Click on each link below to read all the chapters in our Education Library.
Information for the Ortho Patient & Family
"So You've Got Braces - What Do You Do Now?"
Help for Improving Oral Hygiene
Instructions for Brushing
Instructions for Invisalign
Instructions for Rubber Bands
Instructions for Retainers
In order to obtain the best results, much depends on the wholehearted and sincere cooperation of the patient during orthodontic treatment.
The diet during treatment should be well balanced, consisting of vitamin-rich foods, fresh fruit and fruit juices, fresh vegetables and proteins so that the health of the gum tissue may be maintained. The diet should have a low sugar content, which will help prevent decay while the orthodontic appliances are in place. Hard, sticky, chewy foods should be avoided. These foods are harmful because they bend and damage the appliances and therefore extend the treatment time.
The teeth and appliances must be kept clean at all times and should be brushed immediately after each meal and before bed.
Orthodontic treatment does not cause decay, but the appliances accumulate food, so special care is required. The portion of the teeth between the brackets and the gums should receive particular attention to prevent decalcification (permanent white scars on the teeth). Cleanliness of teeth cannot be overemphasized. We recommend using a fluoride mouth rinse (ACT) once a day, preferably before bed and flossing at least once a day.
If any orthodontic appliance becomes loose or broken, or in case of an injury to the mouth, call the office immediately for an appointment. The appliance mechanism is very finely adjusted and under control will move the teeth slowly and efficiently to their desired positions. The patient’s care of the appliances and cooperation in following instructions can affect results obtained in treatment.
missed appointments, and failure to follow instructions will result in extended treatment time and additional appointments. If something is loose, please call the office immediately. We will try to expand the existing appointment or to schedule an appointment sooner to repair the breakage. Maintaining the appliances in good condition will help us minimize your time missed from school or work.
Appointments for regular adjustments are scheduled approximately every 6 weeks and each appointment lasts about 30-45 minutes. Longer appointments, such as those to place or remove appliances are infrequent and will be made during the morning. During the school year, we will make every effort to schedule regular adjustment appointments in the afternoon. These after-school appointments are considered to be a
privilege. Patients who maintain their appliances, show good hygiene, and are on time for their appointments may continue to schedule appointments during the afternoon. If you miss an appointment or cancel it with less than 24 hours’ notice, you will be given lower priority to schedule regular checkups during the afternoon.
If you have to cancel an appointment, please give the office at least 24 hours’ notice. We may not be able to reschedule you for several weeks depending on the schedule, so it is best not to cancel appointments. Failure to maintain appointments will extend the treatment time. In order to protect our staff and other patients from contagious diseases, we prefer not to treat patients who are sick or have a fever; we ask that their appointment be rescheduled.
Please inform the office if there is any change in the medical or dental history of the patient, new medication being taken on a regular basis, or new allergies to medications. We also request that you update any address or home/work phone number changes.
Regular periodic examination and cleaning appointments by the patient’s dentist every 6 months should be continued during orthodontic treatment.
Informed Consent of Potential Risks and Limitations of Orthodontic Treatment
Just like any medical procedure, there are some risks that go along with braces. Fortunately, in orthodontics the complications are infrequent and when they do occur they are, most often, of minor consequence. Nevertheless, they should be considered when making the decision to undergo orthodontics. Please feel free to approach Dr. Mullen or one of the staff members with any questions or concerns you have at any time.
Decay, gum disease, and decalcifications (permanent white markings) are all a possibility if you do not brush and floss your teeth properly. They are completely avoidable, but it will take a commitment from you to brush frequently and properly. Brushing with braces on is a little different from brushing without braces, but our staff will be sure you understand how to do it, and will work with you during the first couple of appointments in particular to make sure you are brushing properly. Sugary snacks and especially sugary drinks and soda should be avoided to lower the risk of decay and decalcification.
Teeth have a tendency to rebound to their original position after orthodontic treatment. The teeth are under pressure when you chew or grind your teeth, and these forces are enough to move your teeth. Even the pressure from your lips and tongue is enough to shift your teeth around. After we finish your braces it will be important to wear retainers to prevent your teeth from shifting. At first you will wear your retainer all the time, then we will scale back to nightly wear and eventually you may be able to wear your retainer once a week at night. We encourage most people to wear their retainer the rest of their lives to hold their teeth in the proper place.
