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Are braces really worth it?

The Worth of a Smile

The thing that goes the farthest
Towards making life worth while,
Which costs the least and counts the most,
Is just a pleasant smile.
The smile that bubbles from a heart
That loves its fellow men,
Will drive away the clouds of gloom
And coax the sun again,
It is full of worth, and goodness too,
With many kindness blent;
It is worth a million dollars
And it doesn’t cost a cent.

There is no room for sadness
When we see a cheery smile,
It always has the same good looks,
It’s never out of style.
It nerves us on to try again
When failure makes us blue,
The dimples of encouragement
Are good for me and you.
It pays a higher interest
For it is sincerely lent;
It is worth a million dollars
And doesn’t cost a cent.

A smile comes very easy,
You can wrinkle up with cheer
A hundred times before you
Can squeeze out a soggy tear.
It ripples out moreover
To the heart-strings that will tug,
And always leaves an echo
That is very like a hug;
So smile away, folks understand
What by a smile is meant;
It is worth a million dollars
And doesn’t cost a cent.

Anon

 

Are Braces Worth It?

Here are some blog comments to consider…

“Good luck, and I recommend braces!!” (Samantha)

“Yes it’s worth it!!! Because the older you get the more your teeth start to shift. and it makes your teeth completely straight. I’ve had my braces for about 9 months and I still have 9 more to go, but my teeth are already pretty straight and they were really bad before. And about the retainer for the rest of your life… you really only wear it at night, as my friend does, so don’t worry about that and wouldn’t you want perfect straight teeth? So go for it!” (Anonymous)

“It’s deffs worth it! Your smile is the first thing people notice about you lol! There’s a lot of people that have done it and they don’t mind the retainer or anything. So if you can afford it do it. ;) Take my word for it! You will be way more attractive so hurry and do them while you are still young!” (Meh:)

“I had braces for 2 years and was told I had to wear the retainer forever. It was worth it and I only wore the retainer for 1 year and then on occasion after that. I think you should because you’re still in high school and it’s still socially acceptable to have braces.” (Dave)

“Yeah they are worth it! :) I have crooked teeth and regret not getting them.” (asban)

“Absolutely since your teeth might look fine but the overbite is a problem that should be fixed. You will love the band behind your teeth once you get your braces off compared to a plastic retainer since you do absolutely nothing with it. You don’t feel it, don’t notice, and most of all will not care about it. The band is simply a tiny metal retainer that goes behind your bottom 4 teeth to prevent it from moving.” (Anonymous)

“A smile costs nothing but gives much. It enriches those who receive without making poorer those who give. It takes but a moment, but the memory of it sometimes lasts forever. None is so rich or mighty that he cannot get along without it and none is so poor that he cannot be made rich by it. Yet a smile cannot be bought, begged, borrowed, or stolen, for it is something that is of no value to anyone until it is given away. Some people are too tired to give you a smile. Give them one of yours, as no one needs a smile so much as he who has no more to give.” (Anonymous)

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Single Phase vs Two-Phased Orthodontic Treatment?

Single phase orthodontics means we wait until nearly all of the permanent teeth are in place prior to starting treatment.  Phased orthodontic treatment means a first phase of treatment is started earlier — commonly at age 7 to 9, when all permanent incisors (front teeth) and permanent first molars are in place but permanent canines and premolars have not yet erupted.  There are indications for both approaches and the option selected should be individually based.

If you select the phased treatment option, it is important to realize that there is a greater than 50-50 chance that you will need to do both phases – i.e. even if you start early you will not finish early, and there may be additional cost and time involved.

In our practice,  we have a comprehensive approach to the first phase, a rigid retention program, and, in fact, 1 out of 3 patients will not need to go on to a second phase.   Furthermore, for the 2 out of 3 patients that still require phase II treatment, the second phase of treatment is often simpler and faster than if we had done single phase treatment.  That being said, we do not do phased treatment on everyone, preferring to wait when problems are mild to moderate.

On the other hand, the benefit of a phased approach to young patients may be worth much more than the extra time or cost.  For example, many female patients finish most or all of their jaw growth prior to the time their full permanent dentition is in place.  Teeth that erupt into the wrong place or are impacted (‘stuck’ or blocked out of place) often require extractions or surgical intervention and this is often circumvented with earlier treatment.

 

The literature lists the following as benefits of phased treatment:

1.       Takes advantage of growth

2.       Requires fewer extractions of permanent teeth

3.       Involves less orthognathic (jaw) surgery

4.       Addresses harmful habits

5.       Causes less tooth trauma and enamel wear

6.       Improves self-esteem and social comfort

7.       Assures greater compliance with the course of treatment than in the challenging teenage years

Most important is the improvement in self-esteem and confidence that occurs when a child is given a beautiful smile during the socially challenging middle school years.  With a list of clear long-term medical benefits, the ultimate decision is still based most often on the consideration of that more intangible factor:

How much is your child’s self-esteem worth?

