Your Health su 14
by Margo Aramian Ragan
Charlie Chaplin wasn't joking when he said "You'll find that life is still worthwhile if you just smile." For most people, a smile is the first thing they notice when they meet a stranger, but for many unfortunate individuals their smile is the last thing they want others to see. Their hands hide a mouth that has crooked teeth, a misshapen jaw and other multiple problems.
Even the ancients wanted a pretty smile! Archeologists have discovered mummies whose remains include metal brackets on their teeth. Cords made from catgut (animal intestines) were run along the teeth in order to close those unsightly gaps. The Etruscans from northern Italy in 700 BC had another, more religious reason for leaving dental appliances in the mouths of important people, and in particular, that of women. Scientists believe they wanted the departed to present an attractive appearance in the afterlife, making them more acceptable to the gods.
Thankfully, times have changed the way dental problems are addressed. Technology and newer methods have transformed orthodontia, and dental professionals like Dr. Todd Welsh are leading the way. "Metal mouth," — a terrible term that once described orthodontic work no longer applies, said Dr. Welsh, an orthodontist. He knows whereof he speaks, since he too once had braces on his teeth and now has a practice at 140 South Clinton Street, Doylestown.
"As a child, my teeth and bite were not correct. I was afraid to smile, and had low self esteem as a result," Dr. Welsh admitted. "My parents were proactive and took me to an orthodontist for several years, which made a tremendous difference in my life. I now had a healthy smile. Once I went to dental school, selecting orthodontics as my specialty became an obvious choice."
Today, more than four million people in the United States wear or have worn braces at one time in their lives. Within that statistic, is the fact that 80 percent of teenagers have had orthodontic treatment, and the number of adults who are now finding their way into an orthodontist office is steadily increasing.
Dr. Welsh sees that profile within his own practice. "Generally, the optimum time to see a prospective patient is when he or she is between seven or eight years old," he advised. "At that time we look to see if there are any potential growth issues, such as a retruded or protruded jaw that is not growing at the same pace as the rest of the mouth. We can initiate steps to stimulate growth or make other recommendations." A dental record is kept which monitors the progress of the permanent teeth as they drop down out of the gums. Generally most children have all their permanent teeth by age 12 and treatment can commence at that time.
More importantly, Dr. Welsh sees an early introduction to his office as an opportunity for him and the child to begin their partnership in the whole orthodontic journey. "I care about the child, and show my respect for him or her as an individual by taking the time to explore what may or may not be happening to them," he said. "Children may not realize why they are scared, but when I talk with them, they open up about their fears which they may not have expressed to their parents. They want to know how the braces will work, how do the teeth move. Will it hurt? Since I too had braces and experienced many of the same concerns, I feel I can relate to their issues."
Dr. Welsh's respectful approach opens the way for the patient to take ownership of their responsibility in the treatment program. Because of the open dialogue between doctor and patient, many of the complaints about orthodontic work are addressed then dismissed.
“Sometimes the ligatures or tiny rubber bands come off, or a patient develops mouth sores. The wires can protrude, cause discomfort, or the greatest embarrassment, food can get caught between the teeth,” said Dr. Welsh. “When the patient is properly prepared for these eventualities and knows what to do if one of these problems pops up, the complaints disappear.”
Once the decision has been made that treatment is necessary, Dr. Welsh reviews x-rays, molds of the teeth, and designs treatment plans to be discussed with the patient, parent, and health care professional team.
The range of options makes former orthodontic treatment seem almost medieval. The fact that there are even options is tremendous. The traditional approach of metal braces is still there, where constant mild pressure is directed toward a change in tooth position. The patient has to be monitored generally on a monthly basis so that the doctor can make adjustments; i.e., tighten the runner bands and check the bite. But even with the metal braces approach, there are changes and improvements.
According to Dr. Welsh, a ceramic brace may be a viable option because they are clear, thus less obtrusive. Ligatures that hold the brackets can be white or clear. Superstar Tom Cruise had clear ceramic braces on his imperfect teeth, and the resulting famous Cruise smile now packs a wow factor that is part of his popular appeal.
Time and patience is needed as the teeth progress to a more perfect alignment. Frequent visits to the office are in order to tighten the rubber bands as they “encourage” the teeth movement. For some people, that process is too slow, and for them, there is an option called AcceleDent that can be considered.
