My dentist said I had a suspicious looking area on the chewing surface of my tooth that may be a cavity. What is the chance of this spot turning into a cavity?

A recent study on this question shows that the chance of this spot turning into a cavity is rare. However, this assumes that the patient has reasonably good oral hygiene habits and is not overloading his or her diet with sugared food or drink. My recommendation is to always monitor suspicious looking areas and concentrate efforts on preventing this spot from turning into a cavity by stressing the importance of good home care and reducing a person's exposure to sugar.

How do I know everything that was promised to me will be kept once I start braces?

Researching the orthodontic office by visiting its website is a good start. I understand that parents are busy and can’t spend a lot of time on the phone, so everything is available on our website. We list information about our fees, payment structure, what to expect at your first visit, how long it will take, etc. Word of mouth from current patients is also a great source of information – your friends will be sure to tell you if there were any hidden fees or surprises along the way. Trust is another element to choosing an orthodontist—it’s important for patients and parents to feel comfortable that their child will have a positive treatment experience.

I am 27 years old and have really crooked teeth and an overbite. What will happen over the next 10 years or so if I do not get my teeth straightened and bite fixed?

If you choose not to get your teeth straightened you will have an increased risk for periodontal (gum) disease because crooked teeth make oral hygiene much more difficult. It is much easier to keep straight teeth clean than crooked teeth. Crooked teeth also have unbalanced forces placed upon them when you bite. This can wear down your teeth and increase the risk of gum disease. A wide, beautiful smile with straight teeth helps people with their self-confidence—especially when meeting people for the first time! Getting straight teeth is easy and affordable. Call 1-800-4braces for a free consultation.

I was told that if I get my wisdom teeth removed there is a chance of nerve damage. What is nerve damage?

It is true that there is a risk of damage to the nerve that provides sensory information to the lower part of the face, lips and tongue. For most patients, this risk is very small. The loss of sensory information can have an impact on one's ability to eat, drink, shave, kiss or play a musical instrument. There are three types of nerve damage. The first is Neuropraxia, or temporary interruption with full recovery in 4-6 weeks. Axonotmesis is more permanent with decreased sensation of feeling. Neurotmesis is a physical separation of the nerve with complete and permanent loss of sensory feeling. Because of the nerve damage risk, removal of wisdom teeth should be done only when impaction is a big concern.

My financial situation has changed, and I can no longer afford orthodontic treatment. My orthodontist told me I can't get my braces removed until I paid my bill. I can't pay the bill right now. Can you help me out?

Sure. I understand that good people sometimes get into a financial bind. I do not believe that people who can no longer afford treatment should be forced to keep their braces on. Please call my office at 1-800-4Braces for a free consultation and I will discuss removing your braces. If you cannot afford my normal fee for removing braces, I will remove them at no charge.

I just moved here and need an orthodontist familiar with the Damon system of braces to continue my treatment. My previous orthodontist informed me that special training was needed to use Damon braces. I called a local orthodontist whose website said they offer Damon braces and low prices. The lady I spoke with said they actually mix traditional braces with Damon braces on patients. She said both braces systems achieve the same result. Is this an effective treatment plan?

I do not agree with this treatment plan. As an orthodontist specially trained in passive self-ligation technology, including the Damon System, I know that traditional braces and Damon braces do not achieve the same quality result. It is like saying that a Walkman cassette recorder is the same as an iPod. They both allow for the mobile playing of music but no one would say they are the same. I encourage you to call my office at 1-800-4Braces for a free consultation to discuss finishing your treatment most effectively.

Is it easier to treat a crooked tooth problem by taking out teeth?

It can be easier but I do not believe it is better for the patient. I am very reluctant to remove healthy teeth because I use the new passive self-ligation technology, which allows me to treat patients without removing any teeth. I am passionate about creating a smile that best fits each patient's face. I found that taking out teeth creates a smaller width smile that does not always complement a patient's face. People who have had teeth extracted as a teen tend to lose their smile under their lip and wrinkle in the mid face area at an earlier age. Wide smiles are more youthful looking, even as you age. If you want a wide smile without having any teeth taken out, call 1-800-4Braces for a free consultation.

