Orthodontic Specialists of Utah | Orthodontist Murray, Orthodontics Sandy & Braces Orem, Utah (UT) | Invisalign Utah | Orthodontist Dr. Gary Carter DDS

Ask The Expert

If you have a question you’d like to submit, please email Dr. Carter [email protected]

Q: My dentist said I have to lose all my baby teeth before you start my braces. Is that true?

A: It is possible. There is an optimum time to start orthodontic treatment depending on your individual problems and your stage of growth. That is why I offer a complimentary consultation to evaluate you or your dentist’s concerns. This way I can determine if we should begin treatment now or wait.

If it is best to start your treatment later, I put my patients on our growth recall program until it is the right time to start. This way I can monitor all the important orthodontic issues and start treatment at the right time so that you will have the perfect bite and smile when we finish.

Q: I went for a few orthodontic consultations and I am getting confused. One doctor said his braces are faster, more comfortable, offer consistent higher-quality results, and will give me a fuller, natural smile in fewer appointments. Are there some braces that are better than others?

A: In a nutshell, all braces do the same thing so it is really an orthodontist’s personal preference as to what braces to use. The real difference is that some braces are manufactured by companies with large advertising budgets. Some orthodontists select the braces they use based on this marketing hype. For example, there are braces today called “speed” braces that were started in the 1970s! Why do you think the manufacture uses the adjective “speed”? Unfortunately, we all can be gullible to marketing. So how does an orthodontist really know which braces if any, are better? We try to determine this by scientific, unbiased, clinical testing.

Recent clinical studies to compare the “newer,” “faster” (low friction), “improved” braces show that all the braces tested were the same. None were “faster, achieved better results, resulted in fuller more natural smiles, were more comfortable, nor resulted in fewer appointments.” This is not surprising to me.

All braces are basically tiny “handles” we place on the teeth to move them into their proper positions. Braces do not move teeth- it is the orthodontic wires that provide the gentle, consistent force needed to move teeth. Since all orthodontists use the same style titanium orthodontic wires, it follows that all braces will do the same thing, in the same amount of time, and do so with reasonable comfort. The choice of braces is therefore an economic decision for the patient and doctor, not a biologic one.

Q: I went to an orthodontist that my dentist recommended in the same building as he is in. He said I needed four teeth removed to do braces. I really liked your office when I came to you for a consultation. You said I did not have to have teeth removed. Will I make my dentist mad at me because I want to go to you instead of the guy he recommended?

A: Hmmm. Good question. While you might think your dentist may “get mad at you.” I guarantee that this will not happen. Dentists refer their patients to certain specialists for many reasons; the specialist might practice close-by, or he could even be a personal friend that the dentist trusts. Whatever the reason, I would always get a second opinion regarding your orthodontic treatment.

Your dentist will respect your right regarding your choice to make decisions for yourself. You may want to discuss both orthodontic treatment options with your dentist so that he can give you his input as well. In fact, I am sure he would respect you highly for seeking his opinion whether you choose to go to his recommended orthodontist or not.

Q: I need an expander and I am a little scared to get one. All my friends are telling me that it will hurt. Do expanders hurt?

A: Expanders are actually not bad when made properly. Our expanders are smooth and fit high up in your palate to prevent interferences with your tongue. A recent study in our orthodontic journal looked at the influence of an expander on oral comfort, speech, and chewing and found that most patients had slight problems but only for the first week. After that things pretty much return to normal. Don’t worry, almost everyone says it isn’t as bad as they thought it would be!

Q: My jaw pops now that I have had braces. Did my orthodontist do something wrong?

A: Not necessarily. Jaw “popping” is one specific condition in the broad category we call temporomandibular disorders (TMDs). The popping probably has nothing to do with your history of orthodontic treatment.

Almost every study of TMD in relation to orthodontics does not show an association. In fact, the general consensus is that orthodontic treatment neither causes nor prevents TMD. I would see your dentist or orthodontist for an evaluation to determine if your jaw popping is a problem or not.

Q: I really want Invisalign. How well does it work?

In my opinion, the perfect candidate for Invisalign is the patient who wants straight teeth, but also would choose to live with their crooked teeth if they had to wear braces. Invisalign will definitely improve the alignment of crooked teeth. The question is: How much improvement? To answer this, researchers designed a recent study that looked at how Invisalign straightens the front teeth and came to the conclusion that “the mean accuracy of tooth movement with Invisalign was 41%.”

Clinically in my practice, this means that to further straighten the teeth; I often do what is called revisions or in the worst case scenario, place cosmetic crystal-clear, sapphire braces because you probably do want to leave your teeth 41% straight!

The good part is that if my adult patients needed braces after Invisalign, they were satisfied because the braces were placed near the end of treatment and the braces were on not as long as if they were placed at the start of treatment. Invisalign works well, but not as predictably as braces do.

Q: Every time I go to the orthodontist, he finds one of my braces is broken. I know it’s not my fault. Can’t he use stronger glue?

A: Braces are attached using a composite material (“glue”) that is similar to the tooth-colored filling material your dentist uses. First we treat the tooth to microscopically roughen it and then a thin resin is painted onto the rough areas. Lastly, the glue is put on the bottom on the brace (bracket) and the bracket is accurately positioned on the surface of the tooth.

You want just enough glue to attach the bracket without any excess that would hinder cleaning the bracket. I’m sorry, but by far the main reason for a broken bracket is biting into something hard, crunchy, sticky, or chewy, and not because the glue is not strong enough.

Other reasons a brace may break may be due to your bite being deep or having a crooked tooth so that you bite on the brace. Call your orthodontist whenever a bracket breaks to decide how to fix it best. Never wait until your next appointment!

Q: My dentist says I need to start braces right now and when I came to you for a consultation; you said you would like to wait a bit before starting treatment. I really trust my dentist. Who should I believe?

A: When you go to your regular dentist for a checkup, he or she is on the lookout for dental problems that usually need correction as soon as possible- like a cavity, root canal, or a cracked tooth. Sometimes however, this “we need to fix it now” thinking also carries over when your dentist sees an orthodontic problem like an overbite or crooked teeth. Orthodontic treatment however, is a process that will take place over time.

Growth can often help an orthodontist correct many common orthodontic problems. That is why I like to coordinate your orthodontic treatment process with an active growth spurt so we can ultimately shorten the amount of time you are in treatment or increase the chance for a successful result So in your case, even though you have an orthodontic problem and probably will need braces, NOW may not be the proper time to start treatment depending on your individual stage of growth.

I was a regular dentist for eight years before I went back to school to become an orthodontist and I thought the same way as your dentist at one time. Your dentist is only trying to look out for you but is not trained to think like a specialist.

Q: My dentist said I needed an expander and you said I don’t. Who do I believe?

A: An expander is a orthopedic (bone-changing) appliance that can permanently change your facial bone structure. There are many reasons why an orthodontist might use an expander to widen your upper jaw. The main reason I use an expander is to correct a “cross bite” due to a narrow jaw.

You see, the upper teeth and jaw drapes over the lower teeth and jaw sort of like the lid fits on a box. A cross bite exists when the upper “lid” fits inside the “box.” An expander corrects a cross bite very nicely while the upper jawbone is growing.

As you age and the upper jawbone sets however, it is unpredictable to permanently widen the upper jaw using an expander by itself. To make a long story short, I would trust the orthodontist who is actually a specialist trained in dentofacial orthopedics.

American Association of Orthodontists
American Dental Association
Utah Dental Association