Q: I am caught in the middle of 2 opinions from 2 different orthodontist. One wants to take out 4 teeth and you recommended treatment without taking out any teeth. I have been going to my dentist for 9 years and I really trust his opinion. Does asking him for advise on which way to go put him in a bind with the 2 orthodontists?

A: No. Your dentist will respect your right to self-determination. He realizes that you have the responsibility to evaluate the factors and options presented to you. Your dentist also has an obligation to promote your welfare and communicate truthfully to you. Your dentist can be used to help sort out the issues involving extractions versus no extractions. While both treatments should be considered acceptable, you must choose the option that you feel is best for you.

Q: I called another orthodontist to see if he uses the Damon System of Braces. His receptionist said they use a "Damon like" bracket and all "self ligating" brackets are the same just different names. Are they all the same?

A: No. His receptionist is misinformed. The Damon System of Braces is a system not a bracket. It is a system that requires extensive training to achieve maximum performance. Damon users have a set protocol and a research and development team that provides training on new developments every year. The "Damon like' are just self ligating braces that use the same methods as traditional braces. They require the same amount of extractions and their results are the same as traditional braces. Ask about the number of patients treated. Ask for before and after photos of patients that have a problem like you have. Please make an informed decision. If you visit his office and then my office, you will find out that his receptionist's statement is inaccurate.

Q: My son has been in treatment since age 12 with another orthodontist. He is now 16 and his orthodontist now tells me my son needs surgery to fix an under bite. I came to you for a 2nd opinion. What's going on?

A: It is called "unfavorable growth" and every orthodontist gets burned by it one time or another. When treating patients with borderline skeletal problems, like an over bite or under bite, we hope that growth will either help us or at least not make the problem worse. Your son hit his puberty growth spurt and the skeletal problem got significantly worse. Bad enough that surgery will be required to obtain an acceptable result.

Q: You just saw my cousin for a bad over bite. You recommended surgery to make her lower jaw longer. She told me that the surgeon was going to break her jaw and screw it back together. Really?

A: No, no, no. That is not what I told her. Using actual pictures that the surgeon was going to very accurately make a cut in the bone to separate to tooth part of the bone from the part of the bone that is connected to the skull. The surgeon would then slide the bone the correct amount to make it longer and place three titanium screws to reattach the two pieces together. "Breaking the bone" sounds uncontrolled like he is going to punch her or use a hammer. It is an extremely well controlled and precise procedure.

Q: When I smile I kind of look like a horse. I'm really gummy. Like over an half inch of gum. How do I fix it?

A: You have "vertical maxillary excess". It is usually caused by the upper jaw growing too far down. The problem is rarely because you have a short lip. Braces and a surgical procedure called a "Lefort I Impaction" is the plan of treatment. You will be in braces for about a year and then have the surgery. The surgeon will cut your upper jaw bone under the lip (all inside the mouth) from last tooth to last tooth. Yes, you are under general anesthesia. He will remove some of the bone too make it shorter and reattach it with thin metal plates. Call me to look at pictures and diagrams. The consult is free.

A: At my office the answer would be “no”. I use only the Damon System of Braces or Invisalign Aligners. Damon Braces are much smaller than most traditional braces. It is rare that I ever use a ring like band for your back teeth. Damon Braces use a passive self ligating brace/wire interface. This means I do not tighten your braces. Both Damon and Invisalign use low force/low friction mechanics to move your teeth. Pain is greatly diminished by using low force systems. I feel the differences in technology between the Damon System of Braces or Invisalign Aligners and traditional braces is as great as the differences between a 1980's cassette player and a 2008 IPOD.

Q: I am getting more dates now that my teeth are straight. I say it is because people notice my smile. My mom says it is because I have more self confidence. Who is right?

A: Come on now, mom is always right. No, you both are. There exist several well done studies showing a significant increase in one's perception of his/her self confidence or self esteem when he/she goes from crooked teeth to straight teeth. The research gets a bit fuzzy when it attempts to distinguish whether a person is attracted to you because you look better or if it is because of your improved self confidence giving you better "game" (first impression). It is probably a combination of both.

Q: My son got a letter from you on his last visit. It informed me that he needed to improve on his brushing or he would get decalcification. What is decalcification?

