First evaluation

When is the best time to begin orthodontics?

Though an orthodontist can enhance a smile at any age, there is an optimal time period to begin treatment. Beginning treatment at this time ensures the greatest result and the least amount of time and expense. The American Association of Orthodontists recommends that the initial orthodontic evaluation should occur at the first sign of orthodontic problems or no later than age 7. At this early age, orthodontic treatment may not be necessary, but through vigilant examination, we can anticipate the most advantageous time to begin treatment.

What are the benefits of early orthodontic evaluation?

Early evaluation provides both timely detection of problems and greater opportunity for more effective treatment. Prudent intervention guides growth and development, preventing serious problems later. When early orthodontic intervention (interceptive care) is not necessary, an orthodontist can carefully monitor growth and development and begin single-phase treatment at the ideal time.

X-ray showing normal development in an 8-year old with unerupted, developing adult teeth

Why is age 7 considered the optimal time for screening?

By the age of 7, the first adult molars erupt, establishing the back bite. During this time, an orthodontist can evaluate front-to-back and side-to-side tooth relationships. For example, the presence of erupting incisors can indicate possible overbite, open bite, crowding or gummy smiles. Timely screening increases the likelihood of an incredible smile.

Comprehensive care: Ready to start!

Most children and adolescents are ready to begin treatment between the ages of 9 and 13, when they have enough teeth to support the appliances and when growth and development have been adequately established to be predictable. The key to success is to start treatment at the optimal time of dental and skeletal development and emotional maturity. This is a highly individual task and is different for each child. These orthodontics cases, which are far and away the most common, are completed in a single phase of care; braces are worn for the appropriate time period and the results are superb.

Interceptive Care: a special way to care for your child.

In cases when early orthodontic intervention is called for, jaw and facial improvements are accomplished through interceptive care. Before the techniques employed in Interceptive Care were developed, children waited to begin orthodontic treatment with full braces until after the complete eruption of permanent teeth. Skeletal problems, if present, were left untreated, which later compromised the final result. For some children, without interceptive care it was extremely difficult to align the upper and lower jaws so that they fit together; the skeletal discrepancy was not functionally healthy or stable. In these cases, otherwise preventable adult tooth extraction or jaw surgery was required.

intercept_childAccording to studies by the American Association of Orthodontists, untreated malocclusions can result in a variety of problems. Malocclusions occur as a result of tooth or jaw misalignment. Crowded teeth are more difficult to properly brush and floss, which may contribute to tooth decay and/or gum disease. Protruding teeth are more susceptible to accidental chipping. Cross bites can result in unfavorable growth and uneven tooth wear. Open bites can result in tongue-thrusting habits and speech impediments.

What are the advantages of Interceptive Care?

Some of the most direct results of interceptive treatment are:

  • Creating room for crowded, erupting teeth
  • Creating facial symmetry through influencing jaw growth
  • Reducing the risk of trauma to protruding front teeth
  • Preserving space for unerupted teeth
  • Reducing the need for tooth removal
  • Reducing treatment time with braces later on

How does Interceptive Care work?

Treatment occurs during a young child’s active growth years, before skeletal problems are firmly set. Treatment plans are designed to guide and enhance a child’s own natural growth to establish proper upper and lower jaw development. An upper or lower jaw that is growing too much or not enough or is too wide or too narrow can be discovered when a child is very young. Because they are growing rapidly, children can benefit enormously from orthopedic (“bone” correction) orthodontic treatment. Early childhood is also an ideal time to treat aesthetic concerns that may have an impact on a young child’s self-esteem. Interceptive Care rarely extends longer than 12 months.

What comes next?

After interceptive care, when most of the permanent teeth have erupted, braces are employed to complete the alignment of both the jaws and permanent teeth for proper function and excellent aesthetics. This phase may last 6 to 24 months depending on the child’s growth and development and the complexity of the treatment.

Appliance Choices


Metal braces

Metal braces are the most common type. They are made of high-grade stainless steel. Today’s metal braces are smaller, comfortable and attractive. RTO uses an incredibly specialized self-ligating bracket that decreases friction, allowing a significantly increased comfort level and decreased treatment time.

Ceramic braces

Ceramic braces are made of translucent (clear) material. They are a popular esthetic option that can dramatically reduce the appearance of the braces.


The Invisalign System is a series of clear overlay templates—called aligners—that have been customized by the doctors, using computer simulation, to gradually move your teeth. This system is available to teenagers with certain orthodontic bite problems. Ask us if your child is a candidate for Invisalign teen®.

Learn more
about Invisalign®

Food Guidelines

Avoid any hard, sticky or chewy foods.

Hard – Popcorn, nuts, peanut brittle, ice, corn chips, Doritos, pretzels, bagels, subrolls, pizza crust, hard candy, lollipops, jawbreakers, etc. Corn may be eaten as long as it is cut off the cob first. Slice hard fruits and vegetables such as carrots, celery, and apples into bite size pieces and chew on your back teeth.

Sticky – Gum (sugarless, Freedent and Stick Free gum), caramel, taffy, gumdrops, Starbursts, Gummy Bears, Sugar Daddy, Charleston Chew, Snickers, Fruit Roll Ups, etc.

