Elastics (Rubber Bands)
Wearing elastics (or rubber bands) improves the fit of your upper and lower teeth. Wear elastics as instructed, and remember that the elastics work far more efficiently if they're worn as prescribed.
Forsus™
The Forsus Fatigue Resistant Device is an alternative to headgear which promotes growth in adolescents, helping to eliminate excessive overbites, improve the fit of teeth, and possibly prevent the need for jaw surgery.
Herbst® Appliance
A HERBST APPLIANCE will improve jaw function. This eventually leads to an ideal bite.
Why a Herbst Appliance?
One of the most common problems presented to an orthodontist is the upper teeth being further forward relative to the lower teeth. In most cases, this is the result of the lower jaw being set back relative to the upper jaw, as opposed to the upper jaw being too far out. The Herbst is a fixed appliance that is used, usually in conjunction with braces, to correct this type of bite or overbite. In the past, orthodontists used head gear to correct overbites; however, head gear was difficult to wear and depended on patient compliance. The Herbst appliance accomplishes the same thing as the traditional head gear and is actually more effective. While it has the same “headgear effect” of holding the top jaw from continuing to outgrow the bottom jaw, it also pushes the bottom jaw forward, helping it “catch up”. The growth center of the bottom jaw is near the lower jaw joint and the Herbst appliance works to “remodel” this area. Most patients find the Herbst appliance surprisingly easy to wear.
How Does a Herbst appliance Work?
The Herbst Appliance is cemented onto the upper and lower molar teeth and requires little compliance. It is hinged and includes two small metal tubes that are attached to the left and right-sided upper molars. Two small tubes on the bottom connect the small metal tubes to the lower teeth. These guidance tubes are designed to slide and create a gentle force meant to push the lower jaw forward. By activating the Herbst appliance your orthodontist is able to control the jaw's position in relation to the upper teeth. Depending upon the severity of the jaw discrepancy this is usually done every few months until the proper jaw position is achieved. The appliance is usually worn for a total of 9-12 months. The treatment time will depend on the patients’ unique needs. Upper and lower braces may also be placed during Herbst treatment but not always so. The main goal of orthodontic treatment utilizing the Herbst appliance is the correction of the jaw discrepancy.
Adjusting to a Herbst Appliance
When your child first gets his or her Herbst appliance you can expect it to take about 7 days to get used to it. The Herbst is hinged allowing the mouth to open and close enough to speak and eat normally, but initially, the patient’s bite will feel different and chewing may be affected. There may be some overall muscle tenderness and soreness of the teeth. As your child's mouth adapts to the appliance, the soreness should fade. Because the Herbst appliance is metal, it may cause some slight tissue irritation, especially on the lower gums. Occasionally, patients can develop sore spots where the appliance rests against the soft tissues of the cheeks and lips. If this happens the application of dental wax can help to ease the irritation. Speaking may be awkward at first and patients often create more saliva than normal. Practicing speaking through singing or reading aloud and becoming accustomed to the appliance should help with saliva reduction and overcoming any awkwardness felt while talking.
Eating with the Herbst appliance.
Eating softer food will help with any muscle soreness, especially after the first week or two after getting the appliance. As with many orthodontic appliances, it’s important to be careful and conscious about the foods you eat while wearing the Herbst appliance. It is very important to eliminate sticky foods, like candy and gum, or hard, crunchy food. Chewing these can damage the appliance and as a result lengthen treatment time. Some examples of foods to avoid are: ice, caramel, whole hard raw vegetables. Our staff will review the foods to avoid once the Herbst appliance is placed. Patients should also be careful not to open their mouths too wide, as this can cause the appliance to come apart.
Care of the Herbst
It is durable and requires little maintenance except for normal cleaning and slight modifications to diet. Since the Herbst appliance lies in contact with the teeth, extreme care must be taken with regards to oral hygiene. The patient should use a daily fluoride mouth rinse and should avoid all sticky and sweet foods that could cause decay. Particular attention should be taken to keep the area of the appliance adjacent to the gum tissue clean and free of food debris. Once the appliance is placed, our staff will review proper cleaning techniques.
What problems can occur with the Herbst?
If any part to the Herbst appliance becomes loose we require you to inform us immediately. A broken appliance will require our attention and we will need to schedule a visit into the office. In addition, please notify us if any irritation of the cheeks or lips persists or if there is an unpleasant smell or taste occurring in the mouth.
What happens when the Herbst appliance is removed?
Once the Herbst appliance is removed, comprehensive orthodontics or braces will be initiated to finalize bite correction and tooth alignment for the greatest stability and esthetics.
The Rapid Palatal Expander.
The Rapid Palatal Expander (RPE) orthodontic appliance is one of the best orthopedic appliances available in orthodontics. It is easy to use and provides large benefits in creating a proper occlusion or bite. The Rapid Palatal Expander appliance is an appliance that is placed on the upper teeth. It "expands" (or widens) the bones in the upper jaw by putting gentle pressure on the upper molars each time an activation is made. Appling this gentle pressure at an early age can separate the mid palatal suture of the bones of the upper jaw, making it wider, and thus, creating more room for the adult teeth to erupt and the smile to better fit with the lower teeth.
