Sutter Orthodontics: 1101 W Tokay Street, Ste. 3, Lodi, California 95242 • 209-334-4111

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Orthodontist Robert Sutter Lodi CA

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So, we can put a probe or two on Mars, our smart-phones have enough technology to launch the space shuttle (I just made that up :) ) and cars can now park themselves - shirley, we don't need headgear anymore!!!  Well, umm... yes we do.

You see, for all the advances we've made in our lives, there are still some time tested things that work very well!  Old fashioned, yes, but effective. 

Hedgear is used to decrease an overjet (how far your upper front teeth stick out over your lower teeth) and also help bring the upper and lower jaws in better position with each other.  This is a slow process that works best when a child is going through their growth spurt.  However, the age at which this happens is usually when your chances of good cooperation begin to decrease.  Thats why its often offered during the pre-teen years.

No one likes to wear it, including yours truly, and thats why in our practice we do not ask the patient to wear to school or in public.  (I had to wear mine to school and I'm still mad about it 35 years later - yes I have issues... want to hear about it??)  I digress, the reason headgear works so well compared to rubber bands, springs and removable appliances is that it uses something outside the mouth to make the changes in overjet.  That is, it pulls from the neck and/or the back of the head.  The three options mentioned previously use the lower jaw and teeth.  This tips the lower front teeth forward and flares them.  Not an ideal choice if you don't want this to happen.  Hygienically, the headgear is also a great option. 

Anyway, just a few thought about questions we get from time to time in the office!  Technology is great and used whenever possible, but its ok to occasionally go "Old School".

Off to watch some shows I taped on my VCR - just kidding!

Dr. Rob

P.S. Shelly says hello!

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I'm back!  Admit it - you missed me, and these riviting ongoing fireside chats :)

 

OK, when I last left you, we were talking about tooth trauma from mild to severe.  But what if the tooth is completely knocked out of the mouth??  (I guess this would be beyond severe???)  This occurence is called AVULSION.  Three factors are important to consider:

      1) Is the root of the tooth fully developed or not ( better chance of survival if not fully formed).

      2) How long is the tooth out of the mouth.  If the tooth can be replaced within 30 minutes or less of the injury, you have a better chance of the tooth surviving.

      3) Fixation - You want the Orthodontist to use a flexible wire - NOT anything rigid!  Flexibility allows the soft tissue to recover better.

So, your watching your kid play a sport and they take a viscious elbow to the face and their tooth is literally on the grass or basketball court - what do you do? (Insert a  musical "DA-DUH" for dramatic effect).  You want the tooth back in its "socket" as quickly as possible.  Hold the tooth by the crown (the white part we all see when you smile) and if dirty, DON"T RUB THE ROOT but rinse with water or milk (yes, it really does a body good in more ways than one).  Try to gently place the tooth back in the mouth.  If you can't, get to the dentist/oral surgeon as fast as possible.  While in transit, store the tooth in MILK.  No milk,  place it under the kids tongue or between their cheek and gums ( If your worried the kid will swallow the tooth or just won't do it - see last resort).  Last resort, parents, hold it in YOUR MOUTH!  (I'm not kidding!!).

Antibiotics and a Tetanus booster will most likely be needed!

Remember, time is of the essence.  You want the tooth back in place as quickly as possible.  Root canal treatment may be needed and ultimately the tooth could be lost, but many are saved if treatment happens fast!

Hopefully you won't ever have to face this scenario, but if you do, I hope this info helps!  Now, go watch your kids play and enjoy the day!

Dr. Sutter

 

 

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So, your kid has braces and also participates in 17 different sports at one time.  You, as the ever faithful and loving parents, travel all around cheering them on, spending endless amounts of $$ on club & coaches fees, uniforms, food,  hotels etc.   Thing are going well, you can already imagine the future endorsements and international travel when suddenly a soccer ball, flailing elbow, wild pitch or 300 lb. lineman gets up close and personal with your kids teeth!   Ok, Ok, maybe it isn't that dramatic but what should you do if your child experiences trauma??  

 Lets take this from mild to severe:

Mild:  Kid gets hit, no bleeding and it doesn't appear any braces are loose or wires bent.  Safest bet is to call your orthodontist and let them know what happened.  They may suggest just taking a look or have you call them if you notice something out of the ordinary.  May be overkill but an individual x-ray from your dentist may be a good idea to have a baseline to help monitor.

