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.  


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.
  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


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…


Is Your New Dentist Ripping You Off?


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.


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,


Are There Risks With Getting Clear Braces?


First, in the interest of full disclosure, I need to let you know that my practice is currently almost entirely made up of patients with “clear” braces. This is different than clear aligners which aren’t braces at all. While clear braces have many upsides, there are some legitimate drawbacks that one needs to be aware of. So, you’re going to learn about clear braces, what makes them different and why I would choose to offer them.

Let’s start with a little background information.  Orthodontic “brackets” are the little things that we cement or bond to a tooth. They act as steering wheel of sorts, allowing the orthodontic wire somewhere to sit as it goes back to its straight, flat original shape, guiding the tooth while it does so. Brackets come in metal, plastic and numerous varieties of what you might call “glass”. The glass, or ceramic brackets come in many different formulations, touted by their manufacturers as having unique advantages such as color matching or durability. However, unlike their metal counterparts, ceramic brackets have some inherent potential problems.

Notice that the wire goes into the bracket and as it straightens out, the bracket acts as a steering wheel.

Due to the fact that the ceramic brackets are, um, ceramic, they can chip or break. They can also be abrasive to the opposing teeth, so some types of clear brackets on the lower can actually accelerate wear of an upper tooth that might be biting onto it.

One of the other huge problems associated with clear brackets and why many orthodontists don’t like working with them is the fact that they are extremely tough to take off. It all stems from the fact that ceramic doesn’t flex. Metal brackets come off because when we squeeze them (note: we don’t “pull” them off the tooth) the bracket flexes and pops off the tooth. If the ceramic brackets don’t flex, how do we get them off? Either break them off in pieces or drill them off.

You may now be asking: “So, doc, why again do you use these devilish types of brackets?”

There’s one company that I believe has solved many of the problems associated with ceramic brackets and without them, I would be using clear  brackets. 3M (a pretty well known company for turning out solid products) created their Clarity Advanced bracket. It’s not only the best looking (i.e.-almost invisible) clear bracket, but it rarely breaks or chips. It also comes with a predesigned cleave line down the inside of it and using a special instrument, one can watch the bracket collapse on itself and almost simply fall of when we’re done using it. Best of all, it comes with a specially designed 3M adhesive (they’re known for their innovative adhesives) that allows this bracket to stay on really well and have so little excess that it shortens placement time and helps keep the tooth from attracting a lot of plaque. Hygienists from general dentists who clean my patients’ teeth often tell me how much cleaner their teeth are when compared to other clear brackets that they see.

Screen Shot 2016-07-31 at 1.20.37 PM

You may wonder why everyone doesn’t use these amazing 3M Clarity Advanced brackets. After all, they stay on well, don’t chip or crack easily, don’t wear down the opposing teeth more than the metal brackets, come off easily and help reduce plaque levels. The reason is cost. They are way more expensive than other clear brackets and many doctors (understandably) don’t want to spend the money, but when my kids needed braces, I used the 3M Clarity Advanced brackets. When dental professionals learn about these brackets, they ask me to use them in their treatment. Once you see them in action, you can understand why I like them so much.

Clear braces are an awesome alternative to metal and clear aligner treatment, but not all brackets are created equal. When you ask for clear brackets ask to see pictures of patients wearing them. Ask about how they come off and if they chip or wear down the opposing teeth. I’ve had numerous orthodontists unnecessarily “bad mouth” clear braces because they were using braces that weren’t that good looking or had other compromises. Just know that there is an answer out there for beautiful, long lasting and safe clear braces.

If you ever have a question, please don’t hesitate to contact me at Doc@KriegerOrthodontics.com .

All the best,


Is Dentistry Like Coca-Cola?


Imagine going into a convenience store, buying a Coke and being charged $5 for the single bottle. The next week, you buy a Coke at a store across the street from the convenience store and it only cost you $2. Why would you ever go back to the first store to buy a Coke? You wouldn’t, unless you like wasting money. The bottle of Coke is a “commodity”; it’s identical no matter where you buy it. Whether you buy it in Manhattan or Peoria, it’s the exact same product and buying it in one place over the other offers no advantage in the product itself.