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Extractions vs. Non-Extractions

A question that comes up often in orthodontic consultation, diagnosis, and treatment planning is: Will it be necessary to remove premolar teeth to straighten your teeth or to correct your malocclusion (bite)?

The answer is that it depends.   There are several factors to consider, including the degree of crowding; flaring; thick versus thin gum tissue; missing, fractured, diseased, or impacted teeth; and the severity of the overbite or jaw imbalance.

A general observation is that about 25 percent of the time extractions are clearly not indicated. These are situations where crowding is mild to moderate, the front teeth are not flared forward, and bite and jaw discrepancies are mild to moderate.

10-25 per cent of the time (percentage varies according to the local prevalent genetic make-up) extractions are definitely indicated.   These are situations where the orthodontic patient has either extreme crowding, flaring of teeth, or a significant overbite.

The 50 to 65 percent of patients in the middle of the spectrum are considered to be border line and usually started on a non extraction trial.    These days, most folks in this group complete their treatment without removing teeth.

The good news is that, looking at all patients combined, premolar extractions can be avoided about 70 to 90 percent of the time!

Here at Kineret Orthodontics, most extraction cases are started non-extraction.   The rationale being that once premolars are removed, you can’t put them back.  So if there is a small but reasonable chance of substantial response to wires and rubber bands, it is best to defer extraction decisions until mid-treatment.

Even when it is certain at the outset of treatment that extractions are indicated, I prefer to defer extractions until mid-course.  The reason being that by mid-treatment we are in large arch wires, have started rubber bands and can more strategically and efficiently close extraction sites.

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Four Keys to Making a Good Orthodontic Decision – By Dr. Stephen Kineret

First of all, choose the right doctor

In this state, it is legal for general dentists to offer and provide orthodontic treatment to their patients (irrespective of the intensity of their orthodontic education).  So, in my opinion, you should be clear on the differences between the levels of training, experience, and expertise that exist between a general dentist with a special interest in orthodontics and a university trained board eligible or certified orthodontic specialist.  Short answer:   the orthodontic specialist made the commitment of a full time 2 or 3 year postgraduate residency in our specialty, earned a clinical certificate (and a masters degree –credentials:  DDS, MS if they did a research project and thesis).

In comparison, the level of training for a general dentist with a special interest in orthodontics is based on the minimal dental school curriculum exposure to basic orthodontics and the weekend courses they have attended.

The orthodontic specialist has limited his practice to orthodontics alone, whereas the general dentist also provides other services.  In my mind, the compounding of limited specialty practice with a 2 or 3 year post graduate residency experience distills down to a substantial difference in levels of experience and expertise.

Here is another way to look at this.  If you needed a quadruple bypass, who would you choose to do it—an experienced, well-trained cardiac surgeon or the family doctor?

 

Secondly, follow these guidelines:  

Do not base your decision on price but on value. 

I believe the general erroneous assumption made by the public is that most doctors’ training, philosophy and results should be the same because our profession is regulated by the state.   Remember appearances sometimes can deceive.  And guess what?  In our community, fees don’t deviate all that much!  So the question is:  Do you want to be in a great practice and have a very positive experience for you or your child or do you want to save a few dollars a month?   May I suggest a checklist to help you choose?

 

If the conditions on the following checklist have been met, congratulations; odds are that you have made a great investment in your oral health.  You have found your new orthodontic home.

Checklist

You have been referred by another patient(s) who had a very positive experience in that office

The doctor can show you similar cases with pleasing results (there are before and after examples on our blog and website)

You feel that there is very good communication and direct and frequent interaction with the doctor

The staff is very friendly and caring

The office is conveniently located and offers office hours throughout the week and runs on time

The office implements contemporary technologies and infection controls

The office helps you maximize your insurance benefits and offers flexible no interest and no down payment options, and cash discounts

 

Choose the right office based on the above checklist/criteria–do not get bogged down in terminology or types of appliances used.

There are fads in orthodontics, just like in other professions and industries.  Decisions should be based on good diagnosis and treatment planning not on marketing fads, or using the latest, greatest widget.  I frequently see this kind of thing happen when the general dentist gives the patient/parent several referral cards; the patient dutifully gathers multiple diverse opinions and then becomes very confused.  Instead, use my checklist.  It will help, I promise.

 

Make sure your child is on board and encourage them to cooperate and follow directions to maximize results

I always tell my patients that a great patient and an average orthodontist can often get better results than the reverse.  Meaning, this is all about team work folks!  If you really want to get a great return on your investment, keep your kids on task with doing their part in treatment—compliance is paramount!  Treatment always turns out better and usually moves along faster, if patients keep their appointments, keep the teeth, gums and braces clean, wear their rubber bands consistently, and are careful not to loosen the non-permanent adhesive that attaches the braces to the teeth.

In our office we have many incentives and rewards in place to encourage compliance and responsibility.  However, if you can maintain tandem reward systems at home, the gains are more than doubled!   The side benefit of this is the maturation and personal growth that occurs when patients take responsibility and become active participants in their treatment.

 

By Dr. Stephen Kineret

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