Medium: Kid gets hit.  Braces are off, bleeding of lips and gums, wires are bent.  Call your Orthodontist if your child seems to be handeling the pain/trauma well.   If your child is in a fair amount of pain, he/she may need to get numb first before the orthodontist can re-bond the braces and place a new wire.  Call your DENTIST, then your orthodontist.  Your dentist has the ability to take the proper x-rays to evaluate the teeth and bone.  They can get them numb and make things more comfortable for the patient.  

Severe:  Kid gets hit, braces are off, wires bent, teeth may be physically pushed out of alignment, extruded or intruded.  Blood is everywhere.  First, remain as calm as possible, rinse the area with water (once the blood is washed off it usually looks better).  Call your dentist, They may refer you to an oral surgeon.  They will get you numb, reposition the teeth as best as possible and clean things up.  Once this is done they should contact the orthodontist and he/she may bond a flexible wire with or without braces to help stabelize the teeth until enough healing has occured and they can replace the braces and continue treatment. X-rays may be taken initially, then at 2, 6 and 12 months to monitor healing.  

After teeth are traumatized, and healing occurs, the tooth can still die.  This doesn't mean you'll lose the tooth, but root canal treatment may be needed along with bleaching to make it look more "normal".  Another outcome that can occur is resorption of the roots of the teeth.  This process is painless and is monitored by x-rays.  This can lead to eventual loss of the tooth.  Root canal treatment with certain medicaments can help in certain cases, but this is why monitoring with x-rays is so important.

What if a tooth is completely knocked out?  Tune in next time for Trauma - Part 2!!

Have a good one!

Dr. Rob

 

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First off, Happy (very belated) New Year!!!

 

Time to get back into the swing of things as we delve into yet another scintillating orthodontic topic :)

I often see kids at an early age with various types of malocclusions (fancy name for crooked teeth/bite).  Sometimes, although the teeth are crooked, the bite itself isn't in that bad of shape.  The question I get asked is, "do they have to have treatment now or can we wait?"  There are two answers to that question!

     1:  No, you can wait, let the "mess" get messier and treat once all the permanent teeth are in.  Treatment in one " Phase".  In a perfect world, this is how I'd like to treat everyone. 

     2: Yes, we can begin treatment now ( First Phase) but understand the reasoning for the treatment.  Usually in these cases treatment begns for cosmetic/psychological reasons.  Is your child being teased at school and/or has told you that they are embarrased with how their smile looks?  Are you, the parent, bothered by how your child's bite looks?  If the answer is yes to either or both questions, then this is reason enough to begin treatment.

Remember, I'm talking about bites where the jaws fit fairly well but the teeth are somewhat crooked and space isn't a big issue.  There are many reasons for early treatment ( we've covered in past blogs).  Also, there is usually a Second Phase of treatment needed once all the permanent teeth have erupted.

 

I hope that helps clear-up some questions I've had recently.  If not, please let me know and I'll give it another try.  Also, if you have any questions I haven't addressed, please let me know!!

 

Till next time,

Dr. Sutter 

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I had a mom ask me this question the other day while examining a new patient.  Truth is, the majority of the time it really doesn't affect the orthodontic treatment needed.  However, there are times when a kid goes through their growth spurt and it occurs assymetrically ( lower jaw grows more to the right or left).  Sometimes, if there is a genetic component involved (Uncle Jed's underbite for example), its important to know that ahead of time so that you can be on alert during treatment if you see it begin to express itself.  It can affect your treatment plan from the start or cause you to change it during treatment.

Girls are usually easier to deal with than boys on this issue.  On average, most (not all) girls are done growing by 15.  Boys on the other hand can easilly grow into their 20's - yours truly included :).  If the growth is excessive in any direction, IT TAKES THE TEETH WITH THEM.  When this occurs, teeeth that used to fit together well, suddenly may not.  Keep in mind that fit is different than alignment.  Your teeth may be perfectly straight, but still not fit together if the jaws are malaligned enough.  Think of it this way, if your building a house and the foundation begins to shift, it will be harder to keep things "square" the more the foundation moves.

So there you have it, growth can affect the quality of treatment outcome.  There are many other factors that can affect treatment as well ( cooperation, habits, hygiene etc) but growth is something only God can control. 

I hope you all have a Merry Christmas and a happy New Year!

Keep smiling!

 Dr. Rob

P.S. (Note the alternating Christmas colors - cool huh!)

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Well, here we are at the start of another holiday season!  You'll be tempted with Halloween treats galore, grandma's double chewie, caramel fudge delites, peanut brittle, taffy as far as you can stretch it and molasses chews and cookies! 

      What's a kid in braces to do?????

Take heart, all is not lost!  FIrst off, remember there are some things that you should avoid regardless of what time of year it is.  Sticky, chewie stuff is bad for the health of your teeth and hard, crunchy candy is great for breaking braces - do your best to avoid these :)  However, if you do induldge in these "Bad Boys" chew them carefully and slowly. 

Things like Cake, Pies and soft cookies are easier on you braces but still provide plenty of food for all the bacteria in your mouth to digest and eat a hole in your teeth!

Toothbrush & toothpaste, floss, fluoride and water are all effective forces against the simple pleasures of life, especially around the holidays!  The key to remember is to use them as soon as possible after indulging!  The quicker you remove the food from in and around your braces, the less chance you have of problems arising.

In Summary:  1) Life is too short to avoid all the goodies but be picky and careful about what you eat! 

              2) ABOVE ALL ELSE, good oral hygiene done IMMEDIATELY or as soon as possible after eating provides the best defense.

              3)  Pumpkin Pie won't damage braces and is quite possibly the world's most perfect treat... but still brush and floss! ( Sorry, that was my inner monologue talking).

Enjoy the Holidays ( and Pie )!

Dr. Rob

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We hear this a lot this time of year.  Sometimes its not kids going off to college, but famillies move and they need to know what to do.  The answer is the same - you can have your treatment transferred to another orthodontist that is within the region of where you're moving or going to school.  We have "orthodontic directories of the world"  so whether its the island of Cyprus or Weed, California, we can usually find someone near you ( we're that good :) ).

Usually your orthodontist will fill out a standardized "transfer form" and then send copies of your records (x-rays, photos and models of the teeth) to the new guy / gal.  A lot of time there is a fee for duplicating & mailing records.  The orthodontist will usually take new, updated photos, study models and x-rays so they can document where you are at in your treatment when they take over. ( Unless the transfered records are of good quality and current then they may not take the new records).

From there its up to the new orthodontist to let you know cost, treatmnet time remaining and if they are going to continue with the original doctors treatment plan or change gears and go with their own.  There is an old saying in orthodontics: You can show the same case to two orthodontists and get three ways to treat it.  So, if the new guy does something different, it doesn"t mean its wrong or the original guy did something bad.  Everyone has their own philosophy and way of treating teeth.  If you feel uncomfortable, then its always best to get a second or third opinion.

Lastly, in most cases, it ends up costing you more money.  Its hard to take over someone elses treatment and requires more work on the part of the new orthodontist to assess what has been done and how to procede from there to finish the case.  Also, if your moving from somewhere in Arkansas to Beverly Hills, you'll usually have to pay more money ( but if you're Jed Clampet then no worries - for those of you a lot younger than me or not addicted to classic TV that was a nod to the Beverly Hillbillies show). 

Hope you have a great Labor Day - Peace out!

Dr. Rob 

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Great Question!  I've been asked this and many other things lately, so its time for:  Ortho Basics 101!

Chain:  Also called a "power" chain or "pain" chain.  You know those colored elastics we place on each brace to hold the wire, well imagine a bunch of them connected to form a "chain".  Its used to close spaces, rotate or retract teeth and can be of varying lengths, usually one "link" per tooth.

 

Elastics:  Also called rubber bands (or "Donuts" in our office - we relate everything to food).  They are used to improve the positioning of the teeth and come in clear or a variety of colors.  Often used to help improve overjets (what the general public often refers to an overbite).  They can also be used to "sock" teeth into position (like a set of gears), close open bites (pulling teet in opposite jaws toward each other so they overlap vertically) or improve underbites ( when the lower teeth stick out in front of the upper teeth).

 

Band:  The brace that usually goes on a molar.  Its a metal ring that is cemented to the tooth.  The wire is placed into tubes located on the band. You can place a band on a tooth other than a molar.

Bracket:  The brace that is usually cemented to the teeth in front of the molar.  You can place a bracket on a molar.

Spacer: Also called a separator.  Its used to make space around a molar befor placing the band on the tooth.

Springs: Some can be used to open or close spaces and it literally looks like a tiny "Sllinky" thats placed on the wire between teeth.  Other types of springs can be made of wire and used to upright tipped molars or erupt (pull-into alignment) impacted teeth (teeth that are "stuck" and can't come into alignment on their own).

Well there you have it!  I hope you we're paying attention, because there will be a quiz later :)

Peace out!

Dr. Sutter

 

 

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Hello ortho fans in and about San Joaquin county!

