Live Q & A with Kidspot

We thoroughly enjoyed taking part in a Facebook live Q&A with Kidspot NZ.

Check out the questions and answers below that were submitted by our audience. We do hope that you find them useful. 
 

Q&A with Kidspot Sept 2015

Q&A with Kidspot May 2015

Q&A with Kidspot Sept 2015

Q: Why is it hard to chew when the bottom braces are put on? Does the discomfort get better after a few weeks?

A: That’s a good question, especially for someone who has just had their braces put on, and you’re right. When teeth meet together there is an ‘overbite’. This is a vertical overlap of the upper front teeth over the lower front teeth. When braces are fitted to the teeth, it very often means that the upper front teeth are biting down on the lower front brackets. This is often very helpful for orthodontic treatment mechanics where commonly, we need to reduce the overbite as part of the treatment. 

For the patient, it is uncomfortable because only the front teeth and brackets make contact and the back teeth don’t make contact. However, this discomfort normally only lasts a few weeks at the most and surprisingly most patients can actually eat normally during this time. As the teeth line up more and more, there is no longer a clash of the teeth and front brackets and the back teeth are able to bite together again. So hang in there, it will all improve!

 

Q: My two, nearly three, year old sucks her thumb and already her front teeth are bucked? At this point cosmetically I'm obviously not concerned but being her baby teeth will this affect her big teeth when they come? I have also felt happy for her to suck her thumb too. 

A: We agree that you should let your child get the satisfaction that infants or toddlers often get from the thumb. At this early stage, it will not be affecting the permanent upper front teeth. However, when the permanent teeth do grow through it would be useful if your daughter were able to stop sucking at that stage (between age 6 and 8). Good luck, and let's talk about it if it is a problem in a couple of years!
 

Q: For a 12 year, if the braces on top were put on a few months before the bottom, (milk teeth were yet to fall for the lower teeth) would the top ones come off first and then the bottom braces?

A: Not necessarily. Most commonly, top and bottom braces are removed at the same time. Occasionally, braces will remain on the lower teeth a little longer, particularly if there are issues with late erupting lower 12-year-old molar teeth (right at the back of the mouth).
 

Q: At what age is it recommended for children to get braces to straighten teeth?

A: Most children who have an orthodontic problem or will have in the future, should only be treated at the time the baby teeth have been lost and the permanent teeth (apart from wisdom teeth) are growing through. The usual age range for this is 12-14 years although there is great variability. However, there are a few orthodontic conditions that should be treated early, such as crossbites of the front or side teeth, teeth erupting incorrectly, extra teeth, a marked protrusion that is causing social problems (or, more rarely, has resulted in damage to the front teeth) and some other issues. Some dentists carry out extensive treatment for children (even as young as 5 or 6 years) who still have plenty of deciduous teeth. Removable plates are used, often for years, with expansive (and expensive) claims of the benefits of this early treatment. The scientific facts are different.

The evidence is that (apart from the few exceptions above) for most orthodontic patients, early treatment does NOT produce a more favourable skeletal (jaw) change, it does NOT eliminate the need for treatment at a later date, NOR does it reduce the need for extraction of permanent teeth. Early treatment neither leads to a better occlusal (bite) result nor reduces the complexity of later treatment.  As a matter of fact, many early orthodontic treatments lead to a less favourable outcome because of patient (and parent) ‘burnout’. By the time patients have reached the stage of dental development \when they’re ready for the main treatment, they’ve all lost interest and had enough time already wearing orthodontic devices – and paying the bills!

For these reasons, orthodontists avoid inflicting early treatment on youngsters if possible, leaving the treatment until teenage years when the teeth and bite are fully developed and can be fixed in one straight-forward treatment. Again, only orthodontists have the specialist training to practise orthodontics.

 

Q: Do you think it is important for preschoolers to see a dentist regularly in addition to the standard annual visit to a dental therapist?

A: Unless you have any particular concerns, regular visits to the dental therapist should suffice. The dental therapist is trained to detect any orthodontic or other problems that may require a referral to a dentist or orthodontist. If you have any worries, talk to the dental therapist.

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Q: Does a small upper lip tie have any negative impact on teeth or speech development? e.g. create a gap between the front two teeth?

