Asking your orthodontist the right questions can ease anxiety about your treatment plan.
Like stressful trips to the dentist, an appointment with an orthodontist can raise anxiety in many patients.
While dentists work on a wide range of oral health issues related to the teeth, the gums and the jaw, an orthodontist is a licensed dentist who is trained to diagnose, prevent and treat misaligned bite patterns and malpositioned teeth and jaws. In short, orthodontists are the specialists in dentistry who are trained to provide teeth straightening and teeth correction services.
Most orthodontists are trained in the growth and development of jaws, teeth and different facial growth patterns, says Harry L. Dougherty, an adjunct clinical professor in the department of orthodontics at the Herman Ostrow School of Dentistry of USC. Orthodontists typically undergo an additional three years of training after four years of dental school.
Orthodontists work on an array of dental issues, including:
— Crooked teeth.
— Overcrowded teeth.
— Identification of face and skeletal growth patterns.
If you’re considering orthodontic treatment, here are eight questions you should ask your orthodontist:
1. What are my treatment options?
Orthodontists use different approaches to straighten the teeth of their patients, Dougherty says. Patients should ask about their choices. “There’s strengths and negatives to each of the approaches,” he says. “It’s important to ask what the options are, and which will work for you within your lifestyle. Not every approach is going to work for everybody.”
Teeth in your mouth respond to the forces applied to them. Therefore, the one thing each approach has in common is that they straighten teeth by pushing them into the correct place.
Widely used orthodontic treatment approaches include:
— Traditional braces.
— Lingual appliances.
— Removable appliances (Invisalign, for example).
— Active retainers.
2. How do different treatments work?
Your orthodontist can explain how each of the orthodontic treatment options work, Dougherty says.
Traditional braces. This was the go-to orthodontic appliance for earlier generations. Braces have brackets bonded to the front surface of the teeth and wires attached to the brackets. The wires create the force for moving teeth into their desired locations.
Lingual appliances. These devices are similar to traditional braces, but are placed on the tongue side so you can’t see them from the front. “For aesthetic purposes, some patients prefer their braces not be visible,” Dougherty says.
— One kind is clear aligners, which resemble clear mouth guards but are very thin and comprised of multiple layers of special plastic material. These aligners typically have tooth-colored attachments that function like brackets that are placed on each tooth. These attachments help the aligners apply the right forces in the right place to create controlled tooth movement. “We’ll change these about once a week, because the amount of movement we get per (aligner) is small,” Dougherty says. “You wear them all the time except when eating.”
— Another type of removable appliance is an active retainer, which has springs and wires that move teeth, he says. One version of this kind of retainer has wires and a plastic base, and another is made completely of wires that are soldered together. The patient wears these kinds of retainers at all times except when eating.
Retainers. When the tooth movement is complete with an active retainer, he or she can wear a traditional retainer (without springs or wires to move teeth) to maintain the position of the teeth. So, unlike the other kinds of retainers, a traditional retainer doesn’t move teeth, it simply keeps them in place. Eventually, the patient may only wear it at night.
3. How can I maintain my oral hygiene at home?
Routine brushing and flossing are absolutely essential to maintain good oral hygiene, Dougherty says. Doing both following meals is essential to preventing the buildup of plaque and avoiding cavities.
If you’re wearing traditional braces, ask your orthodontist to demonstrate the best way to brush and floss. Maintaining good oral hygiene is particularly critical for people who wear braces because food can easily be caught in the wires, bands and brackets of these appliances.
Oral hygiene for people who use aligners is simpler because aligners are removable, so they don’t get in the way of your typical home care routine of brushing and flossing. “You can use the same oral care techniques you typically use, and it will be easier and take less time,” he says.
It’s also important to see your dentist at least every six months to make sure your teeth are clean and free of cavities.
4. Will insurance cover my orthodontic procedures?
Many dental insurance plans will have a certain level of orthodontic coverage that can be used toward comprehensive orthodontic treatment, says Tanya Vaysman, an orthodontist in private practice in New York City. Typically, insurance covers varying levels of orthodontic treatment for adults and adolescents. Some plans have an age limit clause, in which treatment is only covered for individuals under the age of 18.
No dental insurance will cover orthodontic treatment completely, so you would expect some out-of-pocket costs. Your orthodontist should be able to verify your insurance coverage as well as show what the out-of-pocket expense would be prior to starting treatment. Most orthodontic offices will have payment plans for patients who need them. You can also check with your insurer to ask what orthodontic treatment is covered and at what percentage.
Some patients have a misconception “that insurance will pay more or less depending on the complexity of the case,” Vaysman says. “That is not true. Different insurers allocate different amounts they will pay toward orthodontic treatment. That amount will not change if the treatment is complicated and will take a long time.”
She notes that patients who have a flexible spending account or a health savings account through their job can use those funds to pay for orthodontic treatment. Flexible spending accounts, or FSAs, and HSAs are programs in which workers can set aside funds (which aren’t taxed) to pay for qualified medical, dental and orthodontic expenses.
5. Does Medicare cover orthodontic treatment?
Medicare doesn’t cover orthodontic expenses, Vaysman says.
Medicaid — the federal government program that insures more than 70 million people, mostly low-income individuals — sometimes covers orthodontic treatment for kids in severe cases. However, most private practices don’t work with Medicaid.
The patient’s parents would need to check with dental schools to see if they qualify for receiving care under the Medicaid program, Vaysman says. Some dental schools will accept Medicaid to defray the cost of the procedures while allowing their students to work with patients.
6. Do I really need braces, even if my dentist referred me?
There are many factors to weigh when determining whether a patient is a candidate for orthodontic treatment, says Craig Feldman, director of orthodontics at the Smilist Dental practice in New York City. First, you’ll need X-rays, intraoral and facial photos and a scan or models of your teeth, which your orthodontist will evaluate.
Some orthodontists may also use special orthodontic imaging and measurements — known as cephalometric tracing — to determine jaw position before deciding on the best treatment plan. “The orthodontist will look at the growth and development of the patient, along with the tooth development,” Feldman says.
The orthodontist will also look for conditions that need to be treated, including:
— Anterior or posterior cross-bites.
— Large spacing.
— Deep bites, which can cause bone loss or destruction in the upper arch.
— Impacted permanent teeth, which are not the third molars or wisdom teeth.
7. Do I need teeth extracted?
Depending on the condition of your teeth and your goals, you might need a tooth or teeth extracted, says Robert Shelling, an orthodontist based in Boca Raton, Florida.
“You want a smile that’s natural, and sometimes removal of teeth are necessary to give you a smile that is perfect for your face,” he says. “It’s usually apparent to most patients when they see their X-rays that they need some teeth removed as part of their orthodontic plan. The benefit is that the extractions will ensure not only a better outcome from braces or an aligner, but also easier maintenance.”
8. Will I need to wear a retainer after treatment?
“I recommend people wear a retainer every night for life,” Shelling says. “Your teeth will shift after you’ve had braces. In truth, even if you’ve never had braces, your teeth will shift. Wisdom teeth move your teeth, but even people without wisdom teeth will see them shift. The retainer maintains the position of teeth that you want them to be rather than where they’re naturally moving.”
To recap, here are eight questions you should ask your orthodontist:
— What are my treatment options?
— How do different treatments work?
— How can I maintain my oral hygiene at home?
— What procedures does my insurance cover?
— Does Medicare cover orthodontic treatment?
— My dentist referred me, but do I really need braces?
— Do I need teeth extracted?
— Will I need to wear a retainer after treatment?
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Update 05/11/22: This story was previously published at an earlier date and has been updated with new information.