I hear great things about you, your staff and your results. I want to be clear; I do not want my daughter to get extractions, screws in her bone or an expander that rips her bone apart. I have already gone for a consult elsewhere and do not agree with any of these methods. Can you accomplish treatment without using these devices or removing teeth?

The answer is yes. I do not use screws in the bone or palatal expanders. I rarely take out any teeth and especially do not want healthy teeth extracted unnecessarily. I have patients here every day with mothers like you who want a second opinion. I listen to what my patients want, and I find your request for less invasive treatment a reasonable goal. Our reputation is well deserved, and I look forward to talking with you. Please call 1-400-4Braces to schedule a complimentary consultation.

I have noticed that my son has bleeding gums from poor brushing. He has braces and has a year of treatment remaining. His orthodontist seems concerned. Should I should end treatment and try later when my son's oral hygiene improves?

It is a difficult decision for me to discontinue active treatment due to poor dental hygiene. I want to get you the finished result as does the parent and child. At my office, my team and I would have frank conversation with you about your son's poor home care. My recommendation could be to continue treatment but leave the wires out for two to four weeks for better cleaning. I would place your son on an antimicrobial mouth rinse to help reduce bacteria levels and high fluoride prescription toothpaste to help prevent white spots. If these measures fail to get the gingivitis under control, then I would recommend temporarily suspending active treatment by removing braces.

I lost my job and can't afford to continue my orthodontic treatment. I want my braces off, but I was told at another office I had to pay to get them removed. I can't afford that fee either. Can you help?

Yes, please call my office at 1-800-4BRACES and I will remove your braces at no charge. I realize that we all sign contracts with good intentions of getting services and outcomes for a fee. Sometimes our financial situation takes a turn for the worse or our priorities change. When this happens, I won't hold a patient in a state of suspended treatment. It is best to temporarily end treatment by removing braces. I advise the patient or parent that since they have already partially paid for my services, they are more than welcome to return to finish treatment once their financial situation improves.

My son just had his braces removed. He has removable retainers, but I do not think he is wearing them as much as he was instructed to wear them. What should I do?

Your concern is justified. A recent study found that the average patient wears his or her retainers an average of just 7 hours per day, not the 12 to 24 hours recommended. Often, patients do not wear retainers for days. To help prevent relapse of teeth, I provide all of my patients with glued-on wire retainers on the backs of their front teeth in addition to the removable retainers. This means that my patients get double retainers for both upper and lower teeth. These glued-on wire retainers are an extra benefit that I provide my patients in the Four Corners area.

I looked at my teeth in a magnifying mirror, and I noticed some lines on my front teeth. I went to my dentist, and he said they were "craze lines" and are normal for my age. He said no treatment was needed. Should I get a second opinion?

While you are always entitled to a second opinion, your dentist's recommendation of no treatment is supported by research. Most craze lines are not noticeable except under bright light and some magnification. Craze lines are not cracked or chipped teeth. They are shallow changes in a person's enamel. As people age, most get some craze lines. Treatment would be considered too invasive by most dentists because treatment would be caps (crowns) or veneers. I agree with your dentist in recommending what is best for you and your teeth.

On my child's last appointment she got her braces adjusted, an exam, a cleaning and one filling. It was great – I was able to combine three appointments into just one visit! Why did you hire a dentist and start providing dental services?

I expanded our services because patients and parents kept requesting that we provide additional dental care. Another reason is a 2011 study on orthodontic treatment that found a separation of responsibilities between doctors during orthodontic treatment had less satisfactory outcomes for a significant number of patients. This study convinced me that providing an environment where dental and orthodontic services could be completed together could help my patients’ dental health during treatment. Patients at my office are welcome to continue services with their existing dental providers or use the dental services at my office for convenience. Call 1-800-4Braces for your free consultation.

I have heard of fluoride treatment at the dentist’s office to help prevent cavities. What is fluoride varnish?

Fluoride varnish is a type of topical fluoride that is "painted" on the teeth and dries quickly. The 2.36% strength varnish has been shown to be very effective in preventing cavities. Cavity varnish is rapidly replacing the 1.23% fluoride gel as the procedure of choice for topical fluoride cavity protection. Almost all patients like the varnish much better than the gel for two main reasons. First, the varnish is quickly painted on teeth with a small brush, while the gel is delivered in a big foam tray that has to be in a patient's mouth for 4 minutes. Additionally, patients can eat 15 minutes after the varnish is placed, but with the gel, it is best to wait several hours before eating to maximize its preventive benefits. My hygienist routinely recommends varnish during orthodontic treatment to prevent cavities.

