Orthodontics
Orthodontic treatment is optimal when timed with your child’s dental and skeletal development. Learn more!
Braces are dental tools that help correct problems with your teeth, like crowding, crooked teeth, or teeth that are out of alignment.
Invisalign® clear aligners Use the Most Advanced Clear Aligner System. Learn More
Some orthodontic conditions are more easily addressed when detected early, and is typically treated in two phases. Learn more.
What to expect before and after, FAQs and useful tips for care & emergencies.
Types of appointments and what to expect, including an introductory appointment, diagnostic, appliance placement, and regular checkups.
The American Association of Orthodontists (AAO) recommends children get their first check-up with an AAO orthodontist either at the first recognition of an orthodontic problem or at age 7.
Around that age, children have a mix of baby (primary) and permanent teeth. An examination at this age gives the child orthodontist a wealth of information. If a problem exists, or if one is developing, your orthodontist is able to advise you on which treatment is recommended, when it should begin, and estimate its length.
If your child is younger than 7, and you notice something that appears “off,” it’s not necessary to wait until your child turns 7 or until you get a recommendation from your dentist. You should take your child to an orthodontist the moment you notice an issue, regardless of age.
At Hoboken Smile Specialists, our Pediatric team is trained to identify bite issues when your child is at an early age and will refer your child to our orthodontist as needed. If early treatment is needed, it is often conducted in two phases. Event if a problem is detected, treatment at an early age may not be necessary, but orthodontic monitoring can help anticipate the ideal timeline for the most effective treatment and also help to prevent more serious problems in the future.
When to seek treatment
We provide in-house age 7 screenings for our growing children to prevent potentially more complex and lengthier future orthodontic treatments, and offer orthodontics for all ages and dispositions including special health care needs.
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Although there are ranges of normal variation, losing baby teeth too early or too late can create problems with the permanent ones that should replace them. A child orthodontist is an expert in recognizing and treating adverse variations.
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Eating should not hurt. Although there is discomfort associated with “teething,” painful chewing may indicate there are orthodontic problems that should be addressed.
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Although orthodontists cannot correct mouth breathing, there are orthodontic problems that can develop as a result of this pattern of breathing which can be addressed and corrected by an orthodontist.
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Shifting of the lower jaw due to a bite problem can lead to jaw pain and other dental consequences. Orthodontists are experts in evaluating how your teeth come together and can make sure they’re properly aligned.
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In a normal bite, the outer cusps of the upper teeth hold the cheeks away from the lower chewing surfaces. If your child is constantly biting their cheeks, they may have a crossbite or other condition that is preventing normal chewing.
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The appearance of the lips, chin, and other facial features are affected by the underlying teeth and jaws. Orthodontists are experts in evaluating the relationship between the teeth, jaws, and the face.
Signs to look out for
Types of Treatment
Metal Braces
Metal braces are a traditional orthodontic treatment that effectively correct misaligned teeth and bite issues. Comprised of metal brackets, archwires, and elastic bands, they gradually apply pressure to shift teeth into the desired position. Despite the visibility of metal braces, they remain a popular option due to their affordability, durability, and proven success in treating a wide range of dental concerns. Modern advancements have made metal braces more comfortable and efficient than ever before.
Clear Brackets
Clear brackets, also known as ceramic braces, are a discreet orthodontic solution for those seeking to straighten their teeth. Made from a translucent ceramic material, they blend in with the natural tooth color, making them less noticeable than traditional metal braces. Clear brackets effectively address various dental concerns, providing reliable results without compromising aesthetics. While they may be more prone to staining and require diligent maintenance, clear brackets offer an appealing alternative for image-conscious patients.
Invisalign®
Let Invisalign® and Invisalign® Teen help perfect your smile – using clear aligners and not metal braces – so your teenage memories can be captured with confidence! Invisalign Teen aligners are removable and virtually invisible, which means you can straighten your teeth without anyone knowing.
Invisalign®
Invisalign® aligner trays are made of smooth, comfortable and virtually invisible plastic that you wear over your teeth. Wearing the aligners will gradually and gently shift your teeth into place, based on the exact movements your dentist or orthodontist plans out for you. There are no metal brackets to attach and no wires to tighten. You just pop in a new set of aligners approximately every two weeks, until your treatment is complete. You’ll achieve a great smile with little interference in your daily life. The best part about the whole process is that most people won’t even know you’re straightening your teeth.