It is truly disheartening to see that today’s consumers treat dental and orthodontic care like a commodity. The assumption is that braces and dentistry in every office are the same, and  the outcome will be the same regardless of where one goes. That simply isn’t true because dentistry is not a commodity. Where you get your work done DOES matter and the quality isn’t the same everywhere.

Things like doctor training, staff continuing education, quality materials & well trained laboratory technicians are all important criteria to consider when choosing an orthodontist and every one of them costs money. Sure, many orthodontists in a community may be similarly priced, within a couple of hundred dollars of one another, but what about the office that’s 20-25% less expensive than everyone else?

There was a famous study performed by Eastman Kodak that evaluated the effect of lower fees on profitability. If one operates at a 75% overhead (high for most orthodontists but in line for most non-specialist dentists) and lowers their fees by just 10%, they will need to perform 67% more dentistry  to make the same profit as before. A 20% discount in fees requires- get ready for this- 400% more dentistry to make the same profit as before!!!

If you take your child to a dentist who charges $5000 for braces and another office that charges $4000 for what they refer to as an “identical” treatment plan, consider that to make the same profit, they are going have to see roughly 4 times the number of patients that the first office. Maybe the second office is simply content with making less money or is thrilled to see 4 times the number of patients, but I am yet to come across that type of office in private practice.

It’s fair to say that just because someone charges more doesn’t mean that they’re going to necessarily give you a better outcome. That’s where you need to ask them to show you outcomes that they’ve provided to others with similar problems. Does the doctor make you feel like you’re getting the personal attention you deserve? Is their dental team changing all the time? Great offices generally show stability in their team over time.

“The more expensive offices are not necessarily the best, but the best offices are often more expensive.”

In a quarter century in the dental field I can tell you emphatically that the least expensive providers in an area are generally not the ones I would go to. Their labs tend to be cheaper, their team members are generally paid less, their equipment does not generally include the newest technology and their level of continuing education is generally not exemplary. Again, if they aren’t cutting costs on all of these items and are charging way less than everyone else, either they are content making very little or they have to increase volume, something that is very hard to do AND maintain exceptional outcomes.

Just remember that when it comes to choosing a provider, give some thought to the math. I understand that finances do play a role, but keep in mind that this is healthcare we’re talking about and not a commodity. You will see different outcomes and levels of attention depending on where you go, and cheaper is by no means the primary factor that should decide where you or your child get a beautiful and healthy smile for a lifetime.

All the best,


Why do I need a crown and not just a filling?

84u0JgEIn 2o years as a practicing restorative dentist, I must have told thousands of patients that they needed a crown. Aside from special situations like implants or teeth with root canals, why are crowns necessary?

All 3 of these teeth have fillings of varying widths which are failing and are in need of replacement. Do they get fillings or do they get crowns?

Take a look at the picture of the three silver fillings. All 3 are in some degree of breakdown and of different widths. If the hole left from the removal of the filling is more than 50% of the width of the tooth, it means that there is more filling than supportive tooth structure, and there’s a decent chance that the tooth will split when put under pressure. That’s when we cover the tooth with a crown.

Think of a telephone pole that is splitting from the top. If one covers it with a metal bucket, it can be struck as hard as possible and it won’t split further. That’s what a crown does. After preparing the tooth into a shape that allows a crown to fit over it, it covers the tooth, replaces missing tooth structure, and keeps it from splitting.

A crown is a cover over the prepared tooth structure and looks like a tooth, replacing lost tooth structure.

Now look at the original image of the three fillings again. The blue area represents the area taken up by the removed filling and any decayed/undermined tooth structure. The left tooth clearly will have enough tooth structure remaining to perform just a filling while the middle one will be over 50% gone, requiring a crown. The tooth on the right is a mix between the first two teeth and might be a great candidate for an onlay (a partial crown).

