Braces for Kids: Interview with Dr. George

Susie McGee
Dr. George talks about braces for kids.

Raymond George, Sr., DMD, has been an orthodontist for 42 years, practicing in East Providence, RI and South Attleboro, MA. He is the president-elect of the American Association of Orthodontists. Dr. George offers information and advice on braces for kids.

Tell us a little about yourself.

I have been an orthodontist for 42 years. Orthodontic treatment was quite different when I began my practice. About the only thing that's still the same is that I still drive to the office. I received my dental education at Tufts and my orthodontic education at Boston University. I am a Diplomate of the American Board of Orthodontics (AAO). I lecture to orthodontic schools in the U.S. and abroad and have served on the American Association of Orthodontists' (AAO) Board of Trustees since 1999. I will become president of the AAO in May 2008.

When should parents consult an orthodontist about braces for their child?

  • Check-up-The AAO recommends that all children get a check-up with an orthodontist no later than age 7. It can be even sooner if parents or the dentist notice something out of the ordinary: things like early or late loss of baby teeth; difficulty in biting or chewing; breathing through the mouth; protruding teeth; an unbalanced facial appearance; or sucking the thumb, fingers or pacifier beyond age two.
  • Identifying Problems-Around age 7, children get their first permanent molars. And by evaluating how these molars meet, orthodontists can identify an existing problem or even alert parents to a problem that may develop. Some children will not need treatment at all. Some children may need to start earlier than later, especially if there are significant problems with the way the jaws are growing. Other children who need treatment may be able to wait until they have all of their permanent teeth.
  • Starting Treatment-Some parents believe that they must wait until their children have a full set of permanent teeth before visiting the orthodontist. Waiting this long may actually be a disservice to their child. There are some problems that are best treated while the jaws and face are still growing. If treatment begins after growth ends, a patient might require surgery in addition to orthodontic treatment.

What are some common problems that kids encounter which can be corrected by braces?

Common orthodontic problems are protruding teeth, crowded teeth, teeth with too much space between them, jaws that are too far forward or too far back, crossbites of front or back teeth or jaws that are asymmetrical.

Most orthodontic problems children have are genetic-passed on by their parents. Some problems can be caused by accidents while others are acquired through thumb- or finger-sucking, dental disease, abnormal swallowing or other repeated actions that place force against the teeth.

What are some common treatment plans that involve braces?

Most everyone is familiar with braces-something an orthodontist calls a "fixed appliance". That's because braces (brackets and wires) are attached to the teeth and can only be removed by the orthodontist. Sometimes, though, we might use a "removable appliance", something that the patient puts in and takes out. The type of appliance used will be based on the orthodontic problem, or malocclusion, that needs correcting.

Some patients might need treatment in two steps, called Phase I and Phase II. The first phase may help to guide the growth of young bones while creating a better environment for emerging permanent teeth. A second phase actually moves teeth into their optimal positions for that healthy, beautiful smile that's good for life.

For those patients who need only one round of orthodontic treatment, most likely braces would be used to move teeth into their desired positions. On average, treatment lasts around two years, although it can be shorter or longer. It just depends on the problems being corrected-and how well the patient follows the orthodontist's instructions. It's so important for patients to brush and floss as directed by their orthodontist, and to see the dentist regularly during orthodontic treatment. Teeth tend to move faster through clean, healthy tissue. Patients play a big role in their own treatment. It's something they need to take an active part in so that the end result is the best it can be.

What types of braces are available?

  • Stainless Steel-A variety of braces are offered today. Those used most often have stainless steel brackets. Compared to brackets when I started practicing, today's brackets are much, much smaller. Their purpose is to act as handles, to hold the wires. It's the wires that actually move the teeth.
  • Tooth-Colored-Tooth-colored brackets made of ceramic or porcelain are an option for some patients. The bracket color blends in with the teeth.
  • Gold-Colored-Some patients even choose gold-colored wires and brackets.
  • Rubber Bands-Some wires are held to the brackets with tiny rubber bands, called "ligatures" or "o-rings." Patients may choose rubber bands in a rainbow of colors, or colorless ones. It's a fun way for children to participate in their treatment. These rubber bands are changed at every appointment, so patients can change their colors with the season or to support their favorite sports team.
  • Self-Ligating-Some braces are "self-ligating," meaning that they take care of holding the wire to the bracket without a rubber band.

What's even better about today's braces are the wires. They have more staying power than wires of even a decade ago. Because of these improvements, patients require fewer adjustment appointments. So, they miss less school, and mom or dad miss less work. It's a "win-win" for everyone.

Once kids have braces, how should they take care of them and their teeth?

It's vital to follow the orthodontist's instructions on taking care of braces so that the patient finishes treatment on time and with good results.

  1. Follow the orthodontists' instructions on brushing and flossing.-Patients will be instructed to brush three or four times a day-even at school-and floss once a day. They need to do a thorough job of removing food debris and plaque from around the braces and at the gum line. The orthodontist may recommend the use of an interproximal brush-a special brush that can grab material stuck between the wires and teeth. A mouth rinse or other hygiene aids may be recommended. The goal is to avoid gum disease, tooth decay or permanent scarring of tooth enamel.
  2. Avoid some foods, but be sure to eat a healthy diet.-Anyone with braces will need to avoid hard, sticky, crunchy or chewy foods-things like hard pretzels, hard taco chips, caramels or taffy. Cut fruits like apples and pears into bite-sized pieces, rather than biting into them. The same goes for sandwiches or pizza-patients may want to cut or tear off pieces rather than bite into them. Patients must never chew ice-whether they have braces or not. Chewing ice is very bad for teeth. It's important to have a healthy diet during orthodontic treatment. Nutritious foods support the biological changes that occur during orthodontic treatment.
  3. Be careful of soda pop, whether it contains sugar or is sugar-free. The acid can eat away at tooth enamel. So limit or eliminate soda pop during orthodontic treatment.
  4. Avoid chewing on pencils, pens or fingernails.
  5. See the dentist at least every six months for a check-up and professional cleaning. If a patient or parent notices that a bracket is loose or the wire is broken, call the orthodontist to see if it's necessary to schedule a repair. If braces are broken, teeth stop moving, or can move in the wrong direction. Either way, broken braces could mean a longer treatment time. So it's important to alert your orthodontist to decide the best course of action.

Where can we learn more about your company?

A wealth of information can be found on the AAO's Web site. And, any time a patient or parent has a question about their child's treatment, talk to the orthodontist.

Braces for Kids: Interview with Dr. George