Braces? At my age?

Recent article featured in WebMD on adult orthodontics 

Feel a little self conscious about your crooked teeth? You aren’t alone. Thankfully, braces aren't just for kids any more. Today, adults make up nearly 20% of brace wearers, says Michael B. Rogers, DDS, president of the American Association of Orthodontists.
Although there are many reasons for adults to consider braces, most people simply want to look and feel their best. Here are a few leading reasons to make a trip to the ortho:

A straighter smile. It’s no surprise that many people want to perfect their pearly whites to achieve a winning smile. And, those smiles pay off. A recent study compared people's reactions to photos that were manipulated to show either straight or crooked teeth. People with straight teeth rated higher on scores of leadership, popularity, and sports ability. (The only score that didn't change was intelligence.)
Shifting teeth. Just because you had braces as a kid doesn’t mean you’re off the hook. "Teeth tend to move a little throughout your life," Rogers says. "Your teeth may shift a little back toward their original positions."
Better oral health. It’s no surprise that straight teeth are easier to brush and floss. So -- if you’re doing your part -- expect less decay and healthier gums, says Pamela K. McClain, DDS, president of the American Academy of Periodontology. Antibacterial mouth rinses can also help keep your teeth and gums free of plaque-causing bacteria.
Braces can help people manage some more serious issues too, like bite problems that cause jaw pain. In some cases, braces are necessary to change the position of neighboring teeth for a new bridge, crown, or implant.

New Options

Thankfully, we’ve come a long way from the days when kids were called "Brace Face." Today’s options are barely noticeable. They include:

• Ceramic braces made of a clear material that is much less obvious than traditional metal braces.
• Brackets attached to the back of teeth to hold the wires that pull teeth into a new position.
• Customized plastic aligners that fit like tooth guards over teeth, gently moving them into a new position.

What to Expect

How long you'll need to wear braces depends on what you have done. Most treatments range from 12 to 44 months. "Adult teeth sometimes take longer than children's teeth to move into new positions,” Rogers says. “But in many cases there's no real difference."
Once teeth are in the desired position, you are likely to need to wear a retainer. Many orthodontists now recommend permanent retainers that are fitted and attached to the back of teeth.
Cost also varies widely depending on the extent of treatment. The typical range is $4,000 to $8,000. A growing number of dental plans cover all or part of orthodontic treatment. Many orthodontists offer discounts if you pay the entire fee up front. If you can't spring that, talk to your orthodontist about monthly installments or other payment plans.

By Peter Jaret
WebMD Feature

Why do patients seek orthodontic treatment?

It has long been believed that orthodontic treatment facilitates proper oral hygiene which reduces the incidence of periodontal disease and dental cavities. In addition, a better bite can help prevent temporomandibular joint disorders. However, it seems that the main reason to have orthodontic treatment is to improve one's esthetics. A person's smile has been identified as the second most observed facial characteristic when it comes to evaluating someone's physical attractiveness. Psychosocial research has shown that a bad bite has a negative impact on one's self-satisfaction with their appearance. This in turn tends to impair social functioning.

A recent study from Brazil looked at the oral health related quality of life of young adults who had completed orthodontic treatment compared with untreated adults. The authors found that untreated individuals had 5X higher oral health impact profile scores when compared to treated individuals. The most frequent impact was "been self-conscious". It was concluded that young adults who receive orthodontic treatment had significant better oral health-related quality of life scores than did the non-treated group of young adults.

Another Brazilian study assessed the changes in esthetic self-perception of adolescents after orthodontic treatment. The authors found that orthodontic treatment improved individual's self-perception compared to those that never received treatment. Individuals who did not receive treatment had significantly worse self-ratings.

We recognize that many people seek and undergo orthodontic treatment to improve esthetics and not necessarily address dental problems that may lead to physiological dysfunction or destruction of tissues in the oral cavity. Whatever the reason, at RiteBite Orthodontics we will provide you with both a beautiful and healthy smile!


Feu et al., Influence of orthodontic treatment on adolescents' self-perceptions of esthetics. Am J Orthod Dentofacial Orthop 2012;141:743-50.

Palomares et al., How does orthodontic treatment affect young adults' oral health-realted quality of life? Am J Orthod Dentofacial Orthop 2012;141:751-8.

Adult Braces: It's Never Too Late To Improve Your Smile!

Braces aren’t just for kids anymore. Tooth alignment can be changed at any age if your gums and bone structure are healthy. We offer a variety of treatments that are designed for different age groups – including adults. A new smile can begin today.

