Orthodontic Treatment

At Drs. Cook and Gutsche’s office, our patients are our first priority, and we will be delighted to provide you with the compassionate, personalized orthodontic treatment care you deserve. Please call one of our helpful scheduling coordinators at (610) 622-4400 to start your path to a great, new smile!

Orthodontic Overview

What a difference straight teeth can make! A great-looking smile can boost your self-confidence and have a positive impact on social and professional opportunities. Orthodontic treatment is the original smile makeover tool — and you will be happy to know that you’re never too old to take advantage of it. But it isn’t all about looks: Properly aligned teeth help you to bite, chew and even speak more effectively. They are also easier to clean, which helps keep your mouth free of tooth decay and gum disease.

The amazing thing about orthodontics is that it harnesses the body’s natural ability to remodel its own tissue. With the application of light, constant force, orthodontic appliances gently reshape bone and move teeth into better positions. Some examples of these appliances are traditional metal braces, inconspicuous clear or tooth-colored braces, and clear aligners, an option for adults and teens.

Common Orthodontic Problems

3%Orthodontic problems can affect both children and adults — even those who wore braces when they were young. That’s because teeth are more mobile than you might think. In fact, teeth move very gradually all the time in response to the normal forces of biting and chewing. But the teeth can also be pushed out of proper alignment when, for example, young children develop unhealthy habits such as thumb sucking or tongue thrusting. These and other orthodontic problems usually become apparent around age 7, when the permanent teeth have started to come in. That’s why an orthodontic evaluation is recommended for all kids at this age.

Adults often see their teeth begin to crowd toward the center of the mouth. Your bite may also shift into poor alignment due to a missing tooth. But it’s good to know that no matter what your age, orthodontic treatment is available for all of the common orthodontic problems listed below — provided your teeth and gums are healthy. It’s also important to remember that wearing a retainer after any orthodontic treatment will help preserve the results for as long as possible.

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Abnormal eruption

Abnormal eruption is when a tooth emerges through the gum in the wrong place. If the tooth is blocked from growing in fully (a situation called impaction), a minor oral surgical procedure may be required to uncover the tooth before orthodontic treatment begins.

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Crossbite

Crossbite is when one or more of the upper teeth bite inside the lower teeth rather than outside. This is usually related to misalignment of the upper and lower jaws. In a child who is still growing, widening the upper jaw with an orthodontic appliance called a palatal expander may solve the problem.

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Crowding

Crowding results from a lack of space for the teeth to fit normally within the jaws, either because the teeth are too big or the jaws are too small. Possible solutions may include removing some teeth and/or making more room in the jaws with a palatal expander or through a surgical procedure.

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Excessive spacing

Excessive spacing may result when one or more teeth fail to grow in, are lost to trauma or disease, or there is a discrepancy between jaw size and tooth size. It’s important to close the gaps because excessive space allows nearby teeth to shift out of position.

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Open bite

Open bite occurs when the upper and lower front teeth do not come together when biting, resulting in an open space between the two. This is often the result of tongue thrusting (also called infantile swallowing pattern) and/or prolonged thumb sucking.

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Overjet

Overjet (protrusion) is when the upper front teeth extend too far forward or the lower teeth don’t extend far enough forward. This may be related to genetics, improper jaw development, missing lower teeth and/or improper alignment of molars. Thumb sucking or tongue thrusting can exacerbate the problem.

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Underbite

Underbite occurs when the lower front teeth extend past the upper front teeth. It can be caused by overgrowth of the lower jaw and/or undergrowth of the upper jaw. Depending on the severity, treatment may involve conventional orthodontics and/or jaw (orthognathic) surgery.

Early Treatment
Orthodontics for Children

In addition to these general guidelines, there are some specific recommendations for children. The American Academy of Orthodontists (AAO) recommends that your child have an orthodontic examination by age 7 — for two very good reasons.   

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One stems from the fact that there’s a wide disparity in tooth development at that age — so it takes an expert to tell if a child may actually have an orthodontic problem, or if it’s just a normal developmental variation. By that time, an orthodontist can usually determine whether or not there will be adequate room in the mouth to accommodate the permanent teeth.

