The basic rule is to avoid anything hard or sticky that can pop off the braces or bend the wires.  Note that every time a brace pops off, it can add 1-3 months to the total treatment time in order to regain control of that tooth.  If a brace does come loose, let us know as soon as you can so we can minimize these side effects.

Examples of foods to avoid altogether are ice, nuts, beef jerky, caramels, hard candies, gummy bears, jelly beans, granola bars, bubble gum, Butterfingers, taffy, Corn Nuts, raw carrots, and bread sticks.  Foods that can be eaten if cut off the core include corn on the cob, apples, chicken, ribs, and steak.  Note that chewing on pens, pencils, or nails may have the same undesired effect of popping off braces or bending wires. 

Finally, avoid foods that increase the levels of acidity in the mouth, as these can lead to white spots or cavities.  Examples of this are soda or lemons/limes (when sucked on).

It takes a little longer to clean your teeth when you have braces on because there are more surfaces to clean, and they are not as easily accessible.  When brushing, it is important to brush the tooth area by the gum tissue, the braces themselves, the tooth area on the other side of the brace, and the tongue side of the teeth.  A Proxi-Brush can be used to clean the space between the braces under the wire.  Finally, flossing is required to clean the surface between the teeth; however, this requires threading the floss underneath the wire with Floss-Threaders, Superfloss, The Platypus, or what ever other product is accessible.  If proper home-care is utilized, cavities and white spots can be avoided, and the teeth will remain healthy and beautiful throughout treatment.

Separators are used to make space between your back teeth to accommodate bands, and take about 1 week to accomplish this task.  For most people, the teeth may be sore for the first day.  Avoid eating sticky foods or flossing where the separators are, which can dislodge the separators.  Note that after they complete their job of creating space, they can sometimes fall out; if you notice one is missing, please call immediately so that we can replace it.  As an alternative, some patients prefer to replace their own separators. 

Instructions: 

1. Thread two pieces of floss through the separator, and hold one double-strand of floss in each hand.
2. Floss one double-strand of floss into the area with the missing spacer.  Ensure that it goes all the way through the contacting point of the two teeth. 
3. Pull the double-strand of floss until the separator is below that area of contact.
4. Lift both double-strands of floss (up from the top teeth; down from the bottom teeth) until the separator circles the contact. 
5. Slide both pieces of floss out, leaving the separator in place. 

A palatal expander is an appliance used to widen the upper jaw by pushing on the teeth.  In order to apply force to these teeth, a palatal expander requires a key to be inserted into the keyhole, and "cranked."  Typically, the appliance must be turned one complete turn each day, and the patient must return for frequent checks to ensure the appropriate amount of widening.  If you are unable to make your scheduled appointment, do not continue turning the appliance, as this may result in overcorrection.  If you miss a day of cranking, do not attempt to "double-up" the next day, as this may lead to adverse effects on the teeth.  

A quad helix also widens the upper jaw, but does not require cranking.  It does, however, require frequent checks to ensure it is functioning properly and not overcorrecting. 

Note that with either appliance, a space will form between the upper front teeth.  This is normal, and the teeth will likely drift back together once in the holding phase. 

Once the desired width is attained, the appliance is "tied off" and held in place for approximately 2 months, before being replaced by a smaller, less bulky appliance. 

A palatal bar or Nance is a wire on the roof of the mouth that holds the position of the molars.  Similarly, a lingual arch is a wire that sits against the lower teeth to hold the position of the molars.  All of these appliances are fixed appliances that should be removed only by our office.  Brush and floss well around these appliances to keep the tissue healthy and prevent swelling.  The appliances on the roof of the mouth may create a small depression on the tongue; this is normal, and may be sensitive, but the soreness should go away after a few days.  Avoid sticky foods or playing with these appliances with your fingers or tongue, as this may distort or loosen the appliances.  If anything becomes broken or loose, please call our office for an appointment.

Headgear is a tool that works extremely well - when it is worn, and worn consistently.  If it is worn 10-12 hours per day every day without fail, remarkable results can be seen at each appointment, and the total months in treatment can be dramatically reduced.  On the other hand, if it is only worn for only a few hours at a time, or with multiple missed days, it is unlikely to offer any change to the existing problem, and the treatment time will likely need to be extended.  In short, the more it is worn, the sooner the treatment will be completed.  

Patients wearing headgear should expect some soreness and disrupted sleep until the teeth and jaw become accustomed to the appliance, which may take 3-7 days. 

