Blog - Warsaw Orthodontics

June 26, 2020 by Dr Watson

Invisalign vs. Smile Direct Club

Many patients who need orthodontic treatment already know that they would prefer Invisalign or a clear option to straighten their teeth. I understand why an adult or even a teenager would want to have clear trays versus metal brackets in their mouth. I was actually one of these cases. I was in college when I had braces and searched the internet for someone who did Invisalign. Unfortunately, at the time, I was not an Invisalign candidate. If you have searched for a clear aligner option, then you are likely familiar with Invisalign and Smile Direct Club. But what is the difference and what do you need to know before starting?

I’m going to use a patient that I saw for a consultation to illustrate. Chris came to me for a consultation and was not interested in braces at all. He also had some very nice gold restorations done by his general dentist. For certain cases, like these, Invisalign is actually my preferred method for straightening teeth. I discussed with Chris, that his bite fit together really well in the back and I didn’t want to change that at all. He had more crowding with his lower teeth than his upper teeth. We would either have to do what is called IPR (inter-proximal reduction) to relieve crowding on the lower or open up spaces in the upper to relieve excessive force on his front teeth. We also discussed the height discrepancy between his two front teeth and what we could do after his Invisalign treatment was complete with his general dentist.

*Note all of his back teeth are touching

I didn’t see Chris for about a year and a half after this appointment. Chris called back and said he saw us a couple of years ago and was concerned with the price of Invisalign. He had decided to try Smile Direct Club. He shared with us that it was a “disaster and completely messed up his bite.” When I saw him again, he continued to tell me he could chew on his right side, but he does so very carefully and cannot chew hard. He brought his “retainers” to me but they did not fit at all. He said his retainers did not fit and when he tried to wear them, if he left them out for a period of time he could feel his teeth shifting. He said he was afraid to bite down because he thought he might break a tooth.

We updated his photos and noticed several things. Are his teeth relatively straight? They are straighter than when he started, but at what cost? Functionally, his bite does not fit together anywhere. He does not know where to bite. He has gum recession present in areas where he did not have it previously. This has resulted in him having to see a periodontist for grafting of his tissue in order to correct the recession.

*Note: Teeth do not fit at all in the back or front. Patient was afraid to bite down for fear of breaking a tooth. Not all rotations corrected. He now has gum recession on some teeth.

Seeing an orthodontist is a lot more expensive than going to a “smile shop,” where there is not a doctor present to even look at your teeth. There is a reason that Smile Direct Club claims their fee is 70% less than traditional orthodontics. Let’s take a look at the differences:

Initial Visit

Orthodontic Specialist: A trained assistant will take photos and a 3D xray. The orthodontist will do a thorough exam of your teeth, review the xray we took, and discuss your treatment options. If you are an Invisalign or clear aligner candidate, a trained assistant will scan your teeth for the trays.
Smile Shop: An assistant scans teeth, no xrays are taken, no specialist evaluates or communicates the findings with the patient.

Second Visit

Orthodontic Specialist: Delivers the trays and bonds attachments to the teeth. What are attachments? They are tooth colored filling material attached to your teeth so that the orthodontist can more precisely move the teeth to the desired point. The orthodontist checks the fit of the trays to make sure that they fit over the attachments well, fit the teeth well, and are not irritating the gum tissue, lips or cheeks.
Smile Shop: There is no second visit. Trays arrive in the mail and the patient begins wearing them.

Third Visit

Orthodontic Specialist: We see patients about 4-6 weeks after the delivery to ensure they are wearing the trays correctly and that the teeth are moving in the direction we want and according to the treatment plan
Smile Shop: There are no visits and no specialist to see even if you visit the store front.

All Subsequent Visits

Orthodontic Specialist: Depending on the case, an orthodontist will see patients every 6-10 weeks to review how the case is progressing. An orthodontist will typically do what are called “refinements” or additional scans for more trays to fine tune and get the teeth in the final position where we want them.
Smile Shop: Again, no additional visits. The patient will wear all trays mailed to them and move into retainers once they have worn all of the trays.

Below are some cases I have treated/ am treating with Invisalign. Please note, the most important thing for these patients, is they have a FUNCTIONAL bite, in ADDITION TO perfectly straight teeth.

If you are interested in Invisalign and want to know if you are a candidate, you can send your pictures through our virtual consult portal and we will be happy to let you know! Drop your photos here at this link: https://www.orthocalc.com/ss/?id=wZ57gdhY. Happy Friday!

May 21, 2020 by Dr Watson

Amaya’s Story: Watch Her Grow!

Amaya started coming to my office when she was almost 8 years old. She had undergone part of a phase I treatment before I started seeing her. This first photo was taken six years ago. One thing I know for sure is that I did not see then, what I see now!

Now, I see that her lips are apart, tongue likely rests down and between her teeth, not up at the roof of her mouth, and her lower jaw is recessed or set further back than the upper jaw. She has a V shaped upper arch because she mouth breathes, so her tongue rests in the down position which has the effect of widening her lower jaw instead of her upper jaw.