Invisalign® Teen
Let Invisalign® Teen help perfect your smile – using clear aligners and not metal braces – so your teenage memories can be captured with confidence! Invisalign Teen aligners are removable and virtually invisible, which means you can straighten your teeth without anyone knowing. You can still eat and drink what you want. Also, you can brush and floss normally to maintain healthy gums and teeth, and there are no wires, metal or brackets to cause mouth abrasions.
Two Phase Orthodontic Treatment
Problems that will eventually need orthodontic attention can become obvious long before a child has all of their permanent teeth. Depending on the type of problem a child has, an AAO orthodontist may recommend two-phase treatment. It means that treatment is done at two different times, often to take advantage of predictable stages of dental development and physical growth.
Phase I
Phase I is recommended for the above listed reasons for Early Treatment and for growth modification while the patient is growing/pre-puberty and recommended for habits like digit sucking or tongue thrust.
Appliances used:
Rapid Maxillary Expander
Schwartz mandibular expander
2×4
Twin Block
MARA
Reverse Pull Headgear
Lower lingual holding arch
Palatal Expander Device (PED)
Both removable and fixed PEDs can be used to address crowding and other issues by expanding the upper jaw to make more room to accommodate tooth and/or jaw alignment.
Phase 2
Phase II includes comprehensive orthodontic treatment with full fixed appliances (braces).
Appliances used:
Metal brackets
Ceramic brackets
Invisalign
Invisalign teen
Inter arch elastics
Carriere
Orthodontic appointments
Consultation
It would be our pleasure to meet with you for a complimentary orthodontic consultation. Your first visit will consist of a careful examination of your or your child’s teeth and jaws and a discussion to address your and your child’s concerns along with our clinical findings. Your initial consultation will take about 30 minutes. Our orthodontist will discuss any orthodontic problems she has found and the treatment options she recommends, along with an estimated length of treatment, cost, and proper time to begin treatment. Our office will discuss financial and insurance details. It is our goal to build a relationship with you, to address any of your or your child’s concerns, share our orthodontic knowledge, and have you feel comfortable in your experience.
The American Association of Orthodontics recommends that an orthodontist examine your child’s teeth by the time they are 7 years old.
Pediatric dentists are trained to identify bite issues when your child is at an early age and will refer your child to our orthodontist at the appropriate time. Orthodontic treatment is optimal when timed with your child’s dental and skeletal development. In a growing child, orthodontic treatment can take advantage of your child’s oral growth and may prevent more complex orthodontic problems from arising and obviate the need for more drastic and invasive dental procedures.
Diagnostic Appointment
After your first visit, the next step is to take initial records to better help our orthodontist develop a custom treatment plan that addresses you or your child’s needs and concerns. The diagnostic records typically include x-rays, study models of the teeth, and photos of the patient’s face and teeth. These initial records also help in tracking the progress of treatment.
Appliance Placement
After you and our orthodontist decide on a treatment plan, it is time to schedule the placement of the orthodontic appliances. This process usually takes one to two hours, and it is recommended that this appointment take place in the morning as this is a more detailed and technique sensitive appointment and we would like ample time to address any questions or concerns about the appliances.
Regular Appointments
After the appliances are placed, you’ll see us at regular intervals of 4-8 weeks apart for adjustments, which take about 30 minutes.
Patients are seen by appointment only, please call us during office hours to schedule an appointment to address any questions or concerns. If you experience breakage or loosening of an appliance, please refer to our webpage “Braces Care” and please call us to let us know that you need an appointment for something to be repaired so that we schedule an appointment accordingly.
Orthodontic After Care
Retainers
Once treatment is complete, a retainer is worn for a period of time, usually just at night. The retainer helps maintain the new smile and also allows for small adjustments, if needed, once the braces have been removed.
The first few days
Learn more about what to expect during the first few days after treatment.
Useful tips & what to avoid
Helpful tips & information about what to do during and after treatment, including eating, brushing, flossing, preventing injuries, and other helpful tips.
