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Southern Smiles Orthodontics and Pediatric Dentistry Brand Element

Services & Dental Treatments 

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At Southern Smiles of NC, our Pediatric Dental Team provides regular and specialty dental care for infants, children, and teens. Our treatment options are designed around the best available techniques with an emphasis on evidence-based best practices. We endeavor to positively impact children of all ages through education on oral health and wellness, functional health of the jaws and teeth, diet, and nutrition.

Infant, Child & Teen Dental Exams 

Infant, Child & Teen Dental Exams 

An examination by the children’s dentist is recommended every six months

There are unique stages of childhood, and not every child’s growth and development occurs in the same way or at the same pace. A theme you will read and hear in our practice is that we strive to meet people where they are. As your child grows, you will notice how we conduct our dental exam, and the educational information we provide you will change. We aim to tailor the experience and the information to your child’s needs.


At a typical exam, we will ask if there are any updates to your child's health history and discuss any current dental concerns. The pediatric dentist will examine your child's head, neck, teeth, and Intra-oral soft tissues. The occlusion, or the way that the teeth are aligned and function together, will also be evaluated. Radiographs or X-rays will be made only if they are needed to make an accurate and complete diagnosis of your child's dental health.

The doctor will then discuss the findings from the examination and answer any questions that you have. In the event treatment is recommended for cavities/tooth decay or other issues, we will discuss the available treatment options.


In the event another dental specialist is needed, we will refer you to a qualified dental specialist. A dental cleaning is typically also completed at each exam; for more information, see the section on Dental Cleanings.


We will also discuss nutrition and the impact of a healthy mouth on the entire body.

Dental Cleanings

A regular dental cleaning is recommended every six months. Everyone on our team is a child at heart and knows how to keep it fun for the kids. Many pediatric dental practices do not have Registered Dental Hygienists licensed by the state on staff. At Southern Smiles, we do have hygienists, and we take a team approach to our dental cleanings to ensure that we are thorough and provide the best service and education. Our hygienists oversee our hygiene department, and they work in tandem with the doctor and our dental assisting team. Just as the education we provide changes depending on patient age and their stage of development, what we do during your child’s Dental Cleaning appointments also changes over time.

How we approach each child is based not only on their dental development, but also on their individual behavioral and social development

Our team progression for dental cleanings is:



Early childhood

Middle Childhood



Dental Cleanings


Sealants are a protective coating bonded to the biting surface of molars and premolars that serve to keep out bacteria, plaque, and food debris. The biting surfaces of these teeth, when viewed under a microscope, are full of deep groves, pits, and fissures. The bristles of your toothbrush cannot reach into these areas to clear away the things that make it into these grooves.


Sealants are easy to apply and are one of the best proven low-cost measures to help keep children cavity-free. Sealants on the permanent molars are generally universally recommended and can be applied as soon as the first set of molars fully emerge, usually around age six

Before Dental Sealant

Before Dental Sealant Image - Pediatric Dentistry

After Dental Sealant

After Dental Sealant - Pediatric Dentisty
Radiographs & X-Rays
Southern Smiles Orthodontics and Pediatric Dentistry Brand Element

Radiographs & X-Rays

Dental X-rays for kids are one of the best ways to detect tooth decay and problems in teeth that are not apparent to the doctor during a visual exam of the teeth.

For more information on our safety standards and X-ray policies, CLICK HERE.

Are Radiographs, Commonly Referred ToAs “X-Rays” Safe For Your Children?

Many parents have concerns about whether X-rays are safe for their kids. At Southern Smiles, we have replaced the old manually processed X-rays and our pediatric dental team uses digital low dose x-ray technology. They are safer because they emit about 90 percent less radiation than traditional film X-rays. The dosage is so low that technically, we do not even need to use a protective apron to drape over the patient while we take the X-rays. However, we still use the protective apron to offer our families that extra peace of mind. The technology has advanced to the point where most of our X-rays are taken with a portable hand-held X-ray unit. In fact, the level of radiation from a set of digital X-rays is less than the level of radiation we’re exposed to naturally in the course of one day.

What Happens If You Decide Not To Allow X-rays?

