For answers to insurance questions, CLICK HERE.

Occasionally accidents happen and something will come loose or will be damaged during treatment. For children and teenagers, make sure you immediately tell your parents if something ever comes loose or breaks. Contact us so that we may advise you on when to visit the office for a repair. When a patient arrives for an adjustment and surprises us with loose or broken appliances, we may not have time in our schedule to both repair and adjust the braces. Letting us know in advance is the best way to keep treatment moving forward on time.

For answers to insurance questions, CLICK HERE.

For answers to insurance questions, CLICK HERE.

For answers to insurance questions, CLICK HERE.

During orthodontic treatment most patients will experience some discomfort. Some people are more sensitive than others. Discomfort can be caused by several different things. You can apply the knowledge below to help make your orthodontic journey as comfortable as possible: Discomfort of the lips, cheeks and sometimes the tongue, is to be expected at the beginning of orthodontic treatment. After the braces are on, your lips and cheeks no longer rest against the smooth surface of your teeth. Usually, it takes about a month for your lips and cheeks to toughen up and get used to braces or appliances. Until then you may be a little sore. Occasionally a small sore spot or even an ulcer may form on your gums or cheek. If this happens, apply some orthodontic numbing medicine on the sore spot. You may also place a small amount of orthodontic wax over the braces in the area that is bothering you. Warm salt water swishes may also help soothe the sore area and help it heal more quickly. Occasionally a wire might poke the lips, gums or cheeks. Applying some orthodontic wax is a good solution. You may also apply some orthodontic numbing medicine on the sore spot. Sometimes you will be able to slide the wire back around into the proper position yourself but be gentle. Only use the orthodontic wax if you really need it. If you use the wax early and often the wax will become a crutch, and your teeth will move more slowly with wax gunked around them. As the teeth begin to move, patients will feel some soreness around the teeth, especially the front teeth if they are crowded. This soreness will likely start about 12 to 24 hours after braces are adjusted or after you start wearing a new set of clear aligners. Soreness will likely last anywhere from 1 to 5 days. Over the counter pain medications may help alleviate discomfort, however we recommend using them sparingly. The following medications, provided the patient is not allergic and there are not contraindications in the patient’s medical history, work very well to minimize soreness: Generic Ibuprofen (which is equivalent to Advil or Motrin) may be taken 2 to 3 times daily. Generic Naproxen (which is equivalent to Aleve) may be taken up to 2 to 3 times daily. Acetaminophen (Tylenol) may also be used, but it is not quite as effective as the Ibuprofen or Naproxen. Dr. McNutt can answer questions you may have about the proper dosage and when to take the medicine throughout the day. Taking over the counter pain medicine when you first get your braces on at the very beginning of treatment is helpful for many people to get used to the discomfort. We recommend taking medicine for the first 4 to 5 days, starting with the day you get your braces or appliances on. Remember, you may not be sore right after getting your braces on, but you probably will be by the next day. Follow this helpful advice and you will be much more comfortable. Chewing sugarless gum prior to a meal may be helpful. Teeth may be sore while you chew your food. You may notice the soreness most when you are eating a meal, and the front teeth may be especially sensitive. Here is a helpful tip. Chew a piece of sugar-free gum for about 30 minutes prior to sitting down to eat. You should use the teeth that are the most sore to chew the gum. This will help work out some of the soreness and you will be more comfortable when you eat. Note that frequent or extended periods of gum chewing are not advised, as this will put orthodontic appliances through a lot of wear and tear.

Save anything that ever comes off and bring it to your next visit! If a part of your braces slides off the wire into your mouth, carefully retrieve it and save it in a plastic bag. The braces are very expensive to replace. Bring it with you to your next orthodontic appointment so that we can reapply it to your tooth.

Occasionally a wire might poke the lips, gums or cheeks. Applying some orthodontic wax is a good solution. You may also apply some orthodontic numbing medicine on the sore spot. Sometimes you will be able to slide the wire back around into the proper position yourself but be gentle. Contact us by phone to schedule a repair.

Orthodontists are doctors and specialists that diagnose, prevent, intercept and treat problems with the alignment of teeth, the alignment of the bite, and problems with the growth and structure of the jaws. In addition to focusing on the health and function of the teeth and jaws, orthodontists are experts in how to engineer and create the best esthetic appearance of the human smile.