Orthodontic treatment at later stages in life can dramatically improve your personal appearance and self-esteem. Improving the health of your teeth and gums is equally important. Crooked teeth and a bad bite can contribute to gum and bone loss, tooth decay, abnormal wear of the tooth enamel and surfaces, headaches and jaw joint (TMJ/TMD) pain.

Good news! The new techniques and appliances we use greatly reduce discomfort levels, decrease the frequency of visits, shorten treatment time and may allow you to choose from several options. Your options may include metal braces, translucent braces or transparent aligners that can be worn to improve mild cases of misaligned teeth.

During the initial examination, Dr. Luis will be able to determine the best possible treatment for your individual needs. During this initial examination, we can outline the treatment plan, time of treatment expected and the approximate cost.

A large percentage of our patients are adults, and they agree that it’s never too late to improve their greatest asset – their smile.

Indirect Bonding: Improving the Braces Experience

RiteBite Orthodontics uses an indirect method of positioning your braces properly on your teeth, ultimately creating an ideal smile for you. Indirect bonding results in an increased level of precision, leading to ideal results much faster than you would with traditional methods. Traditional application of braces involved a long appointment, placing the braces on the teeth one at a time, directly in the mouth. The old method of placing braces directly on the teeth, one at a time, while the patient is in the dental chair is prone to inaccuracy and errors due to the inability to directly view the teeth properly and patient movement.

How does it work?

Once you have decided to proceed with orthodontic treatment, an appointment is arranged to take very accurate impressions of your teeth. The impressions are then poured and a model representation of your teeth is produced. The model of your teeth, allows Dr. Luis to examine your teeth from every angle imaginable, for precision positioning of your braces. Dr. Luis then positions your braces on your tooth model.


What does treatment with indirect bonding mean to you?

With the indirect bonding system, the top and bottom braces are placed as a single unit, rather than tooth-by-tooth, resulting in a much shorter and pleasant appointment the day you receive your braces. The treatment results generated by this method enable exceptional accuracy when positioning braces, because Dr. Luis is able to fine tune bracket placement with unmatched precision. Because of increased accuracy, patient cases using indirect bonding progress much faster than usual, meaning less time in braces and patients also have to undergo fewer adjustment appointments. This means less disruption to your everyday life.

Imagine No More Dental Impressions!

Millions of impressions are taken each year for the fabrication of orthodontic models and appliances. Orthodontic offices take a number of these “patient hating” procedures on a daily basis. A new system is now available that creates digital free impressions of a patient’s teeth.

The iOC Scanner, a digital orthodontic impression system powered by iTero, ensures a more accurate impression from the start, which results in improved orthodontic treatment.

The iOC scanner will eliminate the need to take physical impressions of a patient’s mouth. Instead of taking oral impressions which is one of the most anxiety producing procedures for patients undergoing orthodontic care, we will soon be able to use the iOC scanner which employs laser technology to capture accurate images of the mouth, doing away with the traditional messy impression. Imagine no goop, gagging or discomfort!

The iOC Scanner is the product of Cadent, now a part of Align Technology. It scans the mouth with a radiation-free laser and in six to eight minutes renders a digitally perfect, 3-D impression of the teeth and soft tissue structures. The iOC Scanner can be used for any orthodontic treatment including traditional metal braces and clear aligner-based orthodontic systems and it is the only product that can be used with Invisalign.

RiteBite Orthodontics, one of the top invisalign providers in the Waterloo Region with practices in Cambridge, Waterloo and Listowel, continues to embrace cutting edge orthodontic technology. If these scanners prove to be as accurate as they claim, you can rest assured that we will be one of the first offices to bring this technology to the Waterloo Region.

Essix versus Hawley Retainers

Both Hawley and Essix type retainers are commonly used by orthodontists. The traditional type is the Hawley retainer, which includes a metal wire that surrounds the teeth and keeps them in place. Named for its inventor, Dr. Charles Hawley, the wire is anchored in an acrylic arch that sits in the palate (roof of the mouth). The advantage of this type of retainer is that the metal wires can be adjusted to finish treatment and continue moving teeth as needed.  The Essix retainer is a vacuum formed retainer. This is a polypropylene or polyvinylchloride material, typically .020" or .030" thick. Essix is a brand name many dental offices are familiar with. This clear or transparent retainer fits over the entire arch of teeth and is produced from a dental mold. Is there any difference between these two type of retainers related to stability and patient acceptance?

A recent prospective study by Kumar and Bansal (2011) compared the effectiveness and acceptability of Essix and Hawley retainers.  The study consisted of 224 patients who had undergone comprehensive orthodontic treatment. The results showed that there was, no clinically significant differences in stability and irregularity, when the two types of retainers were compared. They also found that Hawley retainers were more acceptable for biting and Essix retainers were more acceptable for appearance and comfort.

