Orthodontic Topics

Orthodontics photo for Dr. Stanley Sheppard

Orthodontic Frequently Asked Questions
Orthodontic Terms
Orthodontic Emergencies/Problems

Orthodontic Frequently
Asked Questions

What age should my child have an orthodontic evaluation?
What occurs when Dr. Sheppard feels orthodontic treatment is indicated?
Why is it important to have orthodontic treatment at a young age?
What Causes Crooked Teeth?    /    How Do Teeth Move?    /    Will it hurt?

What age should my child have an orthodontic evaluation?

The American Association of Orthodontists (AAO) recommends an orthodontic screening for children by the age of 7 years. At age 7 the teeth and jaws are developed enough so that the pediatric dentist can see if there will be any serious bite problems in the future. Most of the time treatment is not necessary at age 7, but it gives the parents and pediatric dentist time to watch the development of the patient and decide on the best mode of treatment. When you have time on your side you can plan ahead and prevent the formation of serious problems. We do an orthodontic evaluation with the initial visit, and each subsequent recall visit for as long as we are treating your child. This evaluation is a regular part of the oral examination.

What occurs when Dr. Sheppard feels orthodontic treatment is indicated?

When Dr. Sheppard feels that your child is clinically ready for orthodontic (braces) treatment, he will discuss this with you and suggest that orthodontic records be taken. This will give Dr. Sheppard the information needed to evaluate your child’s growth potential and aid him in selecting the best treatment options for your child. Orthodontic records are equivalent to medical tests used by a physician to evaluate different methods of treatment. After the records are taken and Dr. Sheppard evaluates them, he will schedule a consult visit to discuss his findings, treatment plan, time required for treatment, cost of treatment, and to answer any questions you may have.

Why is it important to have orthodontic treatment at a young age?

(Phase I / Phase II)

Research has shown that serious orthodontic problems can be more easily corrected when the patient’s skeleton is still growing and flexible. By correcting the skeletal problems at a younger age we can prepare the mouth for the eventual eruption of the permanent teeth. If the permanent teeth have adequate space to erupt they will come in fairly straight. If the teeth erupt fairly straight their tendency to get crooked again after the braces come off is diminished significantly. After the permanent teeth have erupted, usually from age 11-13, complete braces are placed for final alignment and detailing of the bite. Thus the final stage of treatment is quicker and easier on the patient. This phase of treatment usually lasts from 18-24 months and is not started until all of the permanent teeth are erupted.

Doing orthodontic treatments in two steps provides excellent results often allowing the doctor to avoid removal of permanent teeth and jaw surgery. The treatment done when some of the baby teeth are still present is called Phase-1. The last part of treatment after all the permanent teeth have erupted is called Phase-2.

What causes crooked teeth?

Crowded teeth, thumb sucking, tongue thrusting, premature loss of baby teeth, a poor breathing airway caused by enlarged adenoids or tonsils can all contribute to poor tooth positioning. And then there are the hereditary factors. Extra teeth, large teeth, missing teeth, wide spacing, and small jaws - all can be causes of crowded teeth or malocclusion.

How do teeth move?

Tooth movement is a natural response to light pressure over a period of time. Pressure is applied by using a variety of orthodontic hardware (appliances), the most common being a brace or bracket attached to the teeth and connected by an arch wire. Periodic changing of these arch wires puts pressure on the teeth. At different stages of treatment your child may wear a headgear, elastics, a positioner or a retainer. Most orthodontic appointments are scheduled 4 to 8 weeks apart to give the teeth time to move.

Will it hurt?

When teeth are first moved, discomfort may result. This usually lasts about 24 to 72 hours. Patients report a lessening of pain as the treatment progresses. Pain medicines such as acetaminophen (Tylenol) or ibuprofen (Advil) usually help relieve the pain.

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Orthodontic Terms

Malocclusion /  Occlusion /  Openbite  /  Overbite /  Overjet
Band & Loop (B&L) /  Functional Appliances /  Herbst /  Lower Lingual Arch (LLA)


Poor positioning of the teeth.

