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- How do I choose an orthodontist?There are many factors you could consider Having practiced more than 35 years means the doctor is EXPERIENCED AND EXPERIENCE IS IMPORTANT. I would suggest that some other factors are also important: Choose an orthodontist who has an office that is convenient to your work or home, who is a SPECIALIST in the field of orthodontics, and has GOOD REPUTATION AND A PLEASANT CHAIR-SIDE MANNER. Good office reviews count. Recommendations by friends who have completed orthodontic treatment and is pleased with the results are useful guides. Make certain that he is competent in treating with all kinds of braces including Invisalign, clear-transparent, lingual (behind-the teeth), and removable braces. A doctor speaks lightly of a treatment method that they do not use in their practice may indicate that they do not have sufficient training in that technique. .
- How much do braces cost?That depends. Here are some factors that will determine the fee you are quoted:
- The number of teeth to be straightened.
- The crookedness of the teeth to be straightened.
- Whether one or both jaws need to have teeth straightened.
- Whether you have type I (normal) jaws; type II, (buck teeth); or type III, bull-dog like jaws.
- Whether teeth need to be removed. (0-4).
- Whether it is one phase or two phase (treat-rest treat) treatment plan.
- Whether the upper jaw bone needs to be widened (a non-surgical procedure).
- Whether the upper jaw needs to be widened (a partly surgical procedure).
- Whether the patient is a child or an adult.
- How young the child needs to be started to begin correction of the problem.
- The number of expected monthly adjustments to complete the treatment.
- The kind of braces to be used: removable, traditional bonded metal, clear- transparent or lingual (behind and in back of, or on the inside of the teeth) Invisalign, the “no-braces” braces have become the gold standard. Dr. Rothstein is preferred provider of Invisalign.
- Are there a variety of payment methods?Most offices try to provide a payment schedule that is sufficiently flexible to accommodate almost everybody’s financial situation. Dr. Rothstein for example, offers a variety of payment plans that include: total payment at the start of treatment with a discount to make it more attractive or an initial payment of between 15% and 45% followed by monthly payments over a period of between 12 and 18 months. Upon occasion the fee may broken up into equal monthly payments with no initial payment.
- Will my health insurance cover the cost of braces?That depends. Remember Insurance typically covers traditional metal braces only. that If you already have health insurance you may have dental insurance included as part of the coverage. However, orthodontic treatment may not be part of the coverage. Insurance coverage for orthodontic treatment comes in many forms Dr. Rothstein takes almost every kind of insurance imaginable. Some of these work by allowing Dr. Rothstein to charge a fee that is not above a certain amount and that is called “fee for service” plan. Others work by paying (indemnifying) the insured person a fixed amount of money (usually somewhere between $800 and $1,600) no matter what the doctor’s fee is. Still others say “we will pay you 50% (65%-75%) of the “usual and customary” fee the doctor charges you. If you have health insurance you can simply consult you benefits pamphlet for your dental-orthodontic benefits. If however, that pamphlet is lost or too difficult to understand, get on the phone and call the benefits department of your insurance company and ask: “Am I covered for dental benefits and do I have coverage for orthodontic treatment? If the answer is yes you would then inquire: :What is the total amount of my benefit under my plan”? Make sure you get the name of the person who gave you the information and the date because clerical people at insurance companies have been known to give misinformation. Since Clerks are sometimes wrong the best way to be100% certain that you have or do not have an orthodontic benefit is to complete one of the claim forms you have and bring it with you when you have your consultation examination at the orthodontist’s office. The office will then submit the form to your insurance company telling them the proposed diagnosis and treatment plan. The insurance company usually takes 4-6 weeks to reply, but when they do they will respond with your total benefit, if any, and how they will pay the benefit out to either you or the orthodontist. For example, they may make an initial payment of between $300 and $800 and then a monthly payment for 18-24 months of between $50 and $150.
- What are “clear” braces?Clear-transparent braces consist of brackets (mini-handles) that are made of a very hard clear-transparent plastic material and tooth-colored wire that attaches to the brackets to make the teeth move. Dr. Rothstein is one of a very few orthodontists that know how to use the tooth-colored wire. His patients are grateful because these braces are barely visible and that takes a lot of the embarrassment out of wearing braces. These braces are just as effective as metal braces, but far more attractive to look at. These braces are especially appropriate where lingual braces are not affordable, but you don’t want sacrifice good appearance because you are really sensitive about having metal braces on your teeth. The clear braces are more fragile then the metal braces, but not so fragile that they break off easily. One must however, as with all kinds of braces, stick to a diet that does not include crispy, crunchy or crusty or sticky foods.
