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We’re all friends here, so if you sometimes feel a bit nervous before your orthodontic appointments, no judging! Ask us about any worries you might have. We are happy to explain procedures, equipment, and your orthodontic options so you know exactly what is going on during treatment. And if X-rays are a concern, we can put your mind at ease here as well.

What Exactly Are X-rays?

Sometimes patients feel reluctant about the process of imaging because X-rays are a kind of radiation. But the fact is, radiation is all around us. We are exposed to radiation naturally from our soil and water, sun and air, as well as from modern inventions such as cell phones, Wi-Fi, and air travel.

Why is radiation so common? Because matter throughout the universe constantly gives off energy, and the energy that is emitted is called radiation. This radiation takes two forms—as particles (which we don’t need to consider!) and as traveling rays. This second type is known as electromagnetic radiation, created by photons traveling in regular waves at the speed of light.

We are exposed to electromagnetic radiation every day, because, whether we can see them or not, these different wavelengths and frequencies create various forms of light. Radio waves, microwaves, infrared, visible, and ultraviolet light, X-rays, and gamma rays are all part of the electromagnetic light spectrum.

Different types of radiation on this spectrum have different wavelengths and different frequencies, and produce different amounts of energy. Longer wavelengths mean lower frequencies and less energy. Because X-rays have shorter wavelengths and higher frequencies than, for example, radio waves and visible light, they have more energy.

How Do Dental X-rays Work?

An X-ray machine produces a very narrow beam of X-ray photons. This beam passes through the body and captures images of our teeth and jaws on special film or digital sensors inside the mouth (intraoral X-rays), or on film or sensors located outside the mouth (extraoral X-rays). These X-ray images are also known as radiographs.

Why are X-rays able to take pictures inside our bodies? Remember that higher energy we talked about earlier? This energy enables X-rays to pass through the softer, less dense parts of our bodies, which are seen as gray background in a radiograph. But some substances in our bodies absorb X-rays, such as the calcium found in our bones and teeth. This is why they show up as sharp white images in radiographs. 

There are many different types of dental X-rays used in orthodontics, including:

• Occlusal X-rays, which show the entire arch of teeth in the upper or lower jaw.
• Panoramic X-rays, which use a special machine to rotate around the head to create a complete two-dimensional picture of teeth and jaws.
• Cephalometric X-rays, which show the patient’s entire profile, and the position and development of the teeth and jaws.
• Cone Beam Computed Tomography, an external device which uses digital images to create a three-dimensional picture of the teeth and jaws.

Why Do We Need X-rays?

You might have noticed that these X-rays, unlike, for example, typical bitewing X-rays, don’t take images of individual teeth. That is because orthodontists deal with the teeth in relationship to each other and to the structures around them.

Beautifully aligned teeth and a healthy bite are the visible result of your orthodontic work, but there’s a lot going on above and below the surface that needs to be discovered and taken into account before your treatment even begins. X-rays help us evaluate:

• The size, shape, and position of your teeth, including impacted teeth and wisdom teeth
• The size, position, and health of your roots throughout treatment
• The size and shape of your jaw bones, and how they affect your teeth alignment and bite
• Your progress during different phases of treatment

How Do Orthodontists Make Sure Your X-rays Are As Safe As They Can Be?

First of all, the amount of radiation you are exposed to with a dental X-ray is very small. In fact, a typical panoramic X-ray provides roughly the same amount of radiation we are exposed to through our natural surroundings in just one day. Even so, Dr. Joseph Brogan and our team are committed to making sure patients are exposed to as little radiation as possible.

Radiologists, the physicians who specialize in imaging procedures and diagnoses, recommend that all dentists and doctors follow the safety principal known as ALARA: “As Low As Reasonably Achievable.” This means using the lowest X-ray exposure necessary to achieve precise diagnostic results for all dental and medical patients.

The guidelines recommended for X-rays and other imaging have been designed to make sure all patients have the safest experience possible whenever they visit the dentist or the doctor. We ensure that imaging is safe and effective in a number of ways:

• We take X-rays only when they are necessary.
• We provide protective gear, such as apron shields and thyroid collars, whenever needed.
• We make use of modern X-ray equipment, for both traditional X-rays and digital X-rays, which exposes patients to a lower amount of radiation than ever before.
• When treating children, we set exposure times based on each child’s size and age.

And now that we’ve talked about some things you might like to know,

Please Let Us Know If . . .

• You are changing orthodontists and have had previous orthodontic X-rays taken. Ask to have your older X-rays sent to our office so we have a complete record of your orthodontic history. (With digital X-ray technology, this transfer can be accomplished with e-mail!)
• You’re pregnant, or think you might be pregnant. Even though radiation exposure is very low with dental radiographs, unless there is a dental emergency, dentists and doctors recommend against X-rays for pregnant patients.

