Category Archives: Preventative Care

Your Medical History, The Mouth/Body Connection


The medical history is an important tool in diagnosis and planning dental treatment. Most State Boards of Dentistry have specific statutes regulating the intervals at which these histories have to be done. Histories must be reviewed at every appointment and all medications reported by the patient, as they may affect treatment.

The Mouth/Body Connection

  • Many patients have little understanding of what their medical history has to do with dental treatment. However, your teeth are attached to your body and are part of:
  • Your circulatory system (in direct connection with your heart)
  • Your central nervous system (if not, your dentist wouldn’t need to use anesthetic)
  • Your musculoskeletal system (all of your teeth are cushioned in a bony socket and attached by ligament tissue to your head)
  • Your lymph system (infections of the mouth drain to the lymph system through nodes under your chin and in your neck)
  • Your immune system (in the presence of an infection, your immune system goes to work to help fight the infection)


9598195Importance of an accurate medical history

The following list is a few of the factors the dental professional needs to know about regarding your past, present, and foreseeable future medical experience:

  1. Birth control pills – If you are taking birth control and your dentist gives you antibiotics, that medication can render your birth control ineffective.
  2. If you are on a blood thinner and you need a tooth removed, a conversation with your MD is necessary, as you may experience excess bleeding following an extraction.
  3. In Connective tissue disorders such as Rheumatoid Arthritis, oral microbes have been found in the joint fluid of patients. 1
  4. Diabetes is the number-one medical condition contributing to the progression and severity of gum disease. We now know that there is a direct relationship between the control of blood sugar and gum disease (periodontal disease). Uncontrolled gum disease adversely affects the control of blood sugar in diabetes and vice versa.
  5. Coronary artery disease – Bacteria involved in gum disease have been found in the atherosclerotic plaques of coronary arteries.
  6. Adverse pregnancy events – Pregnant women with gum disease may be more likely to give birth to pre-term, low-birth-weight babies. Oral bacteria can cross the placenta and expose the fetus to infection. 2, 3
  7. Congenital heart defects, a history of damage to the surface of the heart (endocarditis) or a history of rheumatic heart disease – Oral bleeding causes millions of bacteria to enter the bloodstream that pose a threat of damaging your heart valves. These conditions may require an antibiotic prior to dental treatment to protect the heart from further damage. Your MD should instruct you on your need for antibiotic treatment prior to dental visits.
  8. Mouth drying medications – There are hundreds of commonly prescribed medications that lead to a condition known as dry mouth. A decrease in saliva production can lead to oral disease costing thousands of dollars to repair.
  9. Recent joint replacement – Some orthopedic surgeons require a pre-medication for two years following joint placement. Talk to your surgeon about the necessity of being pre-medicated for dental appointments following your joint replacement surgery.
  10. Medication prescribed to treat osteoporosis: If you need an extraction and you do not tell the dentist about this medication, you could have serious problems with healing.

Many patients fail to fully inform their dental caregiver of their medical history, unknowingly putting themselves at risk for greater medical complications. If you choose to omit important information regarding your medical history and sign the form anyway, you are solely responsible for the outcome.

  1. Ogrendik, M. (2009). Oral bacteria found in RA synovial fluid: Oral bacteria directly associated with RA development. Modern Rheumatology. [Epub ahead of print]
  2. Katz, J. et al. (2009). Localization of P. gingivalis in preterm delivery placenta. Journal of Dental Research, 88(6): 575-78.
  3. Leon, R. et al. (2007). Detection of Porphyromonas gingivalis in the amniotic fluid in pregnant women with diagnosis of threatened premature labor. Journal of Periodontology, 78(7):1249-55.




We have come a long way in the development of toothpaste and mouthwash. Products today include the following ingredients:

  • Fluoride, which is proven to significantly reduce tooth decay
  • Hardeners to strengthen (recalcify) enamel softened by acid
  • Ingredients that help neutralize acid from foods and bacteria
  • Ingredients that interfere with acid metabolism in bacteria
  • Anti-bacterial agents


Fluoride is absorbed by the surface of the tooth, which includes the enamel covering the crown of your tooth and the surface of the root (cementum, see Parts of a Tooth), in the case of people with root exposure. Dental fillings called glass ionomers (see Fillings) also absorb fluoride and release it over time around the margins of the filling, helping to prevent future decay. Most over-the-counter toothpastes contain fluoride, and most dental professionals would recommend it for daily use.

Today we have a number of products with higher concentrations of fluoride intended for daily use by individuals with a high cavity rate and tooth sensitivity. When your dentist or hygienist recommends a more concentrated level of fluoride mouthwash or toothpaste, it is given as a prescription.  The prescription is used in addition to the topical application found in toothpaste and the fluoride applied by the hygienist during your dental appointment.

Fluoride in mouthwash or toothpaste is a topical form of fluoride use; systemic fluoride is incorporated into the developing tooth bud prior to its appearance in the mouth. Fluoride mouthwash and toothpastes are a topical form of fluoride, and repeated use will not harm the teeth in any way.

Tooth Hardening Biological Agents

Tooth hardening (recalcifying) mouthwash and toothpastes contain biological agents that help restore teeth that have softened from some form of acid. Acid attack (see Acid Erosion and Tooth Decay) can result from several sources:

  • The combination of bacteria, sugars, tooth structure and time
  • Acidic fruits, fruit juices, and other foods
  • The addition of lemon or lime to beverages
  • The phosphoric acid that is a primary ingredient in carbonated beverages (carbonated water, regular soda, and even diet soda). With repeated use, anything carbonated beverage will break down enamel.
  • Coffee, tea

Saliva contains natural ingredients which work to harden (recalcify) areas of your teeth softened (decalcified) by acid from bacteria or food. Problems occur when this process cannot keep up with consumption of acidic fruit, fruit juices, carbonated beverages, and/or poor oral hygiene. Regular use of the newly developed mouthwash and toothpastes can help keep your teeth stronger and healthier.


The addition of xylitol to toothpaste, mouthwash, and even gum has revolutionized the battle against tooth decay. Xylitol does not kill the bacteria, but it renders the bacteria 1) unable to metabolize sugars, therefore they cannot produce acid and 2) it interferes with the production of the glue-like substance that helps bacteria stick to teeth. Bacteria that are unable to stick to teeth cannot damage the tooth.

Antibacterial mouthwashes/toothpastes

Antibacterial products kill bacteria and create an environment where bacteria cannot reproduce and adhere to surfaces of teeth causing disease. Most of these mouthwashes are intended to treat gum disease (gingivitis and periodontal disease). Bacteria cannot be permanently eliminated; the goal is to help control and reduce the number of harmful bacteria. Swishing with mouthwash never replaces brushing and flossing. For those patients who won’t floss, a capful of antibacterial mouthwash added to the water in the waterpik reservoir, sprayed between the teeth is a good alternative.

Mouth-wetting mouthwashes/toothpastes

There are a number of medical disorders and medications that cause the mouth to produce less-than-desirable amounts of saliva. When the flow of saliva is decreased, the number of bacteria in the mouth increases. When the number of bacteria is increased, the incidence of dental disease increases as well.

A number prescription drugs – among them ones prescribed for high blood pressure, depression, anxiety, and heart disease – cause dry mouth (see Dry Mouth). Patients are often not fully informed about the problems that can occur when their mouth dries out. Saliva helps neutralize acid and supplies natural biological agents needed to harden and strengthen (recalicify) tooth enamel, so when saliva production decreases, these protections decrease as well. Decreased saliva permits bacterial numbers to increase which often leads to an increase in cavities and gum disease. Unless you have impeccable oral hygiene and have spent your early childhood in an area that supplied fluoridated water, the problem can be devastating.

Mouth-wetting mouthwashes and toothpastes help replace the reparative properties of natural saliva. They contain salivary enzymes, antibacterial properties, and agents that help neutralize substances made by bacteria that cause mouth odor.



Fluoride is controversial subject for many people. Many patients oppose the use of fluoride in any form. Fluoride is used in two different ways, 1) Systemic- taking in fluoride in drinking water whether it is added by the Public Health Department or occurs naturally 2) Topical- where it is applied directly on to the surface of the teeth. Research has shown however that drinking fluoridated water (.7-1.0 ppm) reduces tooth decay by up to 60%, with little proof of harmful side effects.

Systemic Fluoride

Systemic fluoride involves the introduction fluoride into the bloodstream through drinking water, at a level of seven tenths to one part per million – a level shown to significantly help prevent tooth decay. Fluoride joins with the enamel as it forms within the tooth bud (a sack within the jaw bone where the tooth grows) and helps prevent tooth decay by making the enamel more resistant to the acid made by bacteria.

