About Orthodontics

What is an orthodontist?

Orthodontists are specialized dentists, who after graduating from dental school, go on to additional full-time university-based education in an accredited orthodontic residency program supervised by orthodontists. That training lasts at least two to three academic years—sometimes more. By learning about tooth movement (orthodontics) and guidance of facial development (dentofacial orthopedics), orthodontists are the uniquely educated experts in dentistry to straighten teeth and align jaws.

Orthodontists diagnose, prevent and treat dental and facial irregularities. Orthodontists limit their practices to orthodontics and dentofacial orthopedics. That means that orthodontic treatment is what they do, and that is all they do. Orthodontists treat a wide variety of malocclusions (misaligned aligned teeth and/or jaws). They regularly treat young children, teens and adults.

Selecting an orthodontist who is a member of the American Association of Orthodontists (AAO) is your assurance that you have chosen an orthodontist: the dental specialist with at least two to three years of post-doctoral, advanced specialty education in orthodontics in a university-based program accredited by the American Dental Association. Specialty education includes the study of subjects in biomedical, behavioral and basic sciences; oral biology; and biomechanics.

Only orthodontists may be members of the American Association of Orthodontists (AAO).

When should I begin treatment?

The American Association of Orthodontists recommends that all children get a check-up with an orthodontist no later than age seven. Although only a few orthodontic problems need to be corrected at that age, an early exam allows the orthodontist to offer advice and guidance as to when the appropriate age to start treatment would be. Let your orthodontist guide you as to when to start treatment. Feel free to ask questions about the timing of treatment.

What are the stages of treatment?

There can be one, two or three stages or phases of orthodontic treatment. Most patients will benefit from one active corrective stage followed by a retention stage. Some patients will benefit from two active treatment stages, often referred to as two-phase treatment. The goals of each phase will be discussed with Dr. Fulton so that patients and/or parents have realistic expectations.

How are teeth moved?

Teeth respond to the gentle forces that are applied to them. "Braces" are a combination of "brackets" and "wires". Brackets are the part of the braces that attach to the teeth. Brackets are the "handles" that help control movement of the teeth. Braces require a wire called an “archwire” that connects the brackets and provides the forces to steer the teeth in the proper direction. It’s actually the wires that move teeth. The interaction of brackets and archwires enables the orthodontist to have three-dimensional control over the movement of the teeth. In many cases, additional forces are needed to help balance the underlying jaw structure and to help the upper and lower teeth fit properly together to make the bite right. Examples of these extra forces include: elastics (rubber bands) hooked to teeth (see photo below); functional appliances; and palatal expanders (see photos below).

1. Ligature - The archwire is held to each bracket with a ligature, which can be either a tiny elastic or a twisted wire.
2. Archwire - The archwire is tied to all of the brackets and creates force to move teeth into proper alignment.
3. Brackets - Brackets are connected to the bands, or directly bonded on the teeth, and hold the archwire in place.
4. D. Metal Band - The band is the cemented ring of metal which wraps around the tooth.
5. Bracket Hooks - The bracket or band extensions that are used for the attachment of rubber bands.

What are the treatment parameters that Dr. Fulton follows?

Like every area of dentistry, the practice of orthodontics is continuously developing. The parameters for treatment encompass a wide variety of considerations, including early treatment, first phase treatment, functional therapy, mixed dentition, permanent dentition, extraction or non-extraction therapy, surgical considerations, temporomandibular joint complications, and retention.

Each orthodontic case has two components to examine: the dental component and the skeletal or facial component. Dr. Fulton analyzes and evaluates the patient's dentition using dental models and panographic radiographs. The skeletal component of the examination includes a series of intraoral and extraoral photographs and cephalometric radiographs. The skeletal component of an orthodontic case may be dynamic if the patient is a growing child. Facial harmony is established when both components fit closely together. The further apart the two components are, the greater the discord and the more complex the case.

At what age should general dentists refer patients to an orthodontist?

The age at which we begin treating patients represents a paradigm shift in orthodontics. At the present time, the American Association of Orthodontists (AAO) recommends seeing children by the age of seven, versus waiting until the 12-year molars have erupted. This change has come about in part due to the use of functional appliances. These appliances are used to arrest, enhance, and/or redirect skeletal growth. The fact that our professional journal is now called "Orthodontics and Dental-Facial Orthopedics" reflects this new emphasis on facial harmony in our specialty.