An orthodontist is a dentist that has graduated from an additional accredited 2-3 year residency program. An orthodontist limits the scope of their work to only things related to orthodontic treatment. A general family dentist provides dental care across the entire scope of patient needs, such as fillings, crowns, implants, dentures, complete dental health exams, extraction of teeth, periodontal disease, and over-seeing dental cleanings by a dental hygienist. For more information on the difference between a dentist and an orthodontist, CLICK HERE.

Legally a dentist is entitled to offer orthodontic treatment. In dental school, dentists are briefly introduced to the concept of orthodontic tooth movement. Most dental students in the US graduate without ever treating an orthodontic patient. Afterward, a general family dentist is able to offer Invisalign treatment to their patients after completing an 8-hour certification course. Orthodontics is an incredibly difficult specialty that requires decades of dedication and experience in order to truly master. As any good orthodontist will tell you, it takes at least five years of exclusively treating orthodontic patients in private practice before you truly begin to see the whole picture. This is an additional five years after their 2-3 year residency program. Only you can decide what is best for your dental health and orthodontic treatment options. We believe that orthodontists are the best option for most orthodontic problems and treatment needs. Most general family dentists know when they are outside their own comfort zone with offering a patient orthodontic treatment and will refer the patient to an orthodontist. Just as a general family dentist will extract teeth, but knows when to send the patient to an oral surgeon for treatment.

Becoming an orthodontist generally requires 10-11 years of college. That means a four-year undergraduate degree, followed by a four-year dental degree, passing a licensing exam, and then completing a 2-3 year residency in orthodontics. So, you are required to become a dentist first. For every 100 dentists that graduate in the United States, less than six go on to become orthodontists.

The answer is absolutely yes, every six months! We cannot emphasize this enough. Our practice is limited to orthodontics, so we must work hand in hand with your general dentist to maintain the optimum health of your teeth and gums. We encourage you to maintain regular 6-month check-ups, and cleanings with your dentist. Adults who have a history of periodontal (gum) disease may also need to see a periodontist (gum specialist) on a regular basis throughout orthodontic treatment.

We have lots of information about this, CLICK HERE to read our recommendations.

You may send an SMS text message to the orthodontic team at 919-553-4512. Please describe the problem as clearly as possible, for example, tell us if the problem is on the top or the bottom, the left or the right, and the front or the back. If we think a photograph will help, we will provide a number or an email address to send the photograph. Please make sure that the photograph is well illuminated, in focus and is not so close up that we cannot see the perspective. IMPORTANT: We cannot receive photographs at the phone number above.

No, this is not an emergency and we do not offer after hours or weekend appointments to repair braces. Contact us as soon as you know there is a problem, and we will work to find the earliest available repair appointment that works for your schedule. If braces are not repaired in a timely manner (for example waiting weeks or a month), teeth may begin to move, and treatment time could be extended a bit to re-align the teeth that have moved.

Only in exceptionally rare circumstances, usually involving significant trauma. In a true medical / dental emergency dial 911 or seek immediate medical care. In the history of our practice, there have only been about 4-5 true emergencies of this kind and they were all related to trauma. An orthodontist is on call for true orthodontic emergencies that do not require immediate medical assistance (follow the prompts after calling our office). This service is for our patients only. Emergency calls made after 8:30 PM may not be returned until after 7:00 AM the next day. When a wire or a part of the braces are causing discomfort to the lip or cheek, contact us as soon as you know there is a problem. If you contact us after hours, we will contact you as soon as we are able during regular business hours. We will work to find the earliest available comfort repair, appointment that works for your schedule. We typically do not schedule comfort repairs after hours or on weekends.

If you still have additional aligners to wear (for example you were given aligners #1-12 to complete prior to your next appointment and you misplace #5), attempt to wear the next aligner in the sequence. If it fits well, continue on with the sequence, however, we ask that you increase the number of days wearing the next aligner by adding on the days / hours you have left with the aligner that was misplaced. If the next aligner is too tight or will not properly fit, go back to wearing the previous aligner in the sequence. In this case, you would contact us as soon as you are able so that we can arrange for a replacement aligner.