If the water supply where you live does not contain fluoride, your doctor should supply the necessary concentration of fluoride, in a dietary supplement, for infants and toddlers. Once your child is old enough to start seeing a dentist, usually at about the age of two, your dentist or physician should monitor your child’s fluoride levels to prevent discoloration of enamel due to a higher than recommended fluoride intake (see Enamel Fluorosis).

Topical Fluoride

Topical fluoride is a gel, foam, or varnish applied to surface of the teeth. Use of topical fluoride should continue as long as you have teeth. It “soaks” into enamel, microscopic cracks and exposed root surfaces, further protecting against tooth decay. This is most important in later years, when many people experience a decline in saliva production. Topical fluoride does not cause enamel fluorosis once the enamel is fully formed.

From the Centers for Disease Control and Prevention:

There is some potential for developing enamel fluorosis when children consume fluoride during the time when teeth are forming under the gums (birth through age eight). Primary, or “baby,” teeth begin to develop at about the fourth month of gestation. Development of the “permanent” teeth begins at about the age of three to four months and continues to about 12-16 years of age. To help prevent both tooth decay and enamel fluorosis, the Centers for Disease Control and Prevention (CDC) recommends the following:

For parents:

Children younger than six have a poor swallowing reflex and tend to swallow much of the toothpaste on their brush, which can contribute to a child’s total fluoride intake. Therefore, as soon as the first tooth appears, begin cleaning by brushing without toothpaste with a small, soft-bristled toothbrush and plain water after each feeding. Begin using toothpaste with fluoride only when the child has reached two years of age, but only in pea-sized amounts. Use toothpaste with fluoride earlier if your child’s physician or dentist recommends it.

  • Do not brush your child’s teeth more than two times a day with fluoride toothpaste.
  • Apply no more than a pea-sized amount of toothpaste to the toothbrush.
  • Supervise your child’s tooth brushing, encouraging the child to spit out toothpaste rather than swallow it. Additional information is available online at the CDC.
  • If your child’s pediatrician or dentist prescribes a fluoride supplement (or a vitamin supplement that contains fluoride), ask him or her about any risk factors your child has for decay and the potential for enamel fluorosis. If you live in an area with fluoridated water, fluoride supplements are not needed.
  • You can use fluoridated water for preparing infant formula. However, if your baby is exclusively consuming infant formula reconstituted with fluoridated water, there is an increased potential for mild enamel fluorosis. Additional information can be found in a CDC fact sheet on infant formula @

For health professionals:

  • Fluoride supplements can be prescribed for children at high risk of tooth decay whose primary drinking water has no or a low fluoride concentration. For children under age eight, weigh the risk for decay without fluoride supplements, the decay prevention offered by supplements, and the potential for enamel fluorosis.
  • Counsel parents and caregivers on the use of fluoride toothpaste by young children, especially those younger than two years old. Fluoride toothpaste is a cost-effective way to reduce the occurrence of tooth decay. However, because they do not have a well- developed swallowing reflex and may like the taste of the toothpaste, young children often swallow a large portion of it from their brush.

The prescription dose of fluoride supplements should be consistent with the standards established by the American Dental Association, the American Academy of Pediatric Dentistry, and the American Academy of Pediatrics.

Fluoride Centers for Disease Control and Prevention. Recommendations for using fluoride to prevent and control dental caries in the United States. MMWR Recomm Rep. 2001;50 (RR-14):1–42. PMID 11521913. Lay summary: CDC, 2007-08-09.Up to 42% caries reduction

Fluoridation Basics
Water fluoridation prevents tooth decay mainly by providing teeth with frequent contact with low levels of fluoride throughout each day and throughout life. Even today, with other available sources of fluoride, studies show that water fluoridation reduces tooth decay by about 25 percent over a person’s lifetime.


Brushing and Flossing


Brushing is important, but flossing is 40% of cleaning your teeth.
Brushing is important, but flossing is 40% of cleaning your teeth.

Brushing and flossing are primary tools for preventing dental disease (see Gum Disease/Periodontal Disease) and maintaining optimal dental health.  Proper technique is necessary to protect teeth, gums and bone from disease.  Cleaning your teeth should be thought of much like cleaning your body in the shower or in a bath; or simply put, cleaning your mouth.



She's going to place the toothbrush at a 45 degree angle to the teeth.

She’s going to place the toothbrush at a 45 degree angle to the teeth.

Ineffective brushing, regardless of frequency, does not prevent dental disease. Unless you effectively remove bacteria, or Dental Plaque (also known as biofilm) every time you consume sugar, acid produced by plaque will dissolve teeth, resulting in tooth decay. In addition the dental plaque of gum disease will cause your own body to attack the gums and bone around your teeth resulting in the onset of gum disease (periodontal disease).

 Instructions for brushing with a manual toothbrush:

  1. The toothbrush should not be dragged back and forth over the tooth surfaces; the focus is to concentrate the brush bristles in specific areas long enough to lift and remove dental plaque (a gooey, sticky film of various layers of bacteria).
  2. You need to take your time: three to five minutes is ideal.
  3. Use a mirror and watch what you are doing until you become proficient.
  4. When brushing the upper back teeth on the cheek side, shift your jaw towards the side you are brushing, to make room for the toothbrush to reach half way around the back of the last tooth.  The other half can be reached when you brush the tongue side.
  5. Develop a system that reaches all areas of the teeth (e.g., start at the upper right and work your way around the upper arch to the left, then move to the inside until you finish on the upper  inside). Repeat the process on the lower teeth.
  6. Hold the brush at a 45-degree angle, bristles under the gum, with your brush handle parallel to the teeth you are cleaning, so the tip of the handle is on the opposite side of your nose.
  7. To effectively brush your front teeth on the inside, place the brush upright and parallel to the  teeth, push either the head or heel of the brush against the teeth and under the gums, and jiggle it in tiny movements. Overlap each area you are cleaning with the previous area to avoid missing  any teeth.
  8. Use a “jiggling” motion as circles tend to get too big, and rolling upward or downward does not clean under the gum line.
  9. Note: right handed people miss the upper right canine (eye tooth); left handed people miss the upper left canines (eye teeth).  When you start brushing on the right molar side (for right handed individuals) and begin to move toward the front of your mouth, turn your head right in order not to miss the right canine. The same holds true for those who are left handed.

Instructions for brushing with a mechanical (‘electric”) toothbrush:

Three points need to be understood about using a mechanical toothbrush versus a manual toothbrush.

  1. The mechanical vibration of this type of brush does all of the “jiggling” for you. The toothbrush is NOT dragged back and forth.
  2. It will clean your teeth better than a manual brush.
  3. The instructions above for overlapping and placement of the brush still need to be followed, as the toothbrush is only as effective as the technique used.


The proper technique for flossing.

The proper technique for flossing.

Flossing is perhaps the most misunderstood dental issue. If you are not flossing, bacteria are growing and living between your teeth and under your gums, causing odor, cavities (tooth decay), gum disease (periodontal disease), staining, and bleeding. Why? Though some cleansing foods – such as apples, salads, and meat – have the capability to remove and interrupt the activity of dental plaque; these foods do not get to the bacteria between your teeth and below the gum line. Flossing should be thought of as brushing between teeth as your toothbrush will not reach between them.

This patient is using a floss aid to clean between his teeth.

This patient is using a floss aid to clean between his teeth.

If you find flossing difficult, many different types of floss and flossing aids are available to assist in thoroughly cleaning between your teeth.  Brushing thoroughly, removes all the plaque your brush can reach, but skip flossing, and you miss 40% of tooth surfaces.

Instructions for flossing:

  1. Wrap the floss around your middle fingers; not your pointer fingers. You need your pointer  fingers to control and manipulate the floss.
  2. Seesaw the floss only to get it between your teeth.
  3. Wrap the floss around one of the two teeth you are between in a C shape and rub the side of the tooth two or three times, gently bumping into the gum tissue. Then wrap the adjacent tooth and do the same thing. Do not “seesaw” on the gum tissue.
  4. Remember to floss behind the last tooth in your mouth, as there is a good chance your brush did not reach there.
  5. Flossing is nothing more than cleaning between your teeth where the brush cannot reach. You are washing the sides of the teeth, much like you wash your arm or leg in the shower.

Cleaning Your Tongue

Cleaning your tongue: If you could see the surface of your tongue under a microscope, you would see a 'forest-like' structure where bacteria can live and cause bad breath.