- What are “lingual” braces? Are they more expensive?Lingual braces look and work exactly like the braces you see on the front of teeth except that they are bonded (glued) to the back of the teeth where they cannot be seen unless you want to show them to your friends. They are the braces of choice for the treatment of certain kinds of bite problems (like very “deep” overbites) . Dr. Rothstein is one of a small number of doctors who is proficient in using them. In fact, in Dr. Rothstein’s practice there are always present between 4 and 8 patients who are currently wearing them. They very user friendly and patients who are especially sensitive and easily embarrassed find them to be the appliance of choice. They cost an additional $2,500 – $3,500 depending on whether you choose them for the upper teeth alone or for both the upper and the lower teeth. If you are interested in learning more about lingual braces you can download a newsletter Dr. Rothstein recently published containing the experiences of 8 of his patients who were treated with lingual braces. You may even call them should you have the desire for direct communication regarding their experiences. (click here for a picture of lingual braces on a patient)
- What are “Invisalign” braces?“Invisalign” is the “no-braces” braces. It is almost like a bleaching tray (a very clear, thin, durable, one-piece fitted covering that goes over the teeth) which acts to move teeth as braces do, and is undetectable and can be removed in an instant if needed. Furthermore, There are no dietary restrictions as with regular braces where you must adhere to a a soft diet and you must avoid foods that are crispy, crunchy and crusty lest you break off the brackets that have been bonded on your teeth. I have been using the technique in my practice since November of “99. You should keep in mind that it was introduced to the orthodontic profession in late 1997 and as of July of ’99. Invisalign’s motto is “Every case is an Invisalign case”. It has not been perfected for problems whose correction requires removal of teeth except in those cases where removal of one lower front tooth is needed. It takes about the same time as regular braces to complete the treatment, and costs about 25% more than regular braces. You can find much additional information by [CLICKING HERE]. [Read what patients who used Invisalign had to say about it.]
- I’m thoroughly confused! There seems to be so many kinds of braces now. How do I choose?You should be. There are so many choices now you have to be a rocket scientist to make the right choice. When your issues are all about keeping the cost as low as possible you will need to choose typical metal braces bonded on to your teeth. When your issues are mainly concerned with vanity (you don’t want the braces to be visible) you choose “Cosmetic” braces: 1. braces that are bonded to the the front of your teeth that are “clear” (preferably with tooth-colored wire) or 2. The OrthoClear “shell” or “aligner technology” braces which are “almost completely invisible plastic shells that, are removable at will. Consequently, there are no brackets or wires bonded to your teeth and consequently no eating restrictions to prevent detached brackets. If however, you need to have 2-4 teeth removed this kind treatment technology is NOT RECOMMENDED. Finally, the KING OF BRACES IS NOW iNVISALIGN. Ps. A good orthodontist can do all of them. Most of my patients take upper and lower clear braces or upper Invisalign and lower Clear braces or upper lingual and and lower clear braces. YES YOU CAN MIX THE BRACES WHEN YOUR ORTHODONTIST IS GOOD. I’m a good orthodontist. EXPERIENCE AND A GOOD REPUTATION ARE THE MAKINGS OF A GOOD ORTHODONTIST.
- How long does orthodontic treatment take?Assuming that you cooperate fully and follow Dr. Rothstein’s instructions, brush your teeth regularly, keep up a soft diet (in order to avoid breaking any of the parts of the braces like the brackets or the wire), keep your appointments as instructed and keep up healthy gums, your orthodontic treatment can usually be completed in 14-18 months if no teeth need to be removed. Younger children usually take longer because they are not adept at cooperating in the above-mentioned matters consequently, their treatment may take 18-22 months. In those cases where teeth do need to be removed to achieve the best result the treatment may take between 6-10 months longer.
- Can I go directly to an orthodontist, or does the dentist have to send me?You do not need to go first to the dentist’s office. If you think you have a problem related to the way your teeth appear (crooked, spaced, rotated, over-bite, under-bite, open bite, cross-bite) you can go directly to an orthodontist’s office. Look in your Yellow Pages telephone directory under Dentist-Orthodontists. The Yellow Pages is an excellent way to choose an orthodontist because you can see at a glance whether they offer the more special treatment methods like clear-transparent and lingual braces or whether they treat TMJ (see question 26) and if they accept various treatment plans. In addition, if they are close to public transportation, that will also be noted. You can also call any dentist’s office and ask the receptionist if they can recommend you to an orthodontist. Dentists are usually willing to give you such assistance, just try it. Most orthodontists belong to the AAO (American Association of Orthodontists), so you can also call that organization at 800-S-T-R-A-I-G-H-T and they will provide you with the names and addresses of orthodontists who are members of the AAO in any zip code.