Issues & emergencies
Learn more about common issues and what to do in case issues happen between visits. In case of a true emergency please call 911.
The first few days
For the first few days following placement of your braces, you may notice the following:
You may be salivating more than usual. This is because your body detects foreign objects in your mouth (i.e. your braces). Although this can last up to a few hours, usually the body adjusts within about 20 minutes.
The braces will feel strange to your lips and tongue. You can wiggle your lips or feel around with your tongue to get used to them. After a few days, your mouth will adjust.
General guidelines following placement of your braces:
The adhesive we use to secure the brackets to your teeth will dry very quickly but can take up to 24 hours to fully set. It is fine to eat right after you leave our office. However, we recommend that you stick with softer foods for the first few days as you get used to eating with your new braces.
There are some foods that are never okay to eat while wearing braces. Please avoid eating hard or sticky foods during your orthodontic treatment, and never chew on ice as it can damage both your teeth in addition to your braces. These foods can damage your braces, causing you to need additional appointments and potentially extending your overall treatment time. Be sure to follow all guidelines you receive from our office.
If spots on your cheek become particularly irritated, you can place dental wax over the bracket in the area to allow the tissue to heal.
Brush your teeth at least twice a day – after breakfast and after dinner. For the first few days, check your braces in the mirror after brushing to ensure that you have removed all food particles. For a child with braces, it can be helpful for an adult to check the braces after the child brushes just to make sure that the braces have been cleaned thoroughly. There may be one or two spots that the child might frequently miss, and if these are identified right away, the child can develop good, thorough brushing habits from the start.
Most patients are only sore for a few days following placement of braces and do not need medication for pain. If soreness is a problem, however, you can take a non-steroidal anti-inflammatory (such as Advil or Motrin) as long as you do not have any allergies to these types of medicine. Please check with your physician if you have special needs or if there are other medications that need to be taken into consideration.
Quick and Comfortable List: Remember to do these 4 things at every appointment to help your treatment go as quickly and comfortably as possible.
Wire Check – Use your tongue to check all around and make sure there are no wires poking out that could cause discomfort.
Instructions Check – Following the instructions we give you at each appointment is a VERY IMPORTANT part of your orthodontic treatment. If you follow instructions, your treatment can move along much more quickly than if you do not do your part. Make sure you know what you need to do to follow all instructions to be ready for your next appointment. These may include directions about your elastics or headgear wear, expander adjustment or how to clean your orthodontic appliances or how to eat. ASK QUESTIONS if you are not exactly sure about what you need to do or how to do it.
Supply Check – Make sure you have enough of the supplies you will need. This includes dental wax, elastic bands, or anything else you might need for your braces or device.
Appointment Check – Make sure you know when your next appointment is, and be sure that it is scheduled before you leave our office. Waiting too long between appointments will cause your orthodontic treatment period to be longer than necessary.
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Having braces should not cause any major changes in your day-to-day activities. You can still dine out, sing, play a musical instrument, or have pictures taken. With proper care and maintenance, you can promote your oral health while on your way to a more beautiful smile.
If you play a wind instrument, several companies make mouth guards and lip protectors, although you may not need them.
For certain sports it is a good idea to wear a mouth guard. Ask us about recommendations based on your specific needs when you come in for your next appointment.
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Try to avoid foods that are particularly hard, chewy, crunchy or sticky. These types of foods can loosen, bend or even break your brackets or appliances.
Examples of Foods to Avoid
Popcorn
Tortilla Chips, Pretzels, Cheetos
Hard Candies
Chewing Gum
Nuts
Granola Bars
Raw Vegetables
Whole Fruits such as Apples, Pears, etc.
Hard TacosTry to choose softer foods, and cut your foods into smaller pieces before eating rather than trying to bite through them. Chop whole fruits such as apples or pears into bite-sized pieces before eating, and please avoid chewing gum and chewing on ice.
After eating always check your braces for any loose or broken appliances. If you find any problems, please give our office a call so that we can make any needed adjustments.
