Orthodontic Appliances

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Headgear | Thumb/Finger Appliances | Palatal Expander | Forsus Appliance | Tongue Thrusting Appliance

Headgear

Sometimes, braces alone aren't enough to move teeth into a better position, or to correct trouble with the bite or remedy problems in the growth of the jaws. In those situations, your orthodontist may recommend the use of special appliances. Orthodontic headgear is the general name for an appliance, worn partly outside the mouth, which creates just enough force to move the teeth properly and guide the growth of the face and jaws.

There are several different types of orthodontic headgear, each designed to work best in a specific situation. We will design a treatment program to address your individual needs, and select the most appropriate type of headgear; we will also instruct you on its use and care. It's important for you to follow instructions carefully so that, working together, we can achieve the best results from your treatment.

Types of Headgear

One common type of headgear is called the cervical pull type. This appliance has a U- shaped wire that attaches to the bands on your back teeth, and a strap that is worn behind your neck. A similar device is the high-pull headgear, which also has a wire connecting to the teeth, plus a strap that goes behind and over the head.

Overjet and Underbite.

These types of headgear are typically used to correct an excessive horizontal overbite (technically called an “overjet”) in children, by holding back the growth of the upper jaw. They can also be used for adults who need help maintaining a proper bite and correct tooth spacing after tooth extraction. Generally, these types of headgear are designed to be worn from 12-14 hours each day.

Another type of headgear is the reverse-pull or “facemask” type. This appliance is generally used to correct an underbite. It gently pulls the upper jaw forward (instead of back), which allows it to catch up with the lower jaw. It consists of two pads — one resting on the forehead, the other on the chin — connected by a vertical frame. Elastics or wires, which connect from the frame to the braces, exert the pulling force. It may be necessary to wear this appliance from 14-16 hours daily.

Making Headgear Work Depends on You

Whichever type of headgear you're wearing, there are some important things you should know. Probably the most essential one is this: In order for it to be effective, you must carefully follow instructions about wearing your headgear — that means putting it on each day for the time specified. If you wear headgear at night and you miss one night, you must make up the time the following day — otherwise, everything you've accomplished in the previous seven days of wear could be wiped out!

It's normal to feel some discomfort as you get used to wearing orthodontic headgear. Fortunately, if you wear it faithfully, the discomfort generally goes away in a few days. Your orthodontist may recommend an over-the-counter pain reliever like Ibuprofen, and/or a soft diet, to help you adjust.

From time to time you may also experience some soreness when chewing, or even a little looseness in the first molars. This is normal, and it shows the appliance is working. However, if you have unusual pain, notice that the anchor band on your first molar (the one the headgear attaches to) has come loose, or find that the headgear suddenly seems not to fit correctly, it could signal a problem. In that case, contact us right away.

Maintain Your Headgear — And Your Oral Health

To keep your orthodontic headgear working as it should — and to maintain your overall oral health — it's important that you follow our instructions about care and cleaning. It's also important that you learn to put headgear on and take it off properly and safely. Remember to bring it with you every time you have an appointment at our office — but leave it behind when you're playing sports, or even horsing around in the living room!

Wearing orthodontic headgear may seem like a big adjustment — and nobody would deny that it takes some getting used to. But remember that you're part of a team, which includes our office, your general dentist... and you! When everyone works together, it's possible to achieve your goal: a beautiful smile that you'll have for your whole lifetime.

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 Child sucking thumb.

Thumb/Finger Appliances

Is there any image that illustrates the comforts of babyhood better than a sleepy infant sucking its thumb? Ultrasound pictures have shown, to the joy of many prospective parents, that this behavior can even occur in the womb. The thumb- or finger-sucking habit seems to relax and comfort toddlers too, and it's perfectly natural. But as a child grows, there comes a point where this habit isn't just socially awkward — it may also be harmful to his or her oral health.

In most children, thumb sucking stops on its own between the ages of two and four years. But if the practice persists after the primary (baby) teeth have erupted, it can drastically change the growth patterns of the jaw, and cause significant misalignment of the teeth. It may be hard to believe that such a benign habit can actually move teeth and bone — but there are a number reasons why this occurs.

Children's jaws, rich in blood supply and growing rapidly, are relatively soft and flexible — especially in kids under the age of eight. So it really isn't hard for the constant pressure of a thumb or finger to deform the soft bone around the upper and lower front teeth. Children who are particularly vigorous thumb suckers are even more likely to change the growth patterns of the teeth and jaws.

If the thumb sucking habit persists, it can result in the upper front teeth flaring out and the lower ones moving back and inward. It can also hold back the growth of the lower jaw, while causing the upper jaw to be thrust forward. This can result in misalignment of the teeth, an anterior open bite (where the front teeth fail to close together), collapse of the upper jaw causing crossbite, or other problems. That's why it is important to stop the behavior at an appropriate time, before damage occurs.

Controlling Thumb or Finger Sucking

Like many potentially harmful behavior patterns, thumb sucking can be a difficult habit to break. Through the years, parents have tried a variety of home remedies, such as having the child wear gloves, coating the digits with a bitter-tasting substance — and even reasoning with their toddlers. Sometimes it works — but in other cases, the allure of thumb sucking proves very difficult to control.

Fixed palatal crib.

