Is TMJ the same as TMD? What does it mean?

Screen Shot 2018-07-17 at 5.46.20 PMWhen something is off with the alignment of your jaw, it’s hard to ignore. It can lead to a whole host of complaints, from headaches to neck pain to ringing ears. One of the most common causes of problems with the jaw and the facial muscles is temporomandibular joint disorder, or TMD. We use the term as a way to describe the jaw pain and dysfunction that can occur when something is structurally off with the temporomandibular joint itself, a problem with the muscles that support it, or both. Because the muscles and joints of the jaws are so complex and full of nerve endings, when something goes wrong, it can cause a wide range of symptoms from mild to severe.

If you’ve ever experienced any possible TMD symptoms, you may find yourself wondering exactly TMD is, and what treatments are available to help correct it. It might also seem strange that an orthodontics practice like Krieger Orthodontics is writing a blog about the topic. What does TMD have to do with orthodontics? Keep reading, because we’re going to break it all down for you below.

What is the difference between TMJ and TMD?

TMD and TMJ are used interchangeably, but incorrectly, all the time. TMJ is not actually a disease or illness. It’s an abbreviation for temporomandibular joint, the hinged points that connect the jaw bones to the head. Located directly in front of the ears, this joint gives us the ability to speak and chew our food. The TMJ has impressive mobility, and rotates, glides, and acts as a powerful hinge all at the same time. It’s also surrounded by a number of complex protectors like tendons, muscles, and joint pads. Generally speaking, these components work well together. If they get thrown off course, however, it can lead to issues like pain, popping, and inflammation. This is where TMD enters the picture. This frustrating set of conditions can be painful, and is especially problematic when you consider that the TMJ is one of the most frequently used joints we have.

Possible symptoms of TMD

TMD will affect different people in different ways. While some will experience only mild symptoms that pop up every now and then, others will have serious symptoms that persist for years. Some of the most common symptoms of TMD are:

  • pain or tenderness in the face, jaw joint, neck, and shoulders
  • pain in or around the ear when chewing and speaking
  • pain when opening the mouth wide
  • difficulty opening the mouth wide
  • jaws that get stuck or locked, whether the mouth is open or closed
  • popping or grating sounds in the jaw joint when the mouth is open or closed
  • popping, grating, or other sounds in the jaw when chewing
  • face feeling “tired”
  • difficulty chewing
  • feeling as though the upper and lower teeth don’t fit together properly
  • swelling on the side of the face
  • ringing or stuffy ears

TMD can be tricky, as its symptoms can be similar to other common dental issues, such as tooth decay and gum disease. They can also mimic medical conditions such as arthritis. In order to receive a proper diagnosis and the most appropriate treatment, you should schedule a thorough examination with an experienced dental and orthodontic professional like Dr. Krieger.

What can cause TMD to develop?

TMD symptoms tend to arise from a problem (or multiple problems) with the muscles of your jaw, or with the parts of the TMJ itself. Some of the most common causes of TMD developing are:

  • grinding or clenching the teeth, which puts extra pressure on the joint
  • movement of the soft cushion or disc between the ball and socket of the joint
  • arthritis in the TMJ
  • stress, which can tighten the facial and jaw muscles, or cause unconscious teeth clenching
  • injury to the jaw, the joint, or the muscles of the head and neck

Leaving bad bites or misaligned jaws untreated can also put unnecessary stress on the sensitive components that connect the TMJ, potentially causing chronic shooting pain that may be felt throughout the face, neck, shoulders, back, and arms, among other symptoms.

How is TMD diagnosed?

Here at Krieger Orthodontics, we are able to use state-of-the-art technology and techniques to pinpoint the source of a patient’s TMD. To gain an accurate diagnosis of TMD, Dr. Krieger will measure different aspects of the teeth and jaw, determine the jaw’s proper resting position, and map out the movement of the jaw during speaking and eating. Once the source of TMD has been found and a proper diagnosis given, our team will have the foundation they need to create a customized treatment plan that addresses each patient’s specific needs.

What treatment options exist for TMD?

Many people with TMD have relatively mild symptoms that only appear periodically. These often  improve on their own within a few weeks or months, though there are things that can be done to help ease and/or eliminate any discomfort, such as eating soft foods, applying ice or moist heat to the affected area, and avoiding extreme jaw movements like wide yawning and gum chewing.

 

Whenever possible, conservative treatment that is reversible is preferred for patients with TMD, as they don’t invade the tissues of the face, jaw, or joint, or involve surgery. These treatments won’t produce any permanent changes in the structure or position of the jaw or teeth, either. An example of this kind of conservative treatment would be splints or night guards. These plastic mouthpieces fit over the upper and lower teeth to keep them from touching, and wearing one of these can lessen the effects of clenching or grinding. They can also help correct the bite by putting teeth in a more desirable position.

Even if TMD symptoms become more persistent, most patients still won’t need more aggressive types of treatment. For troublesome cases of TMD, missing teeth may need to be replaced, and crowns and bridges may be used to balance the biting surfaces of the teeth. For patients who require more complex bite correction, orthodontic treatment such as braces or Invisalign may be required.

If left untreated, TMD can lead to long-term issues with inflammation, swelling, and chronic pain. It can also contribute to progressive dental problems, such as premature tooth wear and periodontal disease. For this reason, anyone with TMD symptoms should get in touch with an experienced dentist or orthodontist like Dr. Krieger to schedule a thorough examination and consultation.

TMD diagnosis & treatment with Krieger Orthodontics

Have you noticed any symptoms of TMD in yourself or a loved one? Are you interested in learning more about the diagnosis and treatment of TMD? If so, we invite you to contact us and set up a time to come in to our Lewisville office for a consultation with Dr. Krieger. When it comes to looking out for your oral health, we’re on the front line!

 

Have You Ever Been Asked This Question?

Most of you know me as your friendly neighborhood orthodontist. I straighten teeth using braces and Invisalign. But there’s one unique question I ask every parent when they bring their kids in: “Does your child snore?” When was the last time, if ever, a healthcare practitioner asked you that question?

