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.

My 8th grade son is in braces. I am constantly reminding him to brush his teeth. The dental assistants have gone over how to brush with him several times, and his orthodontist told him that if he keeps brushing poorly it could add 6 months to a year to his treatment time. I was shocked to hear this. How does poor brushing make treatment longer?

Poor brushing may not necessarily make treatment longer, but it does increase chances of gingivitis, cavities and white spots. In severe cases, oral hygiene problems caused by poor brushing can prolong treatment. An orthodontist may even recommend removing the braces until severe oral hygiene issues are resolved in order to best care for the teeth. Broken brackets and poor rubber band wear can also prolong treatment.

My son is getting braces. I am very concerned about him keeping up with his oral hygiene during treatment. Do you do anything special to help your patients maintain good oral hygiene?

Yes. Maintaining excellent oral hygiene during orthodontic treatment is so important to me that I have an oral hygiene department in my office with two dental hygienists on staff. No one else in the Four Corners offers both orthodontic and dental hygiene services in one location, and this convenience is one of the main reasons why parents choose my office for their children’s orthodontic care. While many offices have oral hygiene issues in almost half of their patients, less than 5% of my patients have oral hygiene issues. My patients with oral hygiene issues are provided immediate access to care in my office to correct the problem and do not have to be referred out. This is both a convenience and a relief to parents. We also remove all wires from the braces when cleaning, which allows for improved access and improved cleaning. For more information, please call 1-800-4Braces.

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 want to get the perfect smile, but I am concerned this expectation is unrealistic. How do you achieve the perfect smile?

Every patient is unique – there’s not one perfect smile! I help patients achieve wide, beautiful, healthy smiles that work with their individual features. At your first visit, I will give you a reasonable expectation of the smile you can expect to achieve after braces. I show photos of my finished patients with similar orthodontic problems so that you can get an idea of your outcome. I always attempt to meet or exceed my patients’ expectations. I believe I can help you get an amazing smile with a customized treatment plan. Call 1-800-4Braces to schedule your 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.

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.

My teenage son is using smokeless tobacco (chewing tobacco). I am afraid that this may lead to smoking. Is my concern justified?

A recent study says that your concern is justified. This study showed that there is a strong association between adolescents using chewing tobacco and smoking. The study also found that using tobacco is strongly correlated with other risk-taking behaviors. This may not be news to any of us who have raised teenagers. Intervention through education may help, but results for teens are extremely varied. The study found that getting teens involved in activities that prohibit the use of tobacco products, like school sports, may be even more beneficial to preventing tobacco use than education on the harm of tobacco or parental intervention.

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 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.

I have braces. Is it better to use a manual tooth brush or an electric toothbrush?

A recent study concluded that an electric toothbrush was "superior" to a manual toothbrush for plaque removal. The study found that the electric toothbrush motion more effectively removed plaque than the manual scrubbing action. Plaque is notorious for developing around braces, so in addition to recommending electric toothbrushes, I use the Damon System of Braces to help make cleaning easier. Damon braces are smaller than traditional braces and don't have wire ties or elastic rings that collect plaque. If you want a wide beautiful looking smile, please call me at 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.

I want to get my teeth straightened and I want to bleach them to make them whiter. Should I do it before or after treatment? How does bleaching work?

If you are using Invisalign aligners to straighten your teeth then it can be done before, after or even during treatment. If you are getting braces, after is best. The active ingredient in bleaching gel is hydrogen peroxide. Hydrogen peroxide is applied to your teeth using a clear plastic tray. As the hydrogen peroxide degrades it produces free radicals that diffuse rapidly through enamel and dentin. These free radicals are strong oxidizers that split up pigmenting compounds that diffuse out of your teeth, causing the tooth to absorb less light. This process causes teeth to look lighter. Call 1-800-4Braces for a free consultation.

Q: I expected that you would monitor the progress of the straightening of my daughter’s teeth. What surprises me is the emphasis you and your staff place on monitoring the health of her teeth and gums. Aren’t you just her orthodontist?

Dr. Herman’s Answer: Yes, but I was a dentist for 8 years before I did a residency to become an orthodontist. The biggest problem any orthodontist has while straightening teeth are issues with gum and dental disease. I put the patient first in making it convenient for each patient to obtain exam and hygiene services. This means you can have exam and hygiene services at the office of your dentist or at my office. While your daughter is under my care my goal is no new gum disease or cavities. However, if you want to help me to accomplish that goal is up to you.