“With AcceleDent, a mouthpiece is added to an existing orthodontic device,” said Dr. Welsh, “and gentle micropulses are transmitted to the teeth and stimulates the gums. The device is approved by the FDA, is safe, gentle, and accelerates the process. The patient uses the device for 20 minutes a day, which is not a burdensome amount of time for what can be ultimately accomplished.”
Two Stanford graduates, neither one of who is a medical professional, have developed an option that is transformative for many patients. Zia Chishti was an orthodontic patient who wanted a more comfortable device other than the metal braces he wore. Chishti invented and designed what we now call Invisalign, which are removable, transparent, molded braces. He enlisted the financial help of a fellow classmate Kelsey Wirth, and together they launched this product.
“We send molds of a patient’s teeth to Invisalign, who then use 3D computer technology to develop a program identifying what the teeth will look like as they progress. A series of plastic trays or braces is created that traces that progress which I then use in treatment. The aligners are changed every two weeks until treatment is completed,” Dr. Welsh said.
Patients who wear the Invisalign brace say they appreciate the fact that the tray is removable, which works well for special occasion dinners or photographs.
Dr. Welsh has seen an increase in the number of adults who are coming into his office for treatment. In fact, he has had patients in the age range from seven to seventy. He is particularly sensitive to the needs of adults. Typically adults come to see Dr. Welsh in the middle of the day whereas young children come at the conclusion of their school day, but conceivably, there could be a time when the two generations overlap.
“I have a private room that is available for anyone who may be anxious or uncomfortable about sitting in the general waiting area,” Dr. Welsh said. “We recognize that an adult may not want to sit in a room with lots of teens around them, so the comfortable private room is open for their use.”
Adults, he says, are very conscious about good oral health, and are aware of the linkage between oral health and lack thereof, and other health issues. “Everyone wants to have a healthy smile, and they are willing to undergo treatment for that smile. They want to be healthy while looking great,” he said.
One of the biggest differences between what Dr. Welsh experienced as a young man, and now, is the environment of the orthodontic office itself. “We try to replicate the familiar environment of a home, with comfortable couches and chairs,” he said. “Since we are in a long term relationship with the child and parent, our office wants everyone to be relaxed while you are there. Many parents are also employed outside the home, so we try to provide them with conveniences that allows them to continue with their work obligations while their child is being treated.”
All of his patients are given counsel about dental care that is vital for the successful conclusion of the orthodontic treatment. “Patients have to keep up with brushing and flossing,” he advises. “Cleaner teeth move faster than dirty teeth.”
Dr. Welsh explained this last statement by saying improper or inadequate brushing or flossing can cause bleeding gums, which is an inflammation. “When a patient understands the ramification of not brushing and flossing, they become more active with their participation.”
From his own life experience and naturally with his professional expertise, Dr. Welsh is an enthusiastic supporter of what orthodontic treatment can mean for an individual. “Having a great smile makes you feel better, more confident about the way you present yourself to others,” he said. “We are living longer, and as we age, our teeth become increasingly important not only to the way we look, but how we process and ingest food. A properly aligned mouth just keeps on giving.”
One last important reminder—do not think that once you have completed your treatment, that you are done with orthodontic devices. “No matter how perfect your teeth look after completion of the program, your teeth can still move,” cautioned Dr. Welsh. “That brings up the subject of nighttime retainers.”
Despite the fact that they have been straightened, teeth can move, and even a slight movement of the teeth can possibly change the alignment that the doctor and patient have worked so hard to correct. Dr. Welsh recommends the lifetime use of retainers, saying that healthier teeth will stay straighter, which was the object you wished to obtain from the beginning.
Orthodontists are not the only ones who praise the beauty of a healthy smile. Just think of the word "smile" and there will be lyrics singing in your head that extol the beauty and power of a smile. Singer Connie Stevens may have said it best, "Nothing you wear is more important than your smile."
For more information, contact Dr. Todd Welsh, 140 South Clinton Street, Doylestown: 215-348-9521: www.bullockorthodontics.com.
(bio)
Margo Ragan is a freelance writer and lecturer at Holy Family College who lives in New Hope, PA.