Frequently Asked Questions
Disclaimer: All information listed on this website is for educational purposes and as reference material for our patients only. Individuals are strongly recommended to clarify and seek individual consultation with a certified dental professional in your local jurisdiction as each individuals dental/medical condition can vary.
General
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Please visit this page.
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Each dental insurance plan is different, some policies covers and some do not. Policy holders are recommended to phone in or log into their insurance claim portals to verify coverage. Our office can also help check if the policy information is forwarded.
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In Ontario, Registered Dental Hygienists and Certified Dental Assistants are regulated professionals that can perform specific dental/orthodontic procedures independently under explicit pre-planned instructions of the dentist. It is important to understand orthodontics is a relatively slow process. This allows the orthodontist to better focus their time and effort on matters that truly require their attention. A lot of the doctor’s expertise is focused on treatment planning. Similar to nurses assisting a wide range of medical procedures independently, it applies to our field as well.
Please be reassured that the orthodontist is still the key personnel for diagnostics, any decision making and verifying the work of the hygienists/assistants. Especially with technological advancements in the past few decade, more detailed diagnostic tools are available for the doctor to remotely monitor the patient’s status.
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Patients are highly recommended to visit the family dentist minimum every 6 months to ensure they can maintain good oral hygiene. General Dentist will have the necessary tools for cavity detection and/or any restorative work. Patients with more serious conditions may be referred to other dental specialists.
Patients with poor oral hygiene may have their orthodontic treatment suspended or even terminated to prevent further deterioration of oral health. In such circumstances, there may be additional charges applied.
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There are many factors that impacts what the proper age is for starting orthodontic treatment. The best approach is to go through the initial consultation with the orthodontist. Referrals are not required for our office. Generally, our office starts seeing patients as early as age 7 to 8.
Some factors the Orthodontist may consider:
Family dentist referral - any special observations
Underbite cases - these are best treated before age 12
Missing/Impacted adult teeth
Patient’s maturity - compliance with wearing orthodontic appliances
Our office may recommend periodic monitoring, it is important to understand it is always better to get a proper assessment even nothing needs to be done.
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Due to the fact that some orthodontic issues are needed to be addressed early and wisdom teeth may never erupt (or exist), it might not be advisable to delay starting orthodontic treatment.
Generally, if all the other teeth were fully aligned and retainer wear schedule was maintained, the wisdom teeth should have limited effects on the other teeth. Considering a full arch clear retainer is able to group all the other 12+ teeth together, it is unlikely a pair of wisdom teeth is able to shift all other teeth.
However, impacted wisdom teeth that is impacting roots of the neighbouring teeth should be addressed. It is recommended to bring this issue up to your family dentist to determine the correct timing for possible wisdom teeth extraction.
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Orthodontic movement requires bone to be broken down (osteoclastic activity) and built (osteoblastic activity) constantly. It is normal to feel the teeth being loose. Under normal circumstances, there is no serious concern and the retainer phase will allow the bone to stabilize at the end of the orthodontic treatment.
However, if a patient has or developed periodontal issues, they must report to their orthodontist as their orthodontic treatment may need to be suspended until they have fully recovered and may need to be assessed/treated by a periodontist.
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Orthodontic treatment does not inherently cause gum recession.
Apart from adhering to proper oral hygiene instructions, and regular dental cleaning by your family dentist, make sure that the orthodontic appliances are not placed or touched by unclean surfaces or containers to avoid cross contamination. This includes properly washing your hands before touching them.
If a patient has or developed periodontal issues, they must report to their orthodontist as their orthodontic treatment may need to be suspended until they have fully recovered and may need to be assessed/treated by a periodontist.
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Please inform our office as soon as possible of your travel plans. Adjustments may need to be done before and after your trip to make sure the treatment does not get extended. The trip cannot be more than four months as our office will be unable to properly monitor your treatment status.
Any extended leave without prior approval is subjected to additional charges and even risk termination.
Aligners
Please review a sample of informed consent from Invisalign (note that it is subject to change). Click HERE
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The recommended time is at least 20+ hours a day. They should only be taken off whilst eating or drinking anything apart from water, and when you are brushing/flossing your teeth.
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Yes, aligners can be designed to be passive and hold teeth.
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Aligners are manufactured based on computer simulations with the doctor’s input that may not always be able to accurately predict actual clinical result. There are many factors that can affect the speed of orthodontic movements for each of the 30+ teeth in a patient’s mouth (more if you count baby teeth!).
Orthodontist’s duty is to monitor and update the prescriptions just like any doctors would need to update medical prescriptions according to actual and most updated patient status.
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Please check out our patient tips page.
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Patients are required to bring their current box of aligners (and/or previous one and the next 4 trays) to their appointment. Any used trays should be placed back into original packaging to allow our staff to identify.
Our staff needs to test for fitting if in case the current tray is not fitting properly.
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Our office typically recommend against doing teeth whitening procedures or products during treatment as there can be attachments on the teeth. The area covered by the attachments will not be whitened. When the attachments are removed, there may be areas with contrasting color tones.
We recommend waiting at least 6 months after all attachments are removed before doing teeth whitening procedures.
Braces
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Braces are very delicate appliance (around 5mm in size) that is glued onto the teeth. As all braces needs to be removed at the end of orthodontic treatment, the glue used cannot be so strong that it can cause damage to the teeth on removal.
Patients with a deep bite, or leaned-in molars will also have an increased chance of having brackets detached. That is why patients must adhere to a strict diet for the full duration of their braces treatment to minimize breakages. That includes eating less chewy foods and even taking more time to chew more gently.