A: The technical term for the extension of the inside of the upper lip into the gum by or between the upper front teeth is “labial fraenum”. This soft tissue extension varies in size from minor to large and fibrous. It does not affect speech development.  It is often most noticeable when the permanent upper front teeth erupt and, as you suggest, is associated with a gap between the teeth. Usually, the gap closes (or at least reduces) as the other adjacent permanent teeth emerge, applying a force that pushes the central incisors together. Even the eruption of the upper canines, which are the third teeth from the front, can have a significant effect on closing the gap.

Another development effect that closes the gap is the vertical growth of the face and jaws. The face grows longer and the upper and lower teeth all erupt towards each other, maintaining contact and therefore requiring more vertical growth of the bone surrounding the roots. This can result in the fraenum being left behind as it does not usually come down with the bone (although it is still attached to the gum) and this will reduce its effect on the gap.
For a small percentage of people, the gap persists into late teenage years or adulthood or the fraenum is so fibrous that the developing teeth and jaws cannot affect it. If it is unsightly the fraenum can be surgically removed and the gap may close spontaneously or will require orthodontic intervention.

Surgical removal of the fraenum, if carried out at all, is best done after the gap (diastema) is closed (with braces). If carried out before the space is closed there is a risk that the ‘papilla’ (gum between the front incisors) can shrink, leading to an unsightly ‘dark space’ developing between the upper incisor teeth. 
The fraenum should not be removed before having the teeth assessed by an orthodontist.

 

 

Q: My son is 5 and he lost his two front teeth like months ago and no sign of adult teeth, and recently he has also lost his bottom front tooth and the one beside is hanging, they're dropping like flies, but no sign of his adult teeth, is there a need to be concerned ?

A: Please don’t be worried. Sometimes the second teeth can take an agonisingly long time to grow through. If there is no sign of them by next March then a visit to your local dentist or dental therapist would be appropriate. The time that the teeth grow through varies widely. Occasionally there can be some issues stopping a tooth or teeth from growing through but I certainly wouldn't be concerned at this stage. One thing to watch for is the tooth or teeth on one side coming through and the other side not showing any signs of emerging. This may require investigation. 

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Q&A with Kidspot May 2015

Q: Once the orthodontics come off what keeps the teeth in place and stops them moving again?

A: Really good question. Firstly it is vital that the orthodontic treatment planning places the teeth in the most stable positions in the face. Orthodontists have the training and the skills to be able to give you the best assurance of this. Secondly, all orthodontic treatments should be retained. This is best carried out with the combination of fixed and removable retainers. With all our patients, multi-strand flexible wires (flexis') are attached behind the upper front teeth and the lower front teeth before braces are taken off the teeth. Removable retainers are worn full time usually for 6-8months after the braces are off the teeth and then at night time only. The duration of night time wear of removable retainers depends on the original orthodontic problem and other factors. Long-term retention gives the best chance of long-term happiness with the result.


Q: Would like opinions on removing 9 year old's back permanent molars due to poor enamel (hypoplasia) so that new adult teeth will move into the gap as they come through. We are going for a 3rd opinion (only because oral health unit asked for a 2nd opinion, then hospital dentist wanted a 3rd opinion) seems as though they are all unsure what the best option would be. One side is definitely worse than the other side so they may be just wondering if both sides should come out at once instead of needing to repeat the op again later on.

A: Another great question about a problem that appears to becoming more prevalent in the community but is probably just due to a much better recognition of enamel “hypoplasia”. The correct term is actually hypo-mineralisation or hypomin which occurs much more often than true hypoplasia. There is an excellent website dealing with this problem: thed3group.org. This will answer many of the questions that you may have.

If the hospital dentist wants a third opinion, it is likely that the hypomin is moderate to serious since the removal of these teeth is being considered. It is essential that you obtain an opinion from a specialist orthodontist as the removal of these teeth will have considerable consequences for the development of the bite and the arrangement of the other teeth. The orthodontist will assess multiple factors, including possible future crowding, any protrusion or overbite, the relationship between the upper and lower jaws and the presence of developing wisdom teeth. The orthodontist will also discuss the timing of the extractions and the likelihood and type of future orthodontic treatment being required. You do not need a referral to make an appointment to see an orthodontist.