- How do I know if I really need braces?There are three basic reasons that you can receive orthodontic treatment: The first and most usual is that your teeth look crooked to you and you are embarrassed by your smile and therefore you never smile. The second reason is that your crooked teeth may be causing harm to the other teeth, gums or bone that holds the teeth in, as well as to the joint that permits your mouth to open and close (the “TMJ, see question 26″). The third reason is that your dentist needs to treat some dental problem you have, but (s) he can not proceed before another problem that requires orthodontic treatment is completed. Most orthodontic treatment is provided because people are concerned about their looks, therefore if you are concerned about your looks, you need an orthodontist who will tell you all the ways, even the non-orthodontic approaches if any to the enhancement of your smile. Sometimes you may need an orthodontist because you sense some kind of discomfort in your bite, but your are not certain why you are having the discomfort. In those cases it may be wise to see the general dentist first because (s) he may be able to identify the cause of your discomfort which may not require an orthodontist at all. In any case, you may proceed directly to an orthodontist who will at least diagnose the problem and advise if orthodontic treatment will benefit you.
- What is an “Informed Consent” document?When a potential patient is about to begin a course of therapy/treatment the would-be patient must be informed by the doctor of all the choices that the patient has including the option of no treatment and the consequences of no treatment. The patient must be told the potential dangers of the treatment proposed. Only with that information can the patient make an intelligent choice whether or not they should go ahead with the treatment. The doctor must let the patient know what factors may cause the treatment to end unsuccessfully. It is the patient who then being informed of all factors related to the treatment gives his consent to having the treatment
- How do braces work? How do braces move the teeth?Braces consist of brackets (mini-handles) bonded (glued) on to most of the 12 or 14 teeth in each jaw. A thin highly flexible wire is fastened to each bracket on each tooth. Suppose a tooth is incorrectly positioned; let us assume it is a tooth that is depressed inwardly and we want to bring it more forward. When we fasten (attach) the wire to all the teeth with brackets the wire flexes in to attach to the depressed tooth. Since the wire is flexible (resilient) it “wants” to “bounce” back to the shape it originally was (straight). So over a long period of time the wire gradually moves the incorrectly positioned tooth in to the desired (corrected) position, that is, in line with the other teeth. As long as the pulling is done gently over a long period of time the teeth will move through the bone without harm to the tooth, or any other teeth, and gums and bone. It can take between 4 weeks and 3 months to move a tooth 1mm (about 1/32nd -1/16th of an inch) depending on whether the tooth is a lower front incisor which is very small with a single root or a lower six year molar which is much larger and has 3 roots.
- Will I need to have any permanent teeth removed when I get braces?If your teeth are very crowded and they are protruding far forward (stick out), removing teeth may be an excellent choice for you. Typically, most orthodontist choose to extract two upper back teeth (premolars) and two lower premolars to accomplish the goals of treatment. Other choices may include the removal of only two upper teeth while still other cases may require the removal of only one lower front tooth.When Dr. Rothstein thinks removal of teeth is the correct treatment option he recommends removing the second premolars because they are farther back in the mouth and is likely to be a cause of embarrassment because the space where the teeth were removed is likely to be visible. Furthermore, Dr. Rothstein has a Ph.D. in facial growth and development which makes him even a better judge as to when the removal of teeth is justified. REMOVING TEETH IS ALWAYS A LAST RESORT.and the orthodontist should always tell you what he can and cannot accomplish by removing teeth. Dr. Rothstein removes teeth in approximately 3% of the patients he treats. In some cases the reasons for removing teeth are very compelling and to fail to remove them would be as ill-advised a treatment as to remove teeth when it barely necessary. Where it is warranted, AN ALTERNATIVE TO REMOVING TEETH IS CALLED SLENDERIZING. It is used to create the space needed to correct moderately crowded teeth. Slenderizing became a very commonly used approach to treatment of crowding when orthodontists began using braces that are bonded to only front surfaces of the teeth. This permitted the sides of the teeth to be available for small amounts of sanding. Such sanding when done on many teeth amounts to the equivalent of removing a tooth and in this way space is created to correct some problems of moderately crowded teeth. This procedure has save countless thousands of patients from having teeth removed unnecessarily.
