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When should my child see an Orthodontist?

August 27th, 2018

We hear this question a lot by our parents and even general and pediatric dentists.  The American Association of Orthodontists recommends the first visit to occur around age 7.  Your child's comprehensive exam with Dr. Altherr is complimentary and only takes about 30 to 45 minutes.  For most of the kids, Dr. A will say keep growing teeth, everything looks good, and we'll see you in about a year.  Also, for most kids, we will eventually wait to treat them when most of their adult teeth are in, which is around 11 for girls and 12 for boys.  For about 5-10% of the kids, however, they will have problems (below) that do require early treatment/intervention.

1) Posterior crossbites.

2) Underbites.

3) Thumb/finger habit after age 6.

4) Traumatic anterior crossbites.

5) Impacted teeth.

6) Ectopic teeth.

If early treatment is not performed prior to age 10, then  future treatment will be more complicated and expensive and even more importantly, less stable.  You do not need a direct referral from your dentist for Dr. Altherr to examine your child.  Also, some parents need the peace of mind to make sure that they are not missing something; so this exam would provide you the assurance that you are wanting.

Note: Dr. Edward Altherr is a board-certified orthodontist in private practice serving Apex, NC, and the surrounding towns/cities of Cary, Holly Springs, Morrisville and Fuquay-Varina.  Dr. Altherr’s training in orthodontics was at the prestigious University of North Carolina at Chapel Hill’s program where we studied under many great orthodontic icons like Dr. William Proffitt and Dr. Camilla Tulloch.  During his orthodontic training, Dr. Altherr’s research and further focus was on the orthodontic treatment of the mixed-dentition (mix of baby and adult teeth in kids between 6 and 14 yo).  With his research and over 16 years of clinical orthodontic experience as of 2018, Dr. Altherr is considered an expert in mixed-dentition orthodontics and other areas of orthodontics like temporary skeletal anchors.  This web blog is for educational purposes only.  Dr. Altherr is licensed only in the state of North Carolina, and cannot diagnose and recommend orthodontic treatment over the phone or internet.

What to do when your child is missing a permanent tooth/teeth?

July 2nd, 2018

Most of the time with children when a baby tooth is lost around 11 or 12, its loss is followed by the eruption of its permanent replacement. However, in about 5-10% of the population, the adult/permanent tooth never forms. The best way to confirm that an adult tooth is missing is via a panoramic x-ray.

The type of treatment and when to start it depends on the age of your child and other variables that may come into play like which adult tooth is missing, the crowding of the teeth and your child’s overall bite. These options can be to keep the baby tooth as long as possible, replace it in the future with an implant/crown or bridge or close the resulting space with orthodontic treatment. Just because a tooth is a baby tooth does not necessarily mean it cannot last a long time, and in the right situations, research out of the University of Iowa has shown that patients who retain their baby teeth (with no permanent replacement), 80% were able to keep the baby tooth well into their adulthood.

In other patients where and when the missing adult tooth will need to be replaced, orthodontic treatment is usually delayed until your child is a mid to late teenager if the replacement option is an implant and crown. If the replacement option is a bridge to replace the missing adult tooth, then orthodontic treatment could begin sooner and then followed with the bridge placed by your general dentist.

And finally in some cases, simply removing the retained baby tooth and orthodontically closing the resulting space may be the best option depending on the typical associated variables like which tooth is missing, overall crowding and your child’s bite. There can be many options for a missing tooth/teeth, so that’s why an orthodontist needs to be consulted so that your child can be accurately examined. With a thorough exam by an orthodontic specialist, you can be given a treatment plan that is customized to your child’s individual problems and your family’s needs.

Note: Dr. Edward Altherr is a board-certified orthodontist in private practice serving Apex, NC, and the surrounding towns/cities of Cary, Holly Springs, Morrisville and Fuquay-Varina. Dr. Altherr’s training in orthodontics was at the prestigious University of North Carolina at Chapel Hill’s program where we studied under many great orthodontic icons like Dr. William Proffitt and Dr. Camilla Tulloch. During his orthodontic training, Dr. Altherr’s research and further focus was on the orthodontic treatment of the mixed-dentition (mix of baby and adult teeth in kids between 6 and 14 yo). With his research and over 16 years of clinical orthodontic experience as of 2018, Dr. Altherr is considered an expert in mixed-dentition orthodontics and other areas of orthodontics like temporary skeletal anchors. This web blog is for educational purposes only. Dr. Altherr is licensed only in the state of North Carolina, and cannot diagnose and recommend orthodontic treatment over the phone or internet.