The great majority of people who have no temperomandibular joint disorder symptoms before orthodontics have no symptoms once treatment is complete. Some people who have TMD symptoms before treatment may have an increase in those symptoms during or after orthodontic treatment. Others who have had no history of TMD may develop symptoms during treatment. Many patients have a reduction or elimination of their TMD symptoms after orthodontic treatment; the relationship between orthodontics and TMD is different for everyone. We will monitor any changes throughout your treatment.
A nonvital or “dead” tooth is a possibility. Sometimes if someone has fallen and bumped their tooth, the nerves and blood vessels inside the tooth will die without anyone knowing, but when we put braces on the tooth will flare up and require root canal treatment. This will not affect orthodontic treatment.
In all cases the root ends of the teeth are shortened, although this does not affect the vitality or stability of the tooth. Most people experience a rounding of the end of the roots, but some people can experience a more severe resorption, sometimes up to 2/3 of the root. The cause of this is unknown, but we will take X-rays throughout treatment to watch for this change.
If a patient is not through growing, an abnormal growth pattern can affect the treatment, and can prevent us from getting an ideal result with orthodontics alone. We will monitor any growth you have left to determine whether it will help or hurt our treatment.
The time in treatment can be extended beyond our estimates. It is important that you show up on time for all appointments, and that you carefully follow any directions we give you. This is the best way to finish your treatment in a timely manner.
Checkups with your regular dentist should be made every six months throughout your orthodontic treatment.
Discomfort: The first few days can be uncomfortable, and you can take whatever pain medications you usually would for a headache
- Tylenol, Advil, etc. It will take a while for your cheeks to become used to the braces, and until then we recommend using the soft wax that we provide to cover up any braces that cause sore spots.
Eating: For the first few days, you will probably want to eat soft foods because your teeth will be sore. Pasta, soups, mashed potatoes, bananas, etc. After the initial discomfort is over, it is important to avoid hard or sticky foods. Stay away from things like gum, taffy, caramel, Starburst, Skittles, very hard pretzels, Doritos, nuts, and refrain from chewing ice. Use common sense, and don’t eat anything that is hard or sticky. Don’t bite into apples, carrots, or other crunchy veggies with your front teeth
- you can cut them into very thin slices with a knife and chew them with your back teeth. It is very important that you avoid drinking soda and other juices and sports drinks when you have braces on, the sugar can do major damage to permanently discolor your teeth. Also, be careful using utensils when you eat, if they hit your braces there could be sparks. (Just kidding, nothing will happen!)
Brushing: Please see the enclosed Brushing Instructions for a detailed description of a very effective brushing technique. You should brush at least 3 times daily
- once after breakfast, once after lunch, and once before bed. Products containing an extra amount of fluoride are also recommended [Prevident 5000 toothpaste (available by prescription only) and ACT mouthwash (available at any drug store)]. The following schedule is recommended:
- After breakfast - brush with Colgate Total, rinse with ACT mouthwash
- After lunch - brush with Colgate Total
- After dinner - brush with Colgate Total using, floss between all teeth
- Before bed - Rinse with Inspector Hector mouthwash to see where to brush, then brush your teeth clean, then rinse with ACT mouthwash. Do not rinse your mouth out with water after you finish brushing.
Following this schedule will reduce your likelihood of developing cavities, gum disease or white spots on your teeth.
Problems: If a wire comes loose or a bracket pops off, please call our office to reschedule your appointment. If something is loose and is hurting you, we will get you into the office as soon as we can. If nothing is hurting, we will try to schedule you around the same time as your original appointment, but we will need a little additional time to fix the problem. If you are seriously injured, please go ahead to the emergency room. Please call us if you have any doubt.
Sports/musical instruments: Always wear a mouth guard when you play sports. Ask us for recommendations. Musical instruments can be played without a problem, although they will feel a little different if you use your mouth to play them.
If you are having difficulty maintaining the cleanliness of your teeth and
braces, there are several things that can help you improve. If you are drinking soda, we would recommend cutting soda out of your diet. It is a very acidic drink and it will cause quite a bit of damage to your teeth. You should also cut back on other sugary drinks such as juices and sports drinks as well as sugary foods.