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Carefully follow all instructions you are given regarding your dental care. Specific steps may vary depending on the type of braces you have. Be sure to brush thoroughly after any meal or snack . It is important to keep your teeth and braces as clean as possible to avoid potential problems. Also, rinse with water or mouthwash after brushing. It’s a good idea to carry a travel toothbrush when you will be away from home. Before going to bed at night be sure to brush thoroughly and floss carefully. It may take a little extra time but this is an important step in maintaining your oral hygiene on your way to a better smile and healthier teeth.
Use a soft rounded-bristle toothbrush that is in good condition. Toothbrushes will wear out faster and need to be replaced more often when wearing braces, so be sure to keep some spare toothbrushes on hand. When brushing you should also brush your tongue and rinse thoroughly when done.
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Flossing is an important part of good oral hygiene. With braces it may take a little more time and practice, and a floss threader may be necessary to get the floss under the archwire. Make sure you clean along and under the gum lines with floss each night before going to bed. After you have properly brushed and flossed, your braces should look clean and shiny, making it easy to see the edges of the braces.
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Please wear your appliance at all times, even while sleeping, or as instructed by our office. Doing so will help reduce treatment time and will also ensure the best possible results from your orthodontic treatment.
Please be sure to bring your appliance to every orthodontic appointment.
Please clean your removable device both morning and night to remove dental plaque. You can clean the appliance with a toothbrush and toothpaste.
Please place your removable device in the provided case any time it is not being worn.
If you have pets, please do not place your removable device anywhere that your pets can reach them. Pets are attracted to saliva and would enjoy chewing on your appliance!
Please do not place your appliance in or on a napkin or tissue. Many appliances have accidentally been thrown out this way!
You may remove your appliance while participating in physical activities, but be sure to wear a mouthguard to protect your teeth, gums and lips.
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Dental wax can be very helpful with any areas that are irritating your mouth or gums. This can be especially helpful at night when sleeping when your mouth may get drier than during the day time when you can regularly hydrate.
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During orthodontic treatment the doctor may use elastics to assist your braces in making adjustments to your teeth and bite. Also known as rubber bands, elastics are typically attached to brackets on the upper and lower teeth and use tension to create changes in the teeth and bite.
You should always wear your elastics as directed. You may remove your elastics when eating and brushing, and you should always replace your elastics with new ones after eating or brushing. Only wearing your elastics occasionally will prolong treatment and also cause any tenderness to persist.
You may experience some tenderness when first wearing elastics, but the tenderness should subside after a few days. Over the counter medications like Ibuprofen should help, but if the soreness continues more than a week, please give us a call.
If an elastic breaks, please replace both the broken one and the adjacent elastic to ensure the same amount of force is applied on each side. You should always carry extra elastics with you in case one should break. If you think you might run out before your next appointment, please stop by our office for more elastics, or give our office a call, and we can mail extras to you.
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Wear a mouth guard when playing sports to protect the mouth from injury.
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Keep these materials on hand to help with the most common orthodontic maintenance and minor emergencies:
Interdental or Proxabrushes fit between teeth and help patients to clean around wires without damaging them.
Non-medicated orthodontic relief wax can be placed over brackets or wires that may be irritating gum tissues.
Antibacterial Mouthwash can be used to reduce inflammation and prevent infection. For minor sores in the mouth, Peroxyl, an antiseptic rinse containing hydrogen peroxide may be used up to 4 times per day after brushing. Refer to the product label for specific instructions.
Dental floss, an interproximal brush or a toothpick can be used for removing food that gets caught between teeth or wires.
Sterile tweezers can be used to replace orthodontic rubber bands that have come off.
A Q-tip or pencil eraser can be used to push a wire up against a tooth if it has come loose and is irritating the cheeks or gums. If it is not possible to reposition the wire so it is more comfortable, place wax over the end of the wire and call our office so that we can set a time to have the wire adjusted and put back into place.
Salt is used for warm salt-water rinses, which help heal sore gums and tissues in the mouth.
Non-prescription pain relievers, such as acetaminophen or ibuprofen, can help with the temporary discomfort that sometimes occurs for the first day or two after an orthodontic adjustment.
Topical Anesthetic Treatments, such as Orabase or Ora-Gel, can be applied with with a Q-tip to any abrasions or sores in the mouth should they occur.