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The second reason for an early exam is that many conditions are far easier to treat if they’re caught at an early stage, when children’s natural growth processes are in full swing. For example, a palatal expander appliance can effectively treat a child’s crossbite (a condition where the upper teeth close inside the lower ones) because a youngster’s jaw is still growing rapidly. However, if left untreated, oral surgery could later be required to correct this serious condition.

There are other problems commonly seen in childhood that may also benefit from orthodontic treatment. These include the early or late loss of baby teeth, persistent thumb sucking, tongue thrusting and mouth breathing. If you notice any of these symptoms, it may be time to visit our office. But keep in mind that early screening doesn’t mean treatment has to start right away — In fact, most kids don’t begin active orthodontic treatment until they’re 9-14 years old.

There are several ways that kids can benefit from seeing an orthodontist at an early age. But it’s important to recognize that early evaluation isn’t necessarily followed by early treatment; in most cases, if orthodontic work is needed, we simply monitor your child’s growth patterns until we see that it’s time for treatment to begin. This gives us an opportunity to get the best results in the most efficient way, and to help prevent future problems.

Although every child’s development is different, in most kids the first adult molars have typically started to emerge by around age six. This, along with other developmental markers, lets us get a handle on the basic alignment of the teeth, from front to back and side to side. It may also be possible at this point to determine whether there is adequate room in the mouth for all of the permanent teeth — and, if not, to take action.

When Earlier Is Better

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Treatment for common orthodontic problems typically begins around age 9-14, when all of the baby teeth are gone and many of the permanent ones are in place. But there are some conditions that are much easier to treat if they’re caught at an early age, when a child’s natural growth processes are going full speed ahead.

One is severe crossbite, a condition where many or all of the upper teeth close inside the lower teeth. To treat this problem, a device called a palatal expander can be used, which gradually and painlessly widens the upper jaw; it’s especially effective when the jaw itself hasn’t fully developed. If we wait too long, a more complicated treatment — or even oral surgery — might be required to correct the problem.

Another condition that may benefit from early treatment is severe crowding. This occurs when the jaws are too small to accommodate all of the permanent teeth. Either palatal expansion or tooth extraction may be recommended at this point, to help the adult teeth erupt (emerge from below the gums) properly. Even if braces are required later, the treatment time will likely be shorter and less complicated.

Early intervention may also be helpful in resolving several other problems. Protruding teeth, especially in front, can be prone to chipping and fractures; they may also lead to problems with a child’s self-image. A severe underbite, caused by the lower jaw growing much larger than the upper jaw, can result in serious bite problems. Orthodontic appliances, including braces and headgear, can be successfully used to correct these problems at this stage, when the child’s development is in full swing, thereby increasing the chances that surgery can be avoided.

Correcting Bad Habits

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At one time or another, anyone may pick up a bad habit. But there are some situations where a youngster’s parafunctional (outside normal function) habits can actually influence the development and function of his or her teeth, jaws and mouth. Some examples of these are persistent thumb sucking, tongue thrusting and mouth breathing.

The sucking reflex is natural in early childhood; it usually disappears between ages 2 and 4. But if it persists much later, the pressure of the digit on the front teeth and the upper jaw can actually cause the teeth to move apart and the jaws to change shape. This can lead to the orthodontic problem called “open bite,” and may impair speech. An open bite can also be caused by the force of the tongue pushing forward against the teeth (tongue thrusting).

Mouth breathing — an abnormal breathing pattern in which the mouth always remains open, passing air directly to the lungs — is related to alterations in the muscular function of the tongue and face. It may cause the upper and lower jaw to grow abnormally, which can lead to serious orthodontic problems. Although mouth breathing may start from a physical difficulty, it can become a habitual action that’s hard to break.

Various orthodontic treatments are available to help correct these parafunctional habits — and the sooner they’re taken care of, the less damage they may cause. But these potential problems aren’t always easy to recognize. That’s one more reason why you should bring your child in for an early orthodontic screening.

Adolescent Orthodontic Care

There are several good reasons why adolescence is the optimal time for orthodontic treatment, though occasionally even earlier intervention is called for. One has to do with the development of the teeth: There’s no set timetable for every kid, but generally by the age of 11-13 the deciduous (baby) teeth have all been lost, and the permanent ones have largely come in. This is the time when we can go to work correcting the problems that cause a bad bite (malocclusion), improper tooth spacing or poor alignment.

