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Southern Smiles Orthodontics and Pediatric Dentistry Brand Element
Southern Smiles Orthodontics and Pediatric Dentistry Brand Element

First Visit & What To Expect

First Visit & What To Expect

When Should My Child First Visit The Dentist?

If your infant has any oral or dental condition that bothers you or appears to be out of the ordinary, then your child should be seen regardless of age. In unique situations, we have seen children as early as their first week of life. This includes any problems with trauma to the teeth or mouth.


The American Academy of Pediatric Dentistry recommends that children receive an oral health risk assessment by six months of age and that they establish a dental home by 12 months of age. The reason for these recommendations is that some infants will develop cavities within months of the time that teeth erupt into the mouth. Often these early cavities are caused by feeding and oral hygiene habits. These early cavities may be avoided if the parents are counseled in these two areas
as the first teeth are erupting. We recommend that you come with your infant shortly after his/her first teeth have erupted.

We will help you with home oral hygiene, diet, pacifier or finger habits, fluorides, toothpaste, and injury prevention. Both Mom and Dad are welcome at these appointments. With professional guidance and demonstration, effective prevention can be stress-free, easy, and fun for the whole family. Families who embrace early parental involvement in home dental care for their children can, very predictably, expect a life with few, if any, dental problems.

If you have older children who are already patients in the practice, then you already have a "dental home. " Additionally, you have been introduced to the home preventive dental care practices that we recommend. Use the same techniques that you have already seen and heard for your newest edition. If you are having any problems or concerns, you are welcome to bring your infant along with your older children so that we can answer your questions.

If you have older children in the practice, are comfortable with your home preventive dental care routine, and don't have any questions or concerns about the oral/dental health of your infant, we recommend that your child come for a first dental visit at age three.

What Should I Tell My Child
Before The First Visit?

When you talk with your child about his or her first dental visit, we recommend that you emphasize both honesty and a positive attitude. Please do not talk to your child about any dental anxieties that you may have. "The dentist will be very kind and gentle when he counts your teeth" and "Mommy will be with you all the time" are good places to start.

Answer all the questions that your child asks to the best of your ability without making a "big deal" out of the experience. We have found that parents are very good at predicting their child's behavior for his or her first dental visit. Some children will feel more at ease if they know, in advance, every detail about the upcoming experience. Others do better if they know nothing at all. Remember, every child is an individual. Prepare your child so that he or she has the best chance for a good experience. We will use our training and experience along with the information that you give us to do the same.

Southern Smiles Orthodontics and Pediatric Dentistry Brand Element
Southern Smiles Orthodontics and Pediatric Dentistry Brand Element

What Will Happen At
The First Dental Visit?

At the first visit, it is very important for our team and doctors to have a good understanding of your child’s overall medical health history. Completing our new patient health history registration form in advance is very helpful. Together we will review your child's health history and discuss any concerns you may have about your child's teeth and oral health.

SPECIAL NEEDS: In the event your child has special needs, we encourage you to discuss in advance the best way for us to schedule your child in order to provide a tailored experience geared toward success!

At the first visit with us, your child will have a doctor's exam and be seen by our hygiene team for an age-appropriate dental cleaning, topical fluoride treatment when appropriate, health and wellness education, and possibly X-rays / radiographs. We will, of course, always find ways to make it fun! Please note X-rays / radiographs will only be made if they are needed to make an accurate and complete diagnosis of your child's dental health, and we will ask for your permission first. We will also ask your permission for a fluoride treatment application. For more information on our safety standards and X-ray policies, CLICK HERE. For more information on our fluoride protocols, CLICK HERE.

The doctor will complete the following:

  • Dental exam of all of the teeth, checking carefully for any tooth-related problems, infections, or tooth decay.

  • Exam of all soft tissues and muscles inside the mouth.

  • A “head and neck exam” where the doctor checks your child’s muscles of the head and neck, as well as lymph nodes (an important screening exam for overall health as well as rare precancerous growths).

  • Evaluate the growing structure and functional relationships of the upper and lower jaws.

  • A pre-orthodontic evaluation of the developing bite pattern and crowding of the teeth.

  • Evaluate any X-rays / radiographs of the teeth that are obtained.

  • Discuss any recommended treatment and address any concerns you may have.

