Tod J. Curtis, DDS, MS
Specialist in Orthodontics

 

2610 Smile Lane
Bedford, IN 47421

 

(812) 279-9473

(888) 998-9473

General Questions

  • Question: How do braces work?

    Braces are pretty simple. Each tooth gets a bracket glued to it, or a band cemented around it. These brackets and bands are the grips for grabbing teeth. The wires are pre-formed in a perfect shape, then deformed into the brackets and held on by the o-rings (which are usually colorful). The wire tries to straighten itself out, and pulls or pushes the teeth into alignment. A variety of wires are used as the teeth get straighter and straighter. If the jaws were perfectly aligned, the teeth perfectly shaped, and the brackets put on with supreme accuracy, then treatment would be easy. However, like anything in the body, there are many problems that have to be adjusted for, which makes achieving an ideal result difficult. That is the main reason orthodontists need a lot of time - so that they can rely on their artistic side to make things look beautiful and fit correctly. Of course, this is only part of the story. There are many devices and appliances that are used to accomplish different things. But overall, your braces are following the sound principles of physics imposed by nature, and are a strange mix of math, biology, and art.

  • Question: How much do braces cost?

    This depends on a number of factors, including the amount of work to be done and the overall difficulty. In our office, comprehensive treatment is a set fee that includes orthodontic records before and after treatment, placement of appliances, adjustments, removal of appliances, and retainers. We offer several payment plan options to fit your particular needs.  In any case, we hope to make orthodontic treatment affordable and worth the investment.

  • Question: How do I know if I (or my child) needs braces?

    Many people are surprised when I tell them that they don't need braces. This is because, for many people, braces are a want, and not a need. On the other hand, there are so many positives of having braces that, for most people, it's worth it. So, any orthodontic treatment should be evaluated on a cost/benefit basis. The benefits of orthodontic treatment are outstanding. The main benefit is the improvement of appearance. It can be quite embarrassing to have a bad smile, and may be a source of psychosocial problems in children. An improvement in the fit of the teeth can improve function, making chewing easier and speech better. Also, there can be a reduction in the rate of injury and dental disease. One study found that children with protruding teeth (buck teeth) have a 1 in 3 chance of experiencing significant trauma to those teeth, such as fracture. A very deep bite can damage the roof of the mouth and cause significant wear to the teeth. Teeth that are properly aligned are also easier to care for. You or your child should seriously consider braces if those things are important to you. There are some situations that clearly braces are a necessity. Otherwise, consider the value to you and base your decision on that.

  • Question: What colors do you have to go around the brackets?

    First of all, we have 3 different bracket colors: silver, gold, and tooth-color. These colors can't change during treatment. At most adjustment appointments, we will change the colors of the O-rings that hold the wire to the brackets. Our colors are: Teal, Clear, Silver, Purple, Rose, Yellow, Navy, Light Blue, Green, Lilac, Black, Red, Blue, Gold, and Burgundy, among others. I hope that we have enough of a selection for you.

  • Question: What is an orthodontist?

    An orthodontist is a person who specializes in moving teeth. An orthodontist has completed dental school and passed the state licensing requirements to become a dentist, then completed a 2 to 3 year residency in orthodontic training to receive either a Certificate in Orthodontics or a Master's degree. There are relatively few orthodontists compared to population: for example, there are only 6-7 graduating orthodontists each year in the state of Indiana, and less than 300 for the entire United States. Orthodontists are not allowed to do fillings or extractions (no needles in my office!). Instead, they are only allowed to focus on their specialty. Most people know that orthodontists straighten teeth, but many are surprised that they can alter growth and improve appearance. Orthodontists can also plan surgeries of the jaws and coordinate that treatment with oral surgeons. Some orthodontists treat symptoms of TMJ, or joint pain in the jaws, but this is becoming less common.

  • Question: What kind of orthodontic problems can you fix?

    Anything that can be fixed. An orthodontist has spent at least 2 years after dental school thoroughly studying orthodontics. As a specialist in this field, I am comfortable treating just about anything (that has to do with moving teeth, of course!). Notice I said anything that can be fixed. There are some problems that become so complex that there cannot be an ideal solution. The braces (even with a lot of cooperation) can only do so much. Sometimes a surgical approach can make things better, sometimes not. Understanding what can and can't be accomplished is an important part of the treatment planning process. If the result will not be ideal, maybe it will be an improvement, and worth pursuing. Common orthodontic problems include: Crowding, excess spacing, diastema closure (closing the space between the top teeth), bringing in teeth that are stuck or off course, and reducing overbite and overjet (the space between the top and bottom of your teeth when you bite together). Improving appearance through growth modification is an important part of what we do. Orthodontists also make retainers, night guards, and sports guards, and evaluate TMJ problems.

