Winter Park Dentistry-Orthodontics (braces)
Dr. Ramzi Matar (Winter Park Dentistry): Hello everybody, welcome to this episode of our video podcast. Today we have a very important topic, it is orthodontics, normally known as braces. Today I have an orthodontist, a specialist, who does strictly that, and his name is Dr. David McIntosh. I’ve got to tell you, I get more questions about braces than anything else. I’ve got to tell you a story; my brother has a child, a daughter due in 3 months. His wife called me and wanted to know if her daughter’s going to need braces. I said “you know, it’s just a little bit too soon”. So big question I get from a lot of parents, “how do I know and when do I need to take my kid to an orthodontist?”. Dr. McIntosh, start us off with this highlight question, please.
Dr. David McIntosh: Sure. It’s a common question, parents worry about that a lot. Generally, the family dentist will see that patient at the regular checkups and say “hey, I see some crowding here, this doesn’t look quite right, maybe a sign to see an orthodontist”, that’ll be typically the first exposure they’ll having to talking about an orthodontic checkup. Sometimes the parents will look and say “these teeth just don’t look right”, there’s lots of spaces in here, I’m worried about it. Sometimes parents just on their own will call, and schedule an appointment for their 6, 7, 8 year old, and that’s fine too. Most of the time, most orthodontic treatments can wait until all of the permanent teeth are out. Certain types of bites, or real skeletal problems, upper jaw too big for the lower jaw, or a cross bite, those kind of things, do need some early treatment to correct for. Most things can wait until the permanent teeth are in and a single phase of braces, versus two phases. Two phases being when a patient is six, seven, nine years old, where we do a bite correction early, maybe about a year’s worth of treatment, then go into a waiting phase while the rest of the permanent teeth come out, and then go back in the braces in the middle school years, in the 12, 13 year old range. Most things can wait until most of the teeth are in, but we see a lot of the young patients just to reassure a parent or the patient too that everything is normal right now. Space between the front teeth, that’s okay, let the other teeth come in. We see many many patients just to reassure them.
Dr. Ramzi Matar (Winter Park Dentistry): Just as a take-home, if I’m a parent watching this video… As early as 6 or 7, they can come see you too, make sure there’s no major cross bites or skeletal problems, I know we know this, but major issues that need to be faced early. But the vast majority, and I do see a lot of the cases that you treat, the vast majority, let’s say, out of a 100 patients, how many are able to be seen in one phase? Just as an average.
Dr. David McIntosh: I would say 90%.
Dr. Ramzi Matar (Winter Park Dentistry): Wow, so 9 out of 10 times, you’re just monitoring the 6 year old, making sure development is okay, and then you’re kind of maybe seeing them once a year, does that sound right?
Dr. David McIntosh: Sometimes we may recommend having some primary or baby teeth removed a little bit early that may facilitate the eruption of some of the permanent teeth, it’s not an unusual thing, no treatment, but referring the patient back to the primary dentist.
Dr. Ramzi Matar (Winter Park Dentistry): In their what, early teens, now I think it’s called tweens, twelve, thirteen, is that when you’re…?
Dr. David McIntosh: Yes, I think that’s probably the most common time, or grade wise, 6th, 7th, 8th, their middle school years, those are the times that most of the patients that need braces, are having them done.
Dr. Ramzi Matar (Winter Park Dentistry): Good, and I do remember, I got my braces the summer before 9th grade, and I think I got them off a week before the graduation from high school. I had 4 full years. What do you see in cases, on a typical, 9 out of 10 children, how long are they in braces?
Dr. David McIntosh: Today, the typical time in braces is maybe 15 to 18 months, that would be an average time for an adolescent to have braces today. There are braces and wires that work more effectively, efficiently, that the teeth respond to better than when I had braces. I had braces for at least 3 years. But it’s pretty rare to have braces on that long, with the present appliances and wires that we use.
Dr. Ramzi Matar (Winter Park Dentistry): So now again, as a parent, I’m watching this video, so you progress through… Let’s say 15, 16 comes around, are you still able in that same general time frame, 15 months, seeing their kids? What if you see a kid that’s 18 years old?