 

Q: Three of my kids have hypoplasia. Why has this happened and what can we do about it? One of them has a really bad molar.

A: The short answer to your question “why has this happened” is that no-one knows and it is certainly not any one’s “fault”. Have a look at this website www.thed3group.org. The first step is to have the hypomin (this is the more correct term for the hypoplasia) teeth checked out by either a dentist who is very experienced in this field or by a specialist paediatric dentist. When a molar is severely affected, its extraction is seriously considered and then the opinion of a specialist orthodontist is necessary. You do not need a referral to see an orthodontist.

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Q: I have an eight-year-old girl and when we went to the dental nurse last year they gave us a form referring us onto an Orthodontist. She has crowding - her 12, 22 are erupting high and they have put there is lack of space. Now, I always thought it wasn't worth seeing an Orthodontist until they were 11/12 ish, as they needed to wait for the baby teeth to be gone. It appears that they have dropped a bit over the time, but I don't know if this will continue. Is this something I should get onto or do we wait a bit longer?

A: Although most full orthodontic treatment is carried out when the permanent teeth are through, eight years of age is a good time for a first orthodontic assessment particularly if the dental therapist is concerned about the arrangement of the teeth. The eruption of the upper lateral incisors (the 12 and 22) can be adversely affected by the pathway of the eruption of the unerupted and developing upper permanent canines. These upper canines can erupt out of place, particularly into the roof of the mouth, and an early assessment may be vital. It may also be advisable to ensure that there is enough room for these lateral incisors to emerge into a reasonable position. 
An orthodontic examination will tell you if something needs to be done now (which it sounds like) or if you can just wait for all the permanent teeth.

 

Q: Can you please recommend an orthodontist in the Lower Hutt/Wellington area? Is it too soon to have a 9-year-old looked at?

A: There is a very good orthodontist - Dr Matt Williams, his website is www.wellingtonorthodontics.co.nz
 

Q: My 9 yr old son has been referred to an orthodontist by his school dentist as he has a deep overbite as well as overcrowding ( he also has an extra tooth not yet erupted, but visible on X-ray) my question is, I have read that it may be more cost effective to have work done before the age of 10, is this accurate? And how much does an Orthodontic consult ion cost on the north shore?

A: First off you should definitely see a Specialist Orthodontist, we don't know the costs charged by orthodontists over the North Shore. To give you a guidance, our consultation for patients under the age of 18 is $240.
It is untrue that having extensive work done at say less than 10 years works out cheaper in the long run. As a matter of fact, it tends to be a little bit like getting on a train you can't get off and the costs tend to be much higher than if the work were done once and at the appropriate time by a specialist orthodontist. The evidence shows very clearly that most orthodontic treatment results are much better when carried out at the appropriate time by the appropriate person (i.e. a qualified orthodontist!)


Q: My 5yr old has tongue and lip ties and her 4 front teeth, 2 top and 2 bottom seem to be being pulled, should we be concerned or seek help?

A: Yes you should see an Orthodontist or a Paediatric dentist to check if it is something to be concerned about. Very occasionally it does require intervention.

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Q: My son is 7 and even though he brushes 2x a day his big teeth are quite yellow. I know they're not supposed to be as white as baby teeth but they even have yellow/brown lines in them. Is there a reason for this or can you suggest ways to improve it? Also, he has a good diet and good oral hygiene yet often has bad breath; what can I do to combat this? And finally, is it normal for big teeth to come through many months after a baby tooth has fallen out? My son still is showing no signs of a big tooth (one next to his front 2) since the baby one came out last year.

A: First of all as far as the tooth colouration goes we recommend seeing a dentist or children's dentist. You could also visit www.thed3group.org which may answer some of your questions. Likewise, with the bad breath, we recommend seeing a good dentist. Yes, it can be normal for a front tooth to take a long time to grow through. It can also be because the tooth is missing or perhaps there is not enough space for the tooth to grow through. This again can be answered by a dentist or an orthodontist.
 

