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Orthodontics/Possible root damage in 12 year old

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Question: My daughter is 12 and had some mandibular crowding when treatment began 4 months ago and central incisors formed slight v shape but small amount(approximate 1 mm) space between canines/premolar on both sides. After 1st appointment, right side had powerchain to close space but not the left.  At the second appointment, the ligature was left off the left central incisor bracket because it was difficult to put on and so the tooth started to drift slightly behind other incisor.  Last appointment an open coil (?-I think) spring was used to open space and assistant used so much force daughter left office with about 2 mm space between central incisors and was crying from pain of this procedure.  This was 5 weeks ago, pain subsided after 4-5 days.  Should I be concerned with very rapid movement and high force level?

Answer

Hi JC and thank you for submitting a very interesting question.

I am going to make some initial assumptions here before answering your question. I am going to presume, given the information provided, that she is receiving comprehensive treatment likely lasting 18-24 months, and that she is scheduled for treatment with braces for upper and lower teeth.

The lower incisors have some of the smallest roots of any teeth in the mouth. Therefore movement of these teeth can sometimes take place fairly rapidly. The small crown size, especially when the lower incisors are rotated and crowded, makes placement of brackets and accompanying ligatures, wires, elastics, etc very difficult at times. Indeed, many orthodontists will often remove and re-bracket a lower incisor once some correction has taken place. The reason for this is that it was impossible to properly initially position and place the incisor bracket due to restricted access because of rotations, angulations, etc.

I feel that the treatment so far is still in its initial stages, and the movement of teeth is still playing out. I have no reason to believe that at this point anything is awry.

I do want to address the issue of "pain" and the fact that your daughter was crying. Patients all have varying thresholds of discomfort, and some patients are really unable to manage pain, especially dental related discomforts. What I am suggesting is that the procedure may very well be quite normal, but your daughter may need to have some extra special touches provided.  By this, I mean to suggest that perhaps the movements or coil strengths can be lessened, albeit at the expense of possibly longer treatment times. Orthodontists see this all the time, and I am certain that if you explained the situation to your orthodontist that he/she will be happy to adjust the treatment approaches and techniques to better fit your daughter's needs.

Have a short conference with your orthodontist at the next visit, and I am sure all will be well. One final comment.... lower incisor orthodontic correction is often very very prone to relapse. Please follow your orthodontist's direction after treatment is completed regarding the wearing of retainers. You will be glad you did.  

Again, thank you for an interesting question.

Paul Supan, DDS, MA, MPH
Http://www.Braces.com
Http://www.LeesburgBraces.com  

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Paul Supan, DDS, MA, MPH

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First may I say please set your questions to Public so other readers can benefit from the response. Also, if you look at my comprehensive answers, they are not short 1 or 2 paragraph quickie replies that anyone can type out in < 5 minutes. Instead I often will ask other colleagues in other specialties for their advice in order to provide you the questioner with a more interdisciplinary perspective. This all takes time. I ask for readers to therefore allow 5-7 days. You will be rewarded with a very detailed response.

Because of the nature of Orthodontic questions, any pictures of the teeth and X-ray images would be very helpful. If you write to me and explain that you have crooked overlapping front teeth can be interpreted in many many ways, and my goal is to provide a specific response that meets your needs.

I hold double specialty credentials. I am Board Certified in Orthodontics and Board Eligible in Dental Public Health. I welcome questions regarding Braces, Invisible Braces, & Invisalign, as well as issues involving combination Cosmetic Dentistry and Orthodontic treatment. Orthodontics alone sometimes is not enough to achieve that perfect smile. Gingival (gum) re-contouring, tooth reshaping, bonding and other services are sometimes needed. I also have substantial experience in the areas of Infection Control and Sterilization in the Dental Environment. My personal websites braces.com and Leesburgbraces.com are non-commercial for information purposes only and may provide you with some background to more precisely frame your question for allexperts.com.

Please allow a week for a reply. I am in full time Private Practice, lecture on occasion, and am involved in many volunteer activities. I am therefore not always able to respond to questions straight away. Your understanding is appreciated.

Experience

Board Certified Orthodontist (ABO Diplomate) with over 25 years of Private Practice experience. Second Specialty Certificate in Dental Public Health with research experience at NIH, and Epidemiology Training & Research at Harvard, NIH, and the Centers for Disease Control (CDC) in Atlanta. Postgraduate Masters degree from the Harvard School of Public Health, as well as a Master of Arts Degree in Education.

Organizations
American Dental Association, American Association of Orthodontists, Academy of General Dentistry, College of Diplomates of the ABO, OSAP - Office Sterilization & Asepsis Procedures Organization, Others

Publications
Available upon Request.

Education/Credentials
BS College of William & Mary, DDS Medical College of Virginia, Masters of Public Health (MPH) Degree Harvard School of Public Health. Dental Public Health Specialty Certificate from NIH. Orthodontic Specialty Certificate from University of Rochester Eastman Dental Center. USPHS clinical research experience at NIH, and Epidemiology Training & Research at Harvard, NIH, and the Centers for Disease Control. Fellow of the Academy of General Dentistry (FAGD), and Fully Board Certified Diplomate of the American Board of Orthodontics. Board Eligible in Dental Public Health. Visiting Adjunct Associate Professor at the Meharry Medical College School of Dentistry, Nashville, Tennessee.

Awards and Honors
Available upon Request Please see my personal websites braces.com and Leesburgbraces.com for further personal background.

Past/Present Clients
Available upon Request

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