Do athletic mouthguards help protect my child from tooth and/or brain injury?

First, let me point out that many types of mouthguards are available—from thin, loosely-fitting generic models to precision-fit, pressure-laminated custom units.  Regarding tooth protection, most mouthguards offer some benefit; however, the better-fitting, thicker mouthguards are able to absorb and diffuse the impact energy of a given collision leading to greater protection from tooth injury.

Regarding the ability of mouthguards to prevent or reduce brain injury such as concussion, clear-cut evidence has been difficult to gather due to the difficulty of designing adequately controlled studies.  However, in a commentary for the Journal of Athletic Training, pediatric dentist Jackson Winter points out, “. . . preliminary work comparing the 1997 through 1999 NCAA college football seasons suggests that (properly fitted, pressure-laminated mouthguards) have made a difference (with respect to concussion resulting from a blow delivered to the mandibular complex).”  To effect this protection, he recommended a 3 to 4mm thickness separating the occlusal (chewing) surfaces of the upper and lower posterior teeth.

Given the risks associated with sports-related head injuries and the potential for reducing those risks through the use of pressure-laminated mouthguards, I recommend that such mouthguards be utilized from an early age.  Custom fitted, this type of mouthguard requires less bulk and, therefore, is less likely to be resisted; early and consistent use creates a habit that can last throughout a sporting life.  More importantly, pressure-laminated guards offer the most effective tooth protection and, if preliminary results are correct, will likely lessen the risk of concussion and brain injury from mandibular impacts.

How long does Invisalign treatment take, and am I, or is my child, a good candidate?

In our practice, Invisalign and traditional treatment with brackets and wires require similar treatment lengths; the total time being dependent upon case complexity.  The key to efficient and excellent treatment with Invisalign is the clinical understanding of Invisalign mechanics, which differ greatly from wire and bracket mechanics.  Most patients, adult and teen, can be effectively treated with Invisalign through the incorporation of advanced Invisalign techniques, the proper sequencing of tooth movement, and, when needed, the limited use of traditional orthodontic auxiliaries.  Many cases that would be difficult to treat with Invisalign alone are hampered by the position of one or two teeth and the corresponding corrective movements that are necessitated.  Often, by utilizing traditional techniques to align these teeth in preparation for Invisalign, an experienced orthodontist can transform the case into one that will allow successful and efficient Invisalign treatment.  Orthodontists skilled in both the use of Invisalign and traditional care can effectively integrate the use of auxiliaries and eliminate those failed Invisalign cases that have resulted in the erroneous impression that Invisalign is either ineffective or takes longer than traditional braces.

Certain cases, such as surgical orthodontic therapy with skeletal fixation, are most commonly treated with traditional braces.  However, Invisalign is a superior modality for non-surgical, high-angle, and/or anterior open bite cases.  And, for the majority of presentations, as noted above, traditional treatment or Invisalign may be effectively used.

Suitability of Invisalign for a child is highly dependent upon not only the orthodontic diagnosis but also the expected level of patient participation.  The necessity of consistent wear of the clear plastic aligners over the full length of treatment can make Invisalign inappropriate for some individuals, whether adult or child.  (Experience in orthodontic practices across the country indicates that the percentage of patients that present with insufficient aligner wear is similar in adult and teen populations.)  The likelihood of high compliance will be discussed with your orthodontist to determine if your child is a good candidate.  I often ask the younger patient if he or she is the type of person who always makes the bed, or habitually brushes his or her teeth without being reminded.  If the answer is no, accompanied by a chuckle and knowing glance between parent and child, I remind everyone that our ultimate goal is to have an ideal result, which will necessitate 22+ hours of aligner wear every single day of treatment.  If the desire for the benefits of Invisalign is not sufficient to instill the necessary dedication and commitment, I suggest that the family reconsider their options.  Patients that do not sustain the necessary level of aligner wear can still attain an ideal result, but usually only following a transition into braces.  Such cases take longer and may cost more than if they had been started with fixed appliances (braces).  Thus, even though many teens prove to be some of the best Invisalign patients, it is important to have a frank appraisal of the most likely level of patient participation before entering any treatment.