Dr. David McIntosh: At 18, patients are pretty much done growing by that time. In the adolescent years, the phase of growth, we can shape that a little bit, in correcting bite discrepancies, in overbites, or underbites. It’s a little more predictable in correcting in growing patients, and that’s why it’s a good time to do it, especially for bite corrections. In a non-growing patient, an 18 year old, they’re pretty much done growing, so we really are left just moving teeth around, we can’t guide the growth a little bit, which can be done in the earlier years.
Dr. Ramzi Matar (Winter Park Dentistry): So treatment might take a little longer as a 20 year old?
Dr. David McIntosh: Longer, yeah.
Dr. Ramzi Matar (Winter Park Dentistry): I do remember, early on, I had to extend my upper arch, I had a little pout, those things that I think at 18 are no longer an option.
Dr. David McIntosh: That’s right. You couldn’t do that when you’re non-growing.
Dr. Ramzi Matar (Winter Park Dentistry): Form e, I like when teeth are straight because they’re easier to clean, less susceptible to cavities and other problems, but a typical patient for me says “Boy, I’m too old, can I even get braces? I’m 55, my kids have braces, can I get braces?”, I know that not to be true, but tell everybody what happens if there’s an adult watching this video.
Dr. David McIntosh: More than half of our patients are adult, meaning over 18. We get them from when they’re 18 to their 80s that have orthodontic care. Braces, Invisalign, the other system that we use, a lot of these alternative braces, that create straight teeth like braces do. There’s some limitations to them, but in adults teeth move like they do in kids. We have to go slower sometimes, sometimes adults have crowns on their teeth, but all those things we work around and make it work very well for adults. Many adults are concerned about it, but they can wear braces very well, or Invisalign treatments, the alternative. It’s an aligner system, you wear those aligners most of the time, and they ease the tooth along, like braces do. That’s a little bit more patient-friendly, if that can be done, if they can take them out to brush, take them out when they have a thing, but they work very well. Take a lot of cooperation, you’ve got to commit to wearing them for about 20 hours a day, but they work very well.
Dr. Ramzi Matar (Winter Park Dentistry): Certainly from a social perspective I could see why adults would rather use Invisalign. That is another question, Invisalign versus regular braces? What is the bottom line there?
Dr. David McIntosh: Invisalign is a great alternative to braces. With most patients, a real bite correction would imply braces are needed, we can’t do everything we can with Invisalign that we can with braces, but the majority of adults can be treated with Invisalign. The patient that needs teeth removed, an extraction, sometimes it’s a little more difficult to get the teeth fixed with Invisalign than it is with braces, so you give patients options, to talk about, what are the limitations associated with Invisalign, but it’s a great system, and we can get the teeth adjusted well.
Dr. Ramzi Matar (Winter Park Dentistry): Kids and Invisalign. Can a thirteen year old get Invisalign?
Dr. David McIntosh: They can. It depends on the patient wearing the aligner. They’ve got to wear these aligners 20 hours a day. And sometimes parents have a little bit more of a concern to that. So I say “well, with the braces on, I know they’re on the teeth, I know they’re going to be working”. If we do Invisalign we’re really relying on the patient, the son or daughter, to wear these aligners as prescribed. If they don’t wear it for the prescribed number of hours, things don’t progress.
Dr. Ramzi Matar (Winter Park Dentistry): Yeah, I think that when I was 13, I probably would have lost it before I left your office. *laughs* So… I just saw on a highway, we were driving down, and we see a billboard that says “fast braces”, there’s two areas here that I want to ask you about, both pertaining to fast braces and the system Acceledent. What is fast braces, is it different, is it using any special potions? I’ve seen 6 months braces! What does the public need to know about? Is it something you do, is it not something you can do?
Dr. David McIntosh: Every day, we do fast braces. But what really fast braces is, it’s a system, a company that sets it up for every restorative dentist to do some limited braces. It would really straighten the front teeth. They would set them up with these braces and it fixes the front teeth. But it’s not for correcting bite relationships, or getting the back teeth to fit together correctly. With an orthodontist who wants to make things fit together or function correctly… Fast braces are something really for the cosmetic benefit of fixing the front teeth. We would like to do everything to make all treatment go faster, we can do this to make you get braces less time, which is great, and certainly it makes your front teeth look pretty straight, but you can’t always fix bite relationships and those sort of things. And the average time is more than 6 months, today, but the fast braces, it’s just an eye-catching advertisement, “look at this, this osunds great”, and it can make things look better in 6 months, but it can’t always fix what we feel is important. Getting bite relationships, or back teeth, get them corrected.