We recommend that you always keep the last two completed aligners in the sequence, store them in the bag they came in. That way if you misplace an aligner you will have options.

Continue wearing your aligners as prescribed. Contact us as soon as you know there is a problem, and we will work to find the earliest available repair appointment that works for your schedule. If an attachment is not repaired in a timely manner (for example waiting weeks or a month), teeth may not move properly, and things could go off course.

This varies depending on the type of treatment and the stage of treatment you are in. Patients who are in active treatment with braces or clear aligners are usually seen about every 5-8. Patients who we are checking on once in a while may only visit us every 4-12 months.

We schedule as many regular adjustment appointments during the early morning (typically starting at 8 AM) and after school hours as we can. Our latest afternoon appointments typically start at 4:30 PM and we are finished for the day at 5 PM. Longer specialized appointments are generally scheduled during in the mid to late morning and early afternoon (examples would be starting braces and getting braces removed).

Yes, you may. Patients are assigned a “home” office for treatment, either Clayton or Cary. Patients can be seen in either office on an occasional as needed basis when we coordinate in advance.

Yes, we do have scheduling restrictions in order to allow the doctor and our team to provide the highest quality treatment to our patients. We are often asked to schedule putting braces on -or- removing them in the late afternoon, or to have a lost retainer re-made in the late afternoon. Like the vast majority of orthodontists, Dr. McNutt is, in general, not able to accommodate these requests. Longer appointments that are very technical are generally scheduled in the mid-morning and early afternoon. This allows patients who are in active treatment to be seen for their regular visits early in the morning and in the late afternoon. This is for the good of everyone. Please note, we cannot accommodate patients who require only after school appointments.

Adults who have healthy teeth and supporting gum tissues are never too old for orthodontic treatment. Increasing numbers of adults are taking advantage of the lifelong benefits of orthodontics. We routinely treat patients aged 30-70 and occasionally treat people in their 80s.

Retainers are used to maintain the teeth in their new positions after treatment is completed. By definition, retainers do not move teeth, they are passive and keep your teeth in their current positions when worn as prescribed. Orthodontists recommend a lifelong commitment to retainers in order to best preserve the results, otherwise teeth tend to naturally drift out of alignment.

We have a plan we help you follow during the first year after treatment has ended. For the first six months following the completion of treatment we recommend that most patients wear retainers for about 16 hours each day. Then we recommend you start nighttime wear. Some patients will only wear the retainers at night, for example, those who have a lower who have permanent bonded wire retainer.

It is very important because tooth movement is made possible because the bone and fibers that hold teeth in place become very disorganized and hold the teeth loosely for months after treatment has ended. Normally the bone and fibers are very solid and well organized. Becoming re-organized to stabilize the positions of your teeth naturally just takes time. Occasionally a teen patient will choose to only wear their retainers at night right after treatment is completed. This risks the teeth moving and some of the treatment result could be lost.

The answer is no. Nature is persistent and there are occasions that teeth will move very slightly even with excellent retainer wear. This is rare; however, no person's teeth will maintain 100% of the exact alignment after treatment. However, it is often the case that the bite will settle in even better naturally after treatment is completed with faithful retainer wear.

For more detailed information on this, CLICK HERE. Certain types of orthodontic problems are more effectively eliminated at an early age, while other types of problems are best treated after all of the baby teeth are lost. All patients present different problems, so it’s always best to have an early evaluation to assess the proper time to start treatment of the patient’s unique condition. The goal of early intervention is to guide the growing jaws and erupting teeth into more favorable positions; therefore, reducing the magnitude of the problem, or in some cases, eliminating the need for complex treatment in the teen years. Thus, if the orthodontic problem stems from underlying skeletal imbalances, or if the permanent teeth that have erupted so far are in poor relationships, early treatment may be suggested. In actuality, the majority of orthodontic problems are best treated in the pre-teen to early teen years.

Patients should brush their teeth after each meal and snack (at least three times daily). During orthodontic treatment it is very important to maintain excellent oral hygiene in order to keep the teeth and gums healthy.

Absolutely. For children going to school and adults at work, it is very important to brush after lunch. Brushing twice a day is not enough. Allowing food to sit around your braces after lunch and then waiting until after dinnertime to brush will be very unhealthy for your teeth. The school systems have made it increasingly difficult for children to brush their teeth at school. We recommend in this case that swishing vigorously with water after lunch and brushing as soon as possible after school.