I've been asked a few times ilately  if a patient who was treated with braces could have the invisalign retainers.  The answer is YES!  Invisalign calls there retainers Vivera ( why I don't know) and is available to anyone.  They can even be made to fit over a bonded "permanent" wire or in place of the wire.  This is a great option if the scoundrel, I mean, patient breaks it often and/or can't keep it clean.  More and more patients are going this route because thay are more comfortable and less invasive than the standard removable retainers.  Also, they can be used a bleaching tray ( so you can maintain that "whiter and brighter than the glory of God" smile that so many of you want... you know who you are!!!).

Of course the standard retainers are still available in a variety of colors with the option of a cute picture placed in the middle of the roof of your mouth!  Here is a thought, how about a picture of your favorite orthodontist pointing his finger at you with the caption "put this back in your mouth!" embedded in the retainer.  Sorry, just thinking out loud - a guy can dream can't he?

Until the next fireside chat...

Dr. Sutter

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Well I'm finally back!  Sorry for the long delay since the last post (new website{hope you like it - we do!}/technical difficulties/trouble in the Middle-East,  yada, yada yada...)

Today's topic Invisalign vs. Braces:

For most "routine" cases, usually there isn't a huge advantage of one vs. the other as far as aligning the teeth.  There are certain issues where braces provide a better mechanical advantage over invisalign.  For instance, impacted teeth can be difficult to "bring into the mouth" but once in, alignment can occur either  way.  Closing extraction spaces was once a huge advantage for braces.  However, Invisalign has made great progress toward narrowing this difference.  Advanced aligner material and improved attachments (tooth colored "bumps" put on your teeth to help hold the aligners in place and move the teeth in the desired direction) are two ways that  make closing extraction spaces more predictable and efficient.  Very deep bites ( when the front top teeth completely cover the bottom lower teeth ) can also be a bit of a disadvantage (although not a complete one) for invisalign, since invisalign tends to deepen a bite even more.

Having said all that, here are advantages of Invisalign over braces:

1: Hygiene issues are practically non-existent.  You take them out to eat, brush AND floss!

2: They are more comfortable than braces.

3: You only wear them 20hrs./ day (Four hours a day with nothing in your mouth - for those mathamatically challenged :))

4: Far fewer eating restrictions!!

5: They're clear ( colors on braces are SOOOOO 90's)

6: Teen cases allow you to lose 6 aligners before they start charging to replace them, plus they have a tracking system so parents can monitor if the kid is really wearing them.

7: You can use the trays to bleach, even with the attachments (tooth colored bumps) in place.

Downside to Invisalign:  You have to wear them!!  However, see points #3 and especially #6!

What about cost you ask??

In many cases, the cost is the same as braces, however the down payment is usually more (Invisalign requires a larger up-front cost than braces - gotta love technology!)  On more difficult cases (complex tooth movements, combined treatment with braces, the cost is usually more but its assessed on a case by case basis.  BTW: Cost of braces/invisalign is based on the difficulty of the case, never on the estimated time!  - I digress. Insurance can also be used the same for braces or invislign.

Bottom line: Both work.  If either could be used on you, I'd say invisalign wins because of the better hygiene.  Remember, orthodontists were dentists first!

Keep smiling!

Dr. Sutter  

 

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Welcome to the blog of Dr  Robert Sutter in Lodi CA

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How often should I brush and floss???

With the Holiday season in full swing and all those "goodies" being served, its time to revisit the fundamentals - you need to brush AND floss after every meal, especially with braces!  The toothbrush and dental floss, the two go together like salt & pepper, peanut butter & jelly, cuff & link ( you get the idea).  Think of mopping your kitchen floor as brushing, and flossing like cleaning under the table and around the edges.  YOU NEED TO DO BOTH!  Food that doesn't get cleaned (around your braces and teeth) feeds the bacteria we all have in our mouth.  The bacteria produce acid and this begins to eat away at the enamel causing decalcification (white spots) and cavities.

Along with, AND NOT IN PLACE OF, brushing and flossing, anti bacterial rinses like Listerine or Crest Pro Health can help as well.  We also encourage a fluoride rinse to help strengthen enamel from the acid attack.  Consider one in the AM and one before bed (always consult your dentist/orthodontist first).  A "Water-Pik" type of appliance is a helpful adjunct as well.

By the way, you don't need to leave on vacation to use your travel tooth brush!  Take it to school ( if they will allow it) and brush after snacks and lunch.  Even if you don't have toothpaste, brushing with water is better than nothing.

I'm asked a lot about drinking carbonated beverages (soda pop).  Here is my opinion.  Even though placing a tooth in a glass of Coca-Cola for 24 hours will dissolve it, I'm not too concerned - here's why:  1: No one I know holds the cola in their mouth for that long ( I've tried it, it hurts too much).   2: The cola is in you mouth for probably a second or less, with your saliva helping buffer the acids and decrease the sugars.  If your still hesitant, try a water "chaser" after the cola.  It too will help rinse out the sugars & acid.  Obviously, brushing/flossing after helps tremendously as well.