  • Question: I'd like to get braces. Where do we start?

    Congratulations! Braces are a great investment. Our office offers a consultation visit at no charge. At that visit, your orthodontic problems will be reviewed, an estimate of the treatment plan and costs involved will be given, and your questions will be answered. If you want to get started, the next appointment will be a records appointment. Models of the teeth will be made, along with photos, and necessary x-rays. A more complete oral exam will also be done. The orthodontist (me) will spend some time formulating a problem list and treatment plan, and this will be reviewed with you at the case presentation appointment about a week following the records appointment. If everything looks good, and you're ready to get the braces on, spacers will be placed (when necessary) and the appliances will go on at the following appointment. After this, appointments will be scheduled every 4-6 weeks for adjustments until we reach the goal of a beautiful smile and ideal fit of the teeth.

Fees, Payment Plans, and Insurance

  • Question: Will my insurance pay for braces?

    Many times your dental insurance will pay a significant portion of the treatment costs. There are so many insurance plans and different policies that nearly every individual has different benefits, so our office will contact your insurance company to determine your benefits at the consultation appointment. One thing to bear in mind is that your dental insurance will cover orthodontics differently than standard dental treatment. In most cases your orthodontic benefits will be subjected to a lifetime maximum of approximately $500 to $1500, which leaves a balance of the fee to be financed. Also, some dental plans have no orthodontic coverage, and many plans do not cover orthodontics after age 19. Orthodontic benefits have been increasing in recent years, due in a large part to increased demand and employees working with their insurance advisor to find plans with better benefits. If you are considering treatment in the future, it may be wise to investigate your insurance options more thoroughly.

     

     We are a Delta Dental Premier and Delta Dental PPO provider, as well as a provider on many other dental plans. Please contact us with eligibility questions.

  • Question: How much do braces cost?

    This depends on a number of factors, including the amount of work to be done and the overall difficulty. In our office, comprehensive treatment is a set fee that includes orthodontic records before and after treatment, placement of appliances, adjustments, removal of appliances, and retainers. We offer several payment plan options to fit your particular needs.  In any case, we hope to make orthodontic treatment affordable and worth the investment.

Treatment Questions

  • Question: What are spacers?

    Spacers (properly known as separators) are little rubber bands that we floss in between some of your back teeth to make room to fit orthodontic bands around them. The orthodontic bands surround your molars to get a good grip, and have a bracket attached to the front. We can also directly bond brackets to those teeth, but they are not as strong and tend to break too often for our liking. Since they are the end of the line for your wire, when one breaks the end of the wire has a tendency to find your cheek!

     

    Spacers hurt because they are moving your teeth (ever so slightly) for the first time. No matter how you move teeth, they usually get sore the first time force is applied. This happens whether you use spacers in advance or directly attach braces to the tooth.

  • Question: Are you certified to use the Invisalign system?

    Not exactly. There are various levels of Invisalign providers and we don't do enough each year to claim any special status. Align Technology requires orthodontists to attend a training seminar before they can use the product. I have done so and received certification.

     

    But, they also require the orthodontist to use their system a certain number of times per year to maintain certification. I have not done so, and am no longer certified. If I had a good reason (or desire) to use Invisalign, I would re-certify.

     

    The Invisalign system is a series of clear overlays that are worn full-time and move the teeth little by little to their appropriate places. The overlays are made using a computer simulation of the needed movements that are approved by the orthodontist. Because of the difficulties in moving teeth in this manner there are very strict conditions that must be met before a patient can use this system. Patients ideal for Invisalign are adults who have a mild amount of crowding or a mild amount of spacing. This system is a little slower than traditional orthodontics and more expensive. For those who want to hide the look of their braces but don't qualify for Invisalign our office offers ceramic (tooth-colored) braces.

     

    There are a number of alternatives to Invisalign that also use clear aligners. We use the Simpli5 system from Ormco. It is a series of clear aligners that are worn over a 6 month period of time.  I have found that to be the longest predictable time frame for this type of treatment, and it is a particularly good system for those that have had a small amount of relapse from treatment at a younger age.

  • Question: Can I be treated with a retainer only?