My 8 year old son grinds his teeth at night. Should I be concerned?

A recent study in The Journal of Sleep Medicine answered this question. Almost half of all first graders in the study had parents reporting that their child grinded his or her teeth at least one time per week. This study found that grinding (bruxing) was not associated with breathing disorders during sleep or snoring. The study did find that there was an association with increased internalizing behaviors such as being depressed, being withdrawn or having anxiety. Chronic, frequent bruxism was also associated with increased health problems and decreased neurocognitive performance (learning). Grinding once a week is probably not a reason for concern. Grinding a few times a week should be checked out.

I heard that you now have a full service dental department. Is that true?

Yes. For years our patients and parents have wanted to make visiting my office a one-stop experience. I introduced dental exams and cleanings for our patients five years ago. We received an incredibly positive response from our patients once we began providing these services. On November 6, Dr. Todd Wahlin, formerly of Sundance Dental, started providing full dental services to our patients. Dr. Wahlin has nine years of experience and will provide all levels of dental health care, including IV sedation during the removal of impacted wisdom teeth. Many of my patients drive hours to be treated and appreciate that they can get everything done in one visit. For more information about our dental department or to schedule a free consultation, please call 1-800-4braces.

My teeth are sensitive to hot and cold sensations. What causes this problem?

Tooth sensitivity can be caused by a number of reasons. Some of the more common culprits are cavities, cracked teeth, broken fillings, grinding your teeth, and receding gums. Everyone has microscopic tubules in their enamel that connect with the nerve of a tooth. If these tubules are exposed, temperature changes from eating hot or cold foods are transmitted more easily too the nerve. If your sensitivity is from a cracked tooth or grinding, then the changes in pressure on the tooth are causing your sensitivity. If your sensitivity does not go away after a few days, you can call 1-800-4Braces for a free consultation to discuss this problem.

My dentist told me that one of my child's baby teeth is stuck to the bone and is delaying eruption of the permanent tooth. Is this a difficult problem to correct?

A baby tooth stuck to the bone is called being "ankylosed", and it can complicate the eruption of the permanent tooth. This baby tooth should be closely monitored. An ankylosed baby tooth usually does not fall out on its own. It usually needs to be extracted. The baby tooth should be removed if the eruption of the permanent tooth is delayed by six months or more. The baby tooth should be extracted as soon as possible if the permanent tooth underneath is ready to come in and if there are developing bone defects or significant changes in the bite. If you have concerns about your child's developmental changes as he or she transitions from baby teeth to permanent teeth, please call 1 800-4BRACES for a free consultation.

My wife says that I seem to have trouble breathing when I sleep. Can this cause me long-term harm?

A recent study found that Obstructive Sleep Apnea (OSA) can take off years from a person's life expectancy. OSA is the cessation of breathing while sleeping because the path of airflow is blocked during respiration. It is estimated that more than 18 million Americans have OSA. Some of the more common signs or contributing factors are: snoring, being overweight, hypertension, diabetes, age, increased neck size (size 17 males and 16 females), morning headaches that soon disappear after waking up and constantly being sleepy during the day. A clinical exam may also reveal a large tongue or a narrow palate or mandible. If you think that you may have OSA it is very important that you seek a screening exam from a qualified health care provider. For a screening call 1-800-4-Braces.

Question: My daughter’s teeth have started to come in. When should I start brushing and using toothpaste on her teeth?

Dr. Herman's Answer: To familiarize your baby with brushing, wipe her gums with a moist, soft cloth or piece of gauze after every meal. As soon as the first tooth comes into place, start brushing with a soft-bristle toothbrush designed for babies. Use water rather than a fluoride toothpaste until your child is about 2 years of age. Once your child is able to spit, she may be ready to brush her own teeth using a pea-sized amount of fluoride toothpaste while you supervise. Be sure to have the child spit out the toothpaste. It also recommended by the American Academy of Pediatric Dentistry that your child visit a dentist by her 1st birthday.