Orthodontic Treatment Philosophy
The Orthodontic Team
Is Led By Orthodontist Dr. Matthew McNutt.
“As a father, I treat children in my practice as if they were my own. There is more to life than just teeth, and I relish the opportunity to be a mentor and a positive influence. As an orthodontist, I strive for the best possible results while trying to be efficient. Orthodontic treatment should be both cost and time effective. Life is busy enough, and we respect the value of time for each individual family in our practice.”
Dr. Matthew McNutt
The orthodontic team has a passion for art, science, and serving people. Our treatment philosophy is centered on functional oral health as a first priority and emphasizes the following:
Thoroughness in our examination of every patient
Every smile deserves an individualized treatment plan based on each unique patient
Taking the time to educate our patients before, during & after treatment
Going above and beyond the norm to communicate with your family dentist
Technology-based treatment options should be proven reliable and effective before being used
on our patients because newer is often not better
Treatment should be evidence based on the best scientific research and clinical outcomes
Patients deserve to know when a type of treatment is controversial and where we stand
Always remember that sometimes the best treatment is the least amount of treatment or no
treatment at all
If the family dentist has already identified significant issues at a younger age, an earlier
evaluation is recommended
That we are never done learning and continually pursue ways to improve for our patients
We recommend every child be evaluated by an orthodontist between ages 8-9; please read our detailed advice below
A common question we are asked is:
“What is the right age for patients to have braces or to be seen for an initial evaluation?”
Parents will also state that kids get braces much younger than when they were a child or they will say the exact opposite. In an effort to clear up confusion and give patients our best advice, let us explain. Many children will never need orthodontic treatment. However, most would benefit significantly from treatment at some point in life. We are conservative and principled with early treatment, however, we will not hesitate to recommend it when it will clearly be of significant benefit or prevent a child from developing worsening problems. Quite often, at a new patient consultation, Dr. McNutt will identify a potential problem, but recommend against starting orthodontic treatment. Dr. McNutt can improve most orthodontic problems at any age. However, there is usually an optimal age in terms of the amount of improvement that can be achieved for a given orthodontic problem. Some problems should be treated at an early age to achieve maximum correction, while other problems are best treated later. This means the optimal age for treatment is different for every patient, so the best time for a consultation is as soon as a possible problem is noticed. The vast majority of children who still have baby teeth and are not yet teens do not need early orthodontic treatment, however, the ones that do may be significantly worse off if they are not treated prior to reaching certain developmental milestones. A classic example of this is when a child needs to have the upper jaw expanded. Well-trained orthodontists understand that the window of opportunity to expand the upper arch easily and with the least amount of risk is generally between age 7 and 10 years of age. After age 11, upper jaw (maxilla) expansion quickly becomes much less predictable and more difficult. This is just one example of many that illustrate the importance of early screening of children so that the ones who have preventable or easily correctable problems get the treatment they need. Another point we would like to make is that we have screened many children between the ages of 11 and 15 that should have been screened at an earlier age. The reason parents give most often for delaying an initial orthodontic screening is the they are waiting for all of the baby / primary teeth to fall out. We have worked with many patients who would have had easier, shorter, more comfortable and less costly treatment if their situation had been managed at an earlier age. For example, a good percentage of children have a problem with the normal process whereby the roots of the baby teeth slowly disappear (called resorption) to allow the permanent teeth to emerge at the proper time or in the proper position. This means that evaluating the developmental pace of each child at an early age is important. Often the solution is as simple as recommending the early removal of a select few baby teeth to allow the permanent teeth to emerge at the proper developmental stage for that individual patient. We are also seeing children who are as young as age 9 who have all of their permanent teeth in and patients at age 14-15 who still have baby teeth. Experienced orthodontists who have watched generations of children grow up become adept at the pattern recognition associated with these kinds of tooth eruption problems. Now let’s move the conversation in the opposite direction. There are also a number of problems that we cannot correct effectively and efficiently at an earlier age while baby teeth are still present. Often we identify a problem with the bite that should be corrected and we will recommend waiting until the teen years when all the permanent teeth are fully developed in the mouth. So the bottom line is, please have your child evaluated around age 8-9. Earlier is generally not a good use of your time or our time, unless the family dentist or pediatric dentist has identified a more severe obvious need. Please know that your child is unlikely to have treatment needs at an early age, however, for the 10-20% who would benefit from some sort of intervention, we won’t then miss the opportunity for those children.
