Our Blog

Maybe you’ve known people with braces and aligners—maybe you’ve worn them yourself!—so if braces or aligners are in your teen’s future, you have some idea what to expect and when to expect it.

But quite often, orthodontic issues require more treatment than braces alone can provide. When misalignment affects not only the teeth but the jaw as well, treatment can be more effective when it begins earlier and makes use of a different kind of appliance—the “functional appliance.”

During the years your child’s bones are still rapidly growing and forming, around the ages of eight to 14, functional appliances can help guide tooth movement and encourage jaw growth and development. One of the most widely used of these devices is the Herbst® appliance.

What does the Herbst appliance do?

There are several types of malocclusions, or “bad bites” treated by Dr. Groisser. A common condition called a Class II malocclusion occurs when the upper jaw and teeth project too far forward over the lower jaw and teeth. Signs of a Class II malocclusion might include an overjet (protruding upper teeth), and/or a small or recessive lower jaw.

While correcting this malocclusion often enhances facial symmetry, which can be very important for a child’s confidence, correcting a Class II malocclusion also promotes jaw and dental health. Misaligned teeth are more difficult to clean, which can lead to decay and gum disease. Bite problems can cause persistent jaw pain and damage to the teeth. And, with an overjet, a child’s upper teeth are more at risk for injury.

The Herbst appliance was developed to treat this kind of malocclusion. It moves the lower jaw and teeth forward to create a balanced, healthy smile.

How does the Herbst appliance work?

The Herbst appliance is fixed in place with stainless steel bands or crowns that are secured to four teeth in the rear of the mouth, often the first molars on each side of the upper and lower jaws. The band or crown on each lower tooth is equipped with a small bar that extends toward the front of the mouth.

An arm on each side links the bands or crowns on the upper teeth to the front of the bar assemblies on the lower teeth. Each arm consists of a rod that fits smoothly into a tube. The telescoping action of the rod and tube allows the mouth to open and close normally. When the mouth is closed, the arms on both sides telescope shut, forming compact cylinders that hold the jaw forward.

While a child’s bones are still growing, the lower jaw’s new forward position can stimulate further bone growth and remodeling to maintain the jaw in that forward position. The Herbst appliance also has a restraining effect on the forward movement of the upper jaw. The result is a steady, noticeable improvement in the relationship between the upper teeth and jaw and the lower teeth and jaw.

Is the Herbst appliance hard to take care of?

The Herbst appliance is fairly low maintenance, but, like any orthodontic gear, it should be treated with care.

• It’s important to watch your child’s diet, because sticky, crunchy, and chewy foods can damage the appliance. Save the caramels for a post-treatment celebration!
• Carefully cleaning around the appliance is necessary, because a buildup of bacteria and plaque leads to consequences like bad breath, gum disease, and tooth decay. A water flosser can make reaching and cleaning tight spots easier if a brush alone isn’t effective.
• If the Herbst appliance is damaged, some minor fixes might be doable at home with instructions from your treatment team. But if a band or crown comes loose, or if there’s a problem you’re unfamiliar with, call our Clarksburg, Gaithersburg, and Hagerstown office right away.
• To help avoid the need for minor (or major) fixes, playing with the appliance with fingers or tongue, nibbling on pens and pencils, chewing on ice, or any other risky habits should be strictly off limits.

When it comes to your child’s health, you always have high expectations. Dr. Groisser and our team have all the answers you’ll need about what to expect from this phase of your child’s orthodontic treatment, and just why the Herbst appliance is the very best option to create a future of attractive, healthy smiles.

Gum disease is one of our most common dental diseases, affecting both children and adults. If you are considering getting braces or aligners, make sure your gums are their healthiest before beginning orthodontic treatment.

• Gingivitis

For both younger and older patients, gingivitis (mild gum disease) can be the result of poor brushing and flossing habits. When plaque builds up around the teeth and gums, it irritates delicate gum tissue. The gums become inflamed, and symptoms such as redness, swelling, tenderness, bleeding, and bad breath can result. Usually, your dentist can treat early stages of gingivitis with tips on more efficient brushing and flossing, a professional cleaning, and suggestions for mouth rinses if needed.

Because brushing and flossing with braces can be more difficult, you need to devote special attention to your cleaning routine to prevent gingivitis from developing after you start treatment. Talk to us any time about how to brush and floss most effectively when you wear braces. Dr. Groisser can also recommend tools designed especially for braces wearers to get your teeth and gums as clean and plaque-free as possible. If you are a candidate for clear aligners, this option can make it easier to keep your teeth their cleanest. We’ll work with you to keep your gums healthy as your orthodontic work takes place.

• Periodontitis

For older patients, gingivitis, left untreated, can eventually lead to periodontitis (severe gum disease). This chronic infection can lead to the formation of pockets between your gums and teeth that become home to bacteria and infection. Over time, periodontitis can lead to the destruction of gum, ligament, and bone tissue. Left untreated, it can lead to loose teeth and even bone and tooth loss.

Making sure you schedule regular dental exams will allow your dentist or periodontist to detect and treat any signs of periodontitis as early as possible. If you have any of the symptoms of gum disease, it’s important to treat the cause of these symptoms as soon as possible to protect your gums, bone, and teeth. Deep cleaning procedures such as scaling and root planing, topical and oral antibiotics, and oral surgeries such as flap surgery or bone and tissue grafting can help reverse the effects of periodontitis.

Because orthodontic treatment involves moving the teeth and re-forming the ligament and bone tissue, which hold them in place, you need healthy periodontