There are lots of “do it yourself” projects you can complete successfully with just a little time and effort. However, “do it yourself” braces is not one of them. Despite that, there are a rising number of videos on YouTube instructing on how to fix your teeth at home, and even more online sites selling braces kits for those who want straighter teeth but want to avoid the orthodontist.
“There’s a common misconception in the general public that braces are simple — you push on the tooth and it moves where you want it,” says Jeffery Iverson, D.D.S., M.S., an assistant professor at the University of Utah School of Dentistry. “Orthodontics is very complex. Human physiology, occlusion, biomechanics, craniofacial growth and development, tooth size, shape and morphology, as well as the patient’s overall lifelong dental health, must be taken into consideration.”
The most basic method of DIY braces is placing a rubber band around teeth in an attempt to move them together. While this may cause teeth to move, it can also cause a number of complications like tooth fracture, gum damage, root damage, tooth loss, or serious medical complications.
“Blood circulates just below the surface of the oral mucosa, and the placement of toxic, non-sterile items in the oral cavity can injure it and is a good recipe for infection,” says Iverson. “These infections can spread through the blood or through facial spaces, and these infections could become life threatening.”
He has seen the damage a simple rubber band can do firsthand. “I saw a 12-year old patient during my residency that tried to close some spaces in her lower mandibular incisors using a rubber band,” Iverson says. “X-ray evaluation revealed severe bone loss on the distal roots of the mandibular lateral incisors.”
The child ended up needing surgery to remove the rubber band, which had done lasting damage to her teeth.
Another option gaining popularity involves companies that will send consumers kits to take impressions of their teeth, and then will send them clear alignment devices. They claim the process is overseen by a qualified orthodontist and that the kits should only be used by those with a “mild” alignment problem. However, Iverson has his doubts.
“If overseen means a doctor looks at some pictures and impressions over the internet and the patient is never seen in the beginning, throughout treatment nor has the final result evaluated at completion, I could see multiple problems with that type of treatment,” he says.
Iverson also says treating even a mild alignment problem is more complex than simply taking teeth impressions and fitting a device. “In an orthodontic office every patient receives a set of orthodontic records, which include orthodontic x-rays,” he says. “I don’t see where these companies are providing an x-ray evaluation on their patients, so many potential problems could possibly be missed.”
There are also “black market” braces options available, which can cause even greater damage. The materials being used may not be sterile or may even be toxic. There is a chance they could come loose or be swallowed. Then there is the issue of removing them. “Removal of DIY braces can fracture the teeth or extract the teeth depending on the method of cementation,” says Iverson.
The bottom line? If you want straighter teeth, see an orthodontist — face to face.
“It takes a trained orthodontist to position the teeth in their correct positions so detrimental damage doesn’t occur,” says Iverson.
The University of Queensland says dozens of children are missing out each week on the chance to have free dental work, as chairs in its $134 million oral health tertiary centre sit empty.
The Herston centre, which replaced a Turbot Street site in the CBD after 73 years , is used to train dental and oral health students who perform dental work for the public.
Most of the services provided at the UQ Oral Health Centre are free, and there is a waiting list of up to six months for adults.
However the take-up rate for children has been underwhelming, UQ Bachelor of Oral Health program coordinator Andrea Maguire said.
She said the school lost many of its regular child patients after an initiative with a Queensland Health dental facility in Yeronga ended in 2014.
Ms Maguire said the university was hoping to see about 70 children between the ages of 3 and 17 each week.
Services on offer include examinations, x-rays, fillings, extractions, stainless steel crowns, cleaning, polishing and fluoride applications.
“The students are very well supervised by registered dentists and oral health therapists,” Ms Maguire said.
“Generally speaking, [children’s teeth] are not in good health. It’s certainly not as good as we’d like to to be, that’s for sure.”
A Queensland Health survey of more than 5000 children taken between 2010 and 2012 found one in three children under six had never been to the dentist.
The survey also showed half of the children aged between 5 and 10 had decay in their primary teeth, and only three quarters of all children brushed their teeth twice a day.
According to the Australian Institute of Health and Welfare, one third of Australians aged between 25 and 44 have untreated tooth decay, and about a third had not visited the dentist in the last 12 months.
Every evening as I get my two year old son Felix ready for bed he will look at me reproachfully – and then run away. I chase after him with pleas and bribes, before resorting to threats about what will happen should he refuse to do as I say. When that, too, fails, I corner him in a headlock, prise his mouth open and force his toothbrush inside. Afterwards there are cross words and tearful recriminations – from me as well as my toddler.
I have always found cleaning my children’s teeth an emotionally-charged nightmare – as do millions of other parents. A report last month found that 42 per cent of parents have to force their children (aged up to 11) to brush their teeth, with 80 per cent of youngsters throwing temper tantrums as they do so. Only a quarter of the 1558 parents surveyed by Aquafresh believe their children are brushing their teeth properly and one in 10 are so demoralised by the process they send their offspring to bed without cleaning them at all.
But our acquiescence comes at a cost. A national dental health survey published in May revealed almost half of eight-year-olds have signs of decay in their milk teeth, while a recent report by the Royal College of Surgeons (RCS) found that tooth decay was the most common reason five to nine year olds were admitted to hospital. Nearly 26,000 children in that age group were admitted in 2013-14, an increase of 14 per cent from 2011.
Professor Nigel Hunt, Dean of the Royal College of Surgeon’s dental faculty, says the state of our children’s teeth has reached “crisis point” adding that“ it is absolutely intolerable that in this day and age, in a civilised country, children are having so many teeth out for decay, which is over 90 per cent preventable.”
Sugary treats and drinks – cheaper and more readily available than ever – cause decay by reacting with bacteria in the mouth to produce acid that weakens tooth enamel . Prof Hunt has called for the amount of sugar in food and drink to be better labelled, and last month Tesco took the unprecedented step of banning some of its most popular sugar laden drinks – including Ribena and Capri-Sun – from its supermarket aisles – ostensibly to tackle childhood obesity but presumably the company is aware of their effects on children’s teeth too.
But substandard brushing and infrequent dentist visits are also to blame for rising child tooth decay – and I am complicit in all three. I find it hard to resist Felix and his four-year-old sister Rosie’s incessant demands for sweet treats and our fraught tooth brushing sessions usually fall short of the NHS recommended twice daily two minutes. And shamefully, until very recently I had yet to take either child to the dentist. A fear of how they would react was the deterrent. With every passing month I grew more worried that my neglect would lead to lasting dental problems, and retreat further into denial.
However, the spate of news stories on the state of our children’s teeth jolted me into action, and so it was that one day last month, Rosie and Felix were sitting in my dentist’s reception awaiting their first check-up. I tried to build enthusiasm for the visit, but both were nervous. “Are you scared of the dentist, too, Mummy?” asked Rosie, and although I didn’t admit as much to my daughter, my own fear has almost certainly exacerbated my children’s reluctance. Indeed, research by a US dental insurance company found that over a third of kids were frightened of the dentist and that this was often a learned behaviour, picked up from parents.
Problems with my own teeth have also left me distrustful of NHS dentistry – which I feel has failed me – so I took my children to my dentist, Dr Mervyn Druian, who runs a private practice in North London. Dr Druian encourages parents to bring their children in from the age of two. “As long as parents are brushing their baby’s teeth, I can’t see the point of bringing them to the dentist any younger” he says. “It’s unnecessary until they have grown around 75 per cent of teeth.”
Antonia Hoyle with her children Rosie and Felix who hate brushing their teeth
But, he warns: “Many parents mistakenly believe that milk teeth don’t matter because they are going to fall out anyway. But they act as ‘space maintainers’ for the permanent teeth that replace them. If a decaying milk tooth has to be removed the ‘wrong’ tooth may come forward in its place.”
After a few minutes of the children riding up and down in Dr Druian’s chair, Rosie was relaxed enough to have her check-up. On the pretence of “counting her teeth” Dr Druian used a hand-held mirror to inspect her molars as Felix looked on. It took a matter of minutes and afterwards Dr Druian told a delighted Rosie (and her mum) that her teeth were “absolutely fine.”
Felix, however, had by this time hidden in the corner of the room and was resolutely refusing to open his mouth. Dr Druian was reluctant to force him but after bribes of Spiderman stickers Felix eventually permitted a brief flash of his bottom front teeth, during which , eventually causing tooth decay.
My heart sank but he told me: “It is unlikely to have led to damage at this stage. I sometimes give children a scale and polish to get rid of it,but because this is his first visit it would be too overwhelming for him.”
We arranged another appointment for six months’ time, in the hope Felix would be more compliant then.
If his junior patients need extensive dental work, Dr Druian sends them to specialist children’s dentist (also in private practice) Jeremy Kaufman who is experienced in performing fillings on children as young as two. I asked Dr Kaufman how I can make brushing my children’s teeth less traumatic. “Use star charts, bribery and begging – all the strategies to get a child to do something they didn’t want to,” he advised. “Try and make it fun – let your children choose their toothbrush. Let them use an electric tooth brush if they want. Stand behind them with your hand under their face and give them a cuddle as you clean their teeth. Allow them to start brushing if they want to, before you carry on.” While child-friendly toothpastes like strawberry are also available although somewhat bizarrely, my kids like them even less than the standard mint.
