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Our Covid-19 Reopening Protocols

May 20th, 2020

To our current and future patients and parents,

First and again, we sincerely hope that everyone is healthy, well and safe.  Thankfully, all of us here at Altherr Orthodontics and our families have been doing well while we all have been home and our office closed.

Long story, short, we will be reopening back up!  Finally, right?  Our first day back will be Monday, June 8th.  Over the next 1-2 weeks, each of our patients and/or their parents will be receiving communications from our office to schedule your next visit with us.

Due to the ongoing Covid-19 pandemic, we have (hopefully temporary) changed some our patient/office interactions which include the following:

1) Only the patient and/or a parent will be permitted to enter and stay in our office during the patient's appointment.  No siblings will be able to stay in the office.  We humbly ask that you please keep any extra people in the car or at home.  We do this for your health, ours and our other patients'.

2) Prior to going much farther into our office, you will be asked some questions, your temperature will be checked and we will need you to please sign a new Covid-19 Informed consent document.  If your answers are such and if your temperature is greater than 100 degrees F, you will need to be rescheduled at least 2 weeks into the future.

3) Each patient will need to rinse with Listerine for 30 seconds, which will be witnessed by a member of our clinical team.

4) When scheduling your next visit, which is critical since we have missed some time during the quarantines, we will ask you to either call from your car or stand at least 6 feet away from the front desk (please don't congregate near the front desk).

We have put measures in place to minimize the transmission of any illness let alone SARS-CoV-2.  The above are part of this as well as additional aerosol capture, extra viral filtration, physical distancing of at least 6 feet between each patient, extra PPE for us, continued vigilent infection control and dedicated days and new equipment to help us minimize the amount of oral aerosols that can be generated and transmitted.

We genuinely appreciate your patience in understanding in our efforts to keep you safe as well as us.  We look forward to seeing you all in the near future!

Dr. Edward Altherr

Factors that can prolong your orthodontic treatment time

August 30th, 2019

This month (August) is always busy with folks either trying to get their braces on or off before school starts, and as exciting as it is to start making your SMILE better, it’s an even better day when your braces get to come off.  Unfortunately, we sometimes have some patients who aren’t able to get their braces removed before school starts, and there are often several reasons why.

  • Patient cooperation and even the family’s cooperation is often the most important factor in making orthodontic treatment finish on time, and also with a high quality result. So, if a patient takes really good care of their braces and doesn’t eat things that will break them, this helps.  A patient doing what they’re supposed to with wearing rubber bands or headgear for example will expedite treatment as well.  Parents, you are vitally important because you live with your children and also can oversee their compliance at home, and you are the ones that usually take them to and make their appointments.  So, if appointments are missed or things are not done at home, these things will delay treatment.
  • There is a difference in orthodontic treatment times from one orthodontist to the next because we are people, and each of us is unique in our own way. So, besides the difference in us as people, each orthodontist in a particular area or your town may have trained at a different dental school or post-graduate program.   Finally, each orthodontist has a different practice philosophy where some emphasize speed versus quality and some increase treatment times more for financing reasons instead of actual clinical, treatmen
  • Lastly, there are some occasions where orthodontic treatment just takes longer than your orthodontist had estimated through no fault of the patient or the doctor. Sometimes, teeth move a lot slower than anticipated or some erupt/come in a lot slower than expected.

For the most part for most orthodontic patients, if you do your part and get support from mom/dad if you are not an adult, this usually results in finishing your orthodontic treatment on time (and sometimes even earlier than expected) and with a great result.  If you are honestly not doing your part, then you know what you need to do.

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 17 years of clinical orthodontic experience as of 2019, 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.

At Home Things to do or use for an Orthodontic Emergency

July 1st, 2019

When in doubt, you can always call our office or your orthodontist’s office to have whatever problem you’re having taken care of in a timely and hopefully convenient manner.  However, if you are out of town or if it is 3 am in the morning and you do not want to go to an emergency room and pay their ransom, this blog may provide you some tips to get you through until we can see you.

An emergency related to your braces occurs when something happens which can cause either discomfort or can cause your teeth to move unexpectedly.  If you are not sure what part of your braces is possibly broken, you can refer to the literature we gave you when your braces were put on or also find the appropriate information on our website, which may already be on.

