Treatment Time
The average time for full orthodontic treatment is usually 10 to 24 months, with an average of 12 to 15 months. This varies from patient to patient, depending on such factors as difficulty of the existing problem, age of the patient, certain physiological characteristics of the patient, and most important: patient cooperation during treatment.

Cooperation
The success of orthodontic treatment is keynoted by cooperation. It is very important that all instructions be carefully and completely followed. The main areas of concern include:

• wearing certain auxiliaries such as elastics and headgears as instructed
• being present and on time for all appointments
• maintaining good oral hygiene
• minimizing appliance breakages
• immediate reporting of broken appliances.

Poor cooperation in any of these areas can markedly lengthen treatment time and may detract from the end result.

Appointments
Cooperation is requested in making and keeping all appointments. Please be aware that many of our appointments are preset at certain times of the day. This is done in an effort to better stay on schedule and see you at your appointed time. As most of our patients are school age, it is impossible to see everyone after school. We will make every effort to give each patient their share of after-school appointments, however please be aware that many appointments, especially those of longer duration, will be during school hours. We are happy to provide a school excuse, if needed. If an appointment must be broken due to illness, accident, or unforeseen circumstances, our office should be informed immediately and another appointment reserved. Whenever possible, advance notice of 24 hours is appreciated if an appointment must be changed. There are no additional charges for missed appointments or same day cancellations unless they become excessive.

Oral Hygiene
Orthodontic bands and wires are food-catchers. It is therefore important that the teeth be carefully brushed after each meal and snack. After brushing, the appliances should be checked to see if they appear clean and shiny with no food particles or plaque. Fluoride gels should also be used each night. These gels can be purchased in the office or at a pharmacy with a written prescription. Failure to keep the mouth clean increases the likelihood of dental decay and etching of the enamel around the edges of the brackets and bands. Patients who keep their teeth clean and use fluoride gels usually have a minimum of decay, if any.

Regular Dental Check-ups
It is recommended that regular 6-month dental check-ups be continued by your dentist during treatment.

Foods
Foods which are hard or chewy should be avoided during orthodontic treatment in order to prevent appliance breakages. Appliance breakages will complicate and thus prolong treatment.

Loose or Broken Appliances
Any breakage of the appliances (loose bands or brackets, broken wires, etc.) should be reported immediately to the office and an emergency appointment made to repair the appliance. Do not wait until your next scheduled adjustment as there is insufficient time during this appointment to repair appliances and make an adjustment. If a repair must be made during an adjustment appointment, you may be rescheduled at a later date in order to make an adjustment. If breakages become excessive, there may be an additional charge made for repairs.

Visits
In order to properly place brackets and fit bands, the first few appointments will be frequent and for intervals of up to two hours, requiring your patience and flexibility. After the appliances are placed, adjustment appointments will then occur approximately every six weeks and for shorter time intervals.

Ceramic Brackets
Although ceramic brackets have several advantages, they also require special attention and care. In order to maintain their aesthetic appearance these brackets must be kept clean. Any foods which have a tendency to stain (such as mustard, tea, and coffee) will turn the clear elastics around the brackets yellow over several weeks and therefore should be avoided, if possible. Ceramic brackets are more brittle than those made of metal and thus require special attention to the types of foods eaten in order to avoid breakage. Finally, ceramic brackets are much harder than the enamel on teeth. For this reason, it is important that the patient contact the doctor's office immediately if he or she is biting on a bracket any time during treatment as this may cause significant wear on the patient's teeth.

Other Dental Treatment and Records
Extractions (if necessary), x-rays, and the restoration of decayed teeth will be done before orthodontic treatment is started. After treatment, a complete set of orthodontic records will be taken. It is recommended that a dental checkup be scheduled with your dentist shortly after braces are removed.

Cooperation with the Head Gear
Head gear must be worn as instructed and handled carefully when inserting or removing from the mouth. The bow should never be forced into or out of the tube as this may cause a band to become loose. The headgear must be brought with you to each appointment so that the tension can be adjusted to maintain and assure progress.

Cooperation with Elastics
Elastics are to be worn all the time especially during meals. Replace twice each day when brushing or as necessary due to breakage. Follow directions. Wearing them in the wrong positions may result in the teeth moving in the wrong direction. If you run out of the rubber bands, call our office for a new supply.

Discomfort & Emergencies
Normally, there will be some discomfort following each adjustment. This may last two to four days. Rinsing the mouth with warm salt water will help somewhat and pain relievers such as those taken for headaches may be taken when necessary. Rubbing the gum area with your finger also helps by stimulating the circulation area. If an area of the mouth becomes unduly irritated, that part of the appliance causing the irritation may be covered with wax, cotton, or some other "cushioning" substance. If the irritation is due to a loose or poking wire, the wire may be removed or pushed out of the way using a blunt object such as an ice cream stick. The above measure provides temporary relief until we can arrange an "emergency" appointment. The doctor can also be reached at home; but if he is away, another orthodontist will provide relief from any problems.

Retention (Retainers)
The period following the removal of the orthodontic appliances is extremely important. Retainers must be worn as prescribed in order to maintain the stability of the finished result. Failure to wear the retainers faithfully invites relapse of the teeth. If bonded or permanent retainers are used, care must be taken to avoid hard foods that would break them and they must be repaired immediately if broken. Teeth shift in position throughout our lives as a normal biological process. It is quite common to observe some crowding of the lower front teeth. For this reason, retention is a lifetime commitment.
 

Treatment and Finances

Treatment Time
If additional time is needed to attain desired results, it will be provided at no additional charge. If, however, treatment is extended because the patient is uncooperative, an additional fee may be charged for completion.

Statements
Monthly statements will be mailed on or around the 20th of each month. Payments are due by the last day of the month.

Exclusions
The total cost does not include the fee for removal of teeth, or general dental treatment that may be needed during treatment.

Insurance Claims
In the case of insurance programs, it is important that parents or the adult orthodontic patient clearly understand and agree that it is their responsibility to see that the originally agreed fee proposal is paid irrespective of benefits that are anticipated from insurance plans. Also, please notify us immediately if insurance is terminated or changed at anytime during orthodontic treatment as payment plans may need to be modified.

Finance Charges
No interest or finance charge of any kind are included in the fees made by this office.

Transfer
In the event that the patient moves to another area, the account shall be adjusted and just settlement made in proportion to the services rendered to date.

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