  • Provide age-appropriate education for parents to help guide their children.

  • Have fun!

To learn more about our Infant, Child & Teen Dental Exams, CLICK HERE.

The hygiene & dental assisting team will work together to complete the following:

  • Complete an age-appropriate dental cleaning.

  • Teach brushing and flossing techniques to help improve care of the teeth and gums.

  • Make X-ray/radiographs when indicated.

  • Assist the doctor with the exam.

  • Help provide education and guidance.

  • Have fun!



To learn more about our protocols for dental cleanings, CLICK HERE.

Follow up when the dental visit is complete:

At the end of most dental visits, we help you to schedule the next regular six-month check-up and cleaning. For children who may have dental treatment needs, for example, if tooth decay has been found, and a filling (restoration) is necessary, we will discuss the options, and cost and help schedule the appointment. We will also discuss how you can help prepare your child for that next visit.

Oral Health
In Children

The development and the health of a child’s teeth and mouth are as important as any other growing part of the human body. Unfortunately, dental decay (the disease properly known as caries) is still the most common chronic childhood disease. At this point it is well established that the dental and oral health of a growing child has a tremendous impact on the future health of the person for the rest of their life. The strong connection between the overall health of the body (systemic health) and our oral health is now well established. Children and adults with healthy mouths and good regular hygiene have far fewer health problems. We now know there are direct links between poor oral health and many diseases, such as diabetes, cardiovascular problems, heart problems, some autoimmune system disorders, and cancer. Childhood dental decay is the most common chronic disease in childhood, yet cavities are preventable. Children who have poor oral health typically miss more school and have lower academic achievement than children with healthy mouths. Left untreated, dental decay and cavities can cause pain, infections, and can lead to problems with eating, speech, and even learning. Before your infant or toddler is able to take care of their own gums and teeth, you can protect and maintain your child’s teeth by following the P-E-A-R-L-S of Wisdom:

Protect tiny teeth.
Ensure to wipe your baby’s gums after each meal.
Avoid putting babies to bed with a bottle.
Remember to brush your child’s teeth twice daily with fluoride toothpaste.
Limit drinks and food with added sugars for children.

Encourage your child to eat healthy foods.

*For children younger than 2 years, consult with us about when to start using fluoride toothpaste and how much to use.

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Oral Health In Children

Common myths about baby teeth:

Myth #1

“Baby teeth don’t really need to be cared for.” The truth is, decay can happen as soon as the first baby teeth appear. So, as soon as the first baby teeth appear, it's time to start brushing…twice daily—in the morning and before bed.

Myth #2

“I can wait to take my child to the dentist until they are older.” You should be visiting the dentist as soon as your child’s first teeth erupt. Follow the “First Visit by First Birthday” recommendation of the American Academy of Pediatric Dentistry.

Myth #3

“They are just baby teeth, if they get cavities they will fall out later anyway.” We hear this too often. One of the most accurate predictors of whether or not children will have dental decay in permanent teeth is whether or not they had active decay in the baby (primary) teeth and whether or not the problem was addressed. The bacteria that cause tooth decay, if left alone to thrive, will spread from one tooth to another, not unlike how the flu spreads from one family member to another.

Myth #4

“It’s okay to let my child sleep with their bottle.” Parents who allow their children to go to sleep with a bottle filled with milk or juice, please understand that this is a particularly harmful thing to do, as it almost always results in early cavity formation. It can also make your baby dependent on having a bottle to sleep. Children who tote around no spill “sip” cups with sugary drinks and juices throughout the day are equally harmful.

Good Oral Health In Children Is Essential!

Children who have good oral health generally have better overall body health, more self-confidence, and better social and psychological health.

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Child Nutrition
& Wellness

It is important for children to establish healthy eating habits. This is an important part of growing up because it impacts the development of the entire body. The developing brain, muscles, bones, nervous system, and immune system are impacted tremendously by the nutrition a child receives through childhood.

It is a good idea to teach children that they need healthy foods and drinks to grow into the best
versions of themselves and to stay strong. In addition to good eating habits, there are many ways to take care of the body, including exercise, regular social interaction with peers, and getting enough sleep. The earlier we introduce children to a variety of healthy foods, the better.

Child Nutrition & Wellness

Begin by teaching children that our bodies need certain things to be in our food in order for our bodies to grow up healthy and strong, like vitamins and minerals. We also need a balance of different types of food. We have many parts to our bodies, and the different parts all need many of the same things; however, our body parts benefit individually from different types of food. For example, the brain benefits from healthy fats in the diet, like those that come from fish. Whereas our hearts don’t benefit in the same way from fat in our diet. Teach your child that not all foods are created equal. Some foods are better than others, and some foods are less healthy and should be eaten less often.

How should we teach children about nutrition & healthy eating habits?

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What Foods Should Children Eat
For A Healthy Body?

Most people are familiar with the five major food groups: fruits, vegetables, grains, protein, and
dairy. A well-balanced plate of food should have half of the plate filled with vegetables and some fruit, that the other half with grains and proteins.

Examples of healthy vegetables include carrots, broccoli, green beans, peas, and potatoes. A good vegetable garden is like a rainbow, with many different colored vegetables. When our diet includes vegetables from across the entire rainbow, our bodies will respond in health-positive ways.

Examples of good fruits include blueberries, blackberries, apples, bananas, avocados, and kiwis.
There are certainly many more examples of healthy vegetables and fruits.

Grains include foods such as pasta, cereal, whole wheat, quinoa, bread, oatmeal, barley, and rice to name a few. We have to be more careful about which grains we eat and not eat too much.

Rounding out our dinner plate is the protein group, which includes meats (such as chicken, beef, pork, & fish), eggs, legumes (beans, lentils, tofu), and dairy (yogurt, milk, cheese) and tofu.

Teaching children about different ways to prepare food is also important. They need to understand that how we prepare our food is just as important as what we eat—for example, roasted red potatoes with a little bit of butter, rosemary, salt, and garlic = yummy and healthy. A regular bag of potato chips, although an occasional delicious treat, is not at all the same. One of the best ways to get children involved in adopting healthy eating behaviors is to get them involved in the kitchen. Teaching children how to cook is an incredibly valuable life skill.

Here are some fun books to inspire your youngster to get into the kitchen with you to learn how to cook healthy recipes:

  • The Complete Cookbook for Young Chefs: 100+ Recipes that You'll Love to Cook and Eat -Authors America’s Test Kitchen Kids

  • The Forest Feast for Kids: Colorful Vegetarian Recipes That Are Simple to Make - Author Erin Gleeson

  • My Very First Cookbook: Joyful Recipes to Make Together! A Cookbook for Kids and Families with Fun and Easy Recipes for Breakfast, Lunch, Dinner, Snacks, and More Author Danielle Kartes

Southern Smiles Orthodontics and Pediatric Dentistry Brand Element

How we cook our food is just as important as what we eat!

What about soda and carbonated beverages?

The truth is that soda is not a healthy drink option. In fact, it is one of the single biggest contributing factors to childhood obesity, and diabetes and is destructive to many parts of the body. The fact that it has become such a normal part of life that many children consume it multiple times daily is quite sad. It seems that our society often looks the other way when it comes to soda consumption in both children and adults. It is the classic example of something that can be very enjoyable, should be rarely consumed, and yet has become an everyday part of life for so many. 


Soda contains a great deal of sugar and is very acidic. In regular soda drinkers, the negative impact on dental health and tooth enamel is immediate, significant, and often permanent.

The ultimate health beverage is undoubtedly water! There really is no substitute and helping children to adopt a healthy appetite for drinking water regularly throughout the day is also one of the best health habits we can teach our children

For parents who wish to read a more in-depth resource on the following subjects:

FAQ & Patient Education
  • How does my orthodontic insurance benefit work?
    For answers to insurance questions, CLICK HERE.
  • Should we call the orthodontic office if something on my braces breaks or comes loose? Since I already have an upcoming appointment, can’t I just show up for that and you can repair it?
    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.
  • What is your insurance financial policy, will you file my insurance for me?
    For answers to insurance questions, CLICK HERE.
  • What if I have two insurance benefit policies?
    For answers to insurance questions, CLICK HERE.
  • Are benefit payments made to me or paid to the orthodontist?
    For answers to insurance questions, CLICK HERE.
  • Do braces or clear aligners like Spark or Invisalign hurt?
    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.
  • What should I do with a brace, a wire or a part of my orthodontic appliances comes off in my mouth?
    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.
  • What should I do if something shifts, and my braces start poking me in my mouth?
    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.
  • What is an orthodontist?
    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.
  • What is the difference between an orthodontist and a general family dentist?
    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.
  • Why does my general dentist advertise and offer orthodontic treatment?
    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.
  • How do you become an orthodontist?
    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.
  • Do I need to see my general dentist for regular dental cleanings and exams while in orthodontic treatment?
    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.
  • AGE FOR FIRST ORTHODONTIC EVALUATION: When should my child have an initial orthodontic examination?
    We have lots of information about this, CLICK HERE to read our recommendations.
  • TEXTING ABOUT A PROBLEM & SENDING US A PHOTOGRAPH: If I am unsure what to do because I think there is a problem with my braces, my clear aligners, or my elastic rubber bands, can I send a text message or send a photograph of the problem?
    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.
  • BROKEN BRACES: If something comes loose on my braces, like a bracket coming off, is this an emergency?
    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.
  • POKING ARCH WIRE CAUSING DISCOMFORT / PAIN: If a part of my braces, like the end of the wire, is poking and causing pain, is this an emergency?
    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.
  • BROKEN OR LOST CLEAR ALIGNERS: If I misplace or break one of my clear aligners, what should I do?
    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.
  • SAVING PREVIOUS CLEAR ALIGNERS: When I am done with a clear aligner and ready to move on to the next one in the sequence, should I keep the previous aligner or discard it?
    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.
  • CLEAR ALIGNER ATTACHMENT COMES OFF A TOOTH: If an attachment comes off of a tooth that is being used for my clear aligners, what should I do?
    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.
  • How often would I need to come for regular orthodontic appointments?
    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.
  • Are appointments available in the early morning or during after school hours?
    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).
  • May I be seen in either office for an orthodontic appointment?
    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.
  • Are there restrictions on what time of day you schedule certain types of appointments?
    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.
  • When is an adult too old for braces or clear aligners like Spark or Invisalign?
    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.
  • What is a retainer & why are they important?
    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.
  • When I finish treatment, how often do I need to wear my retainers.
    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.
  • Why is it especially important to be very faithful to our retainer wear instructions during the first six months after treatment is completed?
    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.
  • If I wear my retainers exactly as recommended, can you guarantee me that my teeth will never move?
    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.
  • EARLY TREATMENT IN YOUNG CHILDREN: Why is “early treatment” recommended for some children and not for others?
    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.
  • How often should I brush my teeth during treatment?
    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.
  • Should I brush at school & work after lunch?
    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.
  • How should I brush my teeth?
    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.
  • Do I need to floss during treatment with braces or clear aligners?
    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!
  • Is it really true that treatment with braces or clear aligners takes longer and the results might not be as good if I choose not to floss?
    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.
  • How do I floss with braces?
    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.
  • Can I just use a Water Pik device instead of flossing?
    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.
  • Are there other kinds of brushes that may be helpful to clean food out that is stuck between braces:
    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.
  • During treatment should I use a fluoride rinse or an anti-bacterial rinse?
    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.
  • Do I need a prescription toothpaste during treatment?
    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
  • When children are not doing well with brushing or flossing, do you update parents?
    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.
  • What happens to my teeth and gums if I am not brushing well or flossing and what are the potential long-term consequences?
    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!
  • Does a healthy diet impact the progress of my orthodontic treatment?
    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.
  • Do I need to eat differently during treatment with braces?
    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.
  • How should I eat crunchy fruits and vegetables with braces?
    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.
  • How should I eat meat that is on a bone?
    When eating meat, always cut it off the bone.
  • Should I avoid sticky and chewy foods?
    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).
  • Can sticky and chewy foods damage my braces?
    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.
  • Which foods cause the most problems with braces and should be avoided?
    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).
  • Are there types of drinks that should be avoided with braces or clear aligners?
    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.
  • How important is patient participation and cooperation during orthodontic treatment?
    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.
  • What do the most successful orthodontic patients have the following things in common?
    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.
  • Why did one of the braces come off my tooth?
    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.
  • Should I avoid chewing on non-food items?
    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.
  • Should a patient with braces who is participating in sports wear a protective mouth guard?
    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.
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