Cleaning your tongue: If you could see the surface of your tongue under a microscope, you would see a ‘forest-like’ structure where bacteria can live and cause bad breath.

Bacterial laque (Dental Plaque) can also grow on the surface of your tongue. Your tongue is covered with tiny projections that can harbor bacterial growth and cause bad breath. Use either a toothbrush or a tongue scraper to remove or reduce bacteria. To be thorough, you should get as far back on the tongue as you can, which can induce some degree of gagging. Most patients develop tolerance to tongue brushing or scraping; though some cannot tolerate even the slightest touch of an object to the back of their tongue.

The Waterpik

Used properly, the waterpik will effectively kill and remove dental plaque under the gum line and between your teeth. As with any tool used to clean your teeth, without proper technique, bacteria will remain and thrive. There are many mouthwashes on the market designed to kill bacteria under the gum line and between teeth that can be used with the waterpik. One of the downsides of these products is the cost. Simply using 1 part bleach to 40-45 parts water in your waterpik will kill bacteria between your teeth.

Instructions for the use of a waterpik

  1. The spray of the waterpik should be pointed between the teeth on both the cheek side and the tongue side because the spray needs to travel between each tooth individually.
  2. The bleach solution is not stable, so it has to be mixed each time you use it.
  3. Although it is cheaper to use bleach, it is caustic and may eventually harm the waterpik, so a capful of antibacterial mouthwash mixed in the water reservoir may be preferable.

Other Tools and Cleaning Aids

There are many over the counter aids developed to help patients thoroughly clean their teeth and mouth.  Many of these items are called “stimulators”, which a misnomer; we’re not trying to stimulate the gum tissue, it will be healthy simply by removing bacteria. Therefore, even though the tool may be called a “stimulator” ask yourself: will it remove the bacteria stuck to my teeth?

Demonstrating one of the uses of the proxibrush.

Demonstrating one of the uses of the proxibrush.

One of the author’s favorite tools for cleaning under bridges and around brackets during treatment with braces is the proxibrush. A cylindrical or pine tree shaped little brush that slips between teeth and under and around tight spaces

Braces (Orthodontics)


A healthy smile during orthodontic treatment.

A healthy smile during orthodontic treatment.

Orthodontics is a specialty of dentistry that treats misalignment (malocclusion) due to crooked teeth and/or improper jaw positioning. Ortho- means “straight” and dontics means “teeth” or, in this case, “the straightening of teeth.”

Most patients think that getting “braces” is only about straight teeth and a nicer smile. Treatment with braces corrects the proper position of the teeth and protects against excessive wear and tear found when teeth are in the wrong position. So braces create not only a nicer smile, but better function and contribute to greater overall dental health.

Many general dentists practice orthodontics, though complicated cases are usually treated by a specialist who has received a master’s degree in orthodontics: 2-4 additional years of education beyond dental school, depending on the program.

How Does it Work and Why is it Important?

The straightening of your teeth can involve anything from simple, minor tooth movement to complicated tooth movement and surgery. Tooth movement takes place when force is applied to a tooth that breaks down bone in the direction of the movement and builds up bone on the other side of your tooth. Surgery can realign and improve the relationship of the upper and lower jaw.

The proper relationship between your upper and lower teeth helps determine how well you can chew food without excessive wear and tear to the teeth.  Since digestion of food begins in your mouth, proper alignment of your teeth plays an important role in overall health.

What are the different kinds of braces?

  1. Movement with a retainer: For minor tooth movement that will not affect any other teeth. This treatment is predominately done to make simple changes to one or two teeth.
  2. Brackets/arch wires: Used for varying lengths of time, depending on the treatment plan, brackets are made of plastic, metal or ceramic material and bonded to your teeth. The arch wire is attached to the brackets, with various bends in the wire to place directional forces on your teeth. This type of treatment can include a number of other devices to help with desired tooth movements or facial growth alteration. These devices include:
    A type of headgear used in treatment with braces.

    A type of headgear used in treatment with braces.

    • headgear: stops or slows the growth of the upper jaw
    • face mask or reverse pull headgear: pulls the upper jaw forward
    • expansion appliances: correct a “cross-bite” or expansion of the upper jaw
    • power chains: place directional force on your teeth
    • rubber bands: place directional force on your teeth
  3. Invisible braces: Consist of a series of clear trays that are worn continuously with the exception of when you clean your teeth and during meals. There are “buttons,” or bumps, of composite filling material that are bonded to various places on your teeth (and removed at the end of treatment) to help create the force needed to move your teeth when the trays are worn.
Young patient with colorful "bracket ties" that can be changed with the seasons, high school colors or holidays!