At the time, the treatment that was done moved her upper jaw back to correct her overbite, instead of bringing her lower jaw forward. Unfortunately, with a lot of orthodontic appliances today, the upper jaw still is still pushed back.

So, in the second photo, when Amaya finished her first phase of treatment, her overbite was in fact corrected. It was also likely easier for her to bring her lips together, although I now notice that she is straining her chin in order to achieve this. Did her upper jaw grow forward? No. Did her lower jaw grow forward? It looks like it did a little bit.

Through photos like these, I’m hoping that you begin to understand why I talk to all of my patients about mouth breathing, lip posture, tongue posture, and straining in the chin muscles. Each of these elements impact a child’s growth pattern. It can cause downward and backwards growth, leading to an overbite, or the lower jaw can grow forward excessively, leading to an underbite.

A year after her braces were removed, I saw her to monitor her growth and to see how her teeth and jaws were developing. My notes from this visit say Amaya was still tongue thrusting (despite using an appliance to keep her tongue back during the first phase). We tried to remind her to keep her lips together when swallowing and the tongue to the roof of her mouth. I see now, her head posture is forward to help her breathe better. She still had mentalis strain, indicating that she was still mouth breathing. Now, both her upper and lower jaws were growing backwards. We took additional photos and I saw mom and Amaya back a month later.

What was my treatment plan at that time? I discussed with Amaya and her mom, the only way to correct her profile and bite at that time was orthognathic surgery. I was going to send her to the oral surgeons and have her undergo surgery to bring both her upper and lower jaws forward. Luckily, at this appointment, Amaya’s mom also shared with me Amaya was having trouble sleeping. She was very restless at night. This improved once her tonsils and adenoids were removed, but since then had gotten worse. She was also having some TMJ pain.

Around this same time, I luckily started taking courses and learning about airway health and reasons kids grow the way they do, instead of just looking at trying to get their teeth to fit together without taking into consideration their profile. I also referred Amaya to Dr. Dan Klauer to address her TMJ issues. After one year of working with Dr. Klauer and doing myofunctional therapy, her lip and tongue posture was better. Mom reported she was doing much better, with less pain. She denied the orthognathic surgery option, which we are both thankful now, she decided not to move forward with that route.

Almost 3 years after her braces were taken off for Phase I, she was ready for the next phase. This was just the amount of time I needed to take several courses focused on airway health alternatives to traditional orthodontics that can help patients grow in a more forward direction.

The two photos below were taken 6 months into Amaya’s treatment. WOW! Amaya, her mom, and our entire office was thrilled with the amazing changes. Amaya had to put in a lot of effort with myofunctional therapy as well as becoming mindful about nasal breathing, keeping her lips together, and her tongue in the roof of her mouth. At this point, she still had a little strain to her chin and we discussed this.

Amaya continued her hard work. The photos demonstrate a more relaxed profile. Mom reported that Amaya was more relaxed, sleeping better, breathing better, and more confident!

Amaya and Denise, thank you both for your trust and allowing me to be a part of Amaya’s orthodontic journey. I will be forever grateful to have a part in Amaya’s beautiful smile and profile. She is one of the many reasons I love what I get to do each day.

“Do the best you can until you know better. Then when you know better, do better.”

– Maya Angelou

May 8, 2020 by Dr Watson

WHAT IS EARLY TREATMENT PART II

In a previous blog post I discussed the benefits of early orthodontic treatment, and answered the question I hear most often, “Why are we starting treatment when my child still has baby teeth?” A question I get asked almost as frequently is, “Why are we starting treatment when my child ONLY has baby teeth? Currently, the youngest patient in our practice is three years old and we have a two-year-old joining the ranks soon! So, why start orthodontic treatment on patients this young? For all the same reasons I listed in the previous blog post: https://warsaworthodontics.com/what-is-early-treatment/

1. 1. Does the child have a thumb sucking habit?
  2. Is the child a mouth breather?
  3. Does the child have a tongue thrust?
  4. Is there anterior and posterior crossbite?
  5. Does severe crowding exist?
  6. Can we intervene to change the child’s growth pattern?

Thumb sucking, mouth breathing, tongue thrusting, anterior and posterior crossbites, and severe crowding. All of these things change a child’s growth pattern whether they have all baby teeth, some baby teeth and some permanent teeth, or all permanent teeth.

What changed my treatment philosophy from the standard, not starting treatment until age seven, to sometimes starting treatment when they are as young as two? Several years ago, I traveled to a course with a colleague. The doctor teaching this course was starting treatment on two and three year old children. That course was the beginning of my journey to where I am today. I went on to take many more courses addressing this subject. I also began to question the growth and development of my own two children. I firmly believe that the earliest intervention is the best intervention for long-term health. My first teacher in this method often says, “If a child needs glasses, do we wait until a certain age to get them glasses so they can see better? No. So why should we wait to treat children until some permanent teeth or all of their permanent teeth are in?”

I have learned that children are much more resilient than we give them credit for. When I started my own daughter at age four, I was more nervous than she was! Grace has done wonderfully! I am so thankful that I have changed the direction of growth now, rather than waiting for it to progress necessitating more extensive treatment later.

The following photos are progress photos that show correction of an underbite when a child has all baby teeth. Also note the dramatic changes to the facial structure.

