You and your braces hunter valley orthodontics by Prue Turon

Hunter Valley Orthodontics 1800 021 064 www.huntervalleyorthodontics.com.au

You and Your Bracesâ&#x20AC;Ś

YOU AND YOUR BRACES Hunter Valley Orthodontics have a highly trained team with over 30 years experience to support and care for you during your journey with braces. We have created this booklet to assist you during your early days with Braces and throughout the course of your treatment. If you have any questions or require any additional information, please donâ&#x20AC;&#x2122;t hesitate to phone us on 1800 021 064.

www.huntervalleyorthodontics.com.au

INDEX 1.

Your Co-operation and Your Role

What to Expect the First Few Days with Braces

Getting to Know Your Braces

Brushing with Braces

Flossing with Braces

Using Neutrafluor 5000 Plus and Monitoring Your Cleaning

Damage Caused by Poor Oral Hygiene

Using Disclosing Tablets

11. Diet and Your Braces 12. Damage to Your Braces and Trouble-Shooting Breakages 15. Mouthguard and Elastic Wear 16. Configuration of Elastics

CONGRATULATIONS! You are the proud owner of Braces!! Like the proud owner of anything new, there are certain guidelines you must follow if they are going to work well and quickly.

YOUR CO-OPERATION…. The most important aspect of your orthodontic treatment is YOU and YOUR CO-OPERATION! Our Orthodontic team will work with you from the beginning to the end of your treatment to ensure that the best possible result is achieved. While you are wearing braces, it is essential that you take care of your teeth and gums. We have issued you a Braces Kit containing products that we recommend to maintain the health of your teeth while wearing braces. All these products are available at most pharmacies and supermarkets, and are also for sale at our surgeries.

YOUR ROLE….  Keep your regular scheduled appointments and be on time. Missing appointments will increase treatment time.  Pay special attention to cleaning your teeth and braces everyday! Brush your teeth after every meal to keep your teeth and appliances clean.  Continue to have regular check-up appointments with your Dentist.  Minimize breakages! Breakages generally mean slower treatment and extra appointments. Ensure you avoid hard, sticky foods that can loosen, break or bend wires and bands when wearing braces. Habits such as nail biting, unnatural tongue thrusting, pencil chewing and nervous picking at your wires can also break your braces.  Cooperate by wearing your Elastics, if you have been instructed to wear them by your Orthodontist. Wear them all day and night (replacing them once a day with a new elastic), seven (7) days a week until your next appointment. 1

WHAT TO EXPECT THE FIRST FEW DAYS WITH YOUR BRACES…. Initially, your mouth will feel “weird” and “uncomfortable” for the following reasons: The braces will feel “big” and “bulky”, which may irritate the inside of your cheeks and lips.  Your teeth will feel the “pressure” from your braces almost immediately, and may become “uncomfortable” or “sore” as they begin to move. You will particularly notice this when you are eating in the first few days.  Your teeth may feel loose and wobbly as they move. The above sensations are normal and to be expected. Most patients find that the discomfort usually reduces after two to three days, and could take up to one to two weeks to adapt. To help you through these first few days as comfortably as possibly, we suggest the following: Use the provided wax on any irritating parts of the braces. Over time your tongue, cheeks and lips will get used to the braces and you will no longer require the use of wax.  Warm salty water mouth rinses as often as you like to help soothe the mouth and help overcome ulcers. Alternatively, you can use Savacol or Cepacaine, however we do not recommend using these products more than three (3) days in a row.  Eat soft foods, and chew slowly and carefully. Your teeth will be sore if you eat firm, chewy foods. Do not eat with your front teeth, and cut all foods into small pieces and chew on your back teeth.  If necessary, use some form of pain relief – as you would use to relieve a headache. Once you get through these first few days / weeks of adjusting to your new braces, you will begin to feel your usual self again. You may find the Adjustment appointments bring similar discomforts, however this usually gets easier as you go through your treatment.

GETTING TO KNOW YOUR BRACESâ&#x20AC;Ś. Have a good look in the mirror at your new braces. They are designed for a specific purpose, and require particular care to avoid breakages, as well as food and plaque being trapped. If you need to identify a concern with your braces, or example a breakage, please refer to the image below so you can accurately describe the problem when you call us.

1. BAND

A metal ring glued around the back teeth as an anchor point.

2. BRACKET

A metal or ceramic attachment glued to the front surface of the tooth.