Young patient with colorful “bracket ties” that can be changed with the seasons, high school colors or holidays!

"Invisible" braces appear as clear plastic trays. There are removable plastic "bumps" placed on teeth and the tray places force on the "bumps" and moves the teeth in the desired direction.

“Invisible” braces appear as clear plastic trays. There are removable plastic “bumps” placed on teeth and the tray places force on the “bumps” and moves the teeth in the desired direction.

Conventional "braces". Note the pink, healthy gum tissue, indicating great home care.

Conventional “braces”. Note the pink, healthy gum tissue, indicating great home care.

The treatments above can also involve a process called “stripping,” a process of creating space where your teeth are crowded. It is done by removing a fraction of enamel from both sides of your tooth or teeth to create space for aligning your teeth. This process is dependent on the thickness of your enamel, which is different for everyone.

How do you know what kind of treatment is necessary?

Patients who are referred to an orthodontic office often have an initial visit, as a type of consultation that allows both the patient and the orthodontist to discuss expectations, risks, benefits, and alternatives. Most orthodontists do not charge for this visit.

Once a patient has made the decision to move forward with treatment, records are gathered and a definitive treatment plan is established. These records include:

  • x-rays of various types; treatment for children involves x-rays to determine growth patterns and adults to measure the relationship between the upper and lower jaws.
  • tooth models/measurements
  • NOTE: all decay and gum disease needs to be treated prior to beginning orthodontic treatment.

What are the different kinds of orthodontic treatment?

The different courses of treatment include the following:

  • Minor tooth movement
  • Full orthodontic treatment
  • Full orthodontic treatment with jaw surgery
  • Initial retention  phase: Once orthodontic treatment is complete and brackets are removed, there is a stage when the movement must be retained while the bone and ligaments around the teeth return to a stable state. The continuous use (except while eating, brushing or flossing) reduces the chance of relapse or tooth movement back to an undesirable position. This phase can last 2-3 years, depending on the orthodontist’s recommendations.
  • Long-term retention: Today the retention  is usually a permanent situation.  After the initial phase,  patients are now encouraged to wear their retainer at night indefinitely.

Teeth move when any of a variety of devices are used to exert force on the teeth. One of the newer improvements to orthodontic treatment is the use of a computerized robot to bend the arch wires. When the arch wires are bent by a human, the desired movement occurs, but that movement is usually accompanied by an additional, undesired movement that then has to be corrected. When arch wires are bent by a computer, undesirable movement is diminished and orthodontic treatment is significantly shortened.

What is jaw surgery and why is it necessary?

Jaw surgery may be required when the upper and lower jaw develop into a less-than-desirable alignment.

For example: An 18-year-old female with a history of a cross-bite in her baby tooth stage (when the individual bites together the back lower teeth are outside the upper teeth; the proper relationship is the lower teeth tucked inside the upper teeth) on only one side of her mouth. Because this was not corrected in childhood, the side of her jaw with the cross-bite grew longer than the opposite side. Furthermore, she was a tongue thruster (when she swallowed, she protruded her tongue out between her teeth) and her upper teeth touched her lower teeth on two back teeth only; none of her other teeth touched when she bit together.

This patient required full mouth brackets/braces for 2.5 years, with her treatment finalized by both upper and lower jaw surgery. The surgical team tipped her upper jaw down in front and cut a section through her lower jaw and slid it back so that her jaw would be the same length from the middle of her chin back to her earlobes, right to left.

Success or failure?

Some patients prefer clear plastic brackets instead of metal brackets because the "braces" are less noticeable.

Some patients prefer clear plastic brackets instead of metal brackets because the “braces” are less noticeable.

Probably the largest determination of success or failure of orthodontic treatment is patient cooperation. Do the patients make all of their scheduled appointments? Is their at home care well maintained? Are they wearing their headgear and/or rubber bands? Are they watching what they eat to avoid breaking brackets and arch wires? Are they seeing their regular dentist to prevent tooth decay and gum disease?

These are the largest obstacles to the positive outcome of orthodontics. Commitment and cooperation are the keys to success in creating a beautiful smile and appropriate function through orthodontic treatment!