X-rays play an important part in helping us make sure your orthodontic treatment provides you with a lifetime of beautiful and healthy smiles. If you have any concerns, contact our Philadelphia, PA office. When it comes to making sure you’re comfortable with all of our procedures, including any X-rays that might be necessary, we’re happy to give you all the inside information!

No matter how careful you are, accidents can happen. Perhaps it’s a slice of apple that was a little bit larger than it should have been. Or you were chewing on your pencil while you were trying to work out an algebra problem. Or you tried a piece of candy that your friend really, truly thought didn’t have a caramel center.

No matter the cause, when something‘s wrong with your braces, you know it. And you want to fix it as soon as possible. What can you do to make yourself more comfortable? And which repairs are best left to orthodontic professionals?

First things first. If you have been injured, and suffered a trauma to your mouth or jaw that has damaged your braces, we want to make sure that you get any medical attention you might need before we worry about your appliance. Call Dr. Joseph Brogan, and your doctor, immediately if you have suffered a medical or dental injury.

Even if your braces are the only injured party, you might need a special appointment if the damage is something that shouldn’t wait and can delay your orthodontic progress. Broken wires, brackets that have fallen off, and loose orthodontic bands, for example, need to be replaced in our office.

But what about minor problems? First, call us to see if it’s something that really is minor, and whether you can do some home repairs to keep you going until your next regular visit.

• Wayward Wires

One of the most common—and most annoying—problems is a broken or out-of-place wire. If a wire end is poking you, dental wax can be applied to the loose end to protect your cheeks and gums. If that doesn’t work, we can let you know how to apply gentle pressure to move the wire away from delicate tissue. Don’t try to cut a broken wire or remove it without talking to us—small pieces can be swallowed accidentally. We’ll give you suggestions for how to handle a broken or loose wire and protect your mouth until you can see us.

• Breakaway Brackets

If your bracket becomes loose, this is another good reason to give us a call. Brackets are specifically placed to let your archwire guide your teeth where they need to be. Without a firmly bonded bracket, the wire isn’t doing you much good! If a loose bracket is irritating your cheeks or gums, you can try a bit of dental wax to stick it in place and cover hard edges until we can re-bond it. If the bracket comes off all together, bring it with you to your next appointment.

• Balky Bands

Spacers are little rubber bands we put between your teeth if we need to create some room between your molars before you get your braces. They have a tendency to fall out after several days. We’ll let you know if their work is done, and you’re ready to start your orthodontic treatment. If you lose one of your ligatures, those colorful bands around your brackets, give us a call and we’ll let you know if replacement can wait.

We’re happy to help you with any braces problems, large or small. It’s best to check with us for even small fixes to make sure you avoid injury. Larger repairs can be handled in our Philadelphia, PA office—and we can give you tips on how to prevent future ones. Accidents happen, but they don’t need to delay your progress toward a beautiful, healthy smile.

When does an underbite need surgery? The short answer is: when Dr. Joseph Brogan and our team recommend surgery as the best way to give you a healthy, functional bite. But let’s take a longer look, and see just why your doctors might come to that conclusion.

• First, what exactly is an underbite?

In a perfect bite, the upper and lower jaws align, well, perfectly. Upper teeth overlap lower teeth very slightly, upper and lower teeth meet comfortably, and jawbones and joints function smoothly. When the alignment is off, it causes a malocclusion, or “bad bite.”

When we talk about an underbite, or Class 3 malocclusion, it means that the lower jaw protrudes further than the upper jaw. This protrusion causes the bottom teeth and jaw to overlap the upper teeth and jaw.

• What causes an underbite?

Sometimes an underbite is caused by childhood behaviors while the teeth and jaw are developing, including tongue thrusting or prolonged thumb-sucking and pacifier use. (Working to stop these behaviors before they affect tooth and jaw formation is one of the many good reasons children should have regular visits with their dentists and pediatricians.)

Most underbites are genetic, however, and tend to run in families. It’s estimated that from five to ten percent of the population has some form of underbite. The lower jawbone (mandible) might be overdeveloped, the upper jawbone (maxilla) might be underdeveloped, both bones could be affected, or, sometimes, tooth size and placement might cause an underbite. These irregularities in jaw shape and size and/or tooth crowding are not something that can be prevented, and require professional treatment.

• Why? What’s the problem with an underbite?

Even a minor underbite can cause difficulties with biting and chewing. A more severe underbite can lead to speech problems, decay and loss of enamel where the teeth overlap, mouth breathing and sleep apnea, persistent jaw and temporomandibular joint pain, and self-confidence issues.

• Can’t my dentist treat my underbite?

Most probably not. A very mild underbite can be camouflaged cosmetically with veneers, but this does not address the cause of the underbite, and will not work for moderate or severe underbites.

• Can my orthodontist treat my underbite?

Dr. Joseph Brogan will create an underbite treatment plan after a detailed study of each patient’s individual dental and skeletal structure. Treatment options will vary depending on the cause of the underbite, its severity, and even the patient’s age.

Early intervention is especially important for children who show signs of an underbite. That’s why we recommend that children visit our Philadelphia, PA office by the age of seven.