Early Treatment Progress Photos

Treatment time: 3 out of 18 months

Treatment time: 6 out of 18 months

April 24, 2020 by Dr Watson

Important Updates for Upcoming Appointments

Dear Patients and Families of Warsaw Orthodontics,

As we continue to operate during the Covid-19 Pandemic, we ask that all patients and parents please take a moment to review our protocol. The health and safety of our patients, families, and staff, is our top priority. We want to be able to provide continuity of orthodontic care in the safest way possible. We have always and will continue to adhere to the recommendations and guidelines provided by OSHA and the CDC.

All areas in the office considered to be “high touch,” will be out of use for the time being. This includes the coffee bar, water dispenser, IPADs, toys, and toothbrushing stations.

Prior to the patient’s appointment

We will be sending an Informed Consent (COVID-19) and Health History form to fill out and return at least 24 hours prior to the appointment (Click Here to complete them online)
Please brush your teeth prior to arriving to our office
Please take your temperature and notify our staff if you have a fever and need to reschedule your appointment

Once you arrive at our office

Text or call (574)269-3621 to let us know that you have arrived
When we are ready for you, our Front Desk Coordinator will text/call back to let you know that you can come into the office
- We are asking that only the patient enter our office unless you are coming for a new patient exam. This greatly reduces the amount of foot traffic in our office and helps to create a safe environment for our staff and our patients.
- All patients over the age of 5 years should wear a mask into the office and while seated in the clinic
- Should a parent need to join their child for the appointment, we are asking that you please also wear a face mask in order to help us keep our environment as safe as possible
Upon entry, we will have all patients sanitize their hands prior to being escorted to the clinic area for their appointment
Once the appointment is complete, a staff member will walk the patient back to the front of the office. Our front desk coordinator will call the parent to discuss the visit and schedule the next appointment. We will also have the patient use hand sanitizer prior to leaving.

After Your Appointment

For the safety and health of our patients and staff, we are kindly asking that you monitor your own health of that of your close contacts for a period of two weeks following your visit to our office. During that two week period, should you or someone that you have had contact with, develop symptoms of Covid-19, please call our office and report this so that we can take appropriate precautions.

Regarding scheduling

Please know, we understand there is some urgency with wanting to continue your treatment and we want to be able to provide that for you. While the nature of our services does not allow for social distancing between clinician and patient, we are practicing social distancing between patients and keeping foot traffic in our office to a minimum. Therefore, it is necessary that we limit the number of patients that we see in our office at any given time. In light of these changes, it may take longer than usual to get your appointments scheduled.

We appreciate your continued patience and cooperation during this time! Stay safe and healthy! We look forward to seeing you at your next appointment!

-Dr. Watson and staff

March 20, 2020 by Dr Watson

What I Learned This Week

This week has been a blur. I have been trying to remember the actual day I realized that I was going to have to close my practice for at least two weeks, and I honestly can’t remember at what time I thought that was even a possibility. Now, it’s even a possibility we may close for months or indefinitely as governors all over the states are mandating dental offices to close except for emergencies. If someone had told me a month ago I was going to have to close my office, I wouldn’t have believed you.

A couple of months ago when everyone kept saying a recession was coming, I asked my financial advisor what was the plan if we entered a recession? How was I going to pay my practice loans and student loans? I couldn’t have fathomed that anything of this magnitude was coming.

Each day this week was filled with the unknown. Every minute that passed, emails were filling my inbox with information on how COVID-19 was going to affect us. Ultimately, the American Dental Association recommended all dentists close their offices and only see patients with dental emergencies. In orthodontics, much of what we do is considered “elective.” First they recommended we close for three weeks. As of last night, the ADA president was recommending three months.

Niki, Bre, Nichole, Doris, Mary, Jess, Kyra, Ana, Myra, Brook, Emily, Gina…my team, my work family. The group of people I spend most of the hours of my week with. Every day, there were questions and issues to work through with my consultants. The thing that was on my mind all day while seeing patients, when I was trying to sleep at night, and the first thing when I woke up in the morning was my team. What would I do about our team if the office had to close? For anyone who has been in our office, I’m sure you can see and feel that our team has great chemistry. We always help each other and have fun and joke almost the entire day! No matter what is going on, my team will say to me, “whatever you need me to do, just tell me and I’ll do it. I’ve got you,” and I say the exact same thing back to them.

Each morning we have a huddle and I typically end it with some type of positive quote about teamwork, great attitudes, what we need to bring to our patients each and every day, etc. But, this week, the only quotes I had were bible verses. Prayer and finding my favorite bible verses gave me the strength and peace to know that I was doing the right thing for my team.

What is the silver lining? Life is so busy, and I constantly say I wish I could spend more time with my family. Well, here is the moment and my opportunity to do so. I have no control over this situation. All I can do is trust that we will get through this and cherish the time I have to spend with my family.

Philipians 4:6-7 Do not be anxious about anything, but in everything by prayer and supplication with thanksgiving let your requests be made known to God. And the peace of God, which surpasses all understanding will guard your hearts and your mind in Christ Jesus.

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