Herbst

• It will take a week or so to become accustomed to eating and biting with the appliance. Teeth and jaw muscle soreness is normal during this time. Be patient. Anytime something new is put in the mouth it takes time to get used to it.
• Sores may develop where the lower front hubs are pushing out into the lip. Wax may help. If the sores do not heal within a week or appear to be getting worse rather than better after several days please call our office.
• Inner cheek sores may also develop where the arms are extending out the back of the sleeves in the upper molar regions if the arms are too long. If these sores develop, please call to have the arms shortened.
• Occasionally the rods may come out of the sleeves when you open very wide. Simply put the rod back in the sleeve if you can. If you are unable, call our office and we will do it for you. If this is happening excessively, please call and we will put longer rods in.
• Due to the complexity of this appliance it is very important to try and minimize breakages. Repairs are many times difficult, time consuming and expensive. Please try to minimize breakages as much as possible by being careful with the appliance.
• Check daily to see if the lower archwire has broken where it goes into the tube on the hub just behind the lower cuspid. It this occurs, call immediately to have it repaired.
• Please call immediately if anything breaks, if bands or crowns come loose, or wires break.
• The Herbst appliance is normally left in eight months. Occasionally it will be left in longer if needed in order to get the desired correction.

Rapid Palatal Expander

• Activate appliance one turn only, two times each day (each morning and night).
• Be sure to put key holder on finger before activation in order to prevent swallowing key.
• If for any reason you miss or have to reschedule your next scheduled appointment in approximately one week, do not continue to activate the appliance past when that appointment was originally scheduled.
• A feeling of pressure is normal for several minutes following activation. There should be little or no pain involved. In the event of continuous pain, discontinue activation and call for an appointment immediately.
• A space may develop between the two upper front teeth after several days of activation. This is normal and will usually close spontaneously over a period of several weeks after activation is complete.
• It is very important to keep the appliance and the roof of the mouth meticulously clean at all times in order to avoid infections. Visually inspect tissues around the edges of the appliance daily and immediately report any signs of infection (redness and swelling)
• Care must be taken with the types of foods eaten as anything hard or chewy can loosen the attachments of the appliance to the teeth. In the event the appliance does come loose, it is very important that you contact our office immediately to set up an appointment to rebond/recement the appliance.
• It will take several days to adjust to having the appliance in the mouth. Speech will be affected during these first few days and the teeth may be sore. These are temporary conditions - be patient.
  

Bite Plate

• The bite-plate must be worn at all times, except when cleaning it after each meal, and while swimming. Your cooperation will determine how long it will have to be worn.
• Eating and speaking will most likely be discouraging the first few days. You are advised to eat soft foods such as eggs, cereals, and soups in preference to chewy meats or hard-crusted breads. However, in a few days, all foods can be eaten and, with a little practice and patience, all words pronounced.
• Cleanliness of both the bite-plate and all of the teeth against which the bite-plate fits is a must. Always remove the bite plate after each meal and rinse it. Clean the bite plate with a toothbrush and toothpaste each morning and night when you brush your teeth.
• Soreness of certain teeth is quite common during the first few days. Actual irritation of the gums, cheeks, or lips should also disappear within 2-3 days. If soreness is persistent or if any wire should be accidentally bent, phone the office for an emergency appointment.
• A bite-plate is constructed to keep the back teeth apart. Removing it and closing your teeth together will slow your treatment significantly.
• You may have to wear the bite-plate for several months. Try not to become discouraged these first few days as eating and speaking will gradually improve. Just be patient.
• There is a fee to replace lost bite plates. Repairs sometimes can be done at no charge if the plaster model is brought in.
   

Removable Retainer

• The retainer(s) are to be worn 24 hours a day until instructed otherwise. This is needed to stabilize the teeth in their new positions. If retainers are not worn consistently during this period the teeth can begin to move back to where they were before treatment.
• If a retainer does not fit (due to inconsistent wear, damage etc.) you must call our office immediately and set up an appointment. It is very important that this appointment be made as soon as possible.
• If a retainer becomes loose, do not attempt to adjust or discontinue wearing the retainer. Call for an appointment immediately.
• Never boil the retainer to sterilize it. The acrylic will distort.
• Retainers are to be kept in the provided retainer case whenever not in the mouth. No exceptions. If you don't have the retainer case with you, don't take the retainers out.
• Retainers are to be cleaned with a toothbrush and toothpaste twice each day (when you brush your teeth).
• If a retainer is broken, always bring the plaster cast with you to the office. Many times the retainer can be repaired in my lab at little or no cost. Do not attempt to repair the retainer yourself.
• There is a charge to replace broken or lost retainers. Please try to avoid this extra charge by following instructions closely.
• Note: All patients, following removal of braces, should see their dentist as soon as possible for a checkup and cleaning.
  

