SEPARATORS

Introduction:
Separators create space between teeth so that silver bands will fit easily on the back teeth. These are placed approximately a week before braces are placed.

What to Expect:
1. If a separator falls out, please contact our office. If it is over the weekend, you may
wait until Monday.
2. Do not play with separators. Keep fingers out of the mouth.
3. Brush normally, but do not floss in the area where the separators are located.
4. No gum or other sticky foods. Such items could dislodge the separator.
5. It is normal for the separators to feel loose/mobile.
6. If there is any discomfort, please feel free to use Tylenol or your choice of oral analgesics, as needed.

HEAD GEAR

Introduction:
The application of extra oral forces (pressure directed to the teeth from outside the mouth) is as old as the specialty of orthodontics. Headgear is primarily used in the correction of overbites. The protrusion of the upper teeth can be either dental or skeletal in nature or the combination of both factors.

Headgear can be used to retract teeth (by producing a dental force) or to influence facial growth patterns (by producing a skeletal effect). Differences in the method of attachment, direction of pull, and the magnitude of force depends upon the results desired.

The length of time that headgear is necessary varies depending on:
1. Type of growth pattern
2. The severity of the discrepancy
3. The rate of growth of the patient
4. The consistency of wear/amount of time worn per day

What to Expect:
Some discomfort during the first week which may affect the ability to fall asleep at night. Taking Tylenol two hours prior to going to sleep will help during the adjustment period)
2. The back teeth may become slightly loose with consistently good wear.

What to Do:
1. Try to wear the headgear, 12 to 14 hour per day. Wearing the headgear all of the time would be ideal but is not usually possible or realistic.
2. Be consistent; wearing it at least every night. Missing even one night, requires several extra nights to make up the lost time and can extend the treatment time.
3. Keep a 'score card' to track the amount of time worn to allow us to determine if the progress is what should be expected from the time worn.
4. Bring the headgear and the score card with you to each orthodontic appointment.
5. Never wear headgear during rough play or sports - injury could occur.
6. If the face bow comes off at night, you may need to increase the force by one hole on each side.

PALATAL EXPANSION

Introduction:
When the upper arch is too narrow to fit properly with the lower arch, expansion of the upper arch is often indicated. In many cases, the most stable way to accomplish the expansion is by applying orthodontic force to the upper arch to achieve skeletal rather than dental expansion. The upper jaw bone in growing patients has growth centers called sutures which are soft cartilage. The mid-palatal suture separates the roof of the mouth into left and right halves. When pressure is applied in a controlled manner, the mid-palatal suture can be significantly widened, correcting crossbites and creating more room for the eruption and alignment of teeth.

The appliance used to expand the maxilla (upper arch) is called a Rapid Maxillary Expander (RME). This appliance is custom made for each patient. It is activated at home by the parents of younger patients or the older patients themselves. Expansion of the upper arch is accomplished in 2 to 4 weeks. The appliance remains in the mouth for approximately 3 to 4 months to hold the expansion while new bone formation takes place.

What to Expect:
1. The back teeth may be uncomfortable for 48 to 72 hours after placing the RME.
2. Swallowing may be awkward for several days because of the room that the appliance occupies in the roof of the mouth. Speech may also be affected for the same reason. Most children adapt and compensate within a day or two.
3. A significant space may develop between the upper front teeth. This is temporary and will usually begin to close automatically when the RME is no longer being activated.
4. After the initial adjustment period, when the RME is activated, the patient may feel pressure for a short time but there should be little, if any, discomfort.

Instructions:
1. Place the key in the front of the center of the RME and push from the front towards the back.
2. Withdraw the key towards the back of the throat when it will not go back any further and a new hole has appeared in the front of the RME. Be careful not to unwind the appliance.
3. Turn as instructed either once or twice a day (once in the morning and once in the evening)
4. Avoid eating hard or chewy candy, do not chew ice, and do not play with the RME with your tongue or fingers.
5. Please call the office if you have any problems or concerns.

Herbst/FReD APPLIANCE

Introduction:
You have been fitted with a state-of-the-art functional appliance that has been custom designed to fit your teeth. Although this appliance has been around since 1905, it has been modified over the last 10 years to make it more durable and more comfortable. This appliance has several unique advantages in that it uses the most natural force around the teeth to cause them to move - the jaw muscle! It positions the jaw into the correct alignment and if timed during jaw growth, the changes occur in both the teeth and jaw position. In order for this appliance to work it will need to be in place 9-12 months and will need to be checked every 6-8 weeks.

What to Expect:
1. As with any new device, you can expect a break-in period that might include a period of discomfort for several days.
2. During the first few days, you will prefer to eat soft foods slowly with your front teeth.
3. Don't try to force your back teeth together!
4. Do not chew ice, pens/pencils, or fingernails.
5. Expect to use Tylenol for any soreness or discomfort you experience during the first week.

Notice:
Over the years we have improved the durability of this appliance however, on occasion, breakage can still occur. The most common problem occurs when the rod separates from the sleeve when the patient yawns. This most often happens at bedtime! Patients usually can replace the rod into the sleeve by simply opening wide and threading the rod back into the opening of the sleeve. If one of the components breaks, don't panic! This is not considered an emergency unless the patient is in pain. Remove any loose rod or sleeve and call our office so that we may schedule an appointment for the upcoming week.

RETAINERS

Introduction:
Congratulations! Your big day has finally arrived and your braces have been removed. We know you are excited and proud of the effort you've put forth to achieve your new smile; but, your work is not finished. Your teeth must be retained, or held in their new positions until the bone, gums, tongue, and lips have adapted themselves to the new positions of your teeth. If you did not make an effort to retain the teeth following their orthodontic movement, they would tend to move back to their original positions.
You have been fitted with delicate plastic appliances called Retainers, which are custom designed and constructed for each patient. Retainers must be relatively thin in order to have a minimal effect on speech, and so must be handled with care to avoid breakage. While your first set of retainers are included in your original fee, an additional charge will be made for lost or broken retainers or for replacing retainers that do not fit properly due to improper wear.

What to Expect:
1. Your teeth may be uncomfortable for a couple of days, similar to when your braces were adjusted.
2. Speech may be affected for a short period of time while you adapt to wearing your retainers.

Instructions:
1. During the first three months: wear the upper and lower retainers for 24 hours.
2. After 6 months, wear both retainers nighttime only.
3. A fine emery board can be used to smooth rough or irritating edges.
4. Remove your retainers for eating, brushing, flossing and for athletic activities which may jar your retainers out of your mouth.
5. While wearing the retainers, do not chew gum. It sticks to the plastic.
6. Keep your retainers clean. While brushing your teeth, brush your retainers with toothpaste and cool water. They should be cleaned with Efferdent Denture Cleaner once a month.
7. When not in your mouth, always place your retainers in their case. Never leave them lying around or wrapped in a tissue.
8. Never place your retainers in hot water or near a hot surface, or leave them in your car on a hot day. The heat will warp the plastic causing them not to fit properly.
9. Pets love to chew on retainers! Keep them out of their reach.
10. Bring your retainers to each appointment. If lost or broken, call our office immediately.