So what can we take away from this? Basically, that your Essix retainers work just as well as traditional retainers but they are more comfortable and you will probably be more pleased with your appearance as well!


Kumar AG, Bansal A. Effectiveness and Acceptability of Essix and Begg Retainers: A Prospective Study. Aust Orthod J 2011; 27 (May):52-56.

Setting your Child up for Success: Parent's Involvement in the Beginning of Orthodontic Treatment

Parents want the best for their children. The best education, the best career, being successful, happy, and of course, having a healthy and beautiful smile.. When your child gets braces, this can be a very exciting experience for the child, the parent, and in some cases, the entire family.

Parents think back to the way that dentistry used to be when they were kids, which was not that enjoyable in some cases. Dentistry and Orthodontics are constantly changing.  We want our patients to LOVE coming to see us, and we are proud to say that most of them do!

Some children need their parents to accompany them into the clinical area, but in most cases, the child is a lot more comfortable during the visit if their parents are not present. There are a number of factors to consider when preparing for the first visit or what is more commonly known as the “braces on” visit:

1.     Most children adapt very well to new surroundings and new things. Children are often at ease immediately upon entering the clinic because the staff at Orthodontic offices all love children and do an excellent job of highlighting the fun parts of the appointment and explaining the procedure in a kid-friendly and fun way. Parents try their best to prepare their children for the first visit, and although they mean well, parents can often dishearten their children based on the way they describe braces to their children. Parents often don't know the particulars of the appointment and end up unintentionally highlighting the wrong things when describing the “braces-on” visit. For example “Don't worry, it won't hurt.” Children immediately think “Should I worry, is this going to hurt? Why would he/she say that?”

2.     Parents are very interested in the braces-on procedure. They often don't intend to ask questions, but sometimes they can't help themselves and what ends up happening is if the parent comes in for the first appointment, the clinician's energy is divided between answering the parent's questions and the child. It is very important that your child is the clinician's number one priority during this time. At the end of the visit, there is time set aside for all questions and discussions about the new braces. It is in the best interest of your child that all questions are held until the end of the appointment in order to be as attentive as possible to the child, and focus on him/her as the number one priority throughout the appointment.

3.     When parents are in the operatory during the braces-on visit, this can also have a negative effect on the child's experience for one very important reason. Parents think that when they come in for their child's visit, they are being supportive. What they don't realize is that when their child is lying back in the chair, they can't see what is going on around them. As soon as the parent attempts to be soothing to the child (i.e. Holding the child's hand or touching their leg), the child interprets this as a situation where they should be afraid, like something scary is going to happen next that they can't see yet, so they can start reacting to this with things like crying, etc, that perhaps would have not happened if the parent was out in the sitting area.

4.     Many contemporary dental offices have open-concept operatories. This has been proven to ease the nerves of patients, especially children because they can see other patients around them at ease during their visits. With the open-concept set up, it is great when the parent comes back with them to watch them get started, then after a few minutes, wander back to the sitting room. The parent is more than welcome to come and check on their child every once in awhile.

In summary, the braces-on visit can be really fun and exciting for your child. After reading this information, try acting and speaking in ways that will positively affect them. During the visit, try leaving the room for most of the visit while “checking back” every once in awhile. This way, your child is at ease because they know you are around if needed, but the clinician is able to focus their energy solely on your child. When explaining braces to your children, try to use really positive and fun descriptions.  Tell them what the braces will do and if you do feel the need to inform your child about the braces-on visit, use descriptions like “It's like crafts, they have to use a special glue to stick on the braces, I hear it's really fun!”

Kids love braces these days, and with your help, all aspects of Orthodontic treatment can be fun and exciting for your child!

Jennifer Stretch, RDH
RiteBite Orthodontics

When is the best time to begin orthodontics?

This is a question we are asked often and it is a good one!  Although seeing an orthodontist can enhance a smile at any age, there is an optimal time period to begin treatment. Beginning treatment at an early age ensures the greatest result and the least amount of time and expense. The American Association of Orthodontists recommends that the initial orthodontic evaluation should occur at the first sign of orthodontic problems or no later than age 7. 

By the age of 7, the first adult molars erupt, establishing the back bite. During this time, Dr. Luis can evaluate front-to-back and side-to-side tooth relationships. For example, the presence of erupting incisors can indicate possible overbite, open bite, crowding or gummy smiles. Timely screening increases the chances for an incredible smile. 

Early evaluation provides both timely detection of problems and greater opportunity for more effective treatment. Prudent intervention guides growth and development, preventing serious problems later. When orthodontic intervention is not necessary, Dr. Luis can carefully monitor growth and development and begin treatment when it is ideal.

