A very common side effect of radiation or chemotherapy is a dry mouth. "Xerostomia" can greatly increase the risk of future cavities and dentists sometimes prescribe fluoride therapy to combat this. There may be a decrease in her immune system or delayed healing and it will be important that she receive a clearance for cleanings and any dental work such as fillings or extractions. A good pediatric dentist will usually request her latest lab work (ANC and platelets) to make sure it is compatible with elective dental care. Ideally all dental work is completed before treatment begins and if not, sometimes dental care is deferred until after cancer treatment. The best scientific summary available on this is from the American Academy of Pediatric Dentistry and can be found by Googling "Dental Management of Pediatric Patients Receiving Immunosuppressive Therapy and/or Radiation Therapy".

Marc D. Thomas, DDS

Usually orthodontic appliances (braces) make it more challenging to properly brush and floss. This can lead to gum inflammation (gingivitis). This is very, very common. There are special tools that can make it easier to floss and also mouth rinses can help. In very rare cases people can have an allergy or sensitivity to nickel which can cause irritation and redness of the gums. If you are taking good care of you teeth I would recommend having a conversation with the orthodontist about your concerns. 

Marc D. Thomas, DDS

There are various methods that can be effective. A Waterpik or mouth rinse can be good to clean around the wires and under the brackets and are relatively easy to use. For true flossing, one option is a "floss threader." The idea is that you thread a piece of normal floss through a loop and then pull the loop and floss under the wire. It is hard because this has to be repeated for ever tooth. A second option is The HARP Flosser. It is a floss stick, but designed to be small enough to floss around the wire. You can Google and buy both directly online. You can also pull up YouTube videos for both to see how they are used.

Marc D. Thomas, DDS

It really depends on the source of the pain. If a tooth is abscessed, the infection tends to spread to the bone and gums which can be painful. In that case, antibiotics may help relieve the pain until the tooth is treated. However, if there is another source of pain such as a cavity, chipped tooth, etc antibiotics would not be helpful. 

Marc D. Thomas DDS

Canyon Ridge Pediatric Dentistry

(303) 841-7900

http://www.canyonridgepediatricdentistry.com/

Generally, they do not market Sensodyne to children. That being said, it is safe to use for kids. Some children may object to the flavor of Sensodyne, but that is the only concern with using it. 

Marc D. Thomas, DDS

Good news, children can use a Waterpik. Generally, they do not have the dexterity to use one alone, but if you are willing to help, it would be a great additional tool to ensure clean teeth.

Marc D. Thomas, DDS

There are different levels of cleaning. With basic polishing, I would not expect a toothache or any soreness. The next level with a cleaning is 'scaling' where a metal instrument is used to scrape off tartar, particularly around the lower front teeth. This can make the the teeth sore for a day or two as well as make the gums sore. Sometimes hygienists can be over-zealous and there can be excessive soreness around the gums. If your pain is more than what I have described there may be something else causing a toothache and it would be worthwhile to discuss it further with your dentist.

Marc D. Thomas, DDS

Usually, a "braces adjustment" means that they are putting on a heavier wire with more force. This increases the amount of force that is being applied to the tooth. Usually, this type of pain will last for a few days and then get better. More force on the tooth means that it is moving in the bone and once it has moved it will feel better. I would take ibuprofen for a few days and they call the orthodontist if it is not getting better. Unfortunately, this kind of pain can be normal when they are doing braces.

Marc D. Thomas, DDS

Yes, braces put a force on the teeth to straighten them. This force is transmitted to ligaments that connect the roots to the bone and the result is that the teeth can feel "tight". Periodically, the orthodontist will change wires and this can make the teeth feel sore all over again as the force is changed and teeth start to move again. I would recommend having him take some ibuprofen and discussing with the orthodontist if the braces are too painful.

Marc D. Thomas, DDS

Yes, Invisalign is marketed to teenagers. I would call around and find an orthodontist who does a lot of Invisalign cases to make sure he gets the best available treatment.

Marc D. Thomas DDS

No, if Invisalign is done well it will make a bite better. I would encourage your son to get Invisalign with an orthodontist to make sure the bite is improved. Sometimes, Invisalign done by a general dentist can have less than ideal results. 

Marc D. Thomas, DDS

It really depends on how bad the overbite is. Orthodontists think in terms of how many millimeters that they they will need to move the teeth to make the bite perfect. The average time is somewhere between 1 and 3 years, depending on any other improvements they need to make. Probably the best thing you could do is speak with your parents and have them schedule a free consultation with an orthodontist to get a more definite timeline. 

Marc D. Thomas, DDS

Yes, that is a very normal age to begin seeing wisdom teeth. There is a range from about 15 years old to 20 when they may start to cut through the gums. The fact that the teeth are erupting is a good sign, indicating that they are not impacted. This typically decreases the risk for complications when it comes time for extractions. 

Marc D. Thomas, DDS

It is probable that the tooth and gum pain may be related to newly erupting molars or loose baby teeth that are close to falling out. To reduce pain you can always give Tylenol or Ibuprofen. Alternatively, cold things such as ice cream and popsicles can help the area feel better. Usually the "teething" pain will linger until the molar fully come in or the baby teeth fall out.

Marc D. Thomas, DDS

This is probably a great question for his orthodontist. In my opinion, the brackets will be bonded to the teeth at the time braces are placed and no numbing will be used. Eating right away will not dislodge the brackets and there is no risk of your son biting himself. The only reason to wait on eating is if his teeth feel sore from the new braces. This is pretty common and usually lasts for a few days and can be kept under controlled with Ibuprofen. 

Marc D. Thomas, DDS

There are three potential causes for cavities. The first is oral hygiene. If he is brushing well I would also make sure that he is flossing daily and perhaps rinsing with a fluoride mouth rinse. I would also consider using an electric toothbrush such as a Sonicare or Oral-B. The second component is diet. More than just candy, I would be sure that he is avoiding soda, juice, chocolate milk and also keep in mind that a lot of processed food has a lot of added sugar. The third factor is genetics. Some people are born with softer teeth, tight teeth, etc., that can predispose to cavities. This is the hardest area to make improvements. The other major concept would be to focus on prevention. This would include placing sealants on the 12-year molars, delaying orthodontic treatment, focusing on daily fluoride exposure, etc.

Marc D. Thomas, DDS

Teeth are different than bones. We eat dairy and drink milk throughout life to get the calcium and phosphates that help with stronger bones. Bones are constantly remodeling and without a supply of healthy components, can get weak over time. Teeth, once they have formed and come into the mouth are not benefited in the same way that bones are. Milk and dairy products can be helpful as teeth are forming in the body, from birth to about 11 years old. Once the tooth enamel is formed and in the mouth it does not continue to remodel like bones do. After 11, there is little benefit to making the teeth stronger. Something that can help after the teeth are in the mouth is fluoride, which is shown to make the teeth harder and more resistant to cavities. 

Marc D. Thomas, DDS

My guess is that they plan to extract a primary molar or canine. To get numb they will give local anesthesia to minimize pain. From there, there are several sedation options. First would be nitrous oxide which is safe, inexpensive and easy to give. The next step up would be oral sedation would would involve drinking a liquid or taking pills to feel more sedated. Finally, they if the patient is very anxious general anesthesia is an option which is very expensive but they would not perceive anything. Usually, baby teeth can be taken out easily with local anesthesia and nitrous oxide. 

Marc D. Thomas, DDS