- If I do need to have teeth removed when do they have to be removed?Rothstein usually bonds (glues) the brackets (mini-handles) on the teeth and then sends his patient to their dentist or in some cases an oral surgeon (who can give gas “conscious sedation”, or handle especially difficult removals) to have the teeth removed. The first wire is generally attached to the brackets-teeth about 10 days after the selected teeth are removed, which is about the time required for the empty tooth socket to heal over.
- How long does it take to glue on (bond) the braces and remove (de-bond) them?Bonding the brackets on to each of the 12 upper teeth takes about 12 minutes and the same for the lower teeth. Dr. Rothstein usually bonds the upper teeth first and 2-5 months later bonds the lower teeth (the lower teeth are smaller and take 35% less time to straighten. Attaching a wire to the teeth take about 6 minutes. Removing the brackets and wire takes less than 90 seconds and then about 10 minutes to remove the remaining adhesive.
- Do braces interfere with kissing?They do not interfere with kissing
- Is it harder to take care of your teeth when you are wearing braces?Your gums tend to become more easily swollen because the braces prevent your teeth from getting the stimulation they normally get from the food which contacts them. furthermore, food particles tend to get stuck in the braces and lodge more easily between the teeth. Dr. Rothstein guides his patients with the rule of “33″. That is, you should brush your teeth 3 times every day for 3 minutes each time after breakfast, dinner and before bed time. It is also important to remember that braces cause your breath to lose its freshness in half the time it usually takes, because the braces have hidden surfaces where bacteria can flourish. For this reason it is prudent to use an antiseptic mouth rinse when closeness is imminent.
- Can braces harm your teeth or gums?No. if you follow Dr. Rothstein’s instructions for the care and maintenance of the braces, keep your appointments and brush your teeth regularly. Dr. Rothstein will tell at each visit if your oral hygiene is being well maintained.
- What is a retainer?A retainer is a simple, removable device that is fitted to your teeth to hold them in their corrected position after the orthodontist removes the fixed (bonded) braces that were used to straighten your crooked teeth. Doctor Rothstein prefers to have his patients wear their retainers (upper and lower, nights only, 6 nights a week for 3 years, and then 2 nights a week for as long as they want their teeth to remain as perfect as they were the day the braces were removed. Dr. Rothstein uses a retainer that is virtually invisible because it is made of a durable shell of clear-transparent plastic that covers the teeth–just like and Invisalign aligner. Under special conditions he will bond a retaining wire behind your teeth.
- Why do teeth get crooked after the braces are removed?The problem of “relapse” of recently straightened teeth is not uncommon.In spite of the careful attention given to informing the patients how important retainers are to prevent the teeth from returning to their crooked position, relapse occurs disconcertingly to the patient and the orthodontist too frequently.This occurs because teeth need time to “permanently set” or grow into their new positions like poured cement setting around a newly placed parking meter.I provide my patients with retainers the day their braces are removed. Of course I am always sad when a patient returns with relapse. I put my heart and soul into straightening the teeth in the first place. I always ask to see their retainers. The inevitable response is that they lost them. How? I ask. “I wrapped them in a napkin at dinner and it was thrown out with the trash”.I advise them to wear it nights only for 3 years and then 1 nights each week for as long as they desire their teeth to stay as straight as the day the braces were removed. I give this advice because your teeth throughout life are continuously erupting into your mouth and never stop migrating forward as well. This is particularly evident in the lower front teeth where relapse is usually the first place to be observed when it occurs, especially when one completely stops wearing the retainer. When the lower front teeth relapse they can deliver forces to the upper front teeth that can cause them to relapse also.
As for the solutions for relapsed teeth: 1. You can restart retainers (transparent) to hold the teeth exactly as they are. 2. You can reapply removable retainers (metal-plastic) and correct the relapsed teeth. I find this approach to be less than 100% accurate and unpredictable except where only one tooth is involved. 3. You can have fixed braces reapplied for 4-8 months assuming the corrections are minor at an additional fee.
- Will I have to have my wisdom teeth removed for the treatment?Rarely. Dentists and orthodontists often argue with each other and between themselves about the benefits and disadvantages of removing wisdom teeth. Removing wisdom teeth should be considered very carefully as to the benefits and possible detriments of their removal. A candidate for removal of wisdom teeth should always ask the dentist about the serious or harmful possible consequences of removing wisdom teeth and the possible alternatives to their removal. You may now download an article that appeared in the health section of the New York Times that addresses the question of “When wisdom teeth should be removed”.
Go to Occasionally Asked Questions