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You might be surprised to see one of your second grader’s friends with a dental appliance. Isn’t orthodontic work just for teenagers? And, if not, should your seven-year-old be sporting braces right now? The answer to both of those questions is “Not necessarily.” Two-phase treatment is a process designed to correct issues that arise during different times in your child’s life.

First Phase Treatment

We recommend that every child have an orthodontic evaluation around the age of seven to determine if there is a problem that would benefit from early treatment. First phase orthodontics is not the same as orthodontics for older patients. The focus here is on the developing bone and muscle structures which form your child’s bite and provide space for the permanent teeth when they arrive.

There are some clear-cut orthodontic goals that are much easier to attain when children’s bones are still growing.

• Reducing Crowding

If your child’s mouth is small, the permanent teeth will have little room to fit in when they arrive. We may recommend gently enlarging the upper dental arch with the use of a palatal expander. This device will provide room for the adult teeth, and could potentially shorten second phase treatment time. Sometimes the extractions necessary to create more room for permanent teeth in later years can be avoided, as well as the possibility of an impacted tooth—one which doesn’t erupt because it is blocked by other teeth.

• Dealing with Jaw and Bite Concerns

Bones and muscles do not always develop properly, leading to problems with jaw and facial structure. Your younger child still has growing bones, so this is a great time to gently re-form the jaw into a healthy shape. Problems caused by crossbites, underbites, open bites, and other malocclusions can be reduced with early treatment.  

• Protecting Teeth

If your child has protruding front teeth, these teeth are more likely to be damaged in falls, at play, or while participating in sports. We can gently reposition them.

Second Phase Treatment

Second phase treatment is designed for your older child. After a resting period, when the permanent teeth finish erupting, we should see your child to evaluate any further orthodontic needs. This is the time to finish the process of straightening the teeth and making sure that each tooth fits together properly for a comfortable and healthy bite. This phase usually makes use of braces or aligners, and can take approximately 12-24 months.

Two-phase treatment is not necessary for every child. But there are some unique reasons that early orthodontics might be recommended for your child, even if it’s clear that more orthodontic work will be needed later. Make an appointment with Dr. Bradley Hoppens and Dr. Mary Beth Meier at our McCook, North Platte, or Ogallala office, and let’s evaluate your child’s orthodontic needs, whether now or in the future, for a lifetime of beautiful smiles.

From the time you were small, you’ve been warned about the dangers of plaque. Why? Because:

• It’s an unpleasant film that sticks to your teeth
• It causes cavities
• It causes gum disease
• It can cause extra problems when you wear braces

And really, do we need to know much more than this to motivate us to brush? But if you’re in a curious mood, you might be wondering just how this soft, fuzzy film accomplishes all that damage. Let’s take a closer look at the sticky problem of plaque.

How does plaque form?

We live with hundreds of species of oral bacteria, most of which are harmless, and some of which are actually beneficial. But when our oral ecosystem gets out of balance, problems can occur. For example, without regular and thorough brushing and flossing, we start to build up plaque.

Plaque starts forming within hours of your last brushing. And even though plaque fits the very definition of “seems to appear overnight,” this biofilm is actually a complex microbial community with several different stages of development.

• It starts with saliva.

Saliva is vital to our oral health, because it keeps us hydrated, washes away food particles, neutralizes acids in the mouth, and provides minerals which keep our enamel strong. Saliva also contains proteins, which help form a healthy, protective film on the tooth surface. This film is called a pellicle.

• Bacteria attach to the pellicle.

There are species of oral bacteria that are able to attach themselves to the pellicle film within hours of its formation. As they become more firmly attached, they begin to grow and divide to form colonies, and are known as the early colonizers of the plaque biofilm.

• A complex biofilm forms.

If you’ve skipped brushing for a few days (please don’t!), you’ll notice a fuzzy, sometimes discolored film on your enamel—that’s a thriving plaque community, and it only takes a matter of days to go from invisible to unpleasant.

If you’re not removing plaque regularly, it can harden further and become tartar. And once you have tartar buildup, you’ll need the care of a dental professional to remove it.

• What happens if we ignore plaque and tartar?

We get cavities and gum disease.

How does plaque cause cavities?

• The bacteria in plaque, like all organisms, need nutrients.

Our normal oral environment and the food in our everyday diets provide the nutrients plaque needs. And, as we mentioned above, certain types of oral bacteria convert these nutrients into acids. Foods such as carbohydrates, starches, and sugars are most easily converted into acids, which is why we recommend that you enjoy them in moderation.

• The biofilm promotes acid production.

Within the plaque film, anaerobic bacteria (bacteria which don’t use oxygen) convert sugars and starches into acids. As the plaque film becomes denser, it blocks acid-neutralizing saliva and oxygen from reaching these bacteria close to the tooth’s surface, creating an ideal environment for the bacteria to produce their acid waste products.

• Acids attack enamel.

The sticky nature of plaque keeps these acids in contact with tooth enamel, where, over time, acids dissolve minerals in enamel, weakening the mineral structure of the tooth.

How does plaque cause gum disease?

• Bacteria cause inflammation and gingivitis.

The bacteria in plaque irritate the delicate tissue of the gums, which causes an inflammation response which can leave your gums swollen, red, bleeding, or tender. This early form of gum disease is gingivitis. Fortunately, good dental care and careful brushing and flossing can usually prevent and even eliminate gingivitis.