Dr. Ramzi Matar (Winter Park Dentistry): Again, a take-home for these fast braces… If I’m an adult seeing this, it’s somewhat marketing, nothing particularly special, or new about it. An orthodontist can do that, if the adult said “I just want to straighten these two front teeth out for whatever reason”, it’s not something you can’t do. Most orthodontists locally, wherever you are, can handle that.
Dr. David McIntosh: It’s nothing new, not special, it’s an advertising, marketing program.
Dr. Ramzi Matar (Winter Park Dentistry): And you were just about to get into… I had recently a patient do Invisalign, and he pulled up his iPhone and iPad, and he showed me this thing called Acceledent, and I reached out to the company to get more information, I have not heard back from them, but that’s neither here nor there, and it was a device that he was going to wear with his Invisalign… I don’t know, I think you might know if it costs more, I do believe it costs more… But I’ll just let you take it over. What is Acceledent? What do people need to know about that?
Dr. David McIntosh: Acceledent is a dental device that you bite on, and it vibrates for 20 minutes, sends these pulses to the teeth, and vibrates the teeth, and it may make the teeth more responsive to the forces of braces, or Inivsalign, that’s put on those teeth. It may make them move faster. It’s something that sounds great, it may very well work, but it really hasn’t been shown in a refereed journals, with studies that show that this is accurate. You bite on it, it jiggles or vibrates and sends these impulses that moves your teeth a little bit, and that might make the bone cells respond to make the teeth move a little bit quicker. But it hasn’t been really shown that it works like they have advertised to do. I think it’s about a thousand dollars, just the flat cost of that device, a significant addition to the cost of braces or Invisalign. Again, it really hasn’t been shown that it’s truly this thing. If it did, that’d be great, I’d love to give that to patients as an option, but until it’s shown to be accurately as depicted, we’re not pushing it or recommending it.
Dr. Ramzi Matar (Winter Park Dentistry): You said you wear this thing for 20 minutes a day?
Dr. David McIntosh: 20 minutes at a time, or at intervals during the day, and it may stimulate the teeth to move a little bit sooner or quicker than they would if that wasn’t there. So that’s the idea behind it.
Dr. Ramzi Matar (Winter Park Dentistry): So here we are, October 2014, and it sounds like the take-home here for an adult or anybody considering the Acceledent system is that there’s some preliminary studies, but it’s still kind of early, just like anything else, when science comes out. But again, as an orthodontist, here in Florida or anywhere, most orthodontists are going to stay tuned to the research and it’s a fair question to say “what is it? How do you feel about it?”…
Dr. David McIntosh: Absolutely. It might be a valid, usable tool for our practices.
Dr. Ramzi Matar (Winter Park Dentistry): People are always trying to get in and out of braces in a relatively shorter time, for me it was 4 years, now it’s 15 months. I heard a rumor, you’re a Florida State graduate, a Florida State fan… So this is kind of the ultimate question, I heard that if both your parents graduated from Florida State, that you naturally as a child of two Florida State graduates, never need braces because your teeth always come in straight 100% of the time.
Dr. David McIntosh:I understand to be true as well.
Dr. Ramzi Matar (Winter Park Dentistry): You just need to make sure both your parents went to Florida State. *laughs* Gee, Florida State’s on top of the heat, Heisman Trophy winners, looks that they could very well repeat as national champions this year, 2014-2015 season…
Dr. David McIntosh: You just got to keep the players out of trouble.
Dr. Ramzi Matar (Winter Park Dentistry): Keep them on the field! Well listen Dr. McIntosh, I really appreciate it. For any of you watching these videos, please, you can leave comments at the bottom, please feel free to ask questions, comments, we’ll do our best to answer them, do what we can to help out. We’re trying to get somebody who’s out there for the public to try and clarify as many questions as we have. Dr. McIntosh, thank you so much for your time.