A: If you don't brush well the bacteria in your mouth forms colonies (similar to condo living) and this is called plaque. The bacteria flush toxins out of their system (like going to the bathroom, yuk) and this runs all over your teeth and starts to demineralize your enamel. If enough enamel is demineralized you first get pretty permanent white spots (decalcification) and then cavities. All patients of mine are encouraged to use Arm and Hammer (the baking soda folks) Age Defying Toothpaste to help get rid of white spots. Also all of my patients are required to have a dental exam and cleaning at their dentist's office or my office every 6 months.

Q: I am 17 years old and I want Invisalign to straighten my teeth. My dentist told me my teeth were too crooked for Invisalign. He sent me to some other orthodontist who told me the same thing. My friend has teeth as crooked as mine and he got Invisalign from you. Will you do Invisalign where others won't?

A: Yes. I have worked hard with the Invisalign folks to develop a greater range of specialty skills to handle the more complex problems using Invisalign. I encourage you to come to my office for a free consultation. Invisalign is continuing to increase in demand. The new Teen Invisalign is becoming more and more a clear alternative for teens age 14-19 who want straight teeth without braces. Call 505-564-9000 today for your free consultation.

Q: My teenager has crooked teeth but wants Invisalign rather than braces. What do you recommend?

A: If the crowding or spacing is mild to moderate then Invisalign will achieve a great result. Unlike braces, Invisalign aligners can be taken out. The new "Teen" Invisalign has a color indicator on the aligner to show that the aligner is being worn the recommended 22 hrs per day. The new "Teen" Invisalign also allows for up to 6 replacement aligners at no extra charge for lost aligners. These new features help with the lack of wear and loss problems teen Invisalign patients tend to experience more than adult Invisalign patients. Call today at 505-564-9000 for your teen's free, no obligation consultation.

Q: I have a middle molar tooth with a huge hole in it. I been told it needs a root canal. I don't want a root canal. What are my other options?

A: There are two. If you have straight teeth you can have the tooth pulled and titanium implant (screw) place into the healed bone. The implant then has a cap cemented on to it. The cost will be around $3,500 for the implant and cap (crown). If your teeth need straightening, then get the tooth pulled and I can both straighten your teeth and close the space from the pulled tooth. The cost will be $3,000-$5,000 depending how crooked your teeth are. Either myself or your dentis can help you decide what is best for you.

Q: How do you decide when braces come off?

A: At the start of treatment I provide patients/parents a time range of when I think treatment will be done. My estimate of time is based on experience of treating almost 14,000 patients over the past 16 years. Active treatment (braces) is finished when myself, the patient and when the patient is under 18, the parent all agree about liking the result (outcome). If one of us expresses that something needs to be worked on, a discussion takes place and we proceed with an agreed upon course of action. Braces do not come off until we all agree that we have done as much as reasonably possibly to accomplish the best outcome.

Q: My son just finished treatment with you. He has a great looking smile and I appreciate the fact that you placed a fixed, wired retainer on the back of his teeth as well as giving him a clear, removable retainer. Do I have to be concerned that the fixed, wired retainer will cause gum problems?

A: Yes. At the delivery of the fixed retainer one of my staff went over cleaning under the retainer with floss. A water pic is also very useful to clean under and around the fixed retainer. A recent study showed that it is possible to maintain good oral hygiene and periodontal health while wearing a fixed retainer. Your dentist or dental hygienist needs to exercise some caution when cleaning your son's teeth so he or she doesn't make the retainer come loose. If the retainer comes loose during cleaning, he or she should be able to easily glue it back to the tooth.

Q: I think I have a snoring problem. My wife says I could have a serious sleep disorder. Should I share her concern?

A: Maybe. Snoring is caused by the vibration of tissues in the posterior oropharynx during sleep. It's a social but not a medical problem. Obstructive sleep apnea (OSA) is a sleep disorder that can be a life threatening problem. It is a cessation of breathing for 10 seconds or more over and over again while sleeping. OSA is caused by a neurological or obstructive problem. With OSA you have a loud snorting sound caused by your body creating negative pressure as it responds to the cessation of breathing. Sleep apnea is positively confirmed by a test called a polysomnogram.