Q:  I have a 4-year-old who was recently seen by the community dental nurse. She made a comment about some of his teeth being a bit chipped, and since the visit (a few weeks ago), more of his teeth are chipping. I've also noticed he's very sensitive to heat and cold in his mouth, to the point of him refusing a treat of ice-cream or cold water from the fridge. He also has a bad habit of gnawing on his fingers and knuckles, more towards the back of his mouth, it's not finger sucking, he's really biting down when he does this. Is it worth taking him back to the dental nurse? Or do you have any suggestions?

A:  Would start with the dental nurse, but depending on where you live there are dentists who specialise in children's dentistry - they are called Paediatric Dentists. There is a very good practice in Meadowbank, Auckland called Kidz-Teeth. The problem sounds more dental rather than orthodontic at this time.
 

Q: What is the estimate cost for braces or the invisible style and how long approximately would a 15-year-old need to wear them?

A: Most orthodontic treatments can be 2 years with fixed braces. This could be less or could be more, based on the individual. Fixed braces can range between $8,500 - $9,500 - This is, of course, payable in instalments over the two years (or the length of the treatment).  The cost of using clear braces is slightly higher, but it is usually within the higher end of the range we noted above. The cost for Invisalign (if suitable for the 15yr olds treatment) will be similar or slightly higher.


Q:  I have a 3-year-old who sucks his thumb. We have tried many different ways to stop this but haven't quite managed yet. Will this affect his adult teeth? If the thumb sucking doesn't stop soon then is he likely to require braces at a later age?

A: Our feeling is at his age of only 3 we would let him suck his thumb - there may be other battles that are more important!
The time to start looking at stopping is at the time the second teeth are growing through, which is about the age of 5-7years old. We should also be careful that the cure isn't worse than the disease!  We have found that at the age of 5-7yrs old, many, if not most children are motivated to stop once they are at school and with their friends.

 

Q: My daughter will be 9 in July, she has a mouth full of issues from overcrowding to crooked, when should I be seeing an orthodontist?

A:  Any time now. Although many orthodontic problems are best treated when the second teeth are growing into the mouth. There are a number of problems that may require intervention now. For the cost of a consultation, it is better to have things checked out and to understand what will be the best treatment and at what age.

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Q: My 4-year-old had an accident at daycare 2 weeks ago, we saw the local dentist attached to the 0800 teeth... and they advised her front two big teeth are dead and will fall out. This left me scared and concerned as no real explanation, also that the adult teeth could be damaged underneath from the trauma from her fall. Her teeth are turning greyish.. will they fall out soon, or at the normal time around 6-7?

A: It is too difficult for us to tell. We recommend that you take your daughter to another dentist to check out both the baby and the developing second teeth. While the baby upper front teeth will likely fall out between 5.5-7yrs old, there is the possibility of damage to the developing permanent front teeth. We understand that this can be very distressing and it is better to have a little comfort that all is well.
 

Q: Are the new 'invisible' braces just as good as the old style braces? Do they have to be worn for a longer time frame?

A: The term “invisible braces” covers two types of braces.  “Lingual Braces” are metal braces that are bonded onto the tongue side of the teeth and therefore cannot be seen from the front. Lingual braces can treat all types of orthodontic problems of any severity and the treatment time is similar to braces on the outside. The other type of “invisible braces” is “Invisalign” which uses a series of clear mouthguard-like appliances made of very thin clear plastic.

Invisalign braces can treat minor to mild problems very well and in a similar timeframe to fixed braces. However, there are certain tooth movements that are more difficult for Invisalign such as severe rotations or rotations of canines and a deep overbite (vertical overlap of the upper front teeth over the lowers). In experienced hands, Invisalign can treat moderate to severe problems but this needs careful assessment and may well involve an extended treatment time. Like fixed braces, invisible braces are only a mechanical means to move the teeth and the most important and fundamental step is a full diagnosis of the orthodontic problem and a correct treatment plan. Without this, even Invisalign will not get a good result. Remember that only an orthodontist has the post-graduate training to practice orthodontics and therefore they can fully discuss all the options with you.


Q: How long is normal for adult teeth to appear after losing baby tooth in a 6yr old? Front right (k9 I think they're known as??)

A: It can be a frustrating time waiting for second teeth to come through. It is more likely to be a front (incisor) tooth rather than a canine tooth. If it seems too long compared to the adjacent tooth, why don't you ask the dental therapist at your child's school?
 

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