Common Questions Patients Have – And The Answers

By Dr. Emily Watson

Patients and the parents of patients often arrive at our offices with plenty of questions.

This isn’t surprising. Orthodontic work isn’t something the average person encounters every day. My team and I are immersed in the intricacies of crowded teeth, narrow jaws, overbites, underbites, and the pros and cons of traditional braces versus clear aligners. What to us seems typical and routine may seem like a mystery to those who live most of their lives outside our world.

Then one day they are thrust into our world, and that’s when the questions bubble up.

We are happy to answer because the better informed the patients are, the more engaged they will be with the process and the more successful the treatment will be.

 

Expanding a Young Child’s Jaw?

One of the most common questions I hear is some variation of this query: Can you really expand a child’s jaw even when they are so young that they still have baby teeth?

The short answer is yes, but the short answer usually needs to be followed with some explanation.

For the uninitiated, let’s start by discussing what jaw expansion means and why it is sometimes needed. 

A brief biology lesson will help: A person’s upper jaw is actually separated into two halves that are joined together at the midpoint of the roof of the mouth. This point where the two halves of the jawbone are fused together is referred to as the intermaxillary suture.

Sometimes a person’s jaw is too narrow, causing problems that interfere with the normal growth of the teeth or in other ways affect the person’s health. To address this, we can expand the jaw using an orthodontic appliance called a palatal expander, which fits inside the mouth, attached to the upper back teeth. The expander gradually begins to separate the two halves of the jawbone at the suture. Over a number of weeks or months, the jaw is widened to where we need it to be.

The most common situations where expanders are used would be to correct severe crowding or a crossbite.  

Now let’s get back to that question about using a palatal expander with children so young that sometimes they still have baby teeth. Although expanders can be used with patients of any age, they actually work even better with younger patients whose jaws are still developing. This is why they often are used with children at about age 7 or 8, long before the jawbone becomes less malleable.

An occasional added bonus is that, once the jaw is widened, the teeth may straighten without the need for braces later on.

 

Referrals to an ENT?

Another question I commonly hear is: Why are you referring me to an ear, nose, and throat specialist?

Their puzzlement is easy to understand. After all, the patient came seeking orthodontic treatment. What does any of that have to do with the ear, the nose, or the throat?

But there are connections, especially when it comes to how patients breathe. Our bodies are designed for us to breathe through our noses. It’s common, though, for people to develop the habit of breathing through their mouths, which can prove problematic when it comes to facial growth and development, the position of the teeth, and other concerns.

Sometimes mouth breathing isn’t just a habit. A child may have difficulty breathing through their nose because of an obstruction of some sort, such as enlarged adenoids or tonsils. They may also have a sleep disorder. If we discover any of these things during an examination, we are likely to recommend they see an ENT to have those conditions evaluated.

 

Braces? Why Not Invisalign?

At Warsaw Orthodontics, we do a lot of hybrid treatments. That is, we may start out a patient with traditional braces for six months to a year, then switch to Invisalign to finish up.

This prompts another often-heard question from young people: Why can’t I go straight to Invisalign?

Once again, this is understandable. Clear aligners like Invisalign are much less obtrusive than traditional metal braces and young people, conscious of their appearance, prefer the subtle touch.

But Invisalign is not always the best solution.

For example, traditional braces are much more efficient when we are trying to correct severely rotated teeth – that is teeth that have come in sideways or nearly sideways. Teeth that are impacted or stuck also are difficult to treat with aligners, and crossbites can be tricky as well.

Those patients can transition to Invisalign eventually – but only after traditional braces have given us a good start in getting the teeth moving the way we want.

 

Extracting a Permanent Tooth?

In the medical world, it’s not unusual for patients to seek a second opinion and on occasion, we have new patients who want a second opinion related to this question: Should the problem with my child’s crowded teeth be solved by pulling one or more of their permanent teeth?

An extraction certainly would create the extra room desired, but pulling a permanent tooth would never be my first option for creating additional space to allow the rest of the teeth to come in. An extraction probably wouldn’t be my second or third option either. 

In fact, I rarely recommend pulling permanent teeth to create more room. This is because I think it’s better to keep those permanent teeth if at all possible and because there are usually other ways I can accomplish the hoped-for outcome. One option for creating more space, as I mentioned earlier, is the use of a palatal expander.

When it comes to finding other options to eliminate crowding, the younger the patient the better because everything is more malleable with them. But even with older patients, I can’t remember the last time I recommended pulling a permanent tooth as a way to solve a crowding issue.

It’s simply not what I want to do.

As you can see, patients come to us with any number of questions – and we welcome those questions. Our goal in answering them is to alleviate the concerns they bring with them and to educate them about what’s possible and what’s not, assuring them that we want to provide the best care possible.