Not All Orthodontists Are Created Equal: What to Look for When Selecting an Orthodontist

In an ideal world, every orthodontist would be trained to the top of their profession and have the skills to provide the exact top-quality, compassionate care you need. In the real world, however, that’s not the case. Providers of orthodontic care can vary greatly in expertise and quality of care they provide. As the patient who is ultimately in charge of your own health, it’s up to you to know how to discern the difference between great and less-than-stellar ones in selecting an orthodontist for your family. Here’s what to look for when choosing a great orthodontist.

Look for Education and Training in Orthodontics

This may be an obvious point, but it’s an important one. In most cases, if you’re seeking orthodontic care, it’s best to get that from an orthodontist.

Let’s take a step back and look at what an orthodontist is, and how an orthodontist is different from a dentist. A dentist has completed dental school and provides routine and ongoing dental care to patients such as fillings, crowns, extractions, and more. An orthodontist is a dentist who has completed an additional two-year or three-year residency program in orthodontics, studying teeth alignment, the jaw, the bite, the anatomy of the face and head, and treatment options to address a variety of related problems.

While an orthodontist has the specialized training in this area, some dentists offer limited orthodontic care in their practices. They may have had a weekend course in orthodontics, and therefore feel comfortable presenting themselves as an expert in orthodontics to their patients.

But clearly a weekend course is no match for a multi-year residency. While some patients may have their orthodontic needs adequately met by a dentist, most others will need the advanced knowledge and expertise of a trained orthodontist.

Look at Expertise, Experience, and Results

Now that you understand the difference in training between dentists and orthodontists, it’s time to understand the difference between individual orthodontists.

While they all receive essentially the same education in their orthodontics residency, individual orthodontists may choose to specialize as they develop their practice. They may focus on serving a particular population, such as pre-teens or older adults, or a type of treatment, like Invisalign, or a related medical condition, like TMD or sleep apnea. As an orthodontist continues to specialize, he or she becomes better in their niche, and achieves better results.

As a patient, you should choose an orthodontist whose expertise and experience matches your needs. Ask about results. Many orthodontists have albums full of before-and-after photos they’d love for you to look at.

Look for Intangibles

Finally, there are other things that set some orthodontists apart from others. These are things that have less to do with the actual treatment and outcome and more to do with the experience you have from start to finish.

Convenience: Whether the office is close to you and maintains hours that work with your family’s schedules.

Affordability: This does not mean lower prices for orthodontic care, it just means affordable for your family. Consider whether an orthodontist takes your insurance, if you have it, or whether they allow payments that suit you.

“Bedside Manner”: How the doctor, the orthodontic team, and the front office staff treat you and your family. Most orthodontists I know are in this business because they care about their patients and want to make a difference in their lives. If you don’t believe your orthodontist feels this way about you or your family, then find another orthodontist you connect with.

Finding the right one for you

The orthodontist for your family is one with the right training, experience, and intangibles that match your family’s needs. Hopefully this blog will help you when it comes time to choosing the right one for you. To learn more about what a top-notch orthodontist is looking out for, check out my article, Why A Great Orthodontist Looks At The Bite, First.

What is holistic orthodontics and is it for real? 4 “Holistic” Busts

There’s a growing trend in orthodontic care: the “holistic orthodontist.”

As an orthodontist myself, one who does not use the “holistic” label, I want to clear up some confusion about what it means to be  “holistic orthodontist.” You may have heard this term and wondered what “holistic orthodontics” is and if ti’s right for you. Read on to learn more about what’s real — and what’s a myth.

Holistic Myth: “Holistic Orthodontics” Means the Same Thing to Every Orthodontist

Holistic Bust: The Term is Not Defined or Regulated

I put “holistic orthodontics” in quotation marks because the term is not one that’s widely defined by the American Association of Orthodontists (AAO) or any other authoritative body. While an orthodontist is someone who has completed dental school and an orthodontics residency, adding the word “holistic” in front of it doesn’t mean anything in particular. It’s essentially a marketing term that some orthodontists use to attract certain clients, and it can mean different things to each person. Same with “integrative” or “functional,” two other terms that are growing in popularity.