3. HOOKS

These are used to attach Elastics (if / when they are necessary throughout the treatment).

4. ARCH WIRE

A length of removable wire that fits into the bracket slots around the dental arch.

5. ALASTICS

Coloured or clear rubber rings that tie the wire/s to the tooth via the bracket. 3

BRUSHING WITH BRACESâ&#x20AC;Ś.

Brushing with an Interproximal Brush (Christmas Tree Brush)

An Interproximal Brush (Christmas Tree Brush) should be used to clean between your Braces and under the Archwires. This should be done after every meal (including snacks), and every time you brush your teeth.

Brushing your Gums

Using a Fluoride Toothpaste and a small Soft Toothbrush, gently brush along the Gumline where the gums meet the teeth, using a small circular motion on each tooth (above the braces in the Upper Arch and below the braces in the Lower Arch). Gently work your way around the mouth from one side to the other. Healthy gums do not bleed. If you notice any bleeding, concentrate on cleaning and flossing that area more thoroughly.

BRUSHING WITH BRACESâ&#x20AC;Ś.

Keeping your Braces Clean

Press your toothbrush firmly enough that the bristles spread into the gaps between the wire and teeth, brushing in a circular motion for ten seconds on each tooth. Brush in a set pattern so that you donâ&#x20AC;&#x2122;t miss any teeth. Tilt the toothbrush bristles upwards and then downwards, so you can brush the area under the wire and between the braces. Brush in and around all the brackets and wires, ensuring that you brush under the wires.

Keeping all Surfaces of your Teeth Clean

Brush the chewing surfaces of your teeth with a firm back and forth motion. Brush both the inside and outside surfaces of your teeth using a gentle circular motion on each tooth.

FLOSSING WITH BRACES…. Many people think you can’t floss if you have braces – THIS IS NOT THE CASE! Daily flossing is especially important during your Orthodontic treatment, because you’re more likely to have food particles trapped in between your teeth, braces, bands and wires, which could increase your risk of gum disease and decay. Plaque is the major cause of gum disease and decay and it must be removed daily. Flossing with braces can be time consuming; however it will get easier with practice.

Flossing with Braces IS POSSIBLE!

 Use a piece of Waxed Floss or Tape, about 45cm long.  Thread the Floss under the archwire (Floss Threaders are provided / available to help with this).  Gently slide the Floss up into the gum line, moving it up and down against the side of each tooth.  Remove the Floss and move onto the next pair of teeth, repeating the above instructions until each side of every tooth has been flossed. Parents and Guardians should play an active role in ensuring their children are undertaking the proper dental care whilst in braces.

USING NEUTRAFLUOR 5000 PLUSâ&#x20AC;Ś. Fluoride protection against tooth decay is needed throughout life. Using fluoride toothpaste twice a day is one of the most proven ways to stay decay free. Fluoride makes teeth more resistant to the acids produced after eating or drinking and puts back minerals that are lost in the early stages of tooth decay. Because your risk of tooth decay may be higher while you are wearing braces, we recommend the use of NeutraFluor 5000 Plus to give you additional protection.

Brushing your teeth with NeutraFluor 5000 Plus

When brushing your teeth at night, use the NeutraFluor 5000 Plus toothpaste that we have provided, instead of your normal toothpaste. You only require a small pea size amount of NeutraFluor on your toothbrush, then brush your teeth as per the normal brushing instructions (brushing your gums, braces, up and under the arch wires, as well as all inside, outside and chewing surfaces). Be sure not to miss brushing any teeth!

WE WILL MONITOR YOUR CLEANING AT EVERY APPOINTMENTâ&#x20AC;Ś. Each time you visit us for an appointment, our Hygienists will evaluate your brushing and flossing, to ensure you are maintaining the best oral hygiene for healthy teeth and gums. Your cleaning will be scored as follows: 1 = Poor

2 = Fair

3 = Average

4 = Good

5 = Excellent

Our Hygienists will let the patient and parents/guardians who are in attendance aware if improvement is required. If no improvement is made by the next visit, a formal letter will be issued to the patient, and parent/guardian.

DAMAGE CAUSED BY POOR ORAL HYGIENE…. Permanent damage to tooth enamel can occur if the teeth and braces are not being brushed and flossed properly, and you are snacking on surgary foods and drinks too frequently. Areas on the enamel surface may begin to lose minerals (the early stage of tooth decay), leaving white spots on the teeth. You may also develop inflamed, bleeding gums (gingivitis).

