The effects of over-the-counter analgesics on orthodontic tooth movement

By far the most frequently asked question in every orthodontic office is, “When are my braces coming off?” In the fast-paced, busy lives of patients, there is little time to spend on lengthy orthodontic therapy.  In the ever-advancing field of orthodontics, many barriers have been overcome, leading to healthier results and more beautiful smiles.  Now, the focus is on reducing treatment time.

Faster care without sacrificing quality would be advantageous in (a) reducing hygiene problems, (b) increasing patient acceptance of treatment plans and (c) creating a higher level of overall treatment satisfaction.

With the emphasis on shortening treatment time, it is critical that practitioners be aware of all medications that patients are taking that could unknowingly slow down their orthodontic treatment. Orthodontic patients often use over-the-counter analgesics to control the discomfort associated with tooth movement as well as to treat other ailments. Many of these pharmaceutical agents are known to systemically influence bone and the velocity of tooth movement.

Research has shown that traditional anti-inflammatories/”pain killers” such as Advil®, Motrin® and Aspirin® decreased the rate of orthodontic tooth movement. Tylenol® had no effect and should therefore be considered the analgesic drug of choice for patients undergoing orthodontics, unless contraindicated by the patient’s medical history or physician.

(Summarized from original article written by Dr. K. Sakas)

Happy (and dentally safe) Halloween!

While dentists and orthodontists have a professional conflict with Halloween, we also know that holiday snacks are a fact of life.  Here are some suggestions to enjoy a fun and dentally safe Halloween:

Before going out trick-or-treating, try to ensure your children eat a good, hearty meal so there will be less temptation to gorge on candy. 

Tooth decay occurs when candy and other sweets mix with bacteria in the sticky plaque that constantly forms on teeth to produce acid, which can wear away enamel.  Chewy, sticky treats are particularly damaging because not only are they high in sugar, but they spend a prolonged amount of time stuck to teeth and are more difficult for saliva to break down.    Hard candies are tough on teeth as well because kids tend to suck on them at a leisurely pace for an extended period of time.

The majority of dentists who hand out candy choose chocolate because when it comes to teeth and sugar, it's really a matter of time. Chocolate dissolves quickly in the mouth and can be eaten easily, which decreases the amount of time sugar stays in contact with teeth.

At the end of the night, it's a good idea to remove the sticky, gummy and chewy choices from your child's candy haul.  And remember: the worst thing a kid can do is go to bed without brushing after gorging on the night's loot.

And last but not least, promote good oral health care habits to your children year-round by encouraging twice daily brushing with fluoridated toothpaste, daily flossing and regular dental checkups.

Happy Halloween!

Is Phase II always necessary after Phase I?

Because orthodontic care is not a “one size fits all” approach, not all patients need or will benefit from a two-phase orthodontic treatment.  Each patient has a unique problem that requires an unique, individualized treatment plan.  In fact, most children do not need Phase I orthodontic treatment and can actually wait until most or all permanent teeth are present.

When early orthodontic intervention is not necessary, careful monitoring of growth, development and observation of the eruption of the adult permanent teeth will allow me to make the call of when treatment start is ideal to obtain the best bite and smile possible in the timeliest manner.

After the completion of Phase I orthodontic treatment, usually a period of retention of the obtained results and observation will follow.  If no long-term risks are associated with not continuing with Phase II treatment, the orthodontist will make it optional and elective for the parents of a child who just underwent Phase I orthodontic treatment.  While this is not typical, it is quite possible.

For some kids that need Phase I orthodontic treatment, however, the problems that are being addressed are extensive, and full correction may not be attained until treatment moves on to Phase II.  The most common problems that usually do require two-phase orthodontic treatment are severe crowding being treated without extraction of permanent teeth, “underbites” and severe “overbites.”

What is “Phase II orthodontic treatment?”

Phase II orthodontic treatment follows early orthodontic intervention (a.k.a. Phase I) usually after a period of “rest and growth.” The goal of Phase II Treatment is to position all the permanent teeth as to maximize and protect their function as well as ensure long term health of the bite and chewing system.

Phase II treatment often does not require extraction of permanent teeth. It is best accomplished with full braces or Invisalign®, and usually lasts less that 2 years due to the improvements made in Phase I Treatment. This is especially relevant for patients as they enter their teenage years.

It is important to note that after Phase I orthodontic treatment most young patients typically have 16 new teeth that are erupting or will erupt in the next two or three years. These new teeth did not have brackets on them during Phase I simply because they were not in the mouth.

An orthodontist cannot determine how these teeth will erupt but can do everything within his or her skills to preserve or gain space for these erupting teeth. We are highly trained professionals but simply cannot control a patient's DNA. Actually, we work against DNA to create healthy and beautiful smiles that will last a lifetime.

How does two-phase orthodontic treatment benefit my child?

The benefits of early treatment are the creation of an environment that promotes unimpeded optimal eruption of the permanent dentition and more balanced chewing/biting and facial growth. This will consequently provide better chewing function, more pleasant dental and facial esthetics and make any needed further correction in a second phase of care more comfortable and timely.

The following is a list of potential benefits of Phase I early orthodontic treatment:
- Reduce of the need to extract permanent teeth through improvement of the width of the dental arches and preserving or gaining space for erupting permanent teeth
- Influence jaw growth in a positive manner thus reducing or eliminating the need for jaw surgery;
- Lower the risk of trauma to protruded front teeth;
- Correct harmful oral habits improve esthetics and self-esteem;
- Simplify and shorten treatment time for definitive orthodontic treatment (phase II);
- Increase stability of final treatment results;
- Reduce likelihood of impacted permanent teeth;
- Improve speech development;
- Guide permanent teeth into more favorable positions; and
- Improve compliance before the busy teenage years.