It’s actually not my question. It comes from the University of Michigan’s Neurology Dept. questionnaire. You see, outside of a cold or bad allergies, no child should EVER snore. Ever. And we need to uncover this because kids are suffering. Some are wetting the bed, others are having night terrors or sleep walking and many are suffering at school or misdiagnosed with ADHD. (Think for a second of the symptoms of sleep deprivation and ADHD and you’ll see how similar they are.)

Yes, I’m an orthodontist, but I’m unique in the sense that I also do an airway and sleep evaluation for every person who comes into my office. It only means asking a few questions and takes just a minute or two but it can change a life.

Like I said, I can straighten teeth using braces or aligners, but I feel that your child deserves to be looked at as more than just a set of teeth. When I have a mom or dad come in and hug me for the changes in their child’s life after some simple orthodontic procedures, or because I referred them to the right specialist, it’s all worth it for me.

So, when it comes to choosing an orthodontist, I’d sure be appreciative if you’d consider Krieger Orthodontics. Not only will I make sure your child’s smile looks awesome, but my goal is to make sure they’re also healthy enough to show that smile off for a very, very long time.

Wishing you all an amazing Father’s Day!

All the best,

signatureblue

Glenn D. Krieger, DDS, MS, FAGD

972-899-1465    Doc@Kriegersmiles.com

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Want To Make Your Child’s Orthodontic Visits Easier?

When I was in my orthodontic residency, I was lucky enough to spend a lot of time with my pediatric dentistry colleagues. One of the more capable residents (let’s call him “Dave”) used to tell me that he chose the profession because it reminded him a lot of poker; He enjoyed the opportunity to anticipate a child’s behavior, and use that knowledge to help them get over their fears of dentistry. I learned a lot from Dave during my 30 months in school, but it was a casual comment he made that has stayed with me to this day.

Dave mentioned that the faculty of the pediatric dentistry department didn’t let parents come back into the clinical areas for kids who were older than toddler age. And while most parents understood that the department had good reasons for the rules, there were some parents who insisted on being by their children’s sides during the appointment. Dave said that he allowed those parents to come back, but under one condition: They weren’t to speak or touch their child during the appointment. He made it clear to them that he was going to take exceptional care of their child and the parents’ presence was allowed for the parents’ sake, not the child’s. The appointments always went well (Dave was a great pediatric dentist), and after a few visits of watching this, those parents who insisted on being there generally decided that their time was best spent outside of the clinic.

Dave further explained that for a child to feel secure and safe, they needed to establish trust with the person who was treating them. There needed to be an emotional connection and he had to build the trust with the pediatric patient. His concern with parents being present is that they were rarely experts in child psychology and often interrupted his very methodical way of establishing rapport. They would answer questions when the child was supposed to answer. They would start touching and mollifying a child when it was unnecessary, drawing the child’s attention away from the very specific approach he was undertaking. Worse, they would often interject themselves and their parenting styles into his trained way of treating a child, by telling the child to “open up” , or saying “there’s nothing to be afraid of” or even asking if everything was OK when he clearly had the situation well under control.

In short, the parents were often (inadvertently, of course) undermining the relationship that the doctor was trying to develop with the patient. There were many parents who were sure that they knew their child better than any doctor ever could (which is true), but it wasn’t knowledge he was looking for; It was trust, and that only comes when an honest one-on-one relationship is built without outside interruptions.

While I have always allowed parents to come into the clinical area with their children, Dave’s comments got me observing the impact of parents’ on patient comfort levels. One thing became clear very quickly. The more involved a parent was in their child’s appointment, the more difficult the appointment seemed to be for the child. In hindsight it’s common sense that a child needs to build a rapport and trust with the doctor and there’s no way that can happen with a parent intervening, but I never realized to what extend this was happening in clinic until I purposely started looking at it.

Without exception, the more the parent hovered over the appointment, the more they talked to the child, the more they rubbed the child’s leg or held their hand, the more scared the child invariably was during the appointment. When a child would come back into the clinic, happily chatting with the assistant, the entire feel of the appointment changed when mom or dad asked: “Do you want me to come back there with you?” Suddenly the child was less open to talking and you could literally feel their anxiety level rise. Conversely, the parents who stayed in the reception area, or sat at the chair checking their Facebook feeds more often than not had kids who cruised through the appointment far easier and high-fived the doctor and team when it was over.

I’m a parent (our oldest is about to start college in the fall) and I know how hard it was for me to “let go” of my need to be a part of the action when went to the doctor/dentist. But I have allowed them to build their own relationships because the appointment is about them, not me. My control of the appointment was replaced with the joy of watching them develop an earnest, comfortable relationship with their healthcare provider. I trust my kids’ doctors 100% and moreover, they are never alone with my kids so I know all is well.

Keep in mind that a healthcare provider doesn’t ever want to offend a parent, so even if the parent’s presence and involvement is negatively impacting the delivery of care, the provider is likely to just “suck it up” and deal with it and allow it to continue. Most clinicians don’t have Dave’s straightforwardness or candor and it’s tough to tell a parent that their presence is impacting their child’s visits. (I can also tell you that 25 years in practice has taught me that the parents who need the conversation the most are also the ones least likely to react well to hearing it.)

If you feel the need to hover over your child during their orthodontic appointments, let it go. I promise that it’ll be better for everyone involved; The orthodontist, the assistants, your child and even yourself.

Best of all, you might even get some time to relax in the reception area because as we all know, being a parent isn’t easy.

Why are retainers important?

Screen Shot 2017-11-15 at 8.32.00 PM

Whether you’ve had your braces on for years, or been wearing Invisalign aligners for a few months, it’s an exciting time when you finally have them removed or can quit wearing them. With this first step of orthodontic treatment completed, you can feel a little freer and smile a little brighter. But don’t get too carried away in your celebrations just yet – you’ve got a little further to go!

 

Whatever orthodontic method you used to straighten your teeth, there’s a second step of treatment necessary to round out the process and help maintain your beautiful new smile. Wearing a retainer regularly is an integral part of keeping your teeth in their new and improved positions, which is why our patients here at Krieger Orthodontics will hear us drive that point home many, many times over the course of treatment!

 

Because routine retainer use is so essential to prevent your teeth from drifting back into their old placements, our team has put together this helpful guide to help you understand why retainers are so important after the first phase of orthodontic treatment. Keep reading to learn more!

So, what exactly is a retainer?