1. ENAMEL DECALCIFICATION - permanent white marks on teeth. 2. SWOLLEN, PUFFY AND BLEEDING GUMS 3. TOOTH DECAY – permanent brown marks on teeth. 8

DAMAGE CAUSED BY POOR ORAL HYGIENE…. Decay is caused by plaque, which is a colourless, sticky film of bacteria found on teeth and gums. Plaque cannot be removed just by rinsing with water – it can only be removed by brushing and flossing twice a day. Gum disease is also caused by plaque, which builds up on the gum line of teeth, and causes gums to become inflamed. Brushing your teeth twice a day Using toothpaste containing fluoride every day Flossing your teeth and gums every evening Using the NeutraFluor 5000 Plus every evening Drinking water containing fluoride every day Avoiding sugary foods and drinks, as well as starchy foods (such as potato crisps)  Regular visits to your Dentist Will all help reduce decay and gum disease!      

Continued poor oral hygiene is going to lead to irreversible damage to the teeth that bleaching / whitening and polishing cannot remove. It will also lead to infection of the gum and surrounding tissues (gingivitis / periodontitis), and will extend your time in braces.

USING DISCLOSING TABLETS…. The disclosing tablet is a solution of pink dye which stains food and plaque that remain on your teeth. (It usually shows up habits of particular patterns of your brushing, where you could be missing the same teeth in a spot where you change the angle of your toothbrush, or change hands for example.)

USING DISCLOSING TABLETS….

The pink stains highlight remaining Food and Plaque on the Teeth and Braces

Use 1 disclosing tablet, once a week in the evening after flossing and brushing, to see what areas you have missed.  Chew one tablet and swish saliva around your mouth for 30 seconds.  Spit and rinse gently with water.  Examine your teeth in good light – the pink stains around your braces show where food and plaque remain from not brushing and flossing thoroughly.  Now brush and floss again, paying particular attention to the areas that were highlighted pink. You are given 4 Disclosing Tablets to use over 4 weeks. By the fourth week, immaculate brushing and flossing should be achieved and you should no longer require anymore disclosing tablets. Please note – the Disclosing solution is a vegetable dye, therefore it is safe for adults and children.

DIET AND YOUR BRACES…. A good diet is important whilst you have your braces on, as teeth move more quickly when you are healthy, keeping your teeth and braces clean, and minimize breakages. The first few days after having your braces fitted and after adjustments, your teeth may be tender. We recommend you eat softer foods during these ‘tender’ times, and have a look at the “Soft Recipes for Tender Mouths” book on our Website: www.huntervalleyorthodontics.com.au under ‘Patient Care’. There are foods that can loosen, break or bend wires and bands when you are wearing braces. To minimize breakages, we recommend you avoid the following: 

Hard or Crunchy foods – Nuts, Muesli Bars, Hard Biscuits, Pork Crackling, Pizza Crust, Ice, Hard Lollies etc.



Sticky or Chewy foods – Minties, Redskins (all Soft and Chewy Lollies), Chewing Gum, Mars Bars, Caramels and Toffees, Tough Meat or Meat off the bone etc.



Biting into Hard foods – Cut foods such as Apples and Raw Vegetables into small pieces and chew them with your back teeth. Cut Corn-on-the Cob off the Cob before you eat etc.



Bad Habits – Chewing on Pens and Pencils, Biting Fingernails, Chewing Bottle Tops or other Hard Objects, Unnatural Tongue Thrusting, Nervously Picking at your Wires or Braces etc.

Consume minimal amounts of sugars and foods containing added sugar (such as sauces, ice-cream, cakes etc) and acids (such as vinegar, salad dressings, lemons etc). Stop intake of Soft Drinks, Cordials, Sports Drinks and Fruit Juices – these should now only be consumed on special occasions such as Birthdays, Easter, Christmas etc. Consuming large amounts of sugary and acidic foods and drinks can erode enamel from the teeth; eating the foods that we recommend you avoid cause more breakages and will overall extend your treatment time in braces.