The red line represents the overall width of the tooth and the blue represents the ultimate shape of the restoration. Notice how the middle tooth would have a hole more than 50% of the width of the tooth and without a crown to cover it, it might split.

The decision to make a crown instead of a filling is a subjective one and up to the discretion of the dentist. However, when the clinician feels that the tooth is in danger of fracture because of a filling that would be too large, a crown can be a fantastic option.

What is “sedation dentistry”?


A friend recently told me that he saw a sign at a mall for “a dentist that specializes in doing procedures where they either knock you completely out of sedate you (their specialty)”. He asked me what my thought was about theses types of dentists and what they do. This post primarily refers to general dentists who offer sedation dentistry for restorative and minor surgical procedures and not oral surgeons or dental anesthesiologists who use IV or inhalation anesthetics for deeper levels of sedation or general anesthesia.

It probably comes as no surprise that a lot of patients are somewhat fearful of going to the dentist. In some cases, the anxiety is so great that the idea of even getting a cleaning is too much for the patient to tolerate, leading to missed appointments and a negative feedback loop which ultimately can lead to catastrophic oral health outcomes. For these patients, regular local anesthetic and even nitrous oxide (“laughing gas”) aren’t enough for them to overcome their fear of the dental office.

Sedation dentistry has been a fantastic option for the aforementioned dental phobic  patient. Imagine getting work done while in a very relaxed state and not even remembering the appointment! Today, there are very safe oral “anxiolytic” (anxiety reducing) drugs that allow one to perform procedures on patients who otherwise wouldn’t have been able to walk into a dental office. Note that we are not discussing drugs that are administered through needles or gases which produce deeper levels of sedation or general anesthesia for which very few general dentists are trained. Those are altogether different subjects that I am not broaching in this post. We’re talking about a very light level of sedation using oral medications with or without the addition of nitrous oxide. So, who can dispense these drugs?

State laws vary, but almost all dentists can perform anxiolytic dentistry, once properly trained.  Please note that this is NOT “sleep” dentistry. Under these procedures, one wants the patients to be drowsy and NOT fast asleep. Additionally, while it is VERY safe, patients need to be screened for medical history issues that could interfere and should be monitored with a pulse oximeter (a device that fits over the finger and monitors blood oxygen levels completely painlessly) and blood pressure measuring device. That’s it, aside from the requisite training which is readily available.

When I was initially trained in sedation dentistry (oral medications and nitrous oxide) over a decade ago, there were companies that tried to get me to sign up with their marketing plan to advertise as a “sedation dentistry” provider using their radio and print marketing program. The whole goal was to use my training in sedation dentistry as a way of getting a stream of new patients into my office.I was qualified to treat patients with anxiolytic drugs with or without the advertising campaign.

Here’s how I see it: Patients have a choice of picking a “sedation dentist” who does dentistry or a dentist who does sedation. My suggestion would be to find a dentist who is highly recommended by peers and patients and then ask them if they do sedation dentistry. For most “smaller” procedures like crowns, fillings, root canals and cleanings, this is easily handled with oral medications. In cases where someone needs a full mouth of work done, I used to bring in an actual dental anesthesiologist who used either IV or inhalation anesthetics to take the patient to a monitored deeper level of sedation that I simply couldn’t (and wouldn’t) do on my own. Again, most of the well-trained restorative dentists that I know offer this service in their offices and one doesn’t need to go to a “sedation dentistry” provider to get that service, though I have nothing against using them if you want to.

Most dentists are comfortable providing light levels of oral sedation in the office and in my 24 years in dentistry I’ve found that this is something that works well for the overwhelming percentage of patients with dental fear. Find a great dentist and then see if they can offer the sedation procedure before simply going to someone because they have an ad in the mall or on the radio.

However, there are cases where patients need to be more deeply sedated or under general anesthesia and again, I am in favor (just one man’s opinion) of having one person handle the dental work and another do the anesthesia. That’s not to say that one person can’t do it well. They can, but again, I would first choose a dentist for the quality of their dentistry, not their sedation experience.

All the best,