In addition to facial orthopedics, another significant advantage to early mixed dentition treatment is the preservation of teeth that would have to be extracted under permanent dentition treatment. Also, early alignment of crowded or rotated anterior teeth decreases the potential for relapse since the transseptal fibers are reoriented and held in the corrected position longer.

How does Dr. Fulton structure the orthodontic treatment plan?

A first phase of orthodontic treatment involving mixed dentition may consist of myofunctional therapy, maxillary and/or mandibular expansion, space maintenance, anterior alignment, a biteplate, etc. The fee for this first phase of treatment can range from $400.00 to $3800.00, depending on the complexity and scope of the case. We work with a patient's family to arrive at a manageable payment plan.

Dr. Fulton’s favorite time to begin a second phase of treatment or full treatment is when the first premolars have erupted but the deciduous second molars remain in place, generally speaking between the ages of 10 1/2 and 11 1/2. Beginning treatment at this stage of development enables Dr. Fulton to fully utilize the leeway space during treatment. The fee for comprehensive treatment can range from $2200.00 to $7500.00. Surgery cases are not necessarily the most expensive cases, due to the fact that a surgical procedure often substantially reduces treatment time. Fees are based on complexity, type of therapy and duration of treatment.

What is Dr. Fulton's approach to working with a patient's dentist?

Dr. Catherine Oden Fulton considers communication with our patients' general dentist to be absolutely vital. This is especially true if their dentist has planned restorative work. Dr. Fulton likes to meet with the general dentist in person to establish an open line of communication and answer any questions about the patient's orthodontic treatment. Progress reports on active patients are sent to the general dentist in January and July. Because Dr. Fulton believes that teamwork between the orthodontist and general dentist is a prime factor in a successful treatment result, suggestions on enhancing patient care are always welcome.

How does Dr. Fulton stay current on new developments in orthodontics?

To keep up with the changing face of orthodontics, Dr. Catherine Oden Fulton subscribes to various professional journals and attends several day and evening courses throughout the year. In addition, she attends at least one three-day course per year. The courses that may be of some interest to the general dentist would include Pankey's and Dawson's courses for specialists.

Dr. Fulton expects the pace of change in the field of orthodontics to increase as new methods and technologies evolve. Our office is committed to staying on the cutting edge of our profession by utilizing treatment enhancements, such as digital photography and video imaging, to serve our patients better. However, there is one constant that you can count on: our commitment to providing our patients the highest quality orthodontic services.

What is a "gummy smile" and what should be done about it?

As an orthodontist, Dr. Catherine Oden Fulton is often the first health care professional to analyze how a child will look when he or she grows up. When she examines a patient's facial features, she considers both the vertical and horizontal proportions of the mouth. The most common areas of imbalance horizontally involve the maxillas, the bones that form the upper jaw, and the mandible, the lower jaw.

The upper jaw can be either too large or too small. If the region from the eyes to the upper lip is too small, the face will appear sunken in and the lower jaw will seem too strong, creating a generally unhappy or sour facial expression. If the upper jaw is too big, the gums will show whenever the lips are parted - producing a gummy smile. The technical term for this condition is vertical maxillary excess. Anything more than a little gum showing above the teeth is considered a gummy smile.

Because a gummy smile is caused by a skeletal malformation involving the growth of the facial bones, early intervention is critical. Sometimes Dr. Fulton can either redirect, stunt or encourage bone growth, depending on which is needed to correct the problem. In many cases, however, a surgical correction is required. If so, Dr. Fulton refers the patient to either a plastic surgeon, who alters the soft tissue areas above the mouth, or a maxillofacial oral surgeon, who adjust the skeletal structure.

Even if surgery is necessary to create the proper balance between the upper and lower jaw, Dr. Fulton very often stays involved in the case in order to straighten the teeth for cosmetic purposes. In fact, the wires and brackets used for cosmetic corrections also play a role in correcting the skeletal components of the case. The oral surgeon uses the brackets, bands and wires that Dr. Fulton installs to move the jaws into the correct position and hold the skeletal parts together during the healing process, which takes four to six weeks.