DAMAGE TO YOUR BRACES…. In almost all cases, damage to your braces is caused by eating hard or sticky foods, or from chewing on pens or other hard objects. Breakages generally slow down your treatment, which means longer time in braces. Breakages causing pain or occurring more than two (2) weeks from your next appointment are important and will require an extra appointment for a repair. Repair appointments are available between 9.30am and 3.30pm where it least impacts the daily schedule of patients. Most breakages are not “life threatening” so firstly check if it is hurting or uncomfortable, and when your next appointment is, to try and avoid yourself the extra appointment. Please understand that additional fees may be incurred if willful repeated breakages occur during your treatment.

Trouble-Shooting Breakages… Loose Bracket – If the Bracket is still attached to the wire, leave it in place. If it’s uncomfortable, cover the loose Bracket with wax. If the Bracket comes out completely, please keep the Bracket and bring it with you to the next appointment. Check when your next scheduled appointment is. If it is more than 2 weeks away, phone for a repair appointment. Do not connect Elastics to a loose Bracket! Loose Band – Please phone for a repair appointment. If the Band is still attached to the tooth, leave it in place. If the Band comes off completely, please keep it and bring it with you to the repair appointment (do not try to put it back on). Do not connect Elastics to a loose Band!

Lost Alastic – If an Alastic has come off, you may be able to put it back on with tweezers. Either way, it is not an emergency, and you can wait until your next scheduled appointment. If it’s uncomfortable, cover this bracket with wax.

DAMAGE TO YOUR BRACES…. Trouble-Shooting Breakages… Loose / Broken Power Chain – If the Power Chain has come loose or is broken, it is not considered an emergency. If your next adjustment appointment is within 2 weeks we can repair it then. If your next appointment is more than 2 weeks away, or the Power Chain is rubbing and causing discomfort, phone us for an appointment.

Arch Wire out of Tube – You may try to re-insert the wire back into the tube of the band with tweezers. If unsuccessful, place wax over the area and check when your next scheduled appointment is. If it is more than 2 weeks away, phone for a repair appointment.

Protruding Arch Wire – If the main arch wire is long and poking you, cover the area with wax and phone us for a repair appointment.

Broken Arch Wire – Please phone for a repair appointment. If the wire hurts your cheek, tongue or gum, place wax over the broken wire edges.

Poking Ligature Wire – This is not considered an emergency. Try tucking the ligature wire away from the gum using the back of a spoon, pencil eraser, or tweezers. If unsuccessful, cover the ligature wire with wax and check when your next appointment is. If it is more than 2 weeks away, phone for a repair appointment.

DAMAGE TO YOUR BRACES…. Trouble-Shooting Breakages… Loose or Broken Appliance – If your Appliance is broken, bent, or no longer fitting, phone us for a repair appointment. If it is possible, continue wearing the appliance until we see you. (Ensure you bring all pieces with you to the repair appointment if it is broken). Lost Removable Appliance – If you have lost your removable appliance, phone us for an appointment. There may be a fee for a replacement; however the Orthodontist will discuss this with you at the appointment. Unable to turn RPE – Phone us for an appointment with the Hygienist. Loose or Broken Coil Spring – Phone our Receptionist to see if an additional repair appointment is required. Rotating Spring Rubbing - Place wax over the spring and check when your next scheduled appointment is. If it is more than 2 weeks away, phone for a repair appointment. Gold Chain from Exposure is Off – Phone your General Dentist or the Specialist who originally bonded the Gold Chain, for a repair appointment. If the gold chain is dangling too low that it’s uncomfortable, phone our Receptionist and enquire if an appointment is necessary. Sporting Injury or Knock / Punch to the Mouth – During business hours, contact your General Dentist for an emergency appointment to check the mobility and vitality of the tooth / teeth damaged. Outside of business hours, go to the Emergency department of the closest Hospital. If a Bracket is loose and / or the Arch Wire is broken, phone us for a repair appointment once the tenderness and swelling has ceased.  We highly recommend you wear a Mouthguard if you are playing contact sports! Teeth Feel Loose and Wobbly – This is completely normal, as your teeth are moving. They become mobile in order to be moved into their new, desired positions. They will stabilize and no longer feel loose once the teeth are aligned and in their final positions.

