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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.

Where are my child's teeth?

August 16th, 2017

Did your child lose a baby tooth some time ago and there is not an adult (permanent) tooth? There are usually two main reasons why this  happens and some other less common ones.

The first main reason for a permanent tooth to not erupt is there needs to be enough space. The front adult teeth are usually much wider than the front baby teeth. This can sometimes catch parents by surprise when a child’s teeth were perfect before the baby teeth started to fall out.  Ideally, the baby teeth should not look perfect, and there should be spaces between all of the front teeth. If there is not enough space when the baby teeth are lost, your child may need orthodontic treatment to assist with their permanent teeth erupting.

A second common reason for a permanent tooth to not come in after a baby tooth has been lost is that the adult tooth underneath is erupting in the wrong direction.  This is called ectopic eruption.  This is not unusual, especially with adult teeth like the lower second bicuspids and molars and the upper canines.  The first step for this problem is typically removing the above baby tooth as soon as the problem is diagnosed. If the eruption path does not change, then orthodontic treatment will be needed to guide the tooth in its correction position.  Why does an adult erupt in the wrong direction?  We do not have this answer currently for most ectopic eruption cases.

There are a few other less common reasons why an adult tooth doesn’t erupt.   First, an adult tooth can never form or develop, and be congenitally missing.  This frequently occurs with upper lateral incisors and lower premolars.  One theory proposed is that as we continue to evolve as a species, the genetic drive for more teeth is no longer needed, so more people are not having the full complement of thirty-two (32) teeth.  Second, a tooth can become “glued” to the surrounding bone and not erupt.  This is called ankylosis.  Why this occurs?  Sometimes, we do not know, but past trauma to the tooth can contribute to this fusion or if a tooth stays in its jaw bone a long time, then it can become ankylosed.  In most situations, these teeth cannot be moved and orthodontics is needed to correct the associated problems.  Finally, an adult tooth can have primary failure of eruption (PFE) which is a condition where a tooth does not erupt.  All normal teeth have a thin layer of tissue around their roots, but a tooth with PFE does not have this tissue and can’t erupt.  Again, orthodontic treatment is needed to correct this problem.  Why this occurs, we do not know.

Bottom line- If your child lost a baby tooth and no adult replacement one has come in, you should consider having an orthodontist examine your child.  An orthodontist is a dental specialist who usually has three (3) years of additional training after the four years of dental school in diagnosing and treating the problems specifically described in this blog.

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.

Why does the cost of braces often vary from office to office?

July 3rd, 2017

If you don’t know already since more and more folks “shop around” for their orthodontic treatment like buying a car, the fees for braces and Invisalign can and do vary locally, regionally and nationally. What affects orthodontic treatment fees and how are they determined?

Unlike a product like a car or a bag of chips where shopping around often can pay off with getting the best deal, a service like orthodontic treatment does vary.  Often times, the experience and training of the orthodontist, board certification, the quality of the treatment outcome, the amenities and customer service of the office do affect the treatment fees.  Other factors that affect any business’s charges/prices/fees like an orthodontic practice are labor, materials, supplies, maintenance and repair of the office, governmental regulations and taxes.   Examples of the supplies are the braces themselves (technically referred to as brackets), the archwires, retainers, rubber bands, impression material, the cement (glue) used for the braces, etc.  Other items used behind the scenes and not always seen are the instruments needed for each patient, the equipment used to sterilize the instruments after each patient,  lab equipment like a model trimmer, and diagnostic equipment like x-ray machines, cameras and the large amount of computer equipment needed to run a modern, high-tech orthodontic practice in the year 2017.

The cliché’ of you get what you pay for cannot be overlooked in the case of orthodontic treatment, especially when delivered by a specialist and expert in orthodontics like Dr. Altherr,  who received nearly 3 years of additional, full-time training specifically in orthodontics (braces, Invisalign, etc).  We hope this information helps answer the above question.

Is there an age limit with Braces?

May 9th, 2017

Quick answer- NO.  Our oldest adult patient during their treatment a few years ago was in their mid 70’s.

As we continue to thankfully live longer, more adults are seeking orthodontic treatment (braces and Invisalign) for the first time or being retreated because of infrequent/lost/damage/etc of their past retainer(s).  Furthermore, with better access to dental care, education and income, more adults have all of their teeth and understand the important relationship between their teeth and their overall health; they want to invest the necessary time and money into their health.  In the past for a lot of adults due to missing teeth and finances, straight teeth and a good, functional bite were often achieved with dentures/fake teeth only.  Now, adults have their teeth and have options.

Past obstacles to orthodontic treatment that we hear from our past adult patients at their complimentary initial exams are the following:

1)      Length of treatment- Will it take a long time?

2)      Will I be the only adult among a bunch of kids?

3)      Will I have a mouth full of metal like the old days?

4)      Cost and financing.

Depending on the extent of an adult’s problems and their expectations, some patients’ treatment times can be as short as 6 months or less!  Really, we are not joking.  Dr. Altherr does joke that his patients’ treatment times are shorter because of him being naturally impatient; but more seriously, it’s because we are experts at orthodontics, we use up to date technology and Dr. Altherr’s board-certified experience and being UNC trained further adds to the efficiency in treatment and the corresponding brief treatment times.

Adults are about 20% or our practice, and growing.  There are some mornings where we only see adults.  There are many more aesthetic options than the metal braces of the past.  We offer clear braces and Invisalign, which a lot of our adults really like.  And finally, with all of our patients (not just adults) and the various treatment options offered, we have many flexible financing options that make affording orthodontic treatment simple and easy.

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, Raleigh 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 15 years of clinical orthodontic experience as of 2017, 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.

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