Questions to ask your orthodontist before starting braces or aligner treatment

By Dr. Jeffery C. Summers

Starting new orthodontics treatment can be an uneasy task. For most patients whether they are choosing aligner or braces treatment, this new orthodontic experience will be their first and also their last. So naturally, there may be some initial anxiety involved. Where does one begin? What are the right type of questions to ask as you embark on this new treatment journey? We thought what better way to get answers to some of these questions than to ask an experienced doctor with a first-hand perspective. In this article, we sit down with Dr. Jeff Summers of Summers Orthodontics in Greenville, South Carolina to get some amazing insight into the ortho treatment process as well as some great insight on smart questions new patients can ask their doctor when beginning treatment.

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Interview with Dr. Summers

How long have you been in orthodontics?

Dr. Summers: Well, I finished dental school in 2000 and then went straight into my orthodontic residency; I've now spent 18 years in private practice. It has been humbling to build relationships and treat many members of the same family over the years. That is very common in my practice—to treat many of the children and often their parents as well. It’s hard to imagine, but we have treated three generations of the same family in many instances.

Approximately how many patients would you estimate you have treated with either braces or aligners?

Dr. Summers: Wow! You know what? We are quickly approaching 10,000 patients. It is amazing to think about all the lives we have impacted!

Do you feel like either braces or aligners offer specific advantages for treating certain conditions?

Dr. Summers: Well… Each modality has certain advantages and challenges. You can look at the challenges as obstacles or you can adequately plan to overcome them—which comes with experience and education. When you stay on top of the advances in ortho treatment options and surround yourself with critical thinkers, you will continue to raise your standards of care. With experience and effort, the challenges can be overcome. Aligners have the challenge of rotating or extruding a tooth. These movements may be much easier with brackets. However, intruding a tooth or bite may be easier with aligners.

We are treating more adults now, and they come with previous dental work such as crowns and bridges, and aligners are often better to use to treat them. Conversely, the orthodontist may feel that quite complicated cases may offer more flexibility using fixed appliances, like braces. Ultimately, I want to treat each case in the most effective and timely manner with whatever modality works the best. I am always mindful of what the patient’s desires may be. The patient experience is critically important to us—so because of that, we ask questions during the consultation like, “If you had a magic wand and could instantly change one thing about your smile or teeth, what would that be?” Once we have the answer to their fundamental goal, and generate the appropriate treatment plan, then we know we have addressed their chief concerns upon treatment completion. So, I'd say learning what a patient's objectives are is absolutely critical.

We also need to understand their lifestyle to determine what treatment modality is best. Some people will be honest with themselves and know they will not consistently wear aligners, so we need to go in a different direction. There is a misconception that aligners are easy but that is not always the case- patients need to be compliant and wear them nearly 22 hours per day, ideally. In general, now a goal of ours is to accomplish the most you can in 12-14 months because after that, many patients just want to be done.

One thing that I am mindful of is that as orthodontists, we are perfectionists and sometimes that can get in the way. We might want to fix one little detail that is not quite right, when, the patient is already completely happy and satisfied. Many patients just want to be better than they were. As orthodontists, we can narrow our treatment goals, regardless of which option patients choose, down to two main areas for success: a healthy bite and beautiful smile.

Wow, that is really a great way to simplify and focus your role and set clear expectations for patients. What are some of the most common questions you get from your new patients?

Dr. Summers:

• How much will treatment cost?
• How long will it take?
• When can we get started?

At the end of the day, we want efficiency—time and cost. One thing I like to ask adolescent patients is, “What is most important for you? Being in treatment the shortest amount of time, or how old you are when you finish treatment?” This helps us set the right path forward early on. For our teen patients, they typically want to get the treatment done as soon as possible or by a certain age. So as long as we know that initially, we can try to plan their treatment accordingly.

If you were a new patient, what are the top 3-4 questions you would ask your doctor?