Holistic Myth: Only Holistic Orthodontists Look at Whole Body-Oral Health Connection

Holistic Bust: ‘Regular’ Orthodontists Understand This Vital Connection, Too

Holistic orthodontists typically tout their focus on whole body health. They stress the fact that they consider not just the alignment of teeth, but also the underlying jaw, bone, and anatomy of the face, and how that affects the whole body. They understand how orthodontic care can help with issues like sleep apnea, snoring, temporomandibular joint disorders, headaches, and other seemingly unrelated symptoms.

Guess what — ‘regular’ orthodontists do this, too! Our training is in this area, and part of what separates us from family dentists is our deep knowledge on how the mouth and surrounding anatomy connect to the rest of the body. Some orthodontists specialize in diagnosing and treating sleep apnea, TMD, and other disorders, whether they call themselves “holistic” or not. If these are issues you want treated, it’s best to look for experience and expertise rather than labels.

Holistic Myth: Only Holistic Orthodontists Try to Avoid Extractions

Holistic Bust: More and More Orthodontists Avoid Extractions Whenever Possible

For many years, removing teeth in order to have “room” in the mouth to straighten teeth was a very common practice in orthodontics; by some estimates, up to 75% of orthodontic cases involved an extraction.

But these days, as technology and treatment options have improved, there’s less of a need to remove teeth. Many orthodontists, not just “holistic” ones, consider extraction a last resort. In my practice, for instance, extractions are necessary in less than 1% of cases. I even recommend patients whose orthodontist suggests having a tooth permanently removed to get a second opinion.

Holistic Myth: “Holistic Orthodontists” Are Green

Holistic Bust: “Holistic” Is Not The Same As “Green”

There’s an assumption that a holistic orthodontist will also be one who cares about the environment, and that may often be the case, but they are not one and the same. Furthermore, many regular orthodontists consider themselves “green.”

Again, there’s no standard definition for this, so it can take on many forms, including how green the office is in terms of energy efficiency, how equipment and materials are sourced and disposed of or recycled, what types of materials are used in treatment, and more. If these things are important to you, ask your current or prospective orthodontist in what ways their office is green. They may not advertise it on their website, but it may be just as important to them as it is to you.

Is a “Holistic Orthodontist” Right for You?

I’m not trying to “bust” any orthodontists who call themselves “holistic,” I just want patients to understand what that term actually means. No one should jeopardize their dental care based on false assumptions. In the end, what really matters is finding an orthodontist whose education, experience, and practice you like and trust, whether they do or don’t call themselves “holistic.” Remember, there was a long while where the label ‘fat free’ implied healthier. Now we know these products are often not healthy and the label was simply a way to generate more sales. When looking into orthodontics, be sure to do your homework.

Why A Great Orthodontist Looks At The Bite, First

Orthodontists are dentists who have gone through additional training after dental school learning about the mechanics of the jaw and teeth, including alignment, the temporomandibular joint (TMJ), and the bite, or the way top and bottom teeth fit together. Some orthodontists look at tooth alignment first, but in my opinion, a great orthodontist is one who looks at the bite first. Why? Because the bite is a foundation of good oral health. A misaligned bite can lead to tooth pain, temporomandibular joint (TMJ) pain, jaw muscle (this also can be labeled TMJ) pain, tooth wear, and gum recession.

That’s why great orthodontists look at bite first. They know that by addressing issues with the bite, they can take care of other issues or symptoms. No sense building a beautiful house on a poor foundation.

Here’s more detail on why.

A Bad Bite Harms the Teeth

When your bite is bad, you may experience that as toothache. It takes a just a fraction of a millimeter of being “off” for it to cause you pain.

Causing even more long-term damage, however, is wear to the tooth’s surface that results from a bad bite. When the bite is off, the top and bottom teeth don’t fit well together. Imagine a gear where the cogs don’t line up; as the gear turns, the cogs rub together and wear away prematurely. It’s the same with your teeth when you have a bad bite. The protective outer layer, the enamel, wears away, exposing the vulnerable dentin underneath. Once this happens, simple fillings are usually not enough to fix the tooth. More complicated and expensive restorative dental work becomes necessary.

A Bad Bite Is Bad For Gums

This one might be surprising, because it’s hard to see the connection at first between the bite and the gums. But a bad bite, which can happen when teeth are even slightly “off,” wears away the gum tissue, leading to gingival recession. Abfraction, or notching of the teeth at the gumline, is another symptom. Both of these symptoms are common in adults over 25 with misaligned bites. When the gums recede too much, they need correction, which can be expensive and invasive to fix.