A retainer is a fairly straightforward orthodontic appliance that’s molded and designed to fit each individual patient’s mouth. They’re primarily made by taking an impression of your newly straightened teeth, then fabricating the retainer out of a clear plastic material (for an Essix retainer) or from wire and an acrylic material (for a Hawley retainer).

 

Most orthodontists now recommend that some type of retainer be worn part-time for the rest of your life after the teeth have been straightened. We know that sounds completely overwhelming at first! However, with a little patience and practice, wearing your retainer can easily become a part of your daily routine. Before you know it, wearing it a few nights a week while you’re sleeping will be all you need to keep your teeth in the desired positions permanently.

 

When you first wear the retainer, it may feel a little weird, and it can sometimes affect your speech temporarily. But even if there’s some initial discomfort, you’ll still need to commit to wearing it as recommended. Failing to do so can keep it from doing its job, which means your teeth could begin shifting back, eventually leaving you right where you started.

 

The types of retainers

There are two types of retainers: fixed and removable. Before deciding which type would be best for you, we take several factors into consideration, including your specific case, your preferences and lifestyle, and the overall compliance expected.

 

Fixed retainers

A fixed retainer will usually consist of a thin wire positioned across the interior surface of the lower or upper front teeth. This is then bonded into place with a glue similar to the one used to attach braces to teeth. The wire will stretch across several teeth, so dental care is more or less the same as it was when you were in braces, particularly when it comes to flossing. If you’re thinking about a fixed retainer, don’t toss that floss threader just yet! It can be very helpful in accessing those interproximal spaces between the teeth to keep them clean.

 

Although this type of retainer takes a little more work to keep clean, it tends to have the best outcome overall. This is because the bonded wire is able to hold the newly straightened teeth in a more ideal alignment over time.

 

Removable retainers

Removable retainers are made up of a wire going across the front teeth. This is held in place with an acrylic material and clasps. The clasps wrap around the back teeth to hold the retainer in place. You may hear this referred to as a Hawley retainer. There’s also a type of removable retainer that looks very similar to an Invisalign aligner, which is often called an Essix retainer.

 

Cleaning your teeth is easier with these retainers, but you will have to remember to wear it daily. At the beginning of this second step of treatment, it’s likely that you’ll need to wear it all day and all night for at least three months. At the end of this period, your teeth will be assessed. If no movement is detected, then you may be able to wear the retainer less often, like only at night, or for a few hours during the day.

 

These retainers do tend to be more prone to loss and damage, so be careful with them. If you have pets, be sure you don’t leave one laying out, since dogs love to use them as a chew toy! There’s usually a charge to replace a lost of broken (or chewed on) retainer, so keep them in a safe place when not in use.

Gum and bone alignment

After your braces come off or your last Invisalign aligner is used, your teeth aren’t the only things we need to stay put! The gums and bones in your mouth will need to align to these new positions, too. The soft and hard tissues that are around the teeth can sometimes take a little longer to align to a different position, but by wearing your retainer as directed, you can help the gums and bones to realign, and your new bite to stabilize.

 

Teeth aren’t just fixed in the jaw. Each tooth is held in its socket by elastic ligaments that attach the roots to the bone. Those ligaments are living tissue affected by the movement of the teeth, and it’s actually this attachment that allows for the small movements of the teeth during treatment. When tension is placed in and around the teeth via braces or Invisalign, new ligaments, and sometimes even bone, are formed.

 

Once the remodeling phase has been completed, those tissues, ligaments, and bone will need time to stabilize. Without the help of a retainer to hold these new positions as they stabilize, the teeth will almost always migrate back to their old positions. It can take anywhere from several months to a few years for the new position of your teeth to become more permanent.

Care for braces and beyond with Krieger Orthodontics

If you’re in Lewisville daydreaming of the day your braces finally come off, or simply needing a refresher on the importance of retainers, Krieger Orthodontics is here to help you! For more information on the role retainers play after orthodontic treatment, get in touch with us today and we’ll be happy to answer any questions or concerns you may have. Krieger Orthodontics can keep your teeth in place and keep a smile on your face!

 

Whether you’ve had your braces on for years, or been wearing Invisalign aligners for a few months, it’s an exciting time when you finally have them removed or can quit wearing them. With this first step of orthodontic treatment completed, you can feel a little freer and smile a little brighter. But don’t get too carried away in your celebrations just yet – you’ve got a little further to go!

 

Whatever orthodontic method you used to straighten your teeth, there’s a second step of treatment necessary to round out the process and help maintain your beautiful new smile. Wearing a retainer regularly is an integral part of keeping your teeth in their new and improved positions, which is why our patients here at Krieger Orthodontics will hear us drive that point home many, many times over the course of treatment!

 

Because routine retainer use is so essential to prevent your teeth from drifting back into their old placements, our team has put together this helpful guide to help you understand why retainers are so important after the first phase of orthodontic treatment. Keep reading to learn more!

So, what exactly is a retainer?

A retainer is a fairly straightforward orthodontic appliance that’s molded and designed to fit each individual patient’s mouth. They’re primarily made by taking an impression of your newly straightened teeth, then fabricating the retainer out of a clear plastic material (for an Essix retainer) or from wire and an acrylic material (for a Hawley retainer).

 

Most orthodontists now recommend that some type of retainer be worn part-time for the rest of your life after the teeth have been straightened. We know that sounds completely overwhelming at first! However, with a little patience and practice, wearing your retainer can easily become a part of your daily routine. Before you know it, wearing it a few nights a week while you’re sleeping will be all you need to keep your teeth in the desired positions permanently.

 

When you first wear the retainer, it may feel a little weird, and it can sometimes affect your speech temporarily. But even if there’s some initial discomfort, you’ll still need to commit to wearing it as recommended. Failing to do so can keep it from doing its job, which means your teeth could begin shifting back, eventually leaving you right where you started.

 

The types of retainers

There are two types of retainers: fixed and removable. Before deciding which type would be best for you, we take several factors into consideration, including your specific case, your preferences and lifestyle, and the overall compliance expected.