You can request a complimentary consultation with Dr. Luis and he can answer all your questions about your child’s orthodontic treatment.

Braces or Invisalign?

When we tell are patients that they can be treated with Invisalign, many are surprised to find out that they don’t need braces to straighten their teeth. Dr. Luis always explains that “teeth do not discriminate between metal or plastic. They just know that they are being moved by forces, that if applied correctly will allow them to move in a certain direction.”  However, Dr. Luis will always evaluate a patient to determine if their orthodontic problem can be best treated with braces or Invisalign. What most people and even many dental professionals are not aware of, is that there are several situations where Invisalign actually provides a better option than braces.

Invisalign can be used to correct many orthodontic problems such as crowding, spacing, deep bites, open bites, crossbites, Class II and Class III malocclusions and even cases that require extractions or surgery.

Invisalign trays are not only more comfortable than braces, they are also removable. This allows patients to brush and floss their teeth without the obstacles of wires and brackets. This also allows you to eat the foods you love that may be forbidden with regular braces.  Additionally, you avoid the discomfort that braces may cause which can include poking wires, mouth sores, and other trauma caused by broken appliances.

Of course, the reason our patients like Invisalign so much is because most people don’t even realize that you are going through treatment since they are practically invisible. And even if a special occasion requires that you remove the trays, go ahead and place them back in when it is over. Can’t get much better than that!  

So if you live in the Waterloo, Cambridge or surrounding areas and are considering straightening your teeth, whether with regular braces or invisible ones, come see us for a complimentary consultation.

Braces and Teeth Whitening

Tooth whitening, also known as tooth bleaching, is used to brighten the shade of teeth. Tooth whitening procedures attempt to remove extrinsic stains. Extrinsic stains are found on the surface of the enamel layer and can usually be removed by having a professional cleaning. Stains that are not removed will begin to penetrate deeper layers of enamel and tend to be more difficult to remove. It is these persistent stains that may still be removed by teeth whitening procedures.


If you have braces or are thinking of getting braces, you should consider having your teeth whitened after your orthodontic treatment is complete, that is when your braces are removed. This usually results in a more esthetic result.

If whitening is done prior to having your braces placed, it is difficult to distribute the whitening gel evenly on teeth that are crooked resulting in different shades and overall dissatisfaction. If teeth whitening is done when the braces are still on, not only is it difficult to do, but after your braces are removed, you will notice darker areas where the whitening gel could not penetrate your teeth under the braces.

Regardless of what stage you are at with your orthodontic treatment, before you start whitening your teeth, consider speaking with your orthodontist. It is also recommended that you have your dentist check your teeth and gums. Whitening a cavity or exposed root could penetrate deep into your tooth and cause sensitivity. Patients who already have sensitive teeth may also experience increased sensitivity.

Braces? But I still have baby teeth!

D-Gainer stands for Damon space re-gainer. It is a gentle way of re-gaining space and arch width as the first step of treatment in 9-11 year olds.

The D-Gainer is also known as a limited fixed appliance. Basically, it comprises of Damon orthodontic brackets placed only on permanent front teeth and permanent first molars.  Initially, just the front teeth are aligned during the first couple of visits so that stronger wires can then be placed connecting the front teeth to the back teeth. Light nickel titanium springs are then placed on either side to gently expand the arch. These appliances are used primarily to create additional space to allow for the eruption of the permanent canines (eye) teeth when it is determined early that it won’t be possible for these teeth to fit into the dental arch. 

The D-Gainer also gently widens the dental arch which also generates space. The appliance can be used in both arches or just the upper or lower arch. This system of treatment has been shown to  produce more physiological acceptable forces and, in many cases, has replaced the use of palatal expanders. When deemed necessary, it is used as the first step to placing full Damon braces on the teeth. This approach is usually started in the 6-12 months preceding the eruption of the adult eye-teeth. This is often around 9 1/2 to 11 years of age. However, this has to be assessed in each individual case. D-Gainers would not be used when all of the teeth have already erupted and more commonly a full set of Damon braces would be chosen at that time. 

With this in mind, Dr. Luis will normally plan for D-Gainer treatment if it appears that the ability for the canine teeth to eventually erupt into the arch is questionable and possible impaction of the canines will result. In many cases, it is fairly clear that if nothing is done, extractions will be required at a future time at the least, or worse, the permanent canines may become impacted and need surgical intervention to be brought into the arch with or without extractions of permanent bicuspids. The duration of this type of early treatment is normally 12 months.