As a bonus, I’ll add that a bad bite not only wears away the gums, but the underlying bone, too. Just another reason to have an orthodontist look at your bite.

A Bad Bite Hurts the Jaw Joint and Can Cause Pain

A bad bite from a misaligned jaw can often lead to pain in the jaw joint, or the temporomandibular joint (TMJ). Problems with this joint are called TMD, or temporomandibular joint disorders.

The reason TMD is so bad is that it can lead to a variety of symptoms like “clicking” or “popping” noises, pain in the jaw, or in some cases, inability to open or close the mouth properly. It can also cause symptoms outside the mouth area, including headaches and pain in the shoulders, neck, and back, and much more, which originate from muscle pain. Unexplained headaches, including migraine headaches, are a common symptom of TMD, particularly early in the morning.

Orthodontists are well-equipped to address this type of “unexplained” pain, which often has a clear explanation, as they are exquisitely trained in the anatomy of the head and neck.

A Great Orthodontist Starts with the Foundation

Imagine a builder comes to your home to fix your wall and puts up plaster, when the real problem is wood rot underneath. The wall may look nice from the outside, but it’s just covering up the real problem, which will only get worse.

It’s the same thing with orthodontic care and the bite. A good orthodontist knows that the bite should be addressed first, or else other problems may emerge or get worse over time.

Oral Care For Kids: 5 Signs Your Child Isn’t Brushing Right

Oral care for kids can be a tricky thing. How do you know if your child is brushing his teeth correctly? You want him to learn to be self-sufficient and brush on his own, but at the same time you want to make sure he’s doing it right. Fortunately, there are a few signs you can look for that indicate your child isn’t brushing his teeth properly.

#1 Brushing is over too quickly

No sooner do you send your little one off to the bathroom to brush her teeth then she comes right back out, declaring “All done!” This is a sure sign she’s not brushing right.

Brushing teeth – even baby teeth, and even when there’s not a full set – should take at least two minutes. It takes a while to get all the tooth surfaces and gums. If her time with her toothbrush is super short, you know it’s wrong.

#2 A coated tongue

Ask him to stick his tongue out at you. What color is it? A clean tongue is pink and fresh looking. A tongue that hasn’t been cleaned, however, may look white or yellow. When the tongue isn’t cleaned, it can develop a coating of dead cells and bacteria. Yuck. Fortunately, it’s easy for your child to get rid of – all he has to do is brush!

#3 Bad breath

That bacteria covering the tongue? That can lead to stinky breath. So can plaque build-up and food particles caught between teeth. If your little one’s breath is on the foul side, you know she’s not brushing correctly. Fresh breath comes from a clean mouth.

#4 Bleeding gums

Gums tend to bleed when they’re not in great shape. Whether your child is flossing his teeth on his own, or you’re still doing it for him, lookout for the telltale sign of blood after flossing. It’s a sign that gums need some TLC.

Flossing regularly will help get gums into shape, and so will correct brushing technique. Make sure your child knows how to brush along the gumline to get rid of bacteria and build-up. As gums get healthier, they’ll stop bleeding.

#5 Cavities

Another sign your child isn’t bushing right is when the dentist discovers decay. A cavity may call for better brushing technique or more frequent brushing. Discuss with your dentist what to focus on to keep her teeth healthy – and avoid more cavities in the future.

How to Encourage Oral Health in Your Child

Whether your child loves brushing his teeth or not – and many children do not – it’s an essential part of the daily routine. Oral health is too important to ignore, not just because it’s important to a healthy smile, but because it’s a critical component of overall health, too. Knowing that, it’s vital to encourage good oral hygiene habits in your child as early as possible. Here’s some things you can try to make that happen.

Start On Time

Children can be expected to start brushing on their own around age 6, which is around the age that they’re coordinated enough to tie their own shoelaces. Before that, you will need to brush your child’s teeth. The American Dental Association recommends brushing twice a day, including once before bedtime, with a fluoride toothpaste and a child-sized brush.

Likewise, you’ll need to floss your child’s teeth until he’s old enough to do it himself. You can expect to start flossing for him as soon as two teeth touch, which occurs around the age of 2, and until he can do it on his own, anywhere between 7-10 years old.