There are several good reasons why adolescence is the optimal time for orthodontic treatment, though occasionally even earlier intervention is called for. One has to do with the development of the teeth: There’s no set timetable for every kid, but generally by the age of 11-13 the deciduous (baby) teeth have all been lost, and the permanent ones have largely come in. This is the time when we can go to work correcting the problems that cause a bad bite (malocclusion), improper tooth spacing or poor alignment.

Orthodontic problems don't improve with age — they simply become harder to treat. It's easier to treat many orthodontic problems during adolescence because the body is still growing rapidly at this time. Whether we use standard braces, or appliances like palatal expanders, we can create an improved appearance and function in a short period of time. In later years, when the bones of the face and jaw are fully developed, many conditions become more difficult (and costly) to treat.

There's even a social element to getting orthodontic treatment in adolescence. If you need braces, you're not alone! Chances are you'll see some of your classmates in our office, and you may even make new friends as you go through the process together. When it's done, you'll have a smile that you can really be proud of, and benefits that will last your whole life.

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Orthodontic Treatment for Adults

You know when your child should come in for an orthodontic exam. Now, how about you? Do you cover your mouth with your hand when you smile? Are you self-conscious around strangers because your smile isn't as perfect as you want it to be? If so then the best time to see an orthodontist might be — right now! Maybe you think orthodontics is just for kids. If so, then it's time to think again! In fact, according to the AAO, around one in five orthodontic patients today is an adult. Why are more adults getting orthodontic treatment? There are plenty of reasons.

Orthodontic treatment can be successful at any age — and in older patients, compliance isn't usually an issue. Plus, with the growing availability of clear aligners or translucent ceramic brackets, it's getting harder to tell whether or not you're wearing orthodontic appliances. So if you worry that metal braces might clash with your professional image, be sure to ask about less-visible alternatives. Of course, it isn't just about looks. Well-aligned teeth are easier to clean and maintain, and less subject to abnormal wear. A better bite keeps you from having trouble eating and speaking, and helps your teeth stay healthy — and healthy teeth can last a lifetime. So why delay getting orthodontic treatment?

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Damon® Brackets

With the Damon® System, treatment time is typically shorter than with traditional braces. Shorter treatment time means fewer appointments and a beautiful smile…faster. You may be surprised at how fast. The Damon® System employs a unique treatment philosophy that goes beyond straight teeth to create broad beautiful smiles. We take into account each patient’s face, profile and other factors, anticipating what patients will look like in their 40’s, 50’s and beyond.

The days of having braces tightened are over. The Damon® System uses tie-less brackets that reduce the pressure on your teeth, allowing them to move more comfortably to their correct positions. The innovative approach to orthodontics ensures greater comfort throughout treatment.

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Damon® Clear

Damon® clear braces are virtually invisible, so no one may know you are wearing braces. Other types of clear braces feature metal parts that are visible, as well as elastic ties that can become discolored and collect bacteria throughout treatment. Damon® clear braces are tie-less and discrete. They are not prone to staining and discoloration.

Elastics (Rubber Bands) in Orthodontic Treatment

Elastics attach to tiny hooks on Damon® braces or buttons created for this purpose on clear aligners (Invisalign®). The bands may stretch from upper jaw to lower jaw, or be connected to teeth in the same jaw. These connection points are carefully determined to create the desired movement of individual teeth or groups of teeth, while preventing other teeth from moving out of alignment. Likewise, the rubber band must be stretched in a precise pattern. For example, it may hook to one upper tooth and two lower teeth, creating a triangle shape. It may attach to four teeth, creating a box pattern. Or it may simply stretch between one upper tooth and one lower tooth on a diagonal. The important thing is that you attach them exactly as instructed. Wearing them incorrectly can prevent the teeth from moving, or create unwanted movement. If you have any questions about how to attach your elastics correctly, please don’t hesitate to ask.

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Important Things to Remember About Rubber Bands

The most important thing to remember is that treatment with orthodontic elastics can only be successful if the rubber bands are worn continuously as directed. They should only be removed for eating or brushing your teeth.  If you wear Invisalign, you already are used to a similar type of routine. If you wear traditional braces, however, assuming this new level of responsibility for the success of your own treatment may be new. But it will be well worth the extra effort!