Types of Malocclusion:

Class I malocclusion

Class II malocclusion

Class III malocclusion

Class I

A Malocclusion where the bite is OK (the top teeth line up with the bottom teeth) but the teeth are crooked, crowded or turned.

Class II

A Malocclusion where the upper teeth stick out past the lower teeth.

Class III

A Malocclusion where the lower teeth stick out past the upper teeth. This is also called an "underbite".


The alignment and spacing of your upper and lower teeth when you bite down.

Types of Occlusion:

Photo of openbite occlusion

Photo of overbite occlusion

Openbite - Anterior opening between upper and lower teeth.

Overbite - Vertical overlapping of the upper teeth over the lower.

Photo of overjet occlusion

Photo of crossbite occlusion

Overjet - Horizontal projection of the upper teeth beyond the lower.

Crossbite - When top teeth bite inside the lower teeth. It can occur with the front  teeth or back teeth.

Photo of Band and LoopBand & Loop (B&L)

A Band & Loop is routinely used to hold space for a missing primary (baby) posterior (back) tooth until the permanent tooth can grow in.

Functional Appliances

These are used to help modify the growth of the jaws in children. The theory behind their action is that if you hold a jaw in a specific position long enough that it will grow into that position. What you usually get is a combination of a little jaw growth with a lot of tooth movement. These are not universally accepted, as they do not always work.

Photo of Herbst applianceHerbst

Another appliance designed to encourage the lower jaw to grow forward and “catch up” to upper jaw growth.

Lower Lingual Arch (LLA)

Photo of Lower Lingual Arch (LLA)A lower lingual arch is a space maintainer for the lower teeth. It maintains the molars where they are, without moving them. This is fabricated by placing bands on the molars and connecting them to a wire that fits up against the inside of the lower teeth. It keeps the molars from migrating forward and prevents them from blocking off the space of teeth that develop later. This is used when you have the early loss of baby teeth or when you have lower teeth that are slightly crowded in a growing child and you do not want to remove any permanent teeth to correct the crowding.

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Orthodontic Emergencies
or Problems

Loose Bracket / Poking Wire / Wire Out of Back Brace
Poking Elastic (Rubber Band) Hook / Sore Teeth

Please feel free to contact the office if you are experiencing any discomfort or if you have any questions. Below are a few simple steps that might help if you are unable to contact us or if you need a “quick fix”.

Loose Bracket

Occasionally, a glued bracket may come loose. You can remove the loose bracket and save it in an envelope to bring to the office or leave it where it is, if it is not causing any irritation. Call the office as soon as possible in order for us to allow time to re-glue the bracket.

Poking Wire

If a wire is poking your gums or cheek there are several things you can try until you can get to the office for an appointment. First try a ball of wax on the wire that is causing the irritation. You may also try using a nail clipper or cuticle cutter to cut the extra piece of wire that is sticking out. Sometimes, a poking wire can be safely turned down so that it no longer causes discomfort. To do this you may use a pencil eraser, or some other smooth object, and tuck the offending wire back out of the way.

Wire Out of Back Brace

Please be careful to avoid hard or sticky foods that may bend the wire or cause it to come out of the back brace. If this does happen, you may use needle nose pliers or tweezers to put the wire back into the hole in the back brace. If you are unable to do this, you may clip the wire to ease the discomfort. Please call the office as soon as possible to schedule an appointment to replace the wire.

Poking Elastic (Rubber Band) Hook

Some brackets have small hooks on them for elastic wear. These hooks can occasionally become irritating to the lips or cheeks. If this happens, you may either use a pencil eraser to carefully push the hook in, or you can place a ball of wax on the hook to make the area feel smooth.

Sore Teeth

You may be experiencing some discomfort after beginning treatment or at the change of wires or adjusting of appliances. This is normal and should diminish within 24-72 hours. A few suggestions to help with the discomfort:

  1. Rinse with warm water, eat a soft diet, take acetaminophen (Tylenol) or ibuprofen (Advil) as directed on the bottle.

  2. Chewing on the sore teeth may be sorer in the short term but feel better faster.

  3. If pain persists more than a few days, call our office.

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