Show That It’s Important

Reinforce the idea that having clean, healthy teeth is important. Do this by modeling good behavior. Your child should know that you brush and floss regularly; it’s even better if she sees you doing it.

She should understand that taking care of our teeth is something we are in control of and is important for healthy teeth, a beautiful smile, and good overall health.

Make It Fun

For little ones who refuse to brush, parents can get creative and do what it takes to make the process fun. What works best depends on your child, but some ideas to try include:

Grab your toothbrush and join in! Brush side-by-side. This also helps reinforce the idea, as above, that brushing is important.

Get a fun toothbrush and toothpaste. Let him pick out the one he likes best, whether that’s in his favorite color or has a character he likes on it. Likewise, there are plenty of kid-friendly fluoride toothpastes that get the job done but come in fun flavors and colors.

Play a special song each time she brushes her teeth – one that lasts about two minutes – and have her brush the whole time the song is on.

Develop a rewards system. A simple chart with a sticky star for every time he brushes his teeth can be very effective!

Follow up brushing with a fun activity your child enjoys. She’ll come to understand that after brushing, she gets to play with a particular toy, or have a 5-minute dance party, or hear story time.

Make It Routine

At the end of the day, whether brushing is fun or not, it’s something that has to happen. Once your child learns that this is a non-negotiable part of the daily routine, he won’t argue anymore. It can take a while to get there, but the reward is a strong foundation of an important habit that will last a lifetime.

Bad Oral Health Habits Parents Pass On

Child see, child do. Kids are great at modeling our behavior. That’s why it’s important to model good habits when it comes to oral hygiene. When your child sees you engaging in bad habits, he may be more likely to copy them. Here are some bad oral health habits to watch out for so you don’t pass them on to the next generation:

Skipping brushing after meals…

You tell your child all the time how important it is to brush after meals. If that’s true, then why don’t you do it? Get into the habit and make a point to tell your child that you’re going to brush your teeth. Your child needs to know that this is something you do regularly, especially after sugary snacks and drinks.

…And forgetting the floss

Ditto for flossing. Your child needs to see that you floss and that you do it regularly.

Sharing your toothbrush

Sharing is a lesson we want to teach our children – except when it comes to toothbrushes! Your child should know that it’s never ok to share toothbrushes with anyone else. So don’t get caught doing it.

Using a gross, old toothbrush

Has your toothbrush seen better days? Are the bristles are worn down and splayed? No good. Not only are frayed bristles not effective at cleaning, they may actually hurt the enamel. Plus, an old toothbrush may harbor gross bacteria… so instead of making teeth cleaner, you’re making them filthier.

Don’t let your little one see you using an old toothbrush. If your toothbrush is old, it’s time for a replacement.

Biting your fingernails

There are lots of reasons not to chew on your fingernails. First off, it makes your fingernails look raggedy. It’s also a great way to bring nasty bacteria from dirty hands straight into your mouth. Finally, it’s bad for your teeth! The constant stress from frequent nail biting can lead to chips and cracks. Break the habit.

Chewing on pens, pencils, etc.

Your teeth are for chewing food and gum, not pens, pen caps, pencils, straws, etc. Using your teeth for things it wasn’t designed for can cause hairline cracks, wear away at the tooth surface, and even cause broken teeth.

Skip the ice, too – yes, it’s food, but it can cause cracked and chipped teeth and can damage the dental work you have, like fillings and crowns. (Note that excessive ice chewing is a sign of anemia, or low blood iron. If you chew ice and can’t stop, talk to your doctor about the possibility of low iron levels.)

Using teeth as a tool

Don’t let your child see you ripping open packages or tearing off tags with your teeth. Take the time to go get scissors or a knife and use the tool that was made for the job. As with the point above, using your teeth in a way they weren’t intended can cause damage.

Eating lots of sweets

Sugary snacks, chocolates, caramels… you don’t want your child eating too many of these things, so why are you eating them? As you know, the sugar left on your teeth after eating sweet snacks leads to cavities. (Technically, the sugars feed the bacteria in your mouth that produce the acid that eats away at the enamel. But the end result is the same.)