    There are very few things that can be accomplished with a retainer. For the most part, retainers are only useful at holding (retaining) the teeth in a set position. After braces, retainers are required to keep the teeth from moving back to where they started. Even after a number of years, nature will start trying to make your teeth crooked again. So nighttime retainer wear is a must as long as you want your teeth to remain straight. One of the things that a retainer can do is move one or two teeth forward. A spring is put in the retainer to push and the tooth moves quite easily. This is useful in fixing an upper front tooth that has come in behind the bottom teeth. Sometimes a retainer can be used to straighten bottom front teeth that are slightly crooked. Otherwise, most problems are best treated with braces, then held with a retainer.

  • Question: Can adults have braces?

    Definitely! There are few limitations on moving teeth based on age. As a matter of fact, the number of adult patients is growing and accounts for more than 25% of new patients in most orthodontic offices. Treatment times are sometimes a little longer because your jaw bones are fully developed and the teeth may move slower, but are certainly reasonable. The biggest problem is that we can no longer change the growth of your face, so more treatment plans rely on surgery or a compromise. On the plus side more adults have braces now, so your co-workers are not as likely to pick on you. Also, modern ceramic brackets are tooth-colored and much less visible. The braces might even make you look younger while they're on, and after treatment you'll be able to show off a beautiful smile.

  • Question: Can you put braces on the back (tongue side) of the teeth?

    It is possible to do lingual (tongue side) orthodontics. However, there are a number of disadvantages. First of all, having brackets where your tongue usually moves can be quite uncomfortable. Second, this technique is considerably more difficult to control. The mechanics of the wires and moving teeth are very different on the inside of the arc rather than the outside. Since treatment is more difficult usually lingual braces are significantly more expensive than the traditional method. This technique began a ride in popularity in the 1970's and has since slipped, due in part to the development of tooth-colored ceramic braces. There are still a number of orthodontists who offer lingual appliances, but I have not found it to be worthwhile. Instead, I prefer the clear braces that are much less noticeable than the standard metal brackets. This helps hide the braces but allows treatment to move along much more easily and efficiently.

  • Question: I grind my teeth at night. Should I worry about it?

    I grind my teeth at night, also. Sometimes I grind so hard that I wake up my wife! I don't go to sleep without putting in a night guard. A night guard is a thin, somewhat flexible tooth cover that keeps the teeth from grinding on each other. When made properly, they can also act as a retainer. So, I grind away on the night guard and not my teeth, and keep my teeth straight with the same device. The night guard does not stop the grinding habit. If your jaw muscles are sore in the morning they probably will still be sore when wearing one. Also, you may eventually chew through the night guard and need to have another one made. Your dentist should be able to provide you with a night guard. If not, we can easily make one for you.

  • Question: What effects will thumb sucking have on my child's teeth?

    Thumbsucking is a part of life for many children. For the most part, there are no lasting effects on the teeth or jaws. When the permanent incisors (the front teeth) start coming in, the habit will prevent them from coming all the way down and will force the top ones forward and the bottom ones backward. Often, when the habit stops the teeth will correct themselves somewhat. If the habit continues very long after the permanent teeth come in then the effects will be visible for life. Also, growth of the jaws can be affected and make it difficult to align the teeth properly later on. Any child over 4-5 years of age should be strongly encouraged to stop thumbsucking. This is a very difficult habit to break, and continual reinforcement is probably the best way to help a child stop. There are some other gimmicks that you can try but I don't know of any that are very effective. We can put an appliance in the roof of the mouth to discourage the habit, but I haven't done enough of them to give you a good idea of their effectiveness.

  • Question: What is tongue-thrusting?

    Tongue-thrusting is a term used for a tongue that pushes forward into the front teeth when swallowing. It is often blamed for causing open bites, where the front teeth don't come down and meet. However, the significance of a tongue thrust is questionable. For teeth to move, constant pressure has to be applied to them for a majority of the hours in a day. Most people don't keep a swallow going long enough to qualify for that! Also, nature wants the tongue to move to the front of the mouth to seal the opening when swallowing, so the tongue thrust between the teeth may be the effect of the open bite rather than the cause. Instead, a condition called resting tongue habit is much more consistent in causing open bites. This would be a large or forceful tongue that is always resting against the front teeth. This kind of pressure does indeed force the teeth apart, and can cause all sorts of problems with relapse following orthodontic treatment.

  • Question: Why do some people have to have jaw surgery to make their teeth fit right?