When you brush your teeth, we recommend a TWO STEP brushing technique as follows: Step 1) Brush and clean your braces and orthodontic appliances. Use your toothbrush without any toothpaste. Toothpaste foams up and can make it difficult to see plaque left on the braces. Focus on removing plaque, food and build up from around your braces. Pay special attention to removing plaque that is trapped between your braces and the gum line. Step 2) Brush normally with toothpaste, taking care to brush all surfaces of the teeth. Spend at least 2-3 minutes brushing.

Yes, you need to floss! This is the most commonly skipped part of the home care routine and this only leads to trouble. People often say things like, it is too difficult, or I do not have time. We are convinced that our patients are smart enough and talented enough to learn how to floss during treatment!

The answer to both questions, is yes, that is true. Treatment time is also often extended because we often accomplish less during your regular adjustment appointment because we may need to use some of your appointment time to clean your braces and discuss how to improve brushing and flossing, instead of adjusting the braces. If this happens often enough, we will undoubtedly see treatment progress at a slower pace. Also, healthy gums allow teeth to move more predictably and more quickly. Patients who do not floss will almost always be in treatment longer because biologically, the teeth will move more slowly. Unhealthy inflammation, plaque and tarter build up will obstruct tooth movement.

Flossing with braces requires a special technique that takes repetition to learn and master. It may be a slow process at first but stick with it and you will soon learn how to floss faster and well! Here is the technique using what is called a floss threader: 1) A floss threader is used to place the floss under the wires between your teeth so that you can floss. 2) Pull out a long piece of dental floss and feed it through the threader, folding the floss in half. Slide the tip of the floss threader under the wire between the teeth. 3) Grasp the end of the threader with your fingers after it has passed under the wire. Pull the dental floss through the contact between your teeth and floss out the food between your teeth. Then pull the floss out from under the wire. When you are flossing, avoid tugging too hard or pulling on the wires. This can lead to damaging your braces or cause braces to come off your teeth. Repeat this process until the teeth are flossed. Note: Floss threaders are not single use and each one can be used repeatedly until it frays or splits. In rare cases, teeth can be so crowded that you are unable to floss between a couple of teeth. That is OK. As the teeth straighten out you will be able to floss between them. The best time of day to floss is in the evening after dinnertime. Realistically you may not have time to floss your entire mouth each day, so our compromise is that our patients will alternate flossing the top and bottom teeth on a daily basis. Stick with it even if you find flossing to be difficult in the beginning. Flossing becomes easier and easier over time.

A Water Pik is a great way to help keep the braces clean, however, it does not remove plaque and bacteria effectively between the teeth. There is no substitution for good old-fashioned flossing.

Yes! What is called a “proxy brush” is also useful to clear away food that may become stuck between your teeth or under your braces. Gently place the brush under the wire and clean away food debris. We provide one of these for patients when they start treatment.

From time to time the doctor may also recommend a daily fluoride mouth wash or a daily antibacterial mouth wash. As long as you are doing well with your daily routine, this should not be necessary. When we see consistent problems, we will usually recommend these types of mouth rinses.

From time to time the doctor may also recommend prescription toothpaste. As long as you are doing well with your daily routine, this should not be necessary. When we see consistent problems, we will usually recommend these types of mouth rinses. We generally recommend a XYLITOL tooth paste with fluoride in these cases. For more information on xylitol toothpaste CLICK HERE

We will typically plan to update a parent when we have a second appointment with hygiene problems and after the third appointment with hygiene problems, we then recommend other steps be taken, such as those noted above. If a patient is not brushing well or not flossing well, we will review the trouble spots and give them advice on how to improve.

There are consequences for patients who choose not to follow the rules of brushing and flossing. When plaque is left on the teeth, especially around braces, bacterial growth will set in. Colonies of bacteria will eat the plaque and the bacteria produce waste material which is very acidic. This will slowly de-mineralize and weaken your teeth, leading to permanent chalky white spots or cavities that will need to be fixed by your family dentist. The sugary foods you have in your diet, the worse this may become. Also, your gums may become infected with bacteria, resulting in a gum disease called gingivitis. Remember, a healthy mouth is a happy mouth!