• Plaque and tartar can lead to periodontitis.

When plaque and tartar build up around and below the gumline, the gums pull away from the teeth, leaving pockets where bacteria collect, leading to infection as well as inflammation. Infections and constant inflammation not only harm gum tissue, they can destroy the bone supporting the teeth. This serious gum condition is periodontitis, and should be treated immediately to avoid further infection and even tooth loss.

How does plaque affect orthodontic patients?

• Plaque collects around your braces.

Braces provide plenty of spots for plaque to hide from your brush. If you aren’t extremely diligent with your brushing and flossing, plaque collects near brackets, wires, and bands—all those spots that a brush and floss find difficult to reach.

• Plaque promotes demineralization

The demineralization process we mentioned above can cause white spots on teeth (decalcification), where minerals have dissolved. Sometimes these spots can be treated, and sometimes they are permanent. They can become quite sensitive, and may lead to cavities.

Careful brushing and flossing around your braces will help eliminate the plaque that can cause demineralization near brackets. Ask Dr. Bradley Hoppens and Dr. Mary Beth Meier about the tools and the brushing and flossing techniques which will give you the best results.

How do we fight plaque?

From the time you were small, you’ve learned how to fight plaque:

• Brush at least twice a day for two minutes, and be sure to brush all of your tooth surfaces and around the gumline.
• Floss to remove plaque from between the teeth and near the gumline.
• See your dentist as recommended for a thorough professional cleaning.

Be proactive. If you have any questions, talk to us at our McCook, North Platte, or Ogallala office about the best way to keep plaque at bay. We can show you the most effective ways to brush and floss, recommend anti-plaque toothpastes and rinses, even suggest plaque-revealing tablets if you’re missing some trouble spots.

We’ve only brushed up on some plaque basics, because there is a lot more to discover about this complex biofilm. Happily, even with all there is to learn about plaque’s growth and development, it’s reassuring to know that getting rid of it is quite simple—with just a soft-bristled brush, some dental floss, and a few minutes of your time each day, you’re on the way to a healthy, happy, plaque-free smile.

Now that many of the schools in McCook, North Platte, or Ogallala are back in session, Dr. Bradley Hoppens and Dr. Mary Beth Meier would like to remind all of our patients about the importance of scheduling appointments in advance. With school, clubs, sports, and family duties to consider, we know that it can be challenging to find time to visit Hoppens & Meier Orthodontics this fall. In order to accommodate all of our patients’ busy schedules, it is important that you plan ahead for your appointments so that we are able to provide you with a convenient appointment time.

As always, please remember to give us advanced notice if you’re unable to make your regularly scheduled appointment with Dr. Bradley Hoppens and Dr. Mary Beth Meier and our team. Feel free to give us a call if you have any questions, or if you would like to schedule your fall appointment.

We’ll see you soon and hope summer is winding down nicely for you and your family!

Although major orthodontic emergencies are relatively rare, when they do happen it is important to seek immediate attention. By comparison, a minor orthodontic issue is something you can usually take care of yourself, or wait until your next scheduled appointment for care. Here are some guidelines to help you understand the difference between an orthodontic emergency and a minor issue.

Orthodontic Emergencies

Acute, Direct Injury to the Mouth, Jaw, or Teeth

Whether undergoing orthodontic care or not, if you injure your mouth, jaw, or teeth, you should see a doctor or dentist immediately. You may need an X-ray to determine the extent of your injury. If the injury affects the orthodontic appliances, they will need adjustment or possibly replacement, depending upon the extent of the injury.

Infected Teeth

It is possible for teeth to become infected following orthodontic treatment. This may or may not be related to your orthodontic appliances. If you experience pain or swelling around a tooth that gets progressively worse, seek professional care as soon as possible.

Minor Orthodontic Issues

While true orthodontic emergencies are rare, minor issues are much more common. Here are some examples of minor orthodontic issues that can be remedied on your own and/or fixed at your next office visit:

• Poking wire
• Loose bracket
• Loose elastic band
• Loose wire
• Loose appliance
• Headgear does not fit
• Lost or broken elastic band
• General soreness

Any of the above issues can happen as a result of normal usage, shifting, and wear of your braces. Eating unusually hard or sticky foods can cause or exacerbate these problems. Vigorous brushing of the teeth can also be a factor. None of these issues are emergencies unless they are accompanied by acute or prolonged pain or discomfort.

As for on-the-spot remedies, covering a loose bracket or wire with wax can be a quick fix to alleviate discomfort until your next orthodontist visit. Poking or protruding wires can be moved with a cotton swab or tweezers, or clipped down with nail clippers. Be sure to sterilize the tweezers or clippers in alcohol first. Cover any clipped wire ends with a small ball of wax.

Some soreness or small abrasions in the mouth are normal, especially with recent orthodontic work. Rinse your mouth with a saltwater solution comprised of eight ounces or warm water and one teaspoon of salt.

When in doubt, be sure to contact our McCook, North Platte, or Ogallala office with any questions, or to schedule an appointment with Dr. Bradley Hoppens and Dr. Mary Beth Meier at Hoppens & Meier Orthodontics.