    Sometimes surgery is required to move the upper and lower jaws to the right position for the teeth to have a chance to fit right with braces. There are basically three major problems which may make surgery necessary. The first involves too much growth of the upper jaw in a downward direction, which makes the lower jaw hinge open and causes the front teeth to be apart. The second involves having too small of a lower jaw and the third involves having too large of a lower jaw. There are other variations but these are the most common. When a child is growing, the orthodontist has the ability to help control growth and minimize the effects of improper growth. After the child is done growing, surgery is pretty much the only way to get the bones where they belong. An orthodontist can camouflage, or mask the growth problem, and achieve a reasonable result in many people, but there are times that surgery is the only good option. Improvements in surgical technique in recent years has made jaw surgery much more stable and easier to tolerate. It has the advantage of improving the appearance of the face significantly. If you have questions about jaw surgery you can contact our office or an Oral and Maxillofacial Surgeon.

  • Question: I have TMJ problems. Will braces help?

    Temporomandibular joint disorder (TMD) is a relatively misunderstood problem. The joints that connect the lower jaw to the head are unlike any other in the body, and the source of many problems. Clicking, popping, grinding, and locking open or shut are all problems associated with the joint. Most people experience these symptoms from time to time, but don't have a problem worth worrying about. When pain is involved, then treatment may be necessary. Pain in this area is often due to the muscles around the joint and in the face, and not necessarily related to the joint itself, so proper diagnosis is necessary before any treatment is made. Many TMJ problems will resolve on their own, without treatment, in less than 6 months. Conservative treatment, such as a bite splint, may help the symptoms. Long-term TMJ problems are more difficult to alleviate, and require consistent care. In any case, the most recent scientific studies and reviews conclude that there are only rare instances that the fit of the teeth have a relationship to TMD, and for the most part having orthodontic treatment does not cause or cure TMJ problems.

Care Questions

  • Question: Should I buy a mechanical toothbrush to use with my braces?

    I think it can be easier to take care of braces with a mechanical toothbrush, but you can save money and do just as well with a regular toothbrush and some effort. It is very important to keep the teeth very clean when the braces are on. If plaque is allowed to sit around the edges of the brackets, decalcification (loss of mineral) around the bracket can occur. When the braces come off white lines are visible from the decalcification. It is very difficult to cover up and doesn't go away. Removing the plaque carefully with a toothbrush is the best way to avoid decalcification. I used a Water-Pik during when I had braces and thought it did a good job of spraying out food that was caught in the brackets and wires. These aren't very expensive and can be found at local drugstores and other stores. However, they are not a substitute for proper brushing. So, mechanical gadgets are completely optional. If you like them, use them. If not, a regular toothbrush will work just fine.

  • Question: Should I use fluoride rinses with my braces?

    In general, fluoride rinses (such as ACT) shouldn't do any harm and may help keep the surface of the teeth healthy during treatment. However, the effect is not great and keeping the teeth very clean is much more important than the fluoride. Recently, many new topical fluorides, or prescription fluorides, have been introduced as a way to help prevent demineralization (the white areas) during orthodontic treatment. Patients who have not shown the motivation to keep their teeth clean may be asked to use these products. But, the journal Oral Health (September 1999) advises against routine use of fluoride in orthodontic patients because of difficulties in judging how much fluoride is getting into the patient's body, which can be harmful. So, in general, feel free to use the inexpensive fluoride rinses during orthodontic treatment but don't get the idea that they will substitute for poor oral hygiene.

  • Question: Can I be treated with a retainer only?

    There are very few things that can be accomplished with a retainer. For the most part, retainers are only useful at holding (retaining) the teeth in a set position. After braces, retainers are required to keep the teeth from moving back to where they started. Even after a number of years, nature will start trying to make your teeth crooked again. So nighttime retainer wear is a must as long as you want your teeth to remain straight. One of the things that a retainer can do is move one or two teeth forward. A spring is put in the retainer to push and the tooth moves quite easily. This is useful in fixing an upper front tooth that has come in behind the bottom teeth. Sometimes a retainer can be used to straighten bottom front teeth that are slightly crooked. Otherwise, most problems are best treated with braces, then held with a retainer.

  • Question: Can adults have braces?

    Definitely! There are few limitations on moving teeth based on age. As a matter of fact, the number of adult patients is growing and accounts for more than 25% of new patients in most orthodontic offices. Treatment times are sometimes a little longer because your jaw bones are fully developed and the teeth may move slower, but are certainly reasonable. The biggest problem is that we can no longer change the growth of your face, so more treatment plans rely on surgery or a compromise. On the plus side more adults have braces now, so your co-workers are not as likely to pick on you. Also, modern ceramic brackets are tooth-colored and much less visible. The braces might even make you look younger while they're on, and after treatment you'll be able to show off a beautiful smile.