Directions: 

1. Handle the headgear carefully and never force it or bend it.
2. Do not wear the headgear during rough contact sports or while rough-housing with siblings/friends. 
3. Call our office immediately if the headgear breaks or a band is loose. 
4. Bring the headgear to every appointment. 
5. Change the elastics once per week. 

Elastics are small rubber-bands that help improve the relationship between the upper and lower teeth.  In order to make significant changes, they need to be worn 23 hours per day (removed only for brushing or eating).  If they are off more than this, no noticeable changes will be made.

In the beginning, the teeth will likely be tender; however, with continued wear, this discomfort should go away.  

Elastics need to be changed three times per day to avoid elastic fatigue.  If more elastics are needed, call our office to arrange for replacements.  If a hook for the elastics becomes lost, call our office to have this replaced. 

With good, consistent elastic wear, the patient can quickly transition to night-time wear for maintenance; then, typically, the elastics can be discontinued altogether. 

A bite plate is used to decrease the overlap of the front teeth by allowing the back teeth to erupt further.  In order to complete this task, the appliance needs to be worn full time, removing it only to eat or to clean the teeth and the appliance.  Due to the delicate nature of this appliance, ensure that it is placed and removed carefully. 

Patients often note difficulty with speaking when they first wear this appliance; however, this often resolves within a day or two.  

The bite plate requires cleaning at least twice per day, otherwise it can harbor plaque and calculus.  To clean, simply brush all surfaces with a toothbrush and toothpaste.

If the appliance becomes cracked, bent, or no longer fits, call our office immediately for an appointment. 

When the active phase of orthodontic treatment is complete, the teeth need to be held steady until the bone and surrounding tissue adapts to their new position, otherwise they will revert back to their pre-treatment positions.  The amount of time necessary to stabilize is different with each patient, and so our office policy is to give retainers to every patient, monitor the patient with check-ups, and encourage a lifetime of wear.  

After several years, as your appointments become less frequent, you will need to monitor your own teeth to be sure no shifting is taking place.  It may be necessary for you to come back to our office for an adjustment.  Due to the normal wear on your retainer it may need to be replaced from time to time.

Instructions for the Care of Removable Retainers:

1. Wear the retainer 22 hours a day (unless advised otherwise).  Remove your retainer when brushing your teeth or eating. 
2. If it is not in your FACE, it is in the CASE.  If you wrap it in a napkin, it will end up in the trash; if it is      available to pets, they will turn it into a chew toy; if it is placed without a case in your pocket, it will likely distort.
3. Do not leave the retainer on the dashboard of your car as the heat from the sunlight can warp the retainer.
4. Brush your retainer with cool (not hot) water and toothpaste.  If additional cleaning is needed, brush      it with baking soda, soak it in white vinegar, or bring it to the office for an ultrasonic cleaning.
5. If the retainer gets contaminated, bring it into the office for sterilization.  Do not try cleaning it on your own because boiling it or using alcohol will ruin it.
6. Place and remove the appliance gently and carefully, dislodging it first from the back, so as to not weaken it.
7. If the retainer breaks, call the office immediately to make an appointment.  Bring in the pieces in case the wires can be reused in your new retainer.
8. Avoid clicking the retainer up and down with your tongue.  This will cause the retainer to loosen      and need to be adjusted more frequently.
9. Wire Retainers: Keep the wire directly in the middle of your teeth between the edge of the teeth and your gums.

Instructions for the Care of Bonded Retainers:

1. Floss under the wire every day!
2. Avoid biting into hard foods with your front teeth – ie. Apples.
3. If the wire comes loose, call the office immediately to make an appointment.  Delaying the visit may give time for teeth to shift to positions that are no longer correctable with retainers alone.

Bleaching is used to enhance your smile by brightening your existing natural teeth.  It will not lighten the shade on crowns, veneers, or fillings, and so these may require replacement following bleaching the natural teeth.  In order to evaluate the changes made, we recommend bleaching the top teeth alone for the first week, then incorporating the bottom teeth into the regimen.  After the first week, we will check your gum tissue health and initial results, though it may take 2-3 weeks for the desired change.

Instructions: 

1. Brush and floss teeth thoroughly prior to placing the tray in the mouth.
2. Place a small drop of gel in the tray at each tooth site that whitening is desired. 
3. Seat the tray completely and firmly onto the teeth.
4. Wipe off excess gel with a toothbrush or clean finger. 
5. Wear the tray for 1 hour each day. 
6. Remove the trays and brush the remaining gel from the teeth. 
7. Rinse the trays with cool water, and store them in their case.  If the trays are also used as retainers, replace them in the mouth.
8. Store the gel in the refrigerator.  There may be enough material to bleach again for 1-2 days every 6-12 months.