Cambridge Waterloo Orthodontist Reviews some Myths about Braces

In this day and age, with the internet at your fingertips, patients usually are well versed when it comes to talking about braces. However, most of the time their research relies mostly on what they have heard from friends, who at one point or another, had braces. As with everything you read on the internet, friends may sometimes not be the most reliable sources of information. So I thought I would review some of the most common myths that people have heard about orthodontic braces and attempt to demystify them for you.


1. Braces need to be painful in order to work— In the past when only stiff wires were available, they were tied into the braces exerting heavy forces resulting in more pain and discomfort for the patient (what most patients referred to as “tightening”). Now, with new technology advanced flexible wires, there is significantly less discomfort associated with tooth movement. Although there is an adjustment period, just like breaking in a new pair of shoes, braces eventually do become comfortable in a few short weeks. We can leave the “No pain, no gain” attitude for the gym!


2. The tighter the better—A common comment from from my patients is, “Make it tighter, doc. I want to get my braces off faster!” You may think that tighter adjustments and heavier forces will move your teeth faster but this is not the case. While a certain level of force is necessary to move teeth, a force level that is too high may start to damage the bone and surrounding tissues. Orthodontics is a delicate balance of forces. Too much force may cause excessive bone breakdown and actually increase the overall time you need to wear braces.


3. Wires need to be changed every visit— Contemporary super-elastic wires (invented by NASA) that are used today can be bent into all different shapes and still spring back to their original shape and form. If you have crooked teeth, the super-elastic wire can be placed in your braces and provide a steady light force to straighten them without needing to change the wire very often. If a wire is used that puts too much pressure on a tooth, the bracket usually either pops off the tooth or the wire becomes permanently deformed and does not move the teeth at all! That is why in the old days, orthodontic patients got many wires with incrementally higher stiffness, and these wires were changed more frequently and also required a lot of wire bending in order to move teeth.


4. My family dentist says he can straighten my teeth— An orthodontist has 2-3 years of specialized training beyond dental school and is a specialist at straightening teeth and insuring proper form and function. A dentist may see a handful of cases a year amid drilling and filling. An orthodontist only practices orthodontics and treats 60-100 patients a day.


5. Orthodontists are appropriate only for the most challenging and complex orthodontic cases— Orthodontists recognize the difference between a simple case and a complex one. And when a case is challenging, orthodontists know what to do. Would you let your family doctor perform heart surgery? The answer most likely is no, so why would you let anyone but an orthodontist straighten your teeth?


6. Only braces can straighten my teeth—Not necessarily. With new technology, it is now possible to have straight teeth without ever having to wear braces! Invisalign clear aligners are the most popular way to straighten teeth without braces. However, before you get too excited, know that Invisalign does have some limitations and the best advice is to seek an orthodontist that is experienced with Invisalign, as he or she can find ways of making Invisalign work for you even in the more severe cases.


7. Once I get my braces off, my teeth will stay straight forever—Getting your teeth straight and attaining the “Rite Bite” is just half the battle. Keeping your teeth straight after getting your braces off is the rest of the battle. Teeth are connected to the bone by elastic fibers. As the teeth are moved into their new straightened positions, these elastic fibers are stretched. After your braces are removed, these elastic fibers will tend to pull your teeth back towards their original position. That is why orthodontic retainers are required when braces are removed to keep your teeth straight.


8. My wisdom teeth are making my teeth crooked—You may think that wisdom teeth cause crowding. However, there is very little evidence to support the fact that wisdom teeth cause crowding. If this was true, then your teeth would never get crowded after your wisdom teeth were extracted. In fact, people who never developed wisdom teeth or who had their wisdom teeth removed may still see their teeth get crooked over time. Teeth just tend to drift as you age regardless of whether or not you have wisdom teeth.


9. The date that I am supposed to get my braces off is set in stone—When patients are told before treatment that they will be in braces for a certain number of months, it is very easy to become fixated on that date. Usually, an orthodontist can judge from his or her experience what the typical time frame is to finish treatment. However this depends on many factors. Some factors that would slow down treatment include: broken braces, not wearing elastics, not brushing well, and not coming in for regular appointments. If you want to get your braces off on time, make sure you co-operate and do your homework!


10. Braces are for kids—  Today, one in five orthodontic patients is an adult. Orthodontic braces were historically associated with teenagers but an increasing number of adults are choosing to wear braces to straighten their teeth and correct their bad bites as well.  Although treatment often may take longer due to more dense bone, restorations, bone loss, missing teeth etc., braces work in the same way regardless of the age of the patient and adults can experience the same beautiful end results as a teenager. And don’t forget we have so many more esthetic options these days to straighten teeth like Invisalign, Lingual Braces (Inside braces) and clear braces.