In my opinion, sticky, chewy candy (Gummy Bears, Taffy, Sugar Babies and aunt Ethel's "Carmellows") and even things like raisins, can do more harm because of their high sugar content and ability to "hang around" long after being eaten .  If not cleaned properly, they sit in the grooves of braces and teeth and provide an ongoing food source for bacteria.

So lets review:  I can't overemphasize the importance of brushing and flossing after every meal especially when in braces.  I did NOT say you can tell your parents you're free to drink soda anytime you want.  If your parents don't want you to, then their rules stand.  I only felt that sticky, chewy foods pose a greater threat to your teeth.  For the sake of family unity though, go ahead and have one of aunt Ethel's "carmellows".  Just brush and floss after.

Adios!
Dr. Rob

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How much do I need to wear my retainer???

Its very common at the end of treatment for patients/parents to ask how long they should wear their retainer.  The truth is there is no "one size fits all" answer.  Orthodontists have researched this for years and the bottom line is there is too much variability among humans to give a single answer.  However, there are some general guidelines we follow:

For the first 3 to 6 months after the braces come off, we suggest you try to wear your retainer as much as possible (taking them out to eat, play sports, sing etc.).  After that, we assess how well the teeth are staying aligned and make a recommendation based on what we see plus feedback from the patient.  Usually, we'll suggest nighttime wear with the option to cut back slowly to "as little as needed".  We always tell the patient that if the retainer is beginning to fit tighter and/or the teeth are visibly moving you need to return to full time wear until it fits passively.    

Retainer wear is for life!  Your teeth are not posts in cement.  Remember there are three things in life you can be sure of: Death, Taxes, and Relapse – teeth moving after treatment.  The American Association of Orthodontics considers a well retained result as having LOST up to 1/3 of the alignment 10 years after you had the braces removed.

Cheer up!  There is a bright side.  We have really cool retainer designs & colors to amaze and delight your friends at parties!!  Plus, there are bonded wire retainers (I'll discuss the pros/cons at a later date) and clear Invisalign retainers as well.

Rock on, my peeps!

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How much longer until I get my braces off????

Ah yes, the immortal question to orthodontists around the world!  The truth is  - it depends!


Is this a first phase (early treatment while baby teeth are still present), second phase (braces on permanent teeth), extraction case, surgical case.  Have you worn your headgear or rubber bands as you should (come on, be honest)??  Have you missed any appointments or broken any braces?  How is your hygiene??  Is it a Tuesday and high tide?? (Sorry, just seeing if your awake :)).


Bottom line: All of that matters!  The last study I read on this subject stated the average case in the united states treats out in just under two and a half years.  My unofficial survey says the general public thinks that two years is the norm - sorry but that's not the case.  In general, if you have impacted (stuck teeth), extracted or slow erupting teeth, it will take longer.  Large overbites and underbites (think Jay Leno chin) tend to take longer as well.  If the wires need to be removed because your gums have swelled up too much, then it takes time to have the hygiene improve and realign the teeth to where they were prior to wire removal.  If we haven't seen you in six months - well, I hope thats self explanatory.  


Know this, my orthodontic minions!  I want them off for you as soon as possible.  However, I want to treat you to the best of my ability.  At the risk of disappointing you sometimes, I will continue treatment until I or your parents (they have the right to say "no mas!" and sign a release form) say we are done.  Just remember - its because we care :) !


Check back later for another exciting topic - Dr. Sutter

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August/September Band Color-

LIGHT BLUE 
 
If you ask for light blue as your braces band color, you will be entered in a raffle to win a $20 gift card to In ‘N’ Out!
If you have Invisalign, on your next visit to the office during August and September, wear something light blue and you can be entered in the raffle as well!
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Hey everybody!!! We have a SPECIAL SUMMER SUPER SAVER CONTEST going June 27th through September 5, 2011. Check the below comment and come into or call the practice for even more details :)

Sutter Ortho if you refer a person, and they start treatment you will be entered into our contest!
Check in at our Practice for even more of these details :)
This contest goes from June 27, 2011 through Monday, September 5, 2011.

PLEASE BE SURE TO INFORM US VIA EMAIL OR IN PERSON SO THAT WE CAN KEEP AN ACCURATE ACCOUNT OF YOUR REFERRALS THAT START TREATMENT!

 

 

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