Types of emergencies with braces include trauma, sores, when they become loose or broken and/or unexpected tooth movement.  If trauma does happen to you while you’re in braces, the good news is that it likely would’ve been worse since the braces almost serve as a protective splint to stabilize your teeth and make them a little better to absorb an impact to your mouth.  However, your lips/cheeks won’t be happy and ice, wax and any over the counter pain medication will help until you can be seen by us or your orthodontist.

Some patients can develop canker sores in their mouth during treatment.  Wax will help smooth an area until you can be seen by your orthodontist.  The biggest contributor to prevent a chronic situation of canker sores in your mouth with or even without braces is to prevent your mouth from being dry.  The toothpaste that you use is often a huge component to drying out your mouth.  For most people, it ends up not being a big deal, but for some, a dry mouth leads to a greater frequency of canker sores.  Most toothpastes have a soaping agent (SDS or SLS) in them that makes them bubbly but also dries out one’s mouth and can create an environment conducive to ulcers/canker sores.  There are non-SDD/non-SLS toothpastes like Closys and in the recent past, Tom’s of Maine used to make one.    Finally, you can also sip a little bit of water throughout the day.  For most patients, your lips/cheeks will “toughen up” and become more resilient to your braces as your orthodontic treatment progresses.

Again, if something is poking you, try to use wax until you can be seen in our office.  There is a simple technique to help improve applying and keeping the wax on the affected area.  You can refer to our website or ask a member of our clinical team for a refresher course at your next visit.  If a brace/bracket/metal band are loose and still connected and not bothering you, contact our office within a few days of discovery so that we can repair the problem.  If you are in discomfort, try to apply wax or have someone (not you) carefully remove the offending part and place in a plastic/Ziploc bag for us to use/replace.

Finally, for some patients, their teeth can move unusually fast especially if they are wearing rubber bands.  Again, if not sure, call our office, but in the present, stop wearing your rubber bands.  Please click the emergency care tab on our website for more detailed information about an orthodontic emergency.

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.

DIY Orthodontics- Is it Legit or not?

February 13th, 2019

Have you noticed a lot of commercials on TV lately about do-it-yourself clear plastic aligners?  I certainly have, and it often makes me cringe a little with the claims the particular company makes regarding the ease and speed of treatment.  The old adage, ‘If it sounds too good to be true, it probably is’, and this is not any different.  The trade-off like most things in life is the possible cost savings versus the time it takes to get the result and the high quality one is expecting.

There are some services such as IT that can be done remotely, and the ease of buying any product online is as easy as 2-3 clicks.  Orthodontic treatment is a service that can be complicated, and often times the reason why a highly trained specialist makes it look so easy is because it is all that he or she does.  I often give an analogy of me thinking that I could play tennis as easy as Roger Federer or soccer like Leo Messi, which is very fitting because like me and other highly trained orthodontists, these guys have been practicing their craft for years!

Another  phrase I often use with this form of do-it-yourself, remote orthodontic treatment- “When you don’t know what you don’t know, how are you going to be able to assess and adjust treatment to achieve the results that you want?”  It can be hard enough for an orthodontist because there are so many variables with a typical orthodontic patient which need to be understood and diagnosed with a thorough and comprehensive initial exam.  At this complimentary exam in our office, a patient’s expectations will be managed appropriately to achieve the high quality results they expect.  Even in these times where some folks are more comfortable with staring at a phone, computer or tablet, there’s so much information that is overlooked when you choose to not get a professional’s eyes on your orthodontic problems.  Again, the trade-off is that treatment takes longer unless the result is compromised.

We have been providing clear aligner therapy to straighten teeth, close spaces and correct bad bites in our practice since 2002.  There are many biomechanical differences with this form of treatment versus metal and clear braces.  One example is that your teeth can only be pushed with clear plastic aligners versus being pushed and pulled with braces.  The extra training (3 additional years past the 4 years of dental school) provides more knowledge and experience to deal with the many adjustments that will need to be made during an orthodontic patient’s treatment, whether it is via plastic or braces.

At least get examined by an orthodontist!  If you still choose to go the DIY route after your orthodontic exam, then at least you will have more information to compare/contrast and be comfortable with your final decision.

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.

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

May 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.

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