The evening after our visit to the dentist – chastened by the plaque developing on my son’s teeth – I was determined to embark on an adequate cleaning session. Rosie – enthused by the princess-decorated toothbrush Dr Druian had given her, managed to endure a full two minutes. Felix, alas, ran away before I resorted yet again to the headlock technique. But he insisted on taking his new pirate toothbrush to bed and his last words before falling asleep were “I go to the dentist again soon.” I live in hope.
Lindsay Argyle M ’15 has plenty of reasons to smile.
The certified dental hygienist officially completed her master’s degree in community health from SUNY Cortland last week when she presented her culminating project on a national award-winning program she helped develop. Her work, which relied on second-year students from SUNY Canton’s dental hygiene program educating schoolchildren in Rome, N.Y., earned recognition from the American Dental Hygienists Association (ADHA) earlier this summer at the organization’s annual session in Nashville, Tenn.
The Student Member Community Service Award sponsored by Colgate recognized a collective effort.
“The national award really is a reflection of both the (SUNY Canton) students’ hard work and dedication to their community and the quality education I received at SUNY Cortland,” said Argyle, of Fayetteville, N.Y.
An adjunct instructor in SUNY Canton’s dental hygiene program, housed in Rome, she also serves as the dental hygienist for Family Health Network’s local school health program, educating children throughout Cortland County on the importance of taking care of their teeth and other oral health services.
As Argyle finished all of her other master’s coursework in December, she saw a way for one quality program to fulfill two needs: the service component of a SUNY Canton community health course for undergraduates and her own capstone project at the College. SUNY Cortland Associate Professor of Health Jena Nicols Curtis encouraged Argyle, who collaborated with Kasey Penoyer, the community health instructor at SUNY Canton.
Lindsay Argyle M ’15
“It all went together,” Argyle said. “In my master’s courses at Cortland, I structured the framework to attempt an oral health promotion or tooth brushing program. After collaboration with Kasey and learning of the need for a community outreach program for the Canton students, I thought, why not structure one program that combines the two?”
The award-winning work started as an oral needs assessment among youngsters in Oneida County. It involved 16 dental hygiene students educating and screening more than 100 second graders at Bellamy Elementary School in the Rome City School District on vital habits such as proper brushing and flossing techniques as well as how to make food choices to ensure oral health.
Schoolchildren who showed signs of tooth decay were given referrals to a dental provider. Others took a field trip to SUNY Canton’s teaching clinic, where many received a dental exam, x-rays and sealants if they were eligible, as well as a fluoride treatment.
Dr. Terrence Thines, the chief of dental surgery for SUNY Upstate Medical University’s dental residency program, and two residents offered dental exams. Dental supply providers GC America, Dentsply, Patterson Dental and Ultradent donated products. And the Cortland College Foundation provided additional funding for the community outreach project.
“Our assessment showed that there was a large percentage of the students who were covered by insurance —including Medicaid — but the percentage indicating a dental visit within the past year was around 30 percent,” Argyle said. “Our needs assessment revealed unmet needs that included dental decay and issues with access to care.
“That’s what this project was about: providing much needed dental health education, identifying gaps in access to care, providing some free preventative services where care was needed, and providing appropriate referrals for problems that may have otherwise gone undetected. It was beneficial for all parties involved.”
The national honor proves as much.
If you plan to retire soon, add this item to your to-do list: a visit to the dentist before your dental insurance disappears.
Retirees transitioning to Medicare are often surprised to learn that the program does not cover routine dental care or more complex procedures.
Overall, 40 percent of the 65-plus population has some form of dental benefit, according to the National Association of Dental Plans. For seniors who use Medicare Advantage managed care plans, about half offer very limited coverage for cleanings and exams. A small percentage of seniors have dental insurance from a former employer, and Medicaid covers dental care for low-income residents in some states, although benefits vary. Some buy individual commercial plans or have coverage through an association such as AARP.
But most seniors just pay for dental care out of pocket – the mean expense for Americans age 65 and older was $870 in 2012, according to the Agency for Healthcare Research and Quality, a research arm of the U.S. Department of Health and Human Services.
The costs can be far higher for more complex procedures. The average cost of a crown in New York City is $2,500; a periodontal procedure in Los Angeles costs $1,700, according to Fairhealthconsumer.org , a service that tracks prices of healthcare and health insurance.