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invisalign braces | orthodontic treatment | orthodontist delaware county

The Invisalign® System is a revolutionary, virtually invisible orthodontic treatment. With Invisalign® you can smile with confidence during and after treatment. Invisalign® is designed to gradually improve your smile using a series of clear, customized and removable aligners.

The aligners are comfortable to wear. Treatment is convenient. You will visit the office every four to six weeks so Dr. Cook and Dr. Gutsche can evaluate your treatment progress and provide you with new aligners. You can keep eating your favorite foods during treatment. Simply brush and floss as normal to keep your teeth and gums healthy. Certain orthodontic problems in teens can be successfully treated using the Invisalign Teen® system.

Clear aligners for adults have been available for over a decade, but until recently they weren’t recommended for teens in most cases. Why not? Chiefly, for two reasons: It was thought that

teens wouldn’t always wear them for the recommended 22 hours per day; also, since many teens have some permanent teeth still erupting (emerging from below the gums), the precisely planned movement of the teeth might be disturbed.

Luckily, technology has come to the rescue. The first problem is addressed by “compliance indicators” located on the aligners themselves. These colored dots fade over time as the aligners are worn in the mouth, showing whether or not you’ve followed the plan. To solve the second problem, aligners made especially for teens come with “eruption tabs” built in; they are designed to hold space for teeth that have not yet fully erupted.

Today, more people than ever — both adults and teens — are finding that clear aligners suit their needs best. Are you one of them? Why not come in to our office and ask whether clear aligners could work for you.

Orthodontics and Surgery

Most of the time, individuals with misaligned teeth or other bite problems can be successfully treated with the many types of orthodontic appliances now available. Jaw development in a growing child can even be guided to improve tooth alignment when appropriate treatment is received before puberty. But sometimes, orthodontics alone isn’t enough to correct problems with the teeth or jaws. That’s when a surgical approach may be needed.

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orthodontic treatment | orthodontist delaware county

Corrective jaw surgery (also called orthognathic surgery) may be recommended for orthodontic problems that are skeletal in nature — meaning the misalignment of the bite is caused not by the position of the teeth in the jaws, but rather by the size or position of the jaws themselves. Some examples include: an open bite, where the upper and lower teeth don’t meet when the mouth is closed; a protruding lower jaw, which makes the lower lip and chin appear too far forward; or a receding lower jaw, which makes the chin less prominent. Correcting these issues in an adult may involve surgically modifying one or both jaws. The goal of corrective jaw surgery is to improve basic oral functions such as chewing, swallowing, speaking and breathing, and to restore facial symmetry.

A Team Approach

Jaw surgery performed in combination with orthodontic treatment is a collaborative process that often includes orthodontists, general dentists, and oral and maxillofacial surgeons. The first step is a thorough evaluation by the orthodontist and the surgeon, which typically includes x-rays and other diagnostic imaging (such as photographs and CT scans), and actual or virtual models of the dentition (teeth and jaws). Using this information, a complete treatment plan will be designed for each individual’s situation.

Several months of orthodontic treatment is often necessary before surgery, to align the upper and lower teeth in preparation for the procedure. The surgery itself is generally performed under general anesthesia in a hospital, an ambulatory surgical center, or an in-office operating suite. Following a recovery period, a second phase of orthodontic treatment may be needed to make minor adjustments and ensure the stability of the re-aligned bite. The total treatment period, including pre- and post-operative orthodontics and surgery, may be 1–3 years.

Evaluating a Surgical Solution

Orthognathic surgery is generally only considered when more conservative treatments (such as orthodontics) are judged insufficient. Thus, it isn’t typically
appropriate for a minor malocclusion (bad bite), but may be recommended for moderate to severe misalignment of the jaws. As with any type of surgery, it
carries certain risks, including infection, numbness and adverse reactions to medications or anesthetics. Before any procedure is undertaken, the potential
benefits and risks will be explained; you should feel free to ask for more complete information about any aspect of treatment you don’t fully understand.

Because this type of surgery makes permanent changes to the jaws, it isn’t suitable for young people whose bones are still growing; however, for adults and some teens, corrective jaw surgery can bring about many positive changes in oral function and appearance that couldn’t otherwise be achieved.