Bonded Retainer
(a wire permanently bonded to the back of the front teeth)

• Care must be taken to try and avoid breaking the bonded retainer by watching what you bite into with your front teeth. Please do not bite into anything hard or chewy.
• Each tooth is attached to the wire with a small pad of white bonding material. Please inspect these bonds several times a week and call us immediately if one is missing or has come unattached from a tooth. Once a tooth comes unbonded it is free to move and often will do so. If this occurs the bonded retainer will have to be removed and remade for which there is a charge.
• If the bonded wire comes completely unbonded it will have to be remade and there will be a charge. Please avoid this by calling us immediately when you can see a bond loose or missing. There is no charge to repair a loose bond.
• Please make sure and brush around the bonded retainer thoroughly twice a day removing all visible plaque. It should also be flossed daily or at least several times a week by using a floss threader as instructed in our clinic.
• If you ever choose to remove a bonded retainer, it should be replaced with a removable retainer that will be worn at night only.
• Please understand: It is the patients responsibility to care for the bonded retainer by being careful what you eat, to inspect it regularly for loose bonds, to call immediately if there are problems and to keep it clean.
  

Fingerspring Appliance

• The appliance is to be worn 24 hours a day until instructed otherwise. Once the crossbite has been corrected the appliance will be worn at night only for one or two months to stabilize the correction.
• For the first few days, the parent will need to verify that the patient is inserting the fingerspring appliance correctly (the spring is beneath the ledge on the back of the tooth).
• If the appliance does not fit (due to inconsistent wear, damage etc.) you must call our office immediately and set up an appointment. It is very important that this appointment be made as soon as possible.
• If a appliance becomes loose, do not attempt to adjust or discontinue wearing the appliance. Call for an appointment immediately.
• Never boil the appliance to sterilize it. The acrylic will distort.
• Fingerspring appliances are to be kept in the provided retainer case whenever not in the mouth. No exceptions. If you don't have the retainer case with you, don't take the appliance out.
• The appliance is to be cleaned with a toothbrush and toothpaste twice each day (when you brush your teeth).
• If the fingerspring appliance is broken, always bring the plaster cast with you to the office. Many times the appliance can be repaired in my lab at little or no cost. Do not attempt to repair the appliance yourself.
• There is a charge to replace broken or lost appliances. Please try to avoid this extra charge by following instructions closely.
   

Headgears

• Needs to be worn 14 hours per day in order to see any progress. Anything less will not work.
• Always bring both your headgear and the time sheet with you to every appointment. Total hours at end of each week.
• Be gentle. Never wear headgear while playing sports or roughhousing. Don't test breakaway system.
• Always call immediately if headgear is not fitting or bands have come loose.
• Teeth will be sore for 3-4 days. Soreness will stop if you are consistent.
• Keep tension on straps by moving to the second hole if needed.
• Make sure you're inserting headgear correctly. Don't insert upside down.
  

Invisalign^®

• When inserting Invisalign aligners rinse with warm water to help them slip over your teeth comfortably. Each aligner is marked with a “U” for upper, an “L” for lower and stage number you are in. Apply equal pressure and make sure they are seated all the way. Be sure NOT to bite aligners into place.
• The aligners are to be worn a minimum of 22 hours a day. The consistent pressure on your teeth is what will make them move. If the aligners are out of your mouth your teeth are not moving. Take aligners out only to eat, drink, brush and floss.
• Do not eat anything sticky or chewy while wearing the aligners. No gum chewing. Except for water, patients should not drink with aligners. Hot drinks will distort aligner, and soft drinks may stain them.
• Teeth may be sore with each aligner placement. The soreness is normal and should disappear. Normal pain medications (Tylenol Advil etc) can be taken. Your speech may also sound different for the first couple of days.
• Aligners are to be kept in the provided case whenever out of the mouth. No exceptions. This will prevent you from losing or breaking them. Keep them out of reach of children and animals. Likewise, do not boil them or leave them in the car because the heat will distort them. If you should lose or break an aligner please call our office immediately.
• Aligners are to be cleaned with toothpaste or warm soapy water twice a day. Do not use denture cleaner or mouthwash.
• Designate the blue storage case for the current set of aligners that are being worn. The red storage case is for the most recently used set. Should you lose or break the current set, we will ask that you go back to the old set until a new set has been made.
• Note: All patients should continue to have regularly scheduled cleanings with your General Dentist. Your dentist should not remove composite attachments. In addition, please consult Dr. Shepherd prior to receiving dental restorations, as this may affect the fit of aligners.
  

Clear Retainers

• When inserting clear retainers, apply equal pressure and make sure they are seated all the way. Be sure not to bite clear retainers into place.
• Clear retainers are to be worn at night only while you sleep.
• Clear retainers are to be kept in the provided retainer case whenever out of the mouth. This will prevent you from losing or breaking them. Keep them out of reach of children and pets. Likewise, do not boil them or leave them in the car because the heat will distort them.
• If you should lose or break a clear retainer call our office immediately in order to get a new one made. There is a charge to replace the retainer.
• Clean the clear retainer with warm soapy water after removing each morning.
• Bring your clear retainer(s) with you to each retainer check appointment.
• Please keep all retainer check appointments. This is very important in order to make sure the retainers are fitting well and the teeth are staying straight. You should be scheduled a 6 week, a 3 month and three 6 month appointments.

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