There are many reasons you don’t want your child to smoke, including the health risks, the money, and the smell. Add bad oral health to that list. Smoking is actually very bad for your oral health, and not just because it’s associated with an increase in mouth, throat, and larynx cancers. It’s also a cause of bad breath, discolored teeth, and gum disease. If you still smoke, try to quit – for your sake, and your child’s.

Get into good habits and break your bad habits. After all, when it comes to encouraging good oral health habits in your child, the best thing you can do is be a good role model.

Practical Advice From an Orthodontist to a New Mom

As a new mom, you have so many things to think about. It’s likely that oral health, dental care, and orthodontics for your new child are far down on your priority list – especially when your little one doesn’t even have any teeth yet! But it’s never too early to make a plan for the future so you know what you’ll do when the time comes. Here’s some practical advice from an orthodontist to new moms:

Hit Oral Hygiene Milestones

Before teeth have even erupted, you can help keep baby’s mouth clean by wiping down her gums at least twice a day with gauze or a moist washcloth.

Plan to start brushing as soon as baby’s teeth come in, around 6 months old. The American Dental Association (ADA) recommends using fluoride toothpaste the size of a grain of rice on a child-sized toothbrush twice a day.

By age 3, your child should have a full set of baby teeth – 20 of them – at which point the ADA recommends upping the amount of toothpaste from the size of a grain of rice to the size of a pea.

Around age 6, your child should be able to brush on his own. He’ll have the coordination to do it himself. At this point, he can also graduate” to using an adult-sized amount of fluoride toothpaste on his brush.

Same for flossing. Plan to floss your child’s teeth as soon as two teeth are touching, and let her floss on her own when she’s got the coordination for it, anywhere from 7-10 years old.

Visit the Dentist – And the Orthodontist – Early

The American Academy of Pediatric Dentistry recommends an initial visit to the dentist when the first tooth erupts, or no later than baby’s first birthday. From then on, make twice yearly check-ups a part of your child’s routine. It’s your choice whether to have your child visit a pediatric dentist or a family dentist. Some children who dislike the dentist have an easier time at the pediatric dentist’s office, which was built with children in mind.

What about the orthodontist? The American Association of Orthodontists recommends (PDF) all children see an orthodontist by the age of 7. This may sound like it’s way too early, but going this early is actually very prudent. Some issues can be addressed more quickly and more when caught early, such as issues with the growth of the jaw bone, remaining baby teeth, impacted teeth, the number of teeth growing in, and more.

Fortunately, the majority of children this age will not need treatment. If treatment is needed, it can often be until the age of 12 or 13 or later. If treatment is needed, however, starting it early can save time, trouble, and money.

Model Good Behavior

Modeling good oral health behavior yourself is one of the best ways to show your child just how important good oral hygiene is. Your child should know that you brush and floss, see your dentist regularly, and avoid sugary snacks in excess. Basically, you should be doing yourself all the things you’re telling your child.

It’s never too early to start a routine or oral health care for your little one. Remember that the habits you help instill now will be with your child for life, ensuring healthy teeth and a beautiful smile.

Toothaches: When To Take One Seriously

Tooth pain can be caused by a variety of things including physical trauma, tooth decay, or even a sinus infection. Some occasional tooth sensitivity may be normal for you and nothing to worry about, but certain types of tooth pain warrant a visit to the dentist or orthodontist. Here’s what you should know about toothaches.

Physical Damage to the Tooth

A fall, object to the face, or even hard candy or other piece of food can lead to physical damage such as a cracked or loose tooth. This is considered an emergency and you should try to see your dentist or orthodontist as soon as possible if it’s during business hours. Otherwise, seek help at an urgent care facility or E.R. and plan to follow up with your practitioner soon after.

If a tooth has come out of the socket completely, or a large chunk of a tooth has broken off, keep it clean and moist by holding it in your mouth or placing it in a cup of milk until you’re seen.

Severe Pain

Pain so severe that you can’t concentrate on what you’re doing should be addressed by a professional. Don’t just keep popping painkillers and hoping it will go away. Pay special attention if this pain:

  • Gets worse with hot or cold
  • Gets worse when chewing or putting pressure on the tooth
  • Is accompanied by fever
  • Is accompanied by pus and fluids in the area

Call your orthodontist’s or dentist’s office and let them know that you’re in severe pain. Hopefully, they will be able to see you right away and help fix the source of the pain.