While the vast majority of adult patients seek out Invisalign over braces, some adults opt for traditional treatment, preferring not to remove and replace aligners.  This is particularly appropriate if the patient is both busy and unconcerned with visible brackets.  We offer crystal clear brackets and tooth-colored wires that greatly reduce the visual impact of traditional treatment.  Lingual braces are yet another option for the adult patient.  These options are available in most orthodontic practices and provide the adult with many acceptable alternatives to metal braces.

Regarding treatment length, there are now technologies (Acceledent, Propel, and Wilckodontics) that enhance the biological processes involved in tooth movement, reducing the time required to achieve an excellent orthodontic result by 25-40%, regardless of modality chosen.  Some of these technologies are easily incorporated, such as Acceledent, and can have the added benefit of reducing the discomfort of orthodontic tooth movement.

In all cases, I recommend that you seek an examination with one or more orthodontists and choose that practitioner who is willing and able to address your questions and concerns.  If Invisalign is your preference, you must use your own judgment regarding the practitioner’s expertise.  As an aid, you may wish to inquire about continuing education; Invisalign is a rapidly evolving modality with many opportunities for advanced training.  Some very competent and busy orthodontists have not yet been able to devote time to Invisalign education and, while excellent practitioners of traditional treatment, are not able to effectively and efficiently utilize the Invisalign system.  As Invisalign becomes more and more prevalent this situation will likely become rare.  For the time being, however, potential patients should educate themselves and be willing to ask questions to determine expertise.

Best wishes on your future treatment, and keep smiling!

My child has an “overbite.” How is that corrected?

The term overbite is typically used to describe what is referred to by orthodontists as overjet.  This is excessive distance between the upper and lower incisors in a horizontal direction with the upper teeth forward of the lower.  This finding can describe a number of situations.  For example, the same overjet may result from protrusion of the upper teeth in the bone or from a retrognathic (receding) lower jaw.  This underscores the importance of an accurate and comprehensive diagnosis.  Orthodontic treatment planning requires three dimensional evaluation and consideration of the fourth dimension of time with the associated biological processes.

Correction of an overjet may involve retraction of protruded upper incisors, differential growth modification of the jaws, alignment of retruded lower incisors, management of soft tissue habits, or a combination thereof.  In some cases, a significant skeletal imbalance requires a surgical solution after growth has ceased.  I encourage you to seek out an orthodontic evaluation from an excellent and experienced orthodontist that is willing and able to communicate with you, to your satisfaction, about your child’s specific case.  Orthodontic evaluations are typically free of charge and it is not uncommon for a parent to seek second or third opinions, if needed.

When should I take my child to an orthodontist?

The American Association of Orthodontists recommends that all children be screened orthodontically at age seven.  Sometimes the reaction to this is one of surprise (“Isn’t that young?”) or suspicion (“Orthodontists can’t wait to get your money.”).  There are, however, very sound reasons for this recommendation.  The intent of the age seven screening is to confirm radiographically that the development and eruption of the permanent teeth is proceeding normally, without complication.  (This cannot be determined by visual examination alone and is not reflected in the appearance/relationships of the primary teeth.)  For those children without complications, the orthodontist will periodically monitor development free of charge.  For children with unseen issues, such as a poorly resorbing primary tooth blocking the pathway of the associated permanent tooth, early intervention can prevent what would otherwise result in a significant malocclusion.  In the case noted, the well-timed extraction of the “baby” tooth would allow the permanent tooth to self-correct, moving toward its proper position.  Other issues that may be discovered include congenitally missing permanent teeth, extra (supernumery) teeth, malformed teeth, and damage to the roots of erupted permanent teeth due to misdirected (ectopic) eruption of other permanent teeth.  The “7-up” check-up is a service that is intended to reduce both the impact of these potential issues on the forming occlusion and the extent of orthodontic treatment, if needed, in the future.

I bite my tongue: can that be changed?

If you repeatedly bite your tongue or cheek, you may have malocclusion of the dentition that is contributing to this painful situation.  Typically, the shapes of the tooth surfaces facing the tongue (lingual) and cheeks (buccal) are such that, when the teeth are positioned correctly, the tongue and cheeks are guided safely away from the biting area.  If this is not the case, orthodontic treatment may be advisable.  Both children and adults suffer from this problem and can be successfully treated in most cases.  Advancement in orthodontics (e.g., wire technology, Acceledent, TADs, Invisalign, etc . . .) makes such treatment shorter in duration than in years past and appropriate for all ages.  (So talking, or consuming your favorite foods, can once again be enjoyable!)