If your child has a thumb or finger sucking habit that has persisted past the age of three, and you've been unable to tame it, then it may be time for you to visit our office. We will consider treating your child with a “habit appliance” such as a fixed palatal crib or a removable device. This crib isn't for sleeping — it's a small metal appliance worn inside the mouth, attached to the upper teeth.

How does it work? The semicircular wires of a palatal crib keep the thumb or finger from touching the gums behind the front teeth. Simply preventing this contact seems to take all the enjoyment away from the thumb sucking habit — and without that pleasurable feedback, a child has no reason to continue the behavior. In fact, the device is often successful the first day it's worn.

Getting and Using a Habit Appliance

If your child could benefit from a habit appliance, the first step is to get a thorough examination, which may include taking X-rays, photographs and dental impressions. If it's recommended, a crib will then be custom-fabricated to fit your child's mouth, and placed at a subsequent appointment. Afterwards, your child will be periodically monitored until the appliance is removed — typically, a period of months.

Although wearing the crib isn't painful, your child may experience some soreness in the upper back teeth for a few hours after it's first installed. He or she may also have a little trouble falling asleep for a day or two afterward. Plenty of extra attention and TLC are usually all that's needed to make everything all right. While the appliance is being worn, it's best to avoid chewing gum and eating hard, sticky food that might cause it to come loose.

A Word About Tongue Thrusting

Like thumb sucking, tongue thrusting is a normal behavioral pattern in young children. It's actually part of the natural infantile swallowing pattern, which will normally change on its own — by the age of six, in most children. If the pattern doesn't change, however, it can lead to problems similar to those caused by thumb sucking: namely, problems with tooth alignment and skeletal development. Fortunately, this problem can be successfully treated with a habit appliance that's very similar to a fixed palatal crib.

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Palatal Expander

Narrow palate.A major benefit of receiving orthodontic treatment in childhood is that it's possible to take full advantage of a youngster's own natural growth process to treat or even prevent malocclusions (“bad bites”). A palatal expander is a device designed to help us do that.

Palatal expanders create more space in a child's mouth by gradually widening the upper jaw. Although this may sound scary, it's really quite easy — both to do and to tolerate. That's because the upper jaw actually develops as two separate halves that don't completely fuse together until sometime after puberty. Before that happens, the two bones can gently be separated and stabilized over a period of several months.

The three situations that most commonly call for maxillary expansion are:

Crossbite.Crossbite — When a child's upper jaw is too narrow to fit correctly with the lower jaw, the back top teeth will bite inside of the lower teeth instead of outside. This can be corrected by expanding the upper jaw.

Crowding — Even before all of a child's permanent (adult) teeth come in, we can tell when there will not be enough room to accommodate them. Widening the upper jaw can create the necessary space without the need for tooth extractions.

Impacted Teeth — When a tooth that hasn't come in (erupted) yet and is blocked by other teeth, widening the upper jaw can allow it to erupt into proper position on its own. This most often happens with canine or eye teeth — the pointier ones located directly under the eyes.

Expanding the upper jaw has other benefits: It can broaden the smile in an aesthetically pleasing way, it can limit the number of teeth that need to be removed to create space and can also improve breathing. And it can shorten overall orthodontic treatment time (the amount of time your child will need to wear braces).

How Expanders Work

 How palatal expanders work.

An expander is custom-made for each individual and fits over several top teeth in the back of the mouth. The appliance has two halves that are connected in the middle with a screw. To activate the device, you simply turn the screw a very small amount each day with a special key. This induces tension at the junction of the two palatal bones, causing them to gradually move apart. Once the desired expansion is achieved, we will leave the appliance in for a few more months to allow new bone to form in the gap and stabilize the expansion. Generally, expanders are worn for 3-6 months altogether.

What to Expect

There can be some soreness or a feeling of pressure for a few minutes after the key is turned, but activating an expander actually causes less discomfort than having braces tightened. Your child may find that speaking and eating feels different at first as the tongue adjusts to the presence of the appliance. It is also completely normal to see a gap develop between the front teeth. This shows that the expander is having the desired effect. When all is said and done, your child's permanent teeth will be beautifully aligned with neither too much nor too little space between them.

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Forsus Appliance

Forus.jpgThe Forsus appliance is used in order to help move the upper molars back while moving the lower arch forward. Composed of a spring coil rod, the appliance is used while a patient is currently wearing braces. It runs from the upper first molar band down to the lower archwire.

You may notice some discomfort initially, so we recommend a soft food diet for the first few days after the appliance is placed. Regular anti-inflammatory medication may help with any pain, if needed. It is important to keep the appliance clean; you may do this by carefully brushing the coil and other metal pieces of the appliance. Also, we recommend that patients not open their mouths very wide, as the appliance may come apart.

If your Forsus appliance breaks, please contact our office immediately to schedule a repair appointment.


Tongue Thrusting Appliance

habit_thumb-tongue_crib.jpgTongue thrusting occurs when the patient presses his or her tongue against the front teeth, usually when swallowing, speaking or resting the tongue. If thrusting is constant, this can cause problems with teeth alignment and must be fixed.

We prefer to correct tongue thrusting by giving patients a tongue thrusting appliance. This appliance, similar to a mouth guard, is usually worn at night. Other times, a more permanent appliance is prescribed and can be only be adjusted by our office.