Occasionally we have parents who will not allow us to take dental X-rays on their children. We are able to work with parents in those situations over a period of time. We will provide education and discuss why it is important to ultimately include X-rays as a part of a full evaluation for your child. Once your child has been with us for a period of about 18 months, if we have not established a level of trust with you that allows the doctor to work with the standard of care, we will help you find another dental home for your child. While X-rays are diagnostic in nature, they are also a preventative measure, helping to spot issues before they become major problems. An examination of your child’s teeth without an X-ray may not reveal potential issues with the teeth and surrounding tissue. Common problems that will go undiagnosed are: decay between the teeth, decay inside the teeth, bone infection, abscesses, missing teeth, extra teeth, impacted teeth, cysts, a variety of genetic or systemic problems, and in rare cases tumors or cancers. The Discovery of these problems at an early stage is vital for an effective plan of treatment. Without X-rays, issues not obviously apparent could go undiagnosed, resulting in progressive worsening, even to the extent of threatening your child’s overall health. Left untreated, an abscess infection can spread to other parts of the body, including the lungs, heart, and brain.

What Is A Radiograph & What Is An X-ray?

A ‘radiograph’ is the picture that is created of the teeth and supporting bone. The picture allows the dentist to essentially see through the structures of the teeth and evaluate the health of the tooth and supporting bone. The term ‘X-ray’ actually refers to the invisible electromagnetic wave that is passed through the body to create the radiograph picture. So X-rays allow us to create radiographs. The lay-person generally uses the term x-ray to describe what a dentist calls a radiograph. Don’t worry, we know how to speak in terms that make it easy for parents!

How Often Should X-Rays Be Taken?

We abide by the standards of the American Academy of Pediatric Dentistry and the ALARA principle. ALARA stands for “as low as reasonably achievable” and children should be protected from unnecessary exposure. When deciding whether a dental x-rays would be beneficial for your child, our experienced doctors will always weigh the risks against benefits. There are no exact guidelines for how often X-rays should be taken. Children who have a significant and repeated history of tooth decay will generally benefit from X-rays more often, whereas children with little or no history of tooth decay should have X-rays less often. We only recommend X-rays when they are truly beneficial and necessary to completely assess your child’s teeth.

Common Types of Pediatric Dental X-Rays

Some dental X-rays require a ‘sensor’ to be placed inside the mouth. This type of X-ray is known as an ‘intra-oral’ X-ray. Most X-rays taken in our pediatric office are of this type. These create small high-resolution images that help us focus on detecting decay and other problems. A ‘bite-wing’ X-ray and a ‘periapical’ X-ray are the two most common types. The sensors are smaller than the old-style film and are more comfortable for children.


Some dental X-rays are taken outside the mouth and create a larger picture that is a lower resolution and provides a very global view of the jaws, teeth, and bones of the face. These are known as ‘extraoral’ X-rays. The most common type is called a panorex or a panoramic radiograph.

Minimally Invasive Comfort Techniques

Techniques now exist in children’s dentistry that allow for minimally invasive correction of some types of dental decay. Not every situation can be solved with these newer techniques; however, there are opportunities to remove tooth decay without numbing your child (no injection of a local anesthetic) and to use higher-tech procedures that help your child get the treatment they need in a quick and comfortable fashion. Our team will be able to provide more education during your visit and discuss whether or not issues your child may have can be addressed with these techniques.

Minimally Invasive Comfort Techniques

Nitrous Oxide Sedation & Dental Anxiety

At Southern Smiles, we believe that it is vital for us to help children have the safest and most comfortable dental experience possible. It is well documented that children who have more comfortable, happy dental experiences are far more likely to grow up and adopt the healthy habit of taking care of their teeth and the healthy habit of seeing a dentist regularly in adulthood.


The use of nitrous oxide during dental procedures is a very effective way to relax children and help them relieve anxiety during a dental experience. We offer the latest and safest methods of offering well-controlled nitrous oxide sedation to our patients.


Nitrous oxide is a safe, breathable gas that is administered simultaneously with oxygen. When inhaled, the body absorbs the nitrous oxide, and it has a very calming effect. The nitrous oxide gas is eliminated from the body quickly just through breathing normally. It takes effect very quickly, and it wears off very quickly afterward.

Nitrous oxide is so effective that we are often able to fill

superficial cavities without any injection of dental anesthetic.

Is Nitrous Oxide Sedation Safe?

This is the safest form of sedation and has a long proven history of use in children. Benefits of use also include the fact that it is not addictive, your child remains fully conscious and they maintain all their normal body reflexes.

Nitrous Oxide Sedation & Dental Anxiety
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Special Instructions & Preparing Your Child For

Nitrous Oxide

There are three main considerations that are important for you to consider:

NO. 1
Recent Food Intake:

We recommend that your child does not have a full meal / full tummy inadvance of a dental appointment with nitrous oxide. In this case, there is a small chance ofnausea or vomiting if the stomach is full.

NO. 2
Breathing Issues:

Also, it is important that you update and inform the doctor and team of anyrespiratory conditions or breathing issues that your child may have, whether temporary orchronically ongoing. If your child is having difficulty breathing through the nose (commoncold, asthma, sinus problems, etc.), we need to be made aware. Breathing issues may reduce theeffectiveness of nitrous oxide & oxygen.

NO. 3

Inform the doctor and our team the day of the dental appointment about anymedications taken within the last 24 hours, even if they are over the counter.

Are There Other Forms Of Sedation?

There are several other forms of sedation that can be administered safely; however, they are special circumstances that apply to each different level of sedation. Examples are below.

Valium (Diazepam) & Ativan (Lorazepam)

Valium and Ativan are both orally taken anti-anxiety medications. These medications help manage anxiety and provide a light sedation. This is a short-acting medication that will not cause your child to go to sleep and has a retro-amnesia effect afterward (usually results in your child forgetting the procedure altogether). These medications are absorbed in the gastro-intestinal tract and are effective within 30-60 minutes of taking the medication.

Special Instructions & PreparingYour Child For Midazolam (Versed)

  1. Eating: No solid foods after midnight the night before the appointment. NOTE: Homemade Jellois acceptable up to two hours prior to the dental appointment.

  2. Drinking: ONLY clear liquids, and no more liquids 2 hours prior to the dental appointment. Examples of approved liquid drinks: Water, clear apple juice, and sprite.

  3. Dosage: The doctor will carefully calculate the proper dosage.

  4. Other Medications: Inform the doctor and our team on the day of the dental appointment about any medications taken within the last 24 hours, even if they are over the counter.

Midazolam (Versed)

Midazolam is an orally taken anti-anxiety medication (known as Versed). This is a short-acting medication that will not cause your child to go to sleep and has a retro-amnesia effect afterward (usually results in your child forgetting the procedure altogether). This is best used for procedures that can be completed rather quickly that the child might perceive as stressful (such as removal /extraction of a baby / primary tooth). Some children may react in an agitated manner afterward, and hydrating with glucose is often helpful to calm your child). This method does not work well for procedures that will take more than about a half an hour start to finish. 

In Office IV Sedation

In certain circumstances, a deeper state of controlled sedation may be recommended. At SouthernSmiles, our pediatric doctor and team are trained in how to recognize when this level of sedation may be necessary. This is a service that we offer in collaboration with an onsite sedation anesthesiology specialist. This requires special planning and preparation by both our team and by the patient family. Our team provides patient-specific instructions and guides your preparation for this type of appointment.

Special Instructions & PreparingYour Child For Midazolam (Versed)

  1. Eating: No solid foods after midnight the night before the appointment. NOTE: Homemade Jellois acceptable up to two hours prior to the dental appointment.

  2. Drinking: ONLY clear liquids, and no more liquids 2 hours prior to the dental appointment. Examples of approved liquid drinks: Water, clear apple juice, and sprite.

  3. Dosage: The doctor will base the proper dosage on your child’s current weight. The medicine is usually a cherry-flavored liquid and is swallowed.

  4. Taking The Medication: This medicine is fast acting with a rapid onset of 15-20 minutes. The doctor will directly administer the medication.

  5. Other Medications: Inform the doctor and our team the day of the dental appointment about any medications taken within the last 24 hours, even if they are over the counter.

Hospital Or Surgical Center Sedation:

Our team provides patient-specific instructions and guides your preparation for this type of appointment. Hospital Or Surgical Center SedationIn certain circumstances a deeper state of controlled sedation may be recommended, and medical history may influence us to consider sedation in a hospital or surgical center. This requires special planning and preparation by both our team and by the patient family. Our team provides patient-specific instructions and guides your preparation for this type of appointment.

Tooth-Color/Silver Fillings,Restorations, Crowns

Tooth-Colored Fillings & Restorations:

When tooth decay is detected, and the decay can be easily removed, the shape and the structure of the decayed tooth can be restored with tooth-colored composite material. The composite material is bonded to the tooth. At Southern Smiles, we do not use the old-style silver amalgam filling material. Tooth-colored composite fillings / restorations are typically appropriate for small to medium-sized cavities and areas of decay.

Tooth-Colored & Silver Crowns:

Primary / baby teeth that have large areas of tooth decay are often best fixed by placing what is known as a “crown.” The doctor will advise you when a simple filling just won’t do and a crown is necessary. Most of the time, we will use a stainless steel silver-colored crown. These are safe, effective, and easy to place at a lower cost. They are also a more conservative way of protecting the tooth. We also offer tooth-colored crowns. However, these are typically more expensive and are not as conservative, as they require additional removal of tooth structure in order to properly make the crown.

Extraction of Baby & Permanent Teeth

Sometimes removal of teeth may be recommended. Common reasons for removal are:

  • Tooth decay that is so invasive it will be difficult or impractical to fix with a filling or a crown.

  • An abscess has formed, and there is a difficult-to-resolve infection.

  • Removal of baby teeth to relieve crowding and problems associated with the underlying permanent teeth.

  • A problem has been identified by an orthodontist, and the removal of baby teeth will help resolve it.

  • Severe crowding has been identified by an orthodontist, and the removal of permanent teeth is required in order to align the teeth and improve the bite.

Extraction of Baby & Permanent Teeth
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Nerve & Pulp Treatments

Decay and infection that penetrates into the center of a tooth where the nerve and blood vessel arehoused within the tooth can cause significant problems. The nerve tissue and blood vessels are collectively known as the ‘pulp’. There are various types of treatments that we offer to help remedy these issues. See examples to the right.

Pulpotomy: A pulpotomy is a procedure where the infected and damaged pulp tissue is removed from the upper part of the inside of the tooth. Then, any remaining tooth pulp will be treated with a special medication that helps protect the remaining pulp from infection. After this, your child's tooth will be protected with a filling or a crown, and the procedure is complete. This procedure is not always successful in every case, and some teeth eventually lose the entire blood supply and nerve tissue. Some people refer to this procedure as a ‘baby root canal,’ and this is only partially true. A true root canal procedure is significantly more invasive and requires a different technique


Direct Pulp Cap & Indirect Pulp Cap: These procedures are even less invasive than a pulpotomy and may be appropriate to effectively treat the nerve issue with the primary tooth. Our pediatric dentist will advise parents as to which procedure is best on a case-by-case basis.

Nerve & Pulp Treatments

Traditional Fluoride Treatment

Fluoride treatments administered at regular dental checkups are one of the safest and most effective proven measures to greatly reduce the risk of dental decay. We regularly offer this service and promote safe dosage measures to protect children. Our general fluoride applications help to strengthen all teeth. We also have special fluoride treatments can be targeted to specific areas of teeth where weakened enamel is just starting to decay to stop the decay process from progressing

  • 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.
Traditional Fluoride Treatment

Silver Diamine Flouride (SDF)

Silver Diamine Fluoride (SDF) treatments were first introduced in the US in 2015. SDF is antimicrobial liquid that is able to treat some types of cavities in a non-invasive, fast, affordable and painless manner. SDF is a topical treatment applied by the dentist directly into the area of tooth decay. Repeated application over time is required to in order to be fully effective.


There are pros and cons to SDF treatment:



  • Appropriate for use to stop the process of decay in teeth with small to moderate sized cavities.

  • 80% of these cavities stop forming when applied twice yearly to the forming cavity.