Your brushing technique right now is not doing a good enough job of keeping your teeth and braces clean, and we are going to recommend that you take a few extra steps to keep things clean:
- We recommend investing in an electric toothbrush and using it to brush between your braces and your gums. Dr. Mullen prefers the Sonicare.
- Before brushing, we recommend using "Inspector Hector" mouthwash, which can be found in many grocery and drug stores. Swish with this mouthwash before you brush and it will stain the areas where you need to brush blue. You will see exactly where you need to brush.
- We recommend using Prevident 5000 Plus toothpaste, which has more fluoride than regular toothpaste. This requires a prescription, which we can give you, or we sell it here in our office (at a pharmacy it may be more expensive and is sometimes difficult to find)
- Make sure you are flossing. If you cannot remember how to floss, do not hesitate to ask us.
- You should be brushing your teeth at least four times a day: Once after each meal, and once more before bed. There is no substitute for proper brushing and it is never more crucial than while orthodontic appliances are in place.
We also recommend an in-office fluoride treatment; a fluoride varnish. We will paint a high concentration of fluoride on your teeth that will cover your teeth and help protect them.
It should be done every other appointment (about every 3 months). It will no longer be necessary once you are doing an exceptional job keeping your teeth clean. If you should have questions or need more information regarding your oral hygiene, we will be happy to discuss it with you. Thank you for your help and concern in this matter.
The following foods should not be eaten because they can damage the appliances:
NO Sticky Foods such as:
- Tootsie Rolls.
NO Hard Foods such as:
- hard bread
- hard pizza crust
- hard pretzels
Be sure to cut up apples & carrots and chew them carefully with your back teeth – etc.
In order to reduce the risk of having permanent stains or cavities, you should limit your consumption of:
- ice cream
- sports drinks.
Brushing with braces is a little different than brushing before you had
braces. You have to do it more often, you have to spend more time when you do it, it may not be very
exciting - but it’s important in order to get all the food and plaque off of your teeth!
Always be sure to use a soft toothbrush; medium or hard is not good for
your gums – never use one of those! An electric toothbrush can also work well, we recommend buying a
Sonicare or an Oral B 3-D. Use any ADA approved toothpaste, I prefer to use Colgate Total.
Brushing should take a total of 3 minutes; if you have a radio near your
bathroom, one whole song is usually about three minutes.
|Proper Brushing Techniques
1. Start on your upper arch, at the back teeth on one side. Hold the brush so that it is angled between your gums and the braces.
Brush each tooth, and count to 5 before moving to the next tooth. Continue all the way around the arch doing this.
2. Starting on the other side of your upper arch, angle your brush upwards so that the bristles
go underneath the wire. Brush each tooth, and count to 5 before moving to the next one. Continue all the way around the arch.
3. Follow the same instructions for the lower arch, first brush below the bracket and then above.
4. Finally, brush the inside surface of your teeth, spending 5 seconds on each tooth in both the upper and lower arches.
You have begun treatment with Invisalign, and we want to be sure your treatment proceeds as smoothly and effectively as possible. Following these instructions will help to ensure the success of your treatment.
The aligners come in a container that hold one upper and one lower aligner. The aligners are worn in sequence, and the number can be found on the back of the aligner container. Peel back the paper, and remove the aligners for the first set. The upper arch has larger teeth, making it easy to tell them apart. It is usually easiest to put the aligners in by seating them on your front teeth first, and then pressing them down over your back teeth. The aligners will "snap" into place, and you shouldn't see any space between the aligners and your teeth if they are seated correctly. To remove them, start in the back and pull them up with your fingernails. They can then be pulled off of your front teeth. Instruments can also be used - Dr. Mullen has some plastic instruments if you have a lot of trouble getting them out. Getting them out is usually more difficult than getting them in, but you will find it gets easier as your treatment progresses.
You will wear each set of aligners for 2 3 weeks. Wear the first one for 2 3 weeks, then take it out, put it back into the original container, and move on to the 2nd aligner. Wear that one for two weeks, then take them out and put the 2nd one back in the container. Wear the 3rd for the same time period, and so on. We keep the old aligners because now and then we will have a tooth that doesn't move like we need it to, and we will need to go back a few aligners. If we don't have the old ones, we need to order them from Invisalign, a lengthy and costly situation.