Your diet directly affects the health of the supporting gum and bone tissues around your teeth. The healthier your body is, the better your teeth will move.

How you eat is just as important as what you eat. In general, try not to bite into any food with your front teeth. Cut up your food into smile bite size pieces or tear all food into small pieces. Take care to chew your food slowly and carefully with your back teeth. We want your braces to remain in good working order during treatment. The braces on your front teeth are bonded to the surface of your teeth. These braces may shear off when biting into hard food.

Unfortunately, a lot of what we normally think of as “healthy food” is very hard on braces. Since it is very important to maintain a healthy diet, fresh fruits and vegetables that are hard and crunchy should be either cut into small bite-sized pieces or cooked until tender. Corn on the cob is a favorite for many people and should be cut off the cob.

When eating meat, always cut it off the bone.

Any food that really sticks to the teeth or that may get stuck around your braces or appliances should be avoided in general. These types of foods usually have high sugar content as well. Sugary foods that become lodged between the teeth and the braces will increase the risk of cavity formation (tooth decay).

Yes. Most patients also have braces bonded on the back teeth. Some patients have bands on the back teeth and these bands go all the way around each tooth. These bands are more resistant to breaking than the braces on the front teeth. However, sticky foods may pull at the bands and eventually break the cement seal. Once the cement seal is broken, plaque begins to leak in and may cause tooth decay. Sticky or chewy foods can also damage the braces and the wires.

We cannot possibly list every type of food that may be problematic with braces. Take a moment to look over some examples of food to avoid. You might call this the ‘common sense’ list. If you want to eat something that is similar to the foods on this list, common sense will say, you probably should avoid eating it: Hard candy, sugary bubble gum, Starburst, Sugar Daddies, Laffy Taffy, Tootsie Rolls, Gummy Bears, Caramels, Jolly Ranchers, corn chips, tortilla chips, popcorn, jerky, ice cubes, hard nuts, hard pizza crust, and corn on the cob (cut it off).

Absolutely yes! There are several types of drinks you should avoid altogether during orthodontic treatment. Avoid all carbonated drinks! This means sodas of any kind…even diet soda…diet soda is even more acidic than regular soda and damages tooth enamel. Sugary drinks should also be avoided as they will lead to decalcification marks and possibly tooth decay. Examples Are: • Most sports drinks (they typically have sugar and are less healthy than the commercials would have you believe). • Energy drinks, which are typically very high in sugar and have unhealthy levels of caffeine as well. Dr. McNutt strongly recommends against consumption of these drinks in general for anyone. • Sweet tea…even this sacred Southern treat is not recommended. • Sugary fruit juices, drink boxes and orange juice.

Patient participation is absolutely key to great results! Successful orthodontic treatment is a “two-way street” requiring consistent, cooperative effort by both the orthodontic team and the patient. The most common way we ask patients to help is by wearing elastic rubber bands to help guide the teeth into a healthy bite position.

Keeping braces, teeth and gums clean. Keep braces in good working order and intact. Keep appointments as scheduled and arrive on time. Wearing elastic rubber bands consistently.

Braces are bonded to your tooth enamel with the same type of composite material that is used for tooth-colored fillings (restorations). The material and the bonding agent is very strong. The only way for a brace to come off a tooth is if pressure or force is applied to the brace that is greater than the composite bonding is able to withstand. Patients who avoid eating the foods we have discussed may still cause something to come loose. This is almost always because the patient is not cutting food up into small pieces and chewing slowly and carefully. In an average week a patient will go through several thousand chewing cycles. Being a little too rough will eventually lead to the straw that breaks the camel’s back…and something will come loose. It is also possible that a patient is grinding their teeth while sleeping and inadvertently caused a problem.

Unless we have prescribed what are called ‘chewies’ for patients with clear aligners, the answer is yes! Patients should also avoid chewing on things like pencils, pens, and fingernails…as this may damage your braces or aligners.

Patients and parents often ask about sports mouth guards. Patients who participate in sports during orthodontic treatment should wear a protective sports mouth guard. Please do not use a custom ‘boil and bite’ mouth guard, as it may get locked in around the braces. We can advise you on which store-bought sports mouth guards work best and we also make orthodontic sports mouth guards in our office upon request.