If an underbite is caused by tooth misalignment or crowding, braces can reposition the lower teeth. Sometimes extractions are necessary to make room for proper alignment.

If the cause is due to jaw structure, children’s bones are still forming, so treatment can actually help correct bone development. Palatal expanders, headgear, and other appliances are various methods of encouraging and guiding bone development.

But braces and appliances aren’t effective for every patient with an underbite, and especially in patients (usually those in their late teens and older) when the jawbones are already fully formed. In this case, we might suggest coordinating treatment with an oral and maxillofacial surgeon.

• What does an oral and maxillofacial surgeon do?

An oral surgeon has the training, experience, and skill to help correct an underbite by surgically reshaping and repositioning the jawbone. This corrective jaw surgery is called orthognathic surgery.

• What will happen during orthognathic surgery?

Your treatment will be tailored to your specific needs. Two of the common surgical procedures for treating an underbite involve repositioning the upper jaw to lengthen it and/or reshaping the lower jaw to shorten it.

Bone is sometimes removed or added, small bone plates or screws are sometimes used to stabilize the bone after surgery—your surgeon will let you know exactly which procedures will give you a healthy, functional bite. The surgery itself is most often performed under general anesthesia and requires a brief stay in the hospital.

• How will my orthodontist and oral surgeon coordinate my treatment?

Correcting a Class 3 malocclusion can take time. Your oral surgeon will work together with Dr. Joseph Brogan to analyze the interrelationship of teeth, bones, and joints to determine dental and skeletal problems, and will develop the best treatment plan possible to create a healthy alignment.

• So, when does an underbite need surgery?

Sometimes, a minor underbite can be corrected with braces and appliances alone. A serious underbite, however, will often require the specialized skills of both Dr. Joseph Brogan and an oral surgeon.

And, while it’s not the primary purpose of surgery, corrective jaw surgery and orthodontics can also make you happier with your appearance and boost your self-confidence. Achieving a lifetime of beautiful, comfortable, and healthy smiles—that’s the answer to your question.

“Yes,” you’re thinking, “I shouldn’t be chewing sugary, sticky gum while I’m wearing my braces.” Or perhaps, “I should check with my orthodontist to see if this sugar-free gum is safe for my braces.” And these are both great thoughts—but today, we’re thinking about gums of a different sort!

While you’ve been taking care of your teeth with regular brushing and flossing, you’ve also been taking care of your gums. And now that you’re wearing braces, your gums need a bit of special attention to keep them their healthiest.

We tend to think of gum disease as an adult problem. In fact, periodontitis, or serious gum disease, is one of the most common chronic infections in the adult population. But young gums need care, too! Gingivitis, a milder form of gum disease, is unfortunately a common problem for both children and adults.

Gingivitis is an inflammation of the gums caused by the build-up of plaque and tartar. When plaque builds up, it irritates delicate gum tissue. And while gingivitis is not as serious as periodontitis, the symptoms caused by this disease are nothing to smile about:

• Redness
• Tenderness and soreness
• Swelling
• Bleeding
• Bad Breath

If you’re already feeling a little tender or swollen after an adjustment, the added discomfort caused by gingivitis is the last thing you want. But even worse, neglected gingivitis can lead to more serious infections of gum and even bone tissue. Luckily, gingivitis is both preventable and treatable with proper dental care.

So, how to protect your gums? We have some suggestions.

• Brushing Better with Braces

It can be hard to brush around your brackets and wires, but keeping these areas free of food particles and plaque makes for healthy gums—and fewer cavities! There are specially designed manual toothbrushes made for braces wearers, and tiny interproximal brushes that can reach tight spaces. Or, perhaps an electric toothbrush will do a better job for you. Just be sure to brush after each meal for the most complete removal of bacteria and plaque.

• Learn New Flossing Techniques

You might wonder how on earth you’ll get in between your teeth with your wires and brackets in the way. We have the answers! We know the best techniques for flossing your specific braces, and we’ll recommend specially designed flossing tools to make the job easier. Water flossers can also be a great help for cleaning in tight spots. Be sure to make flossing part of your daily routine—you’ll be able to remove plaque from places brushing just can’t reach.

• Rinsing? Recommended.

Talk to Dr. Joseph Brogan about the best dental rinses for reducing plaque and tartar, or how gargling can help prevent irritation. And drink water! Water helps wash away plaque and bacteria, and is a great way to rinse teeth and braces if you absolutely can’t brush after eating.

• Keep up with Professional Cleanings

Be sure to keep up with your regular dental exams and cleanings. Your dentist or hygienist will be able to remove any plaque or tartar build up that home brushing can’t handle.

We want your time in braces to be as healthy—and comfortable—as possible. If you have any gum discomfort, swelling, or sensitivity, give our Philadelphia, PA office a call. With prompt action, gingivitis can be treated, and with careful attention to your cleaning routine, gingivitis can be prevented altogether. Something to think about!