Chewy – Beef jerky, Slim Jims, granola bars. Meats such as chicken, steak, spare ribs, and pork chops may be eaten but please cut meat from the bone.

Hints – Instead of biting down into foods with your front teeth, you may find it easier to use a fork and knife to cut food into bite size pieces. One way to damage your appliances is picking at them or playing with them. Chewing on pens and pencils can cause brackets to break.

Remember – If anything becomes loose or broken, call the office as soon as possible for instructions.

Download a printable pdf file of these guidelines.

More about Appliances

Oral Hygiene and Broken Brackets

Compliance is the key to success in orthodontics. Poor brushing and excessive breakage of brackets will result in longer treatment, compromised outcomes, cavities and staining of the teeth. Braces can sometimes come loose from the teeth. If this happens, just given us a call to help determine the best time to repair it. Clean teeth move faster, more predictably and will never be stained or decayed. We will help you learn the proper way to brush and floss with braces!

Broken Brace

Poor Oral Hygiene


Retainers are used to hold your teeth in their corrected position. There are two types: removable and fixed (bonded in place) retainers. We will recommend the style that we feel will maintain your correction best.

To keep your teeth in their new position, your retainers should be worn 24 hours a day for one week, then at night while you sleep. We will instruct you further when you may reduce wearing time. ALWAYS keep your retainers in your case when eating. NEVER leave them on a lunch tray, in a pocket, or wrapped in a napkin. Any of these situations may result in losing or breaking your retainers and an unnecessary expense. When brushing your teeth, be sure to brush you retainers also. (Remember plaque can also form on your retainers, so keep them clean.) Use your toothbrush, toothpaste, and cold water. Never boil or use hot water as this could damage your retainers. Your speech may be affected the first few days of wearing your retainers. Reading aloud to yourself can help you become more accustomed to your retainers and will allow your speech to quickly return to normal. To assure a proper fit, it is very important to bring your retainers to your appointments so they may be adjusted. To avoid a charge for broken or lost retainers, please handle with care!

Download a printable pdf file with more information.

Removable Retainer

Lower Fixed Retainer

Fixed Retainer


Separators are little rubber elastics which fit in between your back teeth. They gently open small spaces between these teeth so that bands can be placed at your next visit.

Your teeth may be sensitive. Any discomfort should disappear in a few days. To relieve any soreness, Tylenol or what you normally take for a headache would be fine. Foods that are sticky or chewy like gum should be avoided.

Please continue to brush regularly and floss only between teeth that do not have separators in them. If a separator happens to fall out, don’t worry, enough space has been made. If you have any questions, please call during our regular office hours.

A lost separator does not have to be replaced.

Download a printable pdf file with more information.

Separator Placement


Elastics help us move your teeth by a gentle but continuous force. Teeth move best when elastics are worn consistently.

Rules to follow

  • Elastics need to be worn 24 hours a day, 7 days a week for your teeth to move.
  • If possible, leave elastics on while eating to gain maximum benefit.
  • Remove elastics to brush your teeth. Change them once a day because they lose their strength. It’s a good idea to leave elastics in the same area when you brush your teeth. This way you will see them and remember to put them back on.
  • ALWAYS carry elastics with you so that if an elastic breaks you will be able to replace it right away.
  • Your teeth may be a little tender for a couple of days. If you wear them as instructed, any discomfort will soon disappear. If you take them on and off, your teeth will never get a chance to become accustomed to them, and your teeth will always be sore.
  • Please call the office if you run low and we will gladly mail some to you.

Download a printable pdf file of these instructions.

Teeth move best when elastics are worn consistently. Click on the left movie to see how teeth will move when elastics are worn 24/7. Click on the right movie to see what can happen if elastics are only worn some of the time.

Proper Elastic Wear

Poor Elastic Wear

Palatal Expander

The palatal expander is used to widen your narrow top jaw. It is usually painless, but some pressure may be felt as the expander is activated.

  1. Your appliance needs to be activated each a day, for the number of turns you have been instructed to apply. [indent a.b.c. in standard outline style]
    1. Insert the key into the hole in the middle of the appliance.
    2. Gently and steadily push the key toward the back of your mouth. Push it as far back as possible.
    3. Remove the key towards the back of your throat trying not to pull forward which would reverse the previous turn!
  2. You will experience a tingling sensation around your nose for a minute.
  3. After several turns (or after several days), you may notice a space between your front teeth. This is a good sign!! This is only temporary and will be closed.
  4. Be sure to keep your appliance free of food particles.
    1. You can do this by brushing your appliance while you brush your teeth, by directing your toothbrush towards the roof of your mouth.
    2. Rinsing with a glass of water will also help loosen food particles which my become lodged on the top of your expander.
  5. If at any time you experience discomfort that does not go away or if your appliance becomes loose, please call the office.
  6. If for any reason you cannot keep your scheduled appointment, do not activate your appliance beyond the instructed number of turns.

Download a printable pdf file of these instructions.

Palatal Expander

Learn more about other appliance choices and treatment options.