Our Commitment To Extra Retainers
For Teens & Adults After Treatment
We are also firmly committed to setting teens up for success following orthodontic treatment. We put an uncommon amount of time and energy into helping our patients maintain the results of orthodontic treatment. The standard of care in our profession is to provide a single upper and a single lower retainer for your teen at the end of treatment. Dr. McNutt’s philosophy is that this standard is not high enough because it creates an expectation for patients to be perfect and to not misplace or break a retainer. We believe that when you factor in the time, money, and commitment that goes into orthodontic treatment, your teen deserves more support. That is why our standard is to provide two upper and two lower retainers. Most teens get what we call “the McNutt Special…” which consists of an upper clear retainer, an upper Hawley retainer (the old school kind that lasts a decade or more made of wire framework and acrylic), a lower permanent bonded retainer for the front teeth, and a lower removable clear retainer. Each style of retainer has strengths and weaknesses. Our strategy protects your investment in your teen’s smile and healthy bite. In the event that a teen loses or breaks a retainer, they already have a back up. Most teens also are given a 3D printed model of their teeth after treatment and these can be used to quickly replace lost or broken retainers. If you go through adult treatment with us, don’t worry, we make the same commitment with retainers for our adults.
Are you getting the sense yet that we are a different kind of practice ?
We appreciate you taking the time to read
about our treatment philosophy!
Phase I Treatment
Early orthodontic treatment usually refers to treatment that occurs when the child has a mixture of baby teeth and some permanent teeth, typically between age 8-10. Early childhood treatment is often referred to as Phase I Interceptive Orthodontic Treatment. Earlier in his career Dr. McNutt described himself as being very conservative with early treatment and this sometimes led people to believe that we are against early childhood treatment. The vast majority of our patients have treatment one time during the teen years. However, there are plenty of children who need and should have early childhood treatment. The best way to describe our philosophy is to state that we will not recommend early childhood treatment without principled and well founded reasons. For example, we occasionally treat children as early as age 4, however, the circumstances that would require such early treatment are rare. Some problems should be treated between age 8-10 because there is a narrow window of growth and development during which the orthodontist can effectively correct certain problems that would be very difficult to improve later, or would require surgery to correct. When a first phase of treatment for children age 8-10 is called for, 90% of those children will go on to have a second phase of treatment, called Phase II Orthodontic Treatment, after all the baby teeth are gone and the majority of the permanent teeth have come in. The reason for this is that when a problem develops that is severe enough to warrant early childhood treatment (Phase I), there is a high likelihood that more problems will develop later that will also need to be addressed.
When it comes to the best treatment options for teens, just like adult treatment, we have lots of great options to consider. We have options for braces and clear aligners (for more detail on options read our adult treatment options above). However, we will also be candid and realistic about the pros and cons of different options. Unfortunately, there is a lot of marketing online and on television about orthodontic treatment that is unrealistic and downright just not true. Teens who have braces or clear aligners like Invisalign or Spark, really want the same things that we want in our orthodontic practice. Teens want treatment to be comfortable, as short as possible, to have healthy teeth and a fantastic smile. We work hard to provide those things for our patients and we go out of our way to create an atmosphere of team work and to be positive mentors. We know that orthodontic treatment is just one small piece of a very busy teen life. We have a deep commitment to helping our patients understand what is realistic and to understand the true responsibility that comes with treatment. We are committed to putting your children ahead of our own interests. When we sense that a teen wants a particular type of treatment that is unlikely to give them the best results or we sense they are not ready for the responsibility, we will not ‘sell’ you on what your teen wants. We will recommend what we believe to be best, just as if your child were our own. Doing what is right is not always the same as doing what is popular.
Teen Orthodontic Treatment
Adult Orthodontic Treatment
Adult treatment options and treatment needs are often different from that of children and teens. We work hard to learn what goals are important to you as an adult and to tailor a unique treatment plan and options to your needs. Often we are working in tandem with your family dentist to align teeth in advance of planned dental work, such as veneers, implants, crowns and cosmetic bonding procedures to enhance the smile. Adults often desire more cosmetic appealing options to align their teeth. Many people are familiar with the fact that there are cosmetic options for braces (like clear and gold) and many are familiar with clear aligner therapy (also known as ‘CAT’) such as Invisalign, Spark or ULAB. We offer cosmetic options for braces, as well as clear aligner treatment. We use Spark Aligners and ULAB Aligners in our practice, as these have proven to be the best option for our patients. Most of our aligners are actually designed and manufactured in house using the ULAB system. Instead of relying on a non-doctor technician at a large corporation to design your digital treatment plan, our orthodontist creates the entire plan, we 3D print the dental models that are necessary to create the aligners, and then we fabricate the aligners ourselves. For the first time in the history of clear aligners, this allows us to control the entire process, assuring accuracy, direct quality control, and significantly reducing the lab fee costs associated with creating clear aligners. This savings are passed on to our patients and makes treatment truly more affordable.