Long-Lasting Pain

Pain that’s not severe but that doesn’t go away is something to have checked. Two days or more of constant pain is not normal and indicates an underlying problem, such as tooth decay or gum recession. In many cases, the earlier you address the problem, the easier it will be to fix, so don’t delay in setting up an appointment to see your healthcare professional.

Long-term pain can also be caused by clenching or grinding, which are symptoms of a problem with the temporomandibular joint (TMJ). An orthodontist can help you with the underlying problem, typically a bad bite,” to address the clenching and grinding.

After Having Work Done on Teeth

If you’ve just had some major dental work done and you’re in bad pain afterwards, you may need to go back for another visit. A little soreness after a cavity filling, crown, or root canal is normal, but excessive pain is not. The work might need to be tweaked or redone completely. If it hurts, it’s best to have it looked at.

One time you can safely skip a visit for toothaches? If you’ve just been to the orthodontist and had your braces tightened. This is likely to cause pain, but the pain shouldn’t be severe and will not last more than a day or two.

Before Long-Distance Travel

Any tooth pain, even if it’s mild or short-lived, should be looked at if you have travel plans in the future, especially if your travel destination is remote or doesn’t have good access to reliable dental care. A small pain now can turn into a big pain later, disrupting your travel plans, costing a lot of money, and causing a lot of pain. A little prevention now can be worth so much later.

Prevent Toothaches in the First Place

The best thing you can do is avoid the pain of toothache in the first place, which you can do by brushing and flossing daily, having regular professional cleanings, and going in for a yearly check-up with your dentist. If you wear braces or any other appliances, or have in the past, a regular visit with your orthodontist to check up on your bite is smart, too.

When it comes to your oral health, it’s better to be safe than sorry. Err on the side of caution and call your dentist or orthodontist when you’re experiencing a toothache.

What to Remember About Your Retainer

The job of a retainer is straightforward: Keep the teeth in place.

After orthodontic treatment, teeth have a tendency to want to move back to where they came from. It takes a while for the mouth to become accustomed to the new arrangement, and that’s why retainers are necessary. If they’re not used, especially in the first months after ending treatment, the risk of relapse is high. Remember, everything in the human body is subject to change over time. Teeth are not immune. There are many forces at work on your teeth including speaking, chewing, and pressure from your cheeks, tongue and lips. These forces can all cause tooth movement without retainers.

There’s actually more than one type of retainer. Most of the time (and in the rest of this blog), when we talk about retainers we’re talking about removable retainers, which can be put in and taken out of the mouth at any time. There are also permanent (often called fixed’) retainers, which are wires bonded to the back of a number of teeth to keep them in place. hey are, as the name suggests, permanent, and can only be removed by your dentist or orthodontist.

A retainer from your orthodontist or dentist can cost hundreds of dollars. It costs a lot because it’s custom-made for your mouth and is created to be very durable. Getting a replacement retainer is expensive, so remember to take good care of your retainer! It should be in your mouth or in its storage case nowhere else. It’s more likely to be damaged or accidentally thrown away when it’s removed and casually laid aside or wrapped in a napkin.

It Needs Regular Cleaning

Each day, make sure to clean your retainer according to instructions from your orthodontist. Otherwise, you risk bacteria growing on it, which you don’t want to put back into your mouth.

Remember to bring it along with you to any orthodontic, dental, or hygiene appointments. It can be checked for fit and thoroughly cleaned in the office, too.

It May Be With You For a While

Once braces are off, your orthodontist will talk to you about your retainer, how often you should wear it, and for how long. It may be anything from nighttime only to 24 hours a day (apart from eating and brushing). It may be for 6 months or two years or forever.

Not too long ago, it was standard to recommend wearing retainers for a year or two after the end of treatment with braces. However, that often led to teeth moving back towards their original positions. Now, orthodontists suggest wearing retainers indefinitely to keep your teeth where they are. Otherwise, teeth could shift to the point where braces are necessary again.

It Only Works If You Wear It!

Retainers are fantastic at doing their job when used properly. To keep your teeth straight and your bite good, wear your retainer according to your orthodontist’s instructions. Know that your orthodontist has come up with your oral care plan very deliberately and is interested in helping you maintain the beautiful smile you invested so much in.

It may a nuisance to wear a retainer, but it’s a small price to pay to keep your smile beautiful.