Braces or Invisalign as an Adult

March 29th, 2018

Adults comprise about 20% of most orthodontic practices’ patients across the US. Obstacles and/or questions that sometimes have prevented adults in the past from even obtaining a consult with an orthodontist have been the length of the overall time in treatment because they are busy with jobs and kids, the cost or am I too old or will I be the only adult amongst kids?

Over the years, our adult patients have been pleasantly surprised that the length of recommended treatment by Dr. Altherr is not years upon years like what they may remember as a teen or from what they’ve heard. The reasons why treatment times are shorter are from technological improvements and the fact that some adults only concern is straightening their front teeth, which may only require 6 months or less of treatment. Our oldest adult patient was in their 70’s, so some would say it’s just a number. Finally, we have some mornings where we see only adults.

We appreciate our adult patients because they are usually more invested and involved in their treatment primarily because they are paying for it (and not mom and dad). Therefore, adults are more compliant than kids with their oral hygiene and other things like wearing rubber bands or retainers.

The most common observation that we hear from our adult patients is the temporary irritation to their cheeks and lips from the braces in the first 2 weeks of treatment. After that, the irritation is not an issue because the lips/cheeks toughen up, and there essentially is no irrigation with clear aligner therapy like Invisalign.
So, we hope this information has helped. If so, please call us today for your complimentary exam with Dr. Altherr.

Is there a difference between a general dentist who provides orthodontic treatment versus an orthodontist?

September 21st, 2017

The simple and quick answer is YES. And why is this important?  We will explain.

After the four years of dental school where a dental student receives very limited training and experience in orthodontics, an orthodontist receives 2-3 years of additional training in orthodontics (braces and Invisalign) only during their residency at a university.  Orthodontists like Dr. Altherr also were required to do research for a Master’s degree while also receiving usually over 5,000 hours of true, hands-on clinical training and experience to expose them to every type of potential problem involving one’s bite and their smile.  University training is important since many laypeople can be confused by some general dentists who advertise that they have received certification in this or that type of orthodontic treatment.  Please keep in mind that the for-profit orthodontic courses that most general dentists attend are roughly 8 hours per day over the course of a 2-3 day weekend.  Let’s compare the time involved for one’s training in orthodontics: 16-24 hours or over 5,000 hours; no contest, we agree.

Why does this matter or why is it important?  It really is like seeing your family physician for heart surgery.  In a severe emergency, if you and your family doc were on an island, could he or she try to treat some sort of heart issue?  Possibly, but in a real world, day-in and day-out basis, where you and they are not on an island, should they?  No.  They simply don’t have the experience and training to successfully perform the specialty procedure(s) with any degree of predictability, and in a timely manner.  Another analogy to describe this difference for your home- one usually would not hire an electrician to unclog a toilet?  Usually a plumber would be hired who is specifically trained and experienced to deal with plumbing problems.

In a 2-3 year orthodontics residency after the 4 years of dental school, a resident is usually expected to start and finish around 50 patients with various problems so that they can get hands-on experience in a controlled clinical setting.  After graduating from dental school, there are continuing education (CE) courses available which allow dentists to further their education and expand the range of services that they can provide to their patients. All practicing dentists and dental specialists are required to obtain a minimal amount of CE per year.  Some of these CE courses are provided at universities, but most are for-profit courses done on weekends in hotels where the only requirement is attendance and payment of the enrollment fee.  These weekend courses may not even allow the general dentist to perform a single orthodontic procedure on a real patient before trying to perform such on an actual patient.  Furthermore, weekend courses have no way of evaluating how orthodontic treatment progresses over time and the weekend instructor is not in the general dentist’s office to help and provide guidance afterwards.

If it sounds too good to be true, it probably is, and just because one can do something, doesn’t mean that they should.  Before you let any dental provider treat you orthodontically (braces or Invisalign), do your research online or ask around town.  If you are in your dental provider’s office, specifically ask them if they are an orthodontic specialist, where they did their orthodontic residency and if they ever had braces as a teem, who provided their orthodontic treatment- their family dentist or an orthodontist?  Most would answer, their orthodontist.

Note from the Author: Dr. Edward R. Altherr, is a board-certified orthodontist who is in the private practice of orthodontics in Apex, NC.  He was trained and had taught orthodontics at the University of North Carolina at Chapel Hill. Dr. Altherr has over 15 years of specialty orthodontic practice and 2-3 years of general dental practice.  This blog is for informational purposes only, and is provided to help you understand currently accepted orthodontic problems and concepts.

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