 

Fixed retainers

A fixed retainer will usually consist of a thin wire positioned across the interior surface of the lower or upper front teeth. This is then bonded into place with a glue similar to the one used to attach braces to teeth. The wire will stretch across several teeth, so dental care is more or less the same as it was when you were in braces, particularly when it comes to flossing. If you’re thinking about a fixed retainer, don’t toss that floss threader just yet! It can be very helpful in accessing those interproximal spaces between the teeth to keep them clean.

 

Although this type of retainer takes a little more work to keep clean, it tends to have the best outcome overall. This is because the bonded wire is able to hold the newly straightened teeth in a more ideal alignment over time.

 

Removable retainers

Removable retainers are made up of a wire going across the front teeth. This is held in place with an acrylic material and clasps. The clasps wrap around the back teeth to hold the retainer in place. You may hear this referred to as a Hawley retainer. There’s also a type of removable retainer that looks very similar to an Invisalign aligner, which is often called an Essix retainer.

 

Cleaning your teeth is easier with these retainers, but you will have to remember to wear it daily. At the beginning of this second step of treatment, it’s likely that you’ll need to wear it all day and all night for at least three months. At the end of this period, your teeth will be assessed. If no movement is detected, then you may be able to wear the retainer less often, like only at night, or for a few hours during the day.

 

These retainers do tend to be more prone to loss and damage, so be careful with them. If you have pets, be sure you don’t leave one laying out, since dogs love to use them as a chew toy! There’s usually a charge to replace a lost of broken (or chewed on) retainer, so keep them in a safe place when not in use.

Gum and bone alignment

After your braces come off or your last Invisalign aligner is used, your teeth aren’t the only things we need to stay put! The gums and bones in your mouth will need to align to these new positions, too. The soft and hard tissues that are around the teeth can sometimes take a little longer to align to a different position, but by wearing your retainer as directed, you can help the gums and bones to realign, and your new bite to stabilize.

 

Teeth aren’t just fixed in the jaw. Each tooth is held in its socket by elastic ligaments that attach the roots to the bone. Those ligaments are living tissue affected by the movement of the teeth, and it’s actually this attachment that allows for the small movements of the teeth during treatment. When tension is placed in and around the teeth via braces or Invisalign, new ligaments, and sometimes even bone, are formed.

 

Once the remodeling phase has been completed, those tissues, ligaments, and bone will need time to stabilize. Without the help of a retainer to hold these new positions as they stabilize, the teeth will almost always migrate back to their old positions. It can take anywhere from several months to a few years for the new position of your teeth to become more permanent.

Care for braces and beyond with Krieger Orthodontics

If you’re in Lewisville daydreaming of the day your braces finally come off, or simply needing a refresher on the importance of retainers, Krieger Orthodontics is here to help you! For more information on the role retainers play after orthodontic treatment, get in touch with us today and we’ll be happy to answer any questions or concerns you may have. Krieger Orthodontics can keep your teeth in place and keep a smile on your face!

 

Whether you’ve had your braces on for years, or been wearing Invisalign aligners for a few months, it’s an exciting time when you finally have them removed or can quit wearing them. With this first step of orthodontic treatment completed, you can feel a little freer and smile a little brighter. But don’t get too carried away in your celebrations just yet – you’ve got a little further to go!

 

Whatever orthodontic method you used to straighten your teeth, there’s a second step of treatment necessary to round out the process and help maintain your beautiful new smile. Wearing a retainer regularly is an integral part of keeping your teeth in their new and improved positions, which is why our patients here at Krieger Orthodontics will hear us drive that point home many, many times over the course of treatment!

 

Because routine retainer use is so essential to prevent your teeth from drifting back into their old placements, our team has put together this helpful guide to help you understand why retainers are so important after the first phase of orthodontic treatment. Keep reading to learn more!

So, what exactly is a retainer?

A retainer is a fairly straightforward orthodontic appliance that’s molded and designed to fit each individual patient’s mouth. They’re primarily made by taking an impression of your newly straightened teeth, then fabricating the retainer out of a clear plastic material (for an Essix retainer) or from wire and an acrylic material (for a Hawley retainer).

 

Most orthodontists now recommend that some type of retainer be worn part-time for the rest of your life after the teeth have been straightened. We know that sounds completely overwhelming at first! However, with a little patience and practice, wearing your retainer can easily become a part of your daily routine. Before you know it, wearing it a few nights a week while you’re sleeping will be all you need to keep your teeth in the desired positions permanently.

 

When you first wear the retainer, it may feel a little weird, and it can sometimes affect your speech temporarily. But even if there’s some initial discomfort, you’ll still need to commit to wearing it as recommended. Failing to do so can keep it from doing its job, which means your teeth could begin shifting back, eventually leaving you right where you started.

 

The types of retainers

There are two types of retainers: fixed and removable. Before deciding which type would be best for you, we take several factors into consideration, including your specific case, your preferences and lifestyle, and the overall compliance expected.

 

Fixed retainers

A fixed retainer will usually consist of a thin wire positioned across the interior surface of the lower or upper front teeth. This is then bonded into place with a glue similar to the one used to attach braces to teeth. The wire will stretch across several teeth, so dental care is more or less the same as it was when you were in braces, particularly when it comes to flossing. If you’re thinking about a fixed retainer, don’t toss that floss threader just yet! It can be very helpful in accessing those interproximal spaces between the teeth to keep them clean.

 

Although this type of retainer takes a little more work to keep clean, it tends to have the best outcome overall. This is because the bonded wire is able to hold the newly straightened teeth in a more ideal alignment over time.

 

Removable retainers

Removable retainers are made up of a wire going across the front teeth. This is held in place with an acrylic material and clasps. The clasps wrap around the back teeth to hold the retainer in place. You may hear this referred to as a Hawley retainer. There’s also a type of removable retainer that looks very similar to an Invisalign aligner, which is often called an Essix retainer.

 

Cleaning your teeth is easier with these retainers, but you will have to remember to wear it daily. At the beginning of this second step of treatment, it’s likely that you’ll need to wear it all day and all night for at least three months. At the end of this period, your teeth will be assessed. If no movement is detected, then you may be able to wear the retainer less often, like only at night, or for a few hours during the day.

 

These retainers do tend to be more prone to loss and damage, so be careful with them. If you have pets, be sure you don’t leave one laying out, since dogs love to use them as a chew toy! There’s usually a charge to replace a lost of broken (or chewed on) retainer, so keep them in a safe place when not in use.