  • Question: Can you put braces on the back (tongue side) of the teeth?

    It is possible to do lingual (tongue side) orthodontics. However, there are a number of disadvantages. First of all, having brackets where your tongue usually moves can be quite uncomfortable. Second, this technique is considerably more difficult to control. The mechanics of the wires and moving teeth are very different on the inside of the arc rather than the outside. Since treatment is more difficult usually lingual braces are significantly more expensive than the traditional method. This technique began a ride in popularity in the 1970's and has since slipped, due in part to the development of tooth-colored ceramic braces. There are still a number of orthodontists who offer lingual appliances, but I have not found it to be worthwhile. Instead, I prefer the clear braces that are much less noticeable than the standard metal brackets. This helps hide the braces but allows treatment to move along much more easily and efficiently.

The Weird and the Wacky

  • Question: Are crooked teeth hereditary?

    You may have noticed that your child has the same overbite or the same crowding that you once had (or still do). Did they inherit this? To some degree, yes. Orthodontists often see the same skeletal and dental patterns between children and their parents, and between the children themselves. Often, identical twins will have very similar problems. The environment plays a pretty big role, too, so it is hard to tell what is hereditary and what is not. There are some problems that are seen quite often in a family tree. Having a very strong lower jaw (one that sticks out) or a very weak lower jaw (like Barney Fife) can often be seen among many members of the same family. Having missing permanent teeth also seems to run in the family. Most ethnic groups have their own tendency toward certain orthodontic problems. A patient's heritage actually plays a role in treatment planning, because an understanding of these tendencies may influence the goals of treatment. Unfortunately, for all ethnic groups, the tendency toward crowding and other orthodontic problems is increasing with each new generation, so a natural perfect smile may someday become extinct.

  • Question: Who was the first person to do orthodontics?

    According to my first textbook in orthodontics, by William Proffit, attempts to correct crowded, irregular, and protruding teeth go back to at least 1000 B.C.! Ancient orthodontic appliances have been found in both Greek and Etruscan materials. Dentistry developed in the eighteenth and nineteenth centuries, and various devices were invented to move the teeth. Many are similar to devices that are sometimes used today. The first good source of information on doing orthodontics was published around 1850 by Norman Kingsley. Edward Angle is considered the true father of orthodontics, and his influence began around 1890. The specialty of orthodontics is the oldest in dentistry, and many schools trained orthodontists starting in the early 1900's. Orthodontics has changed significantly in the last 30 years. The brackets and wires are smaller, as are the resulting forces on the teeth. Technology allows orthodontists to work more efficiently and provide better diagnosis and treatment planning. Evidence-based treatment is gaining hold, which means that science is proving what really works and what really doesn't. As we go further into the new millennium, the quality of treatment should continue to improve significantly.

  • Question: Why did you want to be an orthodontist?

    Good question! To tell you the truth, I don't remember exactly why I wanted to be an orthodontist. I wanted to be a computer scientist and spent most of my school life planning for that. My senior year in high school a good friend of mine decided he wanted to be a dentist, and the details seemed pretty good. I had just gotten out of braces, and I started to think about being an orthodontist. Computer scientists spent most of their time fairly isolated in those days, and the technology was not as cool to work with as it is today. I wanted to be able to see lots of people every day and build relationships, and I didn't think that would happen in computer science. Orthodontics is similar to programming because you spend most of your time finding ways to solve problems and you have to think in a logical and straightforward manner. So, I planned on using my skills to be an orthodontist and never looked back - which is good because I love it!

  • Question: Why does it take so long to straighten teeth?

    Most orthodontic treatment performed by an orthodontist will take around 2 years to complete, and sometimes longer. You may notice that your teeth look straight after a few months. So what is the orthodontist doing? The orthodontist cares about straightening the teeth, of course, but also wants them to fit together ideally. If the jaws do not match up well, then it takes more time (and usually effort) to get the teeth to fit right. Every effort to move one tooth one way causes the others to move the opposite way. In order to maintain control the orthodontist will focus on problems one at a time until they are all taken care of. Also, teeth do not move very quickly. The body has to remove bone to make way for the teeth and fill in the bone afterwards. Sometimes teeth have to move a long way in the bone and take a while to get where they need to be. Adding more force doesn't make them move faster. In fact, they move quite quickly with very little force. The orthodontist will spend the last months of treatment making very small movements to improve the final look of the teeth. Then the braces come off and hopefully the beautiful smile was worth the time invested!