YOU AND YOUR MOUTHGUARD…. If you are playing contact sports or any other activity where your teeth are at risk of trauma, we strongly recommend you wear a Mouthguard. Mouthguards will prevent injuries to your teeth, mouth, cheeks, tongue and jaw. Dental injuries that can occur without the use of a Mouthguard include chipped or broken teeth, lip and cheek injuries, root damage (of the teeth), fractured jaws and concussions (and damage to your braces). We will issue your first Mouthguard free of charge, then any replacement Mouthguards can be purchased from any of our surgeries for a small fee, or can be purchased from your local Pharmacy. The mouthguard we provide can be re-moulded, as your teeth will be continually moving with braces on. We recommend you check how your mouthguard is fitting before each use, to determine if you need to remould it prior. It is as simple as placing the guard in hot water to soften for 10 seconds, inserting it immediately in position, biting firmly but gently for an even bite. Mould the guard around the side of the teeth with your fingers for a tight fit. Remove guard and place in cold water to cool.

ELASTIC WEAR…. Elastics are small clear Rubber Bands that your Orthodontist may ask you to wear at some stage throughout your treatment, to assist in the movement of the teeth. There are a number of different sizes of Elastics, which are identified by a different picture of an Animal on the packet (Owl, Fox, Rabbit, Parrot, Quail, Kangaroo and Eagle). If you have been instructed to wear Elastics by your Orthodontist, you must wear them as directed only. Improper wear of Elastics can incorrectly change your treatment and cause damage. When wearing Elastics, you must wear them all day and all night for seven (7) days per week. Part-time wear only wobbles the teeth back and forth, making them sore, and achieves nothing. Re-new each Elastic every day, and replace any that happen break (therefore it is important to always carry spares with you). Remove your Elastics to eat and brush your teeth; however put them back on straight away once you’re done.

CONFIGURATION OF ELASTICS…. Depending on how your Orthodontist wants your teeth to move, they will instruct you to wear your Elastics to certain teeth to help accomplish that movement. Common configurations include:Class II (2) Elastics – Wear Elastic from the hook on the Lower Molar Band to the hook on the Upper Eye Tooth. You could be instructed by your Orthodontist to wear on either the Left hand side, or Right hand side, or both.

Class III (3) Elastics – Wear Elastic from the hook on the Upper Molar Band to the hook on the Lower Eye Tooth. You could be instructed by your Orthodontist to wear on either the Left hand side, or Right hand side, or both.

Upper Intra Elastics – Wear Elastic the hook on the Upper Molar Band to the hook on the Upper Eye Tooth. You could be instructed by your Orthodontist to wear on either the Left hand side, or Right hand side, or both.

Lower Intra Elastics – Wear Elastic from the hook on the Lower Molar Band to the hook on the Lower Eye Tooth. You could be instructed by your Orthodontist to wear on either the Left hand side, or Right hand side, or both.

Triangle Elastics – Wear Elastic from the hook on the Upper Eye Tooth to the hook on the Lower Eye Tooth, then to the Premolar Tooth behind, and back up to the Upper Eye Tooth. You could be instructed by your Orthodontist to wear on either the Left hand side, or Right hand side, or both.

CONFIGURATION OF ELASTICS…. Box Elastics – Wear Elastic from all hooks on the four (4) Eye Teeth.

3-3 Elastic – Wear Elastic from the hook on the Left Eye Tooth to the hook on the Right Eye Tooth. You could be instructed by your Orthodontist to wear on either the Upper Arch or Lower Arch.

Up Down Elastics – Wear Elastic from the hook on the Upper Eye Tooth to the hook on the Lower Eye Tooth. You could be instructed by your Orthodontist to wear on either the Left hand side, or Right hand side, or both.

Anterior Cross Elastics – Wear Elastic from the hook on the Upper Eye Tooth to the hook on the opposite Lower Eye Tooth. You could be instructed by your Orthodontist to wear from either the Upper Left hand side, or Upper Right hand side, to the opposite Lower Eye Tooth. Remember, Elastics must be worn at all times if you have been instructed by your Orthodontist to wear them. Failure to wear your Elastics will result in longer treatment time (and your Orthodontist will know if you have not been wearing them). If you run out of your Elastics or lose them, please phone us and request more (telling us the Animal on the front of the packet), and we will post them out to you.

Hunter Valley Orthodontics 1800 021 064 WARNERS BAY 1st Floor, 464 The Esplanade 2282

NEWCASTLE 1st Floor, 139 Scott Street 2300

SALAMANDER BAY Shop 5, 5 Town Centre Circuit 2317

SINGLETON 254 John Street 2330

MAITLAND 1st Floor, 52 Ken Tubman Drive 2320