  • Relieves sensitivity pain related to decay.

  • Helps delay fillings being placed in teeth that are not fully.

  • Cost effective.

  • Non-invasive



  • Permanently stains the cavity black.

  • 20% of cavities treated with SDF will continue to progress and grow larger.

  • If a hole has formed in a tooth, it will eventually require a filling.


Not an option for deep large areas of dental decay

Note: In some cases, the black staining can be masked by adding a white coating of what is known as Glass Ionomer Cement (GIC coating).

Silver Diamine Flouride

Pre-Screening Exam

The following are common orthodontic problems and terms:

  • Crossbite

  • Deep Overbite

  • Openbite

  • Underbite

  • Protrusion of Incisors

  • Traumatic Bite Relationship

  • Impaction

  • Excessive Crowding

  • Excessive Spacing

  • Missing Teeth

  • Extra Teeth

  • Jaw Growth Deficiency

  • Excess Jaw Growth

Our children’s dental examination includes a basic orthodontic pre-screening evaluation. We begin this at a very early age and recommend that all children be evaluated by an orthodontist, generally between the ages of 8-9. There are certain problems that may necessitate a referral to an orthodontist at an even earlier age. Our prescreening includes evaluation of your child’s developing bite (known as the occlusion), jaw structure, and alignment of the teeth. It is important to understand that you should not wait until all the baby / primary teeth fall out before being evaluated by a qualified orthodontist. For detailed information on when a child should first be evaluated by an orthodontist and early childhood orthodontic treatment, CLICK HERE.

Pediatric Dental Trauma

Trauma to the permanent teeth and baby teeth occurs in children. Our dental team has the knowledge and experience to help guide you through what to do if trauma occurs. After significant trauma that involves knocking out a tooth or fracturing the crown of a tooth, the child needs dental care as soon as possible. For the best outcome, the child should see the dentist within 1 hour of the incident.

Pediatric Dental Trauma
Orth Prescreening Exam

First Aid For A Knocked-Out Permanent Tooth

  • Calm, quick, and decisive care is best.

  • Wear medical gloves, if available.

  • Position the child so that bleeding does not cause choking.

  • Control any bleeding.

  • Try to find the tooth.

  • If you find the tooth, DO NOT handle it by its roots.

  • If the tooth is dirty, gently rinse it with water.

  • Do not scrub or use antiseptic on the tooth.

  • Reinsert the tooth if it is a permanent tooth.

  • Do not reinsert a primary tooth.

  • Gently place the tooth back into the socket in the correct position.

  • Press down on the tooth with your thumb until the crown is level with the adjacent tooth.

  • Have the child bite down on a wad of gauze or cloth to stabilize the tooth until arrival at the dentist.

Image by Oleg Laptev

If you cannot reinsert the tooth, see the options below:

How to Transport a Knocked-Out Tooth:

For the best chance of survival for a tooth that has been knocked out, place the tooth back into the socket while waiting for dental care. If that is not possible, use one of the options below:

Milk Transport

  • Option 1 (Best): Place the tooth in a small plastic bag with some milk. Put the plastic bag in a cup of ice.

  • Option 2: Place the tooth in a cup of cold milk.


Saliva Transport

  • Option 1 (Use only in children older than 12 years): Put the tooth inside the child's mouth. Caution the child to be careful not to swallow it.

  • Option 2: Put the tooth in a cup. Keep the tooth moist with the child's saliva (spit).

Wet Cloth Transport

If milk and saliva are not available, wrap the tooth in a wet cloth.


Note: If you cannot find a knocked-out tooth, it is still important to have the child see a dentist as soon as possible. The tooth, whether permanent or primary, might be knocked up into the gums.


Southern Smiles Orthodontics and Pediatric Dentistry Brand Element

Additional Resources

A link to the American Academy of Pediatric Dentistry guidelines for dental trauma can be found here:

A link to the International Association of Dental Traumatology Dental Trauma Guidelines can befound here:

A link to what your pediatrician has likely been taught about how to manage dental trauma can be found here:

At Southern Smiles, we are always focused on learning the latest techniques and emphasize continuing education to ensure that our patients get the best possible treatment options!

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