When is a palatal expander needed?
During an examination, our Orthodontists will evaluate how the upper and lower teeth bite together. When the upper teeth are on the inside of the lower teeth in the back sections of the mouth, it is called a posterior crossbite. If the posterior crossbite is only on one side, it can cause the lower jaw to grow asymmetrically, or unevenly to that side. RPE appliances are often used to correct posterior crossbites to prevent asymmetrical growth of the lower jaw and to obtain more room for the other unerupted teeth. We correct posterior crossbites as soon as we see them because it is better to do this procedure at a younger age before the palatal suture becomes fused.
With adults, the upper jaw can be expanded by using an RPE and having surgery preformed by an oral surgeon. This procedure is called Surgically Assisted Rapid Palatal Expander (SARPE).
How to activate the RPE.
The activation of an RPE is usually done by a parent, guardian or other household member. The patient is given a small wrench that fits over the screw of the RPE appliance. The patient tilts their head back and opens very wide so that the RPE can be seen clearly. Holding the wrench securely with two fingers it is placed on the screw of the RPE as close to the upper teeth as possible. The wrench is then rotated towards the bottom front teeth. After one "swing" of the wrench, it is carefully removed without turning the screw backwards and a second "swing" of the wrench is completed. Two "swings" of the wrench is considered one activation. Our orthodontic team will provide detailed instructions about when and how to activate the RPE once it is placed. Usually a patient will activate the expander once or twice a day for a prescribed number of days. Once the RPE is placed regular follow up visits are scheduled to closely monitor the progress of the expansion.
How long is RPE treatment?
Response to orthoodontic treatment can vary with every patient. The amount of time a patient requires for RPE treatment varies with the amount of expansion desired and their response to the appliance. Typically the RPE activation phase is three weeks. Once the desired expansion is achieved the RPE remains in place without activation, or turning, for about six months. This non-activation time is required to allow the palatal suture to solidify with new bone growth and the expansion of the palate bones to become stable. If the RPE is removed early, some of the width or expansion gained could be lost. During the expansion, a space may develop between the central incisors or two front teeth. This is normal. When the activation phase of the RPE treatment is completed, the gum tissue between the front teeth will pull the teeth closer together and possibly eliminate this new space. If not, any space that remains will be closed at the completion of treatment.
Questions our Patients may have regarding RPE treatment.
How does it feel to wear an RPE appliance?
It will likely take 3-5 days to get used to having the rapid palatal expander appliance in your mouth. Wearing an RPE does not hurt. After you turn the expander with the wrench you will feel pressure. The pressure lasts for about 4 to 5 minutes and feels like you are pushing on your teeth with your thumb.
Certain speech sounds may be difficult for you to say at first, such as "th" and "s" sounds. This will improve with time. Speaking, singing and reading out loud can be vey helpful. You will feel like you have extra saliva in your mouth when you first get your expander appliance. Your brain automatically starts saliva production when you put something in your mouth, even if it isn't food. It can take a few days to get used to swallowing but carring a water bottle and practicing by taking small, frequent sips of water will help. Try not to rub your tongue and cheeks on the expander as your mouth tissues can become irritated and sore. If this happens you can try rinsing with warm salt water for a few days. Placing dental wax on the RPE opposite a sore spot may also be helpful allowing your cheek to glide over the expander.
Eating with the RPE
There are certain foods that you cannot eat while your RPE appliance is in place. This would include sticky/hard foods. Our staff will carefully review any dietary recommendations and restrictions when the RPE appliance is placed and answer all your questions.
Possible problems and care of your RPE appliance.
As with all orthodontic appliances there is a small chance your RPE may become loose. In the event the appliance does become loose do not wiggle it and do not do any further activation. Contact us immediately to schedule an appointment. It is important the RPE is always attached firmly to your teeth.
Orthodontic appliances need to be brushed when teeth are brushed. You need to take extra care to brush the midddle and sides of the RPE. If a piece of food becomes lodged try rinsing your mouth with water or use a toothbrush to get rid of it. Never pick at or pull on your expander with your fingers or tongue. You do not want to loosen the cement that is holding your appliance in place. Our staff will carefully review appliance care with you and your parents or guardian when the RPE appliance is placed and be available to answer any questions that may arise once you are home.
Retainers
Retainers may be removable or fixed. They hold your teeth in their new, correct positions after your teeth have been straightened. Your orthodontist will instruct you on how to care for your retainer and about the duration of the wear. Wearing your retainer as directed is crucial to prevent regression of your treatment.
Separators or Spacers
Separators are little rubber doughnuts that may be placed between your teeth to push them apart so that orthodontic bands may be placed during your next appointment. The separators will be removed before we place the bands. Separators do not mix well with sticky foods, toothpicks, or floss.