Most breakages that happens after a week of bonding is unlikely due to craftsmanship and likely caused by eating habits or bite pattern.
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Over the entire duration of the orthodontic treatment, teeth are being constantly repositioned. This means in some cases, the original length of the wire may become insufficient (as the dental arch expands), and the wire may come loose. Clinicians cannot pre-emptively leave too much of excess length as it may poke into the gums of the patient.
In some cases, patient may have missing teeth or switching between baby and adult teeth. This causes a longer “bridge” of wire that increases the chance of the wire becoming loose from eating.
Please visit this page for tips on fixing loose wires.
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If there were any detached pieces or wires or braces, please inform our office prior to the appointment and bring it along to the next scheduled appointment.
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Our office typically recommend against doing teeth whitening procedures or products during treatment as there are braces on the teeth. The area covered by the braces will not be whitened. When the braces are removed, there may be areas with contrasting color tones.
We recommend waiting at least 6 months after all braces are removed before doing teeth whitening procedures.
Elastics
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Elastics are a essential tool used by all orthodontists. They can be different sizes and thickness for better control. Aligners or braces alone can only straighten teeth in each dental arch. To coordinate the upper and lower dental arch, elastics must be used. Elastics may also be used to accelerate some movements that aligner or braces alone may not be possible.
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The same elastic can be used until:
if elastics are prescribed to both sides, if one side breaks, then both sides needs to be replaced
2 days maximum
Some third-party sources may recommend to switch twice or thrice a day as elastics degrade over time. However, based on our office’s elastic selection and treatment plan, our office already accounted for this degradation effect and does not recommend patients to switch that frequently.
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Elastics can snap based on how much they are stretched, and whether the patient is able to bite on it.
Generally, replacing elastics once or twice a day is within acceptable rate. If the rate is much higher, report to our office immediately including the frequency, time of day and position that it occurs. We may advise to reduce hours or simply have to defer the elastic wear until later phase of the treatment.
Maxillary Expanders
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The expander has limited effect on your overall facial profile. Some online sources says expander “widens” the face. Depending on the degree of expansion needed, it can be mostly attributed to natural growth and/or soft tissue changes from weight changes.
There has been some studies that detected some increase in the base of the nose, but it was only temporary.
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Expanders work by stretching the intermaxillary suture in the middle of the upper palate before it fuses. This allows orthodontist to help permanently correct narrow upper jaws.
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It takes around 6-12 months for the expander effect to settle.
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If the orthodontist offered no other options, then it is truly necessary. Patient needs to understand that there are skeletal and dental components to orthodontics.
Skeletal is assessing the actual jaw bone. Dental is the position of each individual teeth.
When the fundamental jaw is too narrow, no matter how we dentally move the teeth, it may still not provide a proper bite. The expander device is needed for effective skeletal changes, aligners and braces have limited skeletal effect.
Extractions
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Typically after 48 hours, when you feel comfortable with them on with no discomfort, you can resume your aligner wear schedule as before.
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Extractions or not depends on the severity of the case. If there are other alternatives for space creation (such as expanders), you will be informed at our consultation.
Typically IPR (Inter-Proximal Reduction) alone is unable to substitute extraction requirements. There may be compromises subjected to patient’s acceptance.
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Unless there are unique circumstances, our office prefers extractions to be done after orthodontic appliances are fitted. Patients should wait for our office’s official referral letter before booking appointment with their dentist. This allows the best orthodontic control and prevent immediate unwanted dental shifting that occurs during bone healing.
Retainers
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Our teeth will never remain in the same position as our bone is a living organic matter. Retainers are recommended to be worn to minimize teeth from shifting.
For removable retainers, our office recommends 20+ hours of wear per day for the first year after orthodontic treatment. After the first year, we recommend 10-12 hours of night time wear for lifetime.
For fixed retainers, our office recommends regular maintenance and keeping it for as long as possible to minimize the chance of teeth shifting.
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Retainer durability depends on many factors, including but not limited to: grinding/tongue/chewing habits, stress levels, post-orthodontic treatment status. If heavy grinding exist, it must be conveyed to the dentist and thicker night guards may be recommended instead.
Clear retainers may last from 3-12 months
Fixed wire retainers can vary greatly from few months to several years.
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Based on patient’s individual needs and status, suitability of retainer type can vary. Patients are highly encouraged to discuss the following points with your orthodontist to determine the most suitable option.
Clear retainers are removable retainers that are usually made of plastic.
- They should only be taken off whilst eating or drinking anything apart water.
- For the first year after orthodontic treatment, our office recommends 20+ hours of wear per day.
- After the first year, we recommend 10-12hrs of night time wear for lifetime.
- They may last from 3-12 months depending on many factors, including but not limited to: grinding/tongue/chewing habits, post-orthodontic treatment status.
- Each set may cost $600+ (as of 2023)Fixed wired retainers are bonded i.e. “glued” to the back of your teeth.
- There can be different designs. Some can be upper and/or lower jaw, and/or span two to six teeth.
- Typically it can only include the incisors and canines as bonding it to premolars/molars may irritate the tongue.
- Since bonding requires more effort, they are typically higher initial cost ($1,000+ as of 2023)
- Patient cannot bite on harder food such as biting directly on a full apple -
Each set of clear retainer may cost $600+ (as of 2023)
Fixed wire retainers may cost $1,000+ (as of 2023). Cost of patch up and repair would be similar to dental restorative work.