Those numbers help explain why 34 percent of seniors had not seen a dentist in two years in 2010, and 22 percent had gone without care for the past five years, according to the Kaiser Family Foundation (KFF).
“Dental care is conspicuously absent from the health care coverage for older adults,” says Dora Fisher, director of older adult programs at Oral Care America, a nonprofit group that advocates for better oral health.
Medicare celebrates its 50th anniversary later this month, and adding basic dental coverage is on the wish list of many health policy experts reflecting on the program’s future.
Research shows clear links between poor oral health, diabetes and heart disease. One out of four Medicare beneficiaries has edentulism – that is, they no longer have any of their natural teeth, according to KFF; that can cause other health issues, such as nutritional deficiencies and problems with speech.
Premiums for private plans, are reasonable – PPO plans cost around $15 per month, Ireland says. But individual coverage is not as robust as group dental plans. “Most have waiting periods before coverage for major procedures begins, and the dollar caps on coverage may be lower,” she says.
Ireland adds that dental insurers have been negotiating with the federal government to offer individual standalone dental plans (independent of health insurance) through the Affordable Care Act insurance exchanges, and she hopes expanded offerings will start showing up in 2016 or 2017.
Dental plans are available on many exchanges now, but they can only be purchased along with general health insurance. That effectively cuts out seniors, who are covered by Medicare.
Consumer advocates are pushing for Medicare to pay for dental care made necessary by other procedures that the program does cover. The Center for Medicare Advocacy (CMA), a non-profit legal organization, has filed lawsuits on behalf of cancer patients who have been denied coverage for dental procedures made necessary due to aggressive radiation of the head and neck.
“Medicare covers what happens to the patient’s eyes even though it doesn’t provide routine eye care – but there’s no coverage for this type of extreme dental care, and people are ending up in the hospital with infections,” says Margaret Murphy, an associate director and attorney with CMA. The Centers for Medicare and Medicaid Services did not respond to requests for comment.
The litigation has not been successful so far, but CMA has not given up. “We’re trying to figure out where to go with it next,” Murphy says.
My son just had his wisdom teeth removed . Lots of pre-surgery angst (How long is the surgery? Will it hurt? How long will it take to heal?) and stress (What to eat? How much missed school?). No worries…I got through it.
As a parent, I’m done with my son’s dental braces (√) and wisdom teeth extraction (√). As an adolescent medicine physician, I’m not done. I often see teens who have unresolved orthodontic issues or who are experiencing mouth pain or headaches due to wisdom teeth impaction.
Dental braces. Orthodontists use dental braces to correct the position of teeth. Many people who need dental braces get them during their early teenage years. The goal of dental braces is to properly align the teeth and improve not only the appearance of the teeth, but also the way a person bites, chews and speaks.
Dental braces offer corrective treatment for:
- Overcrowded or crooked teeth
- Too much space between teeth
- Upper front teeth that overlap the lower teeth too much
- Upper front teeth that bite behind the lower ones
Dental braces usually remain on for six months to two years. After the braces are taken off, removable retainers are worn according to a prescribed schedule. Wearing braces is generally very safe. However, as with any procedure, there are potential risks including gum disease and cavities due to bacteria that gather in spaces caused by the braces.
Wisdom teeth extraction. Wisdom teeth , or third molars, are located in the back of the mouth and usually start to emerge between ages 17-25. They are the last adult teeth to erupt. Most people have four wisdom teeth — two on the top and two on the bottom. A panoramic X-ray done during adolescence assesses the presence, development and position of the wisdom teeth.
Wisdom teeth become impacted when they don’t have enough room to emerge or grow normally. The following signs or symptoms may develop with impaction:
- Painful, swollen or bleeding gums
- Swelling around the jaw
- Halitosis (bad breath)
- Unpleasant taste
Dentists recommend removing a teenager’s wisdom teeth if they are impacted . In addition, because the third molars are in the back of the mouth and may be difficult to clean, some dentists suggest removing them if they are at risk for tooth decay and gum disease. Most wisdom teeth extractions are uneventful. Rarely, however, problems may occur , such as:
- Dry socket, or exposure of bone when the post-surgical blood clot is dislodged from the site of the surgical wound (socket)
- Infection in the socket from bacteria or trapped food particles
Bottom line: Teenagers need to have regular dental check-ups not only to have their teeth cleaned and to be checked for cavities and gum disease but also to evaluate for orthodontic issues and wisdom teeth impaction. These common dental issues may be bumps in the road for teens (and their parents!) but it’s all good when you see their beautiful smiles.