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Do
Use your fingers to put your aligners place. First place the aligners over your front teeth, and then use your fingers to push the aligner down gently over your molars. When aligners are correctly inserted, they will fit all the way down on the teeth, with no space between the top of the aligners and the top of the teeth. Aligners will fit tightly at first but should fit well at the end of the two week period.
Keep aligners in except when flossing, brushing, eating. It’s also best to remove the aligners when drinking warm beverages such as coffee or tea.
Remove the aligner by pulling it off both sides of your back teeth simultaneously then lifting it off of your front teeth.
Place your aligners in the case we provided any time they are not being worn.
Clean aligners with a toothbrush and toothpaste.
Wear each set of aligners for two weeks unless our office directs you to vary from this schedule.
Wear aligners in the correct numerical order. (Each aligner is labeled by number and with a U or an L to designate upper or lower.)
Keep all of your old aligners and bring them to your orthodontic appointments.
Don’t
Don’t place your aligners in or on a napkin or tissue. Many aligners have accidentally been thrown out this way!
Don’t use your teeth to “bite” your aligners into place.
If you have pets, don’t place your aligners anywhere that your pets can reach them. Pets are attracted to saliva and would enjoy chewing on your Invisalign trays!
Do not use Denture cleaner, alcohol, or bleach to clean your aligners.
Do not use boiling water or warm water on your aligners.
Don’t chew gum with your aligners in.
It would be best not to smoke while wearing aligners. The smoke can stain the aligners as well as your teeth.
Just in Case
If you lose the tab attached to your tooth that helps the aligner snap on, please call our office right away so that we can determine if you need to come in before your next scheduled appointment.
If you lose one of your aligner trays, please wear the next tray if you have it. If you do not have the next tray, please wear the previous tray. It is extremely important to use a tray to keep teeth from shifting. Call our office to let us know which tray was lost so that we can determine if a replacement tray is needed. There will be a fee if replacement trays are required.
Useful tips & what to avoid
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Non-prescription pain relievers, such as acetaminophen or ibuprofen, can help with the temporary discomfort that sometimes occurs for the first day or two after an orthodontic adjustment. A diet of soft foods for a day or two can also be helpful.
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There are two types of ligatures that may be used to attach the arch wire to the brackets. They may be tiny rubber bands or small, thin wires.
If a rubber band ligature comes off, it may be possible to put it back in place using clean tweezers.
If a wire ligature comes off, it can be removed with clean tweezers. If it is poking the mouth but is not loose, it may be possible to bend it back down away from the tissues with a Q-tip or clean pencil eraser. Let our office know about the problem so that we can decide if we need to see you before your next scheduled appointment.
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Non-medicated orthodontic relief wax can be placed over brackets or wires that may be irritating the mouth.
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Dental floss, an interproximal brush, or a toothpick can be used for removing food that gets caught between teeth or wires. Sometimes tying a knot in the dental floss before threading it through the brackets can help to catch and remove the food.
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If a wire is out of place and poking the cheek, use a Q-tip or pencil eraser to push the wire against the tooth. If this is not possible, or if the wire is still uncomfortable, place wax over the end of the wire and call our office to set up a time to have the wire adjusted and put back into place.
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Rinsing with warm salt-water several times a day can help to heal sores in the mouth. To lessen discomfort, topical anesthetic treatments, such as Orabase or Ora-Gel, can be applied with with a Q-tip to any abrasions or sores in the mouth.
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For minor sores in the mouth, Peroxyl, an antiseptic rinse containing hydrogen peroxide, can be used to reduce inflammation and prevent infection. Use Peroxyl up to 4 times per day after brushing. Refer to the product label for specific instructions.
Emergencies
If you experience a breakage or loosening of any of your appliances please call our office during office hours. Please do not come directly to the office. By calling us first we will be able to schedule a time to see you. If you have a scheduled appointment already, please call to let us know that you need something repaired so that we may add additional time to your appointment if needed.
After hours – in a true emergency please call 911, if you need assistance after hours please refer to our topics listed below for solutions to discomfort problems. If you or your child are still in discomfort, please call our office during business hours.
Each member of our staff is highly trained to assist you in your orthodontic experience. Our staff can address orthodontic concerns and schedule an appointment accordingly.