You should wear the aligners at all times, except when you are eating, drinking, or cleaning them. It is OK to drink water with them in, but if you eat or drink anything other than that they should be removed. This will reduce the chances of developing cavities. When you do take them out, be sure to store them in one of the cases that we provide you. The easiest way to lose them is to wrap them in a napkin and throw them out with the trash. Replacing them costs $100 per aligner; keep good track of them! When you take them out to eat it is best to brush your teeth and to clean the aligners before putting them back in. Clean them by brushing them with a toothbrush under a faucet. Do not use toothpaste to brush them, and do not boil them or soak them in any cleaning solution. They are sensitive to heat and will absorb cleaning solutions. Using the invisalign cleaning system is OK, but usually brushing them well is adequate. Store them dry inside your case.
If you do lose one, make sure you either put the one you just took out back in or go ahead to the next aligner and give us a call so we can bring you back in. NEVER GO WITHOUT AN ALIGNER! Always put one back in.
If they irritate your cheek or tongue, you can place some wax on them, or smooth them with a nail file. Feel free to give us a call if you have any questions or problems. Wear them 22 hours a day!
Dr. Mullen has asked you to wear rubber bands on your braces. They are used to move your teeth, and it is very important that you follow the instructions completely in order for your teeth to move. If you don’t wear your rubber bands in the right place and for the correct amount of time each day, your teeth will not move and you will have to wear your braces much longer. Following these instructions is the best thing you can do to help us get your braces off as soon as possible!
When wearing your rubber bands, you must not take them out for longer than 30 minutes at a time. You may take them out to eat, but do not leave them out for longer than 30 minutes, and be sure to remember to put them back in. An easy way to remember is to put them on your pinkie – when your circulation is cut off, it’s about time to put them back in! Some people prefer to eat with them in
because it is just easier. Put new rubber bands in at least every 8 hours, maybe in the morning when you wake up and at night after dinner. Be sure to have some with you at all times in case one breaks.
At first, the elastics may cause your teeth to be tender. That's because your teeth are moving, which is the goal. Usually the tenderness lasts only a day or two. Not wearing your rubber bands as instructed will only make the tenderness last longer, and make the tooth movement take more time. If you need more rubber bands, give us a call and we can mail some to you.
Why wear a retainer?
It is important to wear retainers to hold your teeth where they are now that you have had your braces removed. The teeth are not directly attached to the bone; there is a small ligament that anchors the tooth to the bones. Like other ligaments, it has some elasticity and tends to want to return to it’s original position, especially immediately following treatment. Your teeth have forces on them every day, whether it is when you chew, when you grind your teeth, or even the force placed on them from your lips and cheeks. These forces all tend to make your teeth move, making it important to wear your retainer almost forever in order to prevent them from shifting.
When do I wear the retainer?
For the first three months, your retainer should be worn 24 hours a day, except when you eat, play sports, or brush your teeth. After three months, you may wear your retainer only at night, but you must wear it every night. We will see you again in 6 months to check the fit of your retainer and to check your teeth.
When you take your retainer out, we recommend that you store it in the case that we provide for you. Be careful to put the retainers in a case when you take them out – it can be very easy to wrap them in a napkin and throw them away. Also keep them away from pets (dogs love to eat them for some reason). There is a $150 charge to make a new retainer if it has been lost or broken.
How do I clean my retainer?
You should clean your retainer once or twice a day. We recommend holding them in your hand and scrubbing them with a toothbrush under the faucet. You should not use toothpaste because it tends to get stuck in the retainers, but hand soap is OK to use. Do not soak them in any chemicals (bleach, mouthwash, etc.), but feel free to freshen them up with some mouthwash. Never use hot water or any other chemicals to clean them, they can be damaged easily.
You will continue to be seen over the next couple years for retainer checks. Be sure to bring your retainers with you so your orthodontist can make sure they still fit well. Keep track of them; it costs $150 each to replace lost or broken retainers! If you should break or loose a retainer, call the office so we can schedule you to come back in and we can make you a new one. Do not wait until your next appointment, your teeth may already have shifted in that time. Please call us if you have any questions, any problems, or if you feel like your retainer isn’t fitting properly.
CONGRATULATIONS! You have completed all the chapters in this tutorial.