Dr. Summers: I love having informed patients that ask questions about treatment and options. It helps further connect the doctor and patient. Think about and list your overall goals of treatment. There is more to a beautiful smile than just straight teeth—like the size and shape of teeth, the gingival (gum) display, how the teeth fit in the patient’s natural smile arc. Some questions I would ask are:

• What would you do if this were you or your child?
• What are the standard and accelerated treatment times?
• Is there anything we can do to speed up treatment time?
• Are there any other treatment options available to me?
• Are there any concerns or contraindications to me doing this?
• Since technology changes and teeth straightening has evolved over the years, what advancements are out there that are new?

Regarding patient pain, are there any tips or tricks you can provide new aligners or braces patients to help minimize the pain early on?

Dr. Summers: When your teeth are sore, you can always consider using ibuprofen or acetaminophen Also, right after your treatment, soft diets (yogurt, pudding, smoothies etc.) are recommended. Be careful about using too much ibuprofen though because studies show high doses of ibuprofen can slow down teeth movement. Acetaminophen can be just as effective for the patient in pain relief. Early on in treatment, I suggest taking what you need for pain, but once you get in the swing of it, you will want to minimize your use. Another good tip is to try and help prepare the body for pain in advance—so you can take pain meds early in the day or before your office visit. There are also products (such as Acceledent®) out there that vibrate and reduce tooth discomfort and may have escalatory benefits. Laser/light therapy can also be used to reduce discomfort. Orthopulse® is a lower level laser light therapy that would come with additional cost. Another option is a newer product—Synapse Dental Pain Eraser™ that creates an electrical stimulus—showing tremendous results and promise—it can be offered during the visit or can be used at home after the visit.

We know that treatment times vary depending on the severity of the case and a plethora of other factors. Of the things that patients can control: What is the best way to speed up a patient’s treatment time?

Dr. Summers: Without a doubt patient cooperation is key, no matter the modality. Treatments can look to be simple and very straightforward, but if the patient is not compliant (with appointments, wearing elastics, wearing aligners, etc.) then even the most routine treatments can become quite difficult. Treatment needs to be a team approach—the orthodontist can only do so much; the patient must do their part to help with results. Treatment accelerators like I mentioned previously can help shorten the treatment time. There is so much more to a beautiful smile than just straight teeth. Brushing and flossing is very important to make sure we go down the right path to get the ultimate result we all want and not have scarring of the teeth.

How soon should patients expect to see results with either braces or aligners?

Dr. Summers: Sometimes with braces you can see the teeth beginning to move in a matter of days! You will typically see some changes faster with fixed appliances (braces, brackets) as compared to aligners, which make slow individual tooth movements. However, collectively you can see relative changes quickly with aligners too. With passive, self-ligating systems like Damon Braces™, which have done an amazing job at reducing friction, it’s amazing how fast you can see teeth move without significant discomfort.

If you can remember, what were both your longest and shortest patient wear times and what factors contributed to the timing?

Dr. Summers: Some faster cases finished in a matter of months and the longest ones really vary! The biggest contributor to timing is usually compliance—in many forms. That affects treatment time the most.

What near or long-term advancements in teeth straightening treatment options are you most excited about?

Dr. Summers: The ortho game changers I’m most excited about are around improving treatment options, patient experience, finding efficiencies and comfort in the most effective time frame. The one thing to remember is that just like other technologies in cars or electronics, orthodontics and bracket technology is always improving. Things we didn’t think we could do 5 years ago are now standard treatments. So, I’m excited to see where things are headed.

Is there any last bit of information you would like new patients to know?

Dr. Summers: I encourage patients to do their research in advance and bring in pictures of examples of smiles you like and wish to achieve. Unfortunately, many people assume straight teeth are all the same… but as I said previously, there is much more to a beautiful smile than just straight teeth. Look for an orthodontist who has been praised for their results—with happy patients and a beautiful result that you would want for yourself or your child. And don’t be afraid to ask questions.