Gum and bone alignment

After your braces come off or your last Invisalign aligner is used, your teeth aren’t the only things we need to stay put! The gums and bones in your mouth will need to align to these new positions, too. The soft and hard tissues that are around the teeth can sometimes take a little longer to align to a different position, but by wearing your retainer as directed, you can help the gums and bones to realign, and your new bite to stabilize.

 

Teeth aren’t just fixed in the jaw. Each tooth is held in its socket by elastic ligaments that attach the roots to the bone. Those ligaments are living tissue affected by the movement of the teeth, and it’s actually this attachment that allows for the small movements of the teeth during treatment. When tension is placed in and around the teeth via braces or Invisalign, new ligaments, and sometimes even bone, are formed.

 

Once the remodeling phase has been completed, those tissues, ligaments, and bone will need time to stabilize. Without the help of a retainer to hold these new positions as they stabilize, the teeth will almost always migrate back to their old positions. It can take anywhere from several months to a few years for the new position of your teeth to become more permanent.

Care for braces and beyond with Krieger Orthodontics

If you’re in Lewisville daydreaming of the day your braces finally come off, or simply needing a refresher on the importance of retainers, Krieger Orthodontics is here to help you! For more information on the role retainers play after orthodontic treatment, get in touch with us today and we’ll be happy to answer any questions or concerns you may have. Krieger Orthodontics can keep your teeth in place and keep a smile on your face!

 

Why do we see younger kids in braces?

After your child completes his or her orthodontic evaluation with us at Krieger Orthodontics, you might hear us mention “two-phase treatment.” It may sound a bit daunting if you have never heard this term before. Thankfully, it’s a lot less intricate than it sounds.

Two-phase treatment is merely an orthodontic process that is delivered in two stages. The first stage is focused on tooth straightening and the second is physical, facial changes. It enables us to give patients a healthy, functional, and attractive result that endures for years to come.

Phase I is called interceptive orthodontic treatment. This stage intercepts orthodontic issues in their preliminary stages to stop them from becoming severe problems later. Treatment usually takes place around 8-9 years old when the permanent front teeth are erupting. We recommend interceptive treatment when postponement can cause severe orthodontic difficulties or worsen the social impact a child may experience by having crooked or misaligned teeth and jaws.  

Phase II is put into motion only after all permanent teeth have erupted. Phase Two is administered to improve teeth alignment, which cannot be done when baby teeth are still present.

What we want to make clear is two-phase treatment is not is a tricky way to get you into two sets of braces. It doesn’t take twice the time or cost twice the money. We actually try to avoid two-phase treatment. However, some cases do require two-phase treatment to achieve lasting results.

Still a little confused by two-phase treatment? Not sure what it really entails? Let’s dive a little deeper to help you understand.

Phase I orthodontic treatment

Phase I orthodontic treatment is usually the first of two phases of treatment. If a young patient requires intervention before starting regular orthodontic treatment, they will go through two different treatment phases. Phase I can include things like partial braces, orthodontic appliances, and retainer-like devices. They are used to correct current issues, prevent future problems, and help to adjust a child’s growth and dental development.  

As this interceptive treatment happens between the ages of 6-10 years, the younger patients will generally still have baby teeth as well as their permanent teeth at the time of treatment. Recommended sparingly, Phase I treatment is used if there is a dental development problem or dental and jaw development issues which would become worse if left untreated. Though many children will not need treatment this early on, Krieger Orthodontics, as well as the American Association of Orthodontists recommends that children undergo their first orthodontic evaluation by the time they turn seven. Having an early consultation with a friendly, experienced orthodontist like Dr. Krieger is the first step in guaranteeing your child’s growth and dental development are the very best they can be.

Phase I corrects a great many dental issues like tooth alignment, jaw development, gum or periodontal health, and crowding and spacing issues. Orthodontists will recommend Phase I treatment for common reasons such as:

  • dental crossbites
  • skeletal crossbites
  • underbites
  • excessively overlapping or deep bites
  • open bites (where the teeth in the front do not contact or overlap)
  • jaw growth or jaws that are not in proportion to each other
  • severely protruding teeth
  • the presence of problematic oral habits, such as extended thumb-sucking, bottle, or pacifier use
  • clefts
  • severe crowding or spacing of the teeth

Not always necessary, often an additional phase of treatment will need to follow Phase I. As Phase I provides early intervention, Phase II isn’t normally as long as the first treatment. When you treat an issue early, severe problems can often be reduced to much simpler issues that can be treated later with braces or other orthodontic devices.

The resting period

At the conclusion of the first phase of treatment, teeth will not be in their final positions as that will happen in the second phase of treatment. Between the two phases, we take a period of rest to allow all remaining permanent teeth to come in.

Phase II orthodontic treatment

Most people are somewhat familiar with the types of orthodontic treatments that take place in Phase II after interceptive treatment. Often it involves placing braces on upper and lower teeth after all the permanent teeth have arrived. Not all tooth and bite-related issues can be addressed and fixed in Phase I, so a skilled orthodontist like Dr. Krieger will use braces to straighten the permanent teeth and correctly align the jaw into a proper bite.   

In the second phase, we are making sure each tooth has an exact, optimal location in the mouth where it can live peaceably with the lips, cheeks, tongue, and other teeth. Orthodontics promote this state of equilibrium, so finally, all teeth with be able to function together properly.  

Post-treatment

After both Phase I and Phase II of your treatment have been successfully completed, retainers will be recommended. Retainers help hold teeth in their new, permanent positions and maintain a beautiful, straight, and healthy smile.

Undergoing two-phase treatment with Krieger Orthodontics

Two-phase treatment isn’t recommended for every child, but for those who need it, it can prevent the need for more invasive treatment later on in life. As with all things, prompt treatment is the most successful plan to get long-lasting results.

If you have a child under the age of seven in the Carrollton, Plano, or Lewisville area who has not yet been to see an orthodontist, contact us today to schedule an initial orthodontic evaluation at our state-of-the-art Lewisville office. Our friendly, experienced team are excited to help you craft a smile that will last from childhood to adulthood and beyond!

 

Want to Straighten Your Teeth? You Deserve a Specialist

I often have patients come to my office telling me that they’ve been recommended to us for Invisalign, but that their dentist also offers Invisalign (and cheaper). They say it as if Invisalign is like a can of 7UP which is the same no matter where it’s bought. Nothing could be further from the truth.

Let me tell you a couple of things about Invisalign that you MUST know before you get treated anywhere.  Aside from the fact that orthodontists ONLY do procedures involving tooth movement and most general dentists do not make this a large part of their practices, orthodontists’ training allows them to better understand how teeth move and how to handle the side effects that can occur. Invisalign has several steps, which at each point can go awry if not addressed properly.

  1. The Impression. Most orthodontists now use digital impressions, meaning that a mold is no longer taken using a tray with that old fashioned “goop”. Aside from being way quicker and easier, digital impressions have way better accuracy. The overwhelming majority of general dentists do not use a digital scanner and I personally would never go through Invisalign using molds if there’s a better option.
  2. The Clincheck. Once the digital scan is sent to Invisalign, it’s up to the actual clinician to decide how to move the teeth, in what order, with what types of movements and determine what is biologically possible. I was a general dentist for 20 years and did Invisalign until I realized that my orthodontist was getting better, more consistent outcomes. It was at that point that I turned off my ego and handed all of my cases over to the specialist to be treated. They just did a better job at the Clincheck.
  3. The Fit. Invisalign trays MUST fit exquisitely well to work properly. Spotting fit problems and taking the time to fix them is critical. As orthodontic specialists, it’s our job to focus on these things and we take hundreds of hours of courses not in bridges, fillings, implants, crowns or cleanings. Nope, we take courses in Invisalign, braces and tooth movement. That’s it, so we can ensure a well fitting tray and make sure you’re set up for success.
  4. The Refinement. When the initial treatment is done, the outcome needs to meet a standard that makes everyone feel satisfied. Refinements (more trays) are a part of the plan from the beginning and they come at no charge in my office. I work on the outcome until it’s the smile and bite that you’ve always wanted, because, again, that’s all we do.
  5. Retainers. When its done, we need to make sure that the right type of retainer is used to allow the teeth to come together properly and for long term stability. Who knows more about retainers than an orthodontist?

If you needed surgery, would you have your internist do it for you just because they offered it? I’m not saying that general dentists are mean, naughty people. On the contrary, most are kind gentle practitioners, however, they look at Invisalign as some simple type of procedure that they can just scan, send in and deliver, whereas orthodontists look at it as a procedure with lots of steps that must be properly handled.

I often see cases treated by general dentists that have ended in catastrophe and now rely on me to put the pieces back together. While these cases started off seeming easy enough for a general dentist, one misstep took them in the wrong direction and that’s why when you’re looking to straighten your teeth, you deserve a specialist.

I’m always here for you if you have any questions about how to get a straighter smile. Just email me at doc@KriegerOrthodontics.com or call the office at 972-899-1465 to schedule a complementary consultation for you or your child.

Wishing you the best,

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Glenn Krieger, DDS, MS, FAGD

6 Things You Must Know Before Considering Straightening Teeth

Invisalign is a method of straightening teeth where removable plastic trays can be used to put selective pressure on certain teeth to move them instead of using traditional braces and wires. The advantages include no dietary restrictions, no wires or brackets to cut lips or cheeks and the ability to floss and clean teeth better.

For years, I was a huge opponent of the idea of Invisalign. When I got certified back in 2004 and did about 50 cases as a general dentist, I never got gorgeous results. Then I became an orthodontist, spent 2 1/2 years learning about how teeth really move and how faces grow and still felt that wires and brackets were still the right way to move teeth.

In the last several years, Invisalign has done a phenomenal job of changing the tools that allow clinicians to move teeth using plastic trays. The “attachments” they use are now allowing more predictable outcomes and having thrown myself into hundreds of hours of Invisalign education from the best in the world, I can safely tell you that my Invisalign outcomes not only compare to my traditional “braces” outcomes, but I’m getting there quicker and more predictably. I can handle even the most difficult Invisalign case with ease and have even had gorgeous outcomes on younger patients. YES, you CAN do Invisalign on younger patients.

But there are several things you MUST know before you consider Invisalign:

  1. Don’t get impressions taken using molds. I use the Itero scanner shown below. No more “goopy” molds. No more mess and best of all, it’s far more accurate than the old methods. In less than 10 minutes I create a digital 3D version of the patient’s mouth and can send it digitally to Invisalign. I can’t believe that anyone would still use the old method of impressions for Invisalign because they are far less accurate, comfortable or predictable than digital scanning.
    Align-iTero-021715-22718-sized-CMYK-Copy
  2. A general dentist is NOT a specialist. I was a general dentist for 20 years before becoming an orthodontist. Don’t let any general dentist convince you that they can do tooth moving anywhere near as well as someone who only moves teeth for a living. Don’t believe me? Ask any general dentist if they would let a general surgeon do their hip replacement, or if they would go to an orthopedist who has the additional training only in hips. I’ve seen horrible Invisalign outcomes that have lifelong consequences for the patients who trusted a general dentist.
  3. There will always be a refinement. When one gets scanned for Invisalign, all of their trays are delivered to the orthodontist at once. If the teeth don’t move as the computer expected, it’s no big deal. I can simply scan real quickly and get new trays made again. I tell patients that every single good Invisalign provider I know does at least one refinement for every case. General dentists do them rarely.  See point number 2.
  4. Don’t accept cheap knockoffs. There are many cheaper alternatives to Invisalign. At the time of this writing, the ONLY reason why anyone would consider any option to Invisalign is that they want to save money. Invisalign is a brand name and is still the flagship way of straightening teeth using clear aligners and their doctor interface and finish and delivery of their aligners are unmatched by any other program. Don’t be fooled by cheaper imitations.
  5. The devil is in the details. Everyone thinks that the orthodontist scans the patient, sends it to Invisalign and they do all the work. The truth is that there is a thing called the “clinicheck” where the clinician tells Invisalign what to do and how to move the teeth. If one just follows Invisalign’s suggestions and doesn’t know how to move teeth (see point 2) the outcomes won’t be the same. The skill of the clinician providing Invisalign plays a huge role in the outcome.
  6. Free consultations are the norm. If someone charges you for an Invisalign consultation, run. Not much more needs to be said about this.

I’m always here for you if you have any questions about how to get a straighter smile. Just email me at doc@KriegerOrthodontics.com or call the office at 972-899-1465 to schedule a complementary consultation for you or your child.

Wishing you the best,

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Glenn Krieger, DDS, MS, FAGD

 

Smile Direct Club-The Boboli of Orthodontics

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Yep, you read that headline correctly. How could I possibly relate a favorite (and amazing tasting) “take and bake” pizza crust to orthodontics?!?! It’s easy, my paisan.

First, let’s talk about Smile Direct Club, a company that allows you to do orthodontic aligners (like Invisalign) at home, without ever needing to go see an orthodontist. Yep, in case you think you’re seeing things, let me say that again: Orthodontics without seeing an orthodontist or dentist. (That’s kind of like do it at home surgery, right?) You are actually expected to take your own impression, mail it to them and have their “dental professional” evaluate the case, make the aligners and send them back to you. Sounds bananas, doesn’t it? Why would anyone want to skip an exam done by the person trained for years to evaluate bites (the orthodontist)? Well, if you ask those who have used the technology, they’re almost entirely motivated by cost savings.

Now, I’m all for savings, but this? Keep reading…

I love finding savings when buying a commodity like a TV. A commodity is something that is exactly the same regardless of where you buy it. Whether you buy your TV online or perhaps at a store that serves wine, in the end it’s exactly the same TV. Save money, I say. Enjoy the savings.

“A commodity is something that is exactly the same regardless of where you buy it. Orthodontics is not a commodity. It matters where you go and who does your treatment. Yeah, kind of like surgery.”

However, straightening your teeth is NOT a commodity. Where you go and the training of who does it plays a tremendous role. There ARE significant side effects that need to be monitored during orthodontic therapy. Do you think we orthodontists go to school for 3 years for no reason? Problem is, I’ve seen huge problems like irreversible bone loss, gum disease, TMJ problems, muscle soreness and irreversible facial changes happen when aligner treatment has been done by general dentists. These are general dentists, and if they couldn’t get it right, are you telling me that someone monitoring their own treatment at home will know how to look for early signs of irreversible damage and correct the problems themselves? ??

People, we’re talking about trying to predictably move teeth through bone!!! This isn’t a do it at home manicure.

“You were so preoccupied with whether or not you could do it, you didn’t stop to think if you should.”-Ian Malcom, from Jurassic Park

If you look around online, it’s not all success stories. In fact, you’ll find many, people who describe terrible customer service, poor (or no) results and others with complaints of damage to their bites. Sure, for those who had successful outcomes, they’ll tell you how happy they are that they didn’t get “scammed” by their orthodontist. Worse yet, and this is the best part, other than straight front teeth, these patients have zero way of evaluating if their bite is properly aligned to prevent later joint and wear problems. Yep, you heard me right. Let me say that again:

Patients have no way of knowing if their bite is properly aligned until problems occur years later.

You can have perfectly straight upper and lower front teeth, but if the bite isn’t properly aligned, you are at considerable risk of joint or tooth wear problems and the worst part is that these terrible symptoms may not show up for decades. Who will be responsible if that happens?

Can you imagine someone finding out a way to do your own eye exams and order your own prescription and glasses without ever seeing an eye specialist, only to find out years later that they did irreversible damage to their eyes? Sure, the glasses looked great and man, it seemed like they could read better, but they missed that one small issue that an eye specialist could have found.

 Think about this: Even if 50% of the people who use remote treatment get a satisfactory result (a number I pulled from thin air) but even a tiny percentage eventually saw considerable damage that could have been avoided and was actually caused by their self-treatment, wouldn’t that sound like something that shouldn’t be allowed.

Smile Direct Club is owned by Camelot Venture Group, venture capitalists  who own things like Sharper Image, Fathead and the Cleveland Cavaliers. Their website says that their goal is “to provide capital for accelerated growth”. That’s what venture capitalists do. I’ve been a health care provider for 25 years and my track record and results (and those of almost every orthodontist I know) would tell you that we’re not out to scam you and that we’ve done an awesome job of taking care of you and your families.

Don’t fall into the simple idea that cheaper is better.

I find it funny that potential Smile Direct Club patients claim that their orthodontist is only interested in money, yet they willingly choose to put their long-term dental  health in the hands of venture capitalists invested in Fathead, the Sharper Image and the Cleveland Cavaliers.

Like Boboli, Smile Direct Club lets you do all the work at home, but remote aligner treatment isn’t the same as going to an orthodontic specialist. Aside from no thorough examination before treatment there are considerable long term risks that simply haven’t had the time to show up yet. If I told you that you could reduce that lifetime risk considerable for less than an additional $100/month over the next 18 months, why wouldn’t that make sense to you. Why wouldn’t you FIRST go see your local orthodontist for a free consultation and discuss it with them? Do you also believe that your doctor, dentist, eye doctor and chiropractor, people who have helped you when you needed them, are ripping you off?

Beware of online review sites that have a place where you can click to learn more about the product. Often they are “affiliates”; sites that get paid to direct traffic to another site. They make money if you go to the destination site. Do you think it’s in their best interests to write a nice review?

My mother taught me a saying: “Caveat Emptor”, or “Buyer Beware”. As an orthodontist with over 25 years treating bite-related pathology, I think that saying is apropos.

So, go cook up a Boboli, sit back and think about my cautionary words. Then go see an orthodontist for a free consultation. If after that visit you’ve still  convinced yourself that orthodontists are the kind of people who just want to overcharge you and that at-home, do it yourself aligner therapy is worth the cost, have at it, but remember…there are potential lifelong risks that will show up well after Smile Direct Club may no longer be around. That’s when you’ll probably go see your orthodontist, because in your heart you know they’re the experts on bite related issues.

 

 

Who owns your dentist?

Happy man enjoying the rain of money

When my grandfather became a dentist, the practice of dentistry was simple. A dentist picked a location, built an office and probably stayed there for the rest of their career. There was no such thing as insurance, 3rd party payers or even a lot of specialists. But, as is the case where there is the opportunity for income, corporations stepped in and the practice of dentistry changed.

According to the U.S. Census Bureau, Statistics of U.S. Businesses, by 2012 *, there were an incredible 194 dental firms employing between 100-499 employees with 1028 dental locations and an even more unbelievable 65 dental firms controlling 3732 dental establishments with over 33,000 employees.

Some of the aforementioned companies are easy to spot; you’ve seen their names plastered all over national commercials, magazine articles and billboards. Even then, they’re not all equal. These groups could be owned by dentists or by Wall Street venture capitalists (VCs) with a goal of squeezing every penny out of the business for investors 2000 miles away. Don’t believe me? Look HERE for just a second to see one company that proudly boasts its intentions of buying dental and medical practices to incorporate into their portfolio.

Worse yet, many of the private equity financed companies give the impression that they are freestanding offices, with the image of a solo dentist owner, when in fact all actions are carefully coordinated by the “home office”. They offer very low rates to lure unsuspecting customers with the hope of taking over an area and often squeeze dentist-owned practices out of the region. Since dentists are not owners of these practices, the almighty dollar is the driving factor in how the way the clinic is run (not the health of the patient), and paying customers (i.e.-patients) have no idea. Just think about it: Does a profit-driven Wall Street banker really care about your root canal or braces the way most dentists would?

It is  often a very different story when multi practice corporation is owned by dentists. Sure, profit is the driving factor, but at least all decisions regarding the corporations are driven by someone who knows about the practice of dentistry. I’m not saying that they are necessarily the greatest providers of dental care, but what I am saying is that I would choose to go to a dentist owned company every single time if given the option of that or a VC run dental practice.

So, the next time you’re in the dental office you chose because they were the cheapest or because they “took” your insurance, ask them who owns the practice; a dentist or a bunch of investors who never once practiced dentistry. You may be surprised…

*http://www.ada.org/~/media/ADA/Science%20and%20Research/HPI/Files/HPIBrief_0815_2.pdf?la=en

Is Your New Dentist Ripping You Off?

stealing

I’ve now practiced dentistry for almost a quarter of a century, during which time I’ve heard a common story from hundreds of people. The tale usually goes something like this: “I’ve been seeing the same dentist since I was a little kid and he’s the best. He just retired and the first time I saw the new dentist, they told me that I have a ton of cavities. I think they’re trying to rip me off, so I’m going to change dentists. I mean, I didn’t have a cavity for 20 years and all of a sudden I have five?!?!?”

So, what’s really happening? Are new owner-dentists just misguided, greedy people looking to fleece the existing patients for as much as they can get? Are the new dentists simply “treatment happy”? Was the old dentist incompetent? Generally, the answer is “no” and there are a variety of legitimate reasons why a switch in providers shows a sudden difference in treatment planning.

It’s important for one to understand that dentistry isn’t a simple “black and white” field. It’s been said that “if you show 20 dentists a patient, you’ll get 22 different treatment plans.” This isn’t like an appendix which is about to burst and everyone agrees that it needs to come out. Dentistry is as much art as science, as much subjective as objective. Things change very slowly and as a result, one dentist may justifiably intervene earlier than another. (Note the word “justifiably”.)

The public naturally assumes that the dentist who is willing to “watch” something rather than treat it is a better dentist, but that’s absolutely not true. I’ve seen dentists observe active painless decay until the patient needed a root canal. Watching does not equal better. There are loose standards as to when one should intervene, and dentists are allowed latitude in that decision, but some err way too much to one end or another of the spectrum of aggressiveness.

Take the image below as an example. I found it on the internet, but we dentists come across these sorts of dark grooves all the time. We use our explorer (the “hook thingy” as my patients have called it) to test the hard tooth for sticky or soft spots; clear indicators that there is a need for a filling.

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If I showed this image to 100 dentists, I’m willing to bet that the audience would be split down the middle in terms of whether or not to fill it. Who’s right? Well, everyone. Of course, there are two sides to the argument. Those who want to fill it would argue that it looks insidious and if we can fill it while it’s still small, we can avoid the progression of a potentially bigger cavity. They could also argue that until one removes the enamel, there’s no way to ensure that the cavity isn’t actually larger.  Those who would “watch” it could argue that it isn’t sticky and that we can keep an eye on it both visually and with periodic X-rays, intervening only when absolutely necessary. Both approaches have merit.

Also keep in mind that your previous dentist had a great rapport with you. You knew the dentist and gave the benefit of the doubt when problems arose. Just imagine the challenge your new dentist has in terms of communicating with you knowing that you’ve never met them before and they have no credit in your legitimacy bank. I’ve been in that position and it’s no fun wrestling with the “should I or shouldn’t I tell them” question. New dentists know that telling you there’s a problem increase the odds that you’ll leave and never come back. However, they also know that not telling you is simply wrong.

Add to the debate that many dentists tend to simply become “watchers” as they get closer to the end of their careers. I can’t tell you why this happens, but I’ve seen it a lot. I’m not talking about the 50 year old who retires, but rather those who practice as a hobby when they reach a certain age. Coincidentally, this is the same age when most dentists begin thinking about retiring and many have stepped away from active participation in meaningful continuing education. I’ve had to hold the least enjoyable conversations of my career when a patient transferred to my office after their dentist of 45 years retired. Many, many times (too many to count) I’ve had to figure out how to tell the patient that they were going to lose teeth that the previous dentist said were “fine”. I am NOT indicting all older dentists, but rather describing something that I and many of my colleagues have seen. Some of the best clinicians I know have been practicing for 40 years but there are also some who have been practicing for 40 years without changing a thing for the last 20.

Of course, like any field, there are those who are trying to make their living on the edge of what is right and moral. I’m not including them in the discussion because they are a fringe element and not indicative of the main reason why patients find differences between the old and the new dentists.

The bottom line is that there are generally legitimate reasons why the new dentist may see things differently than the previously retired dentist. Don’t  naturally assume that they are too aggressive or trying to rip you off. The beautiful thing about dentistry today is that we have a variety of digital tools with which we can explain treatment needs to patients. If the dentist is unwilling to spend the time it takes to help you feel comfortable with understanding the treatment recommendations, I would strongly suggest that you seek a second opinion…and give your new dentist the benefit of the doubt until the facts say otherwise.

As always, I can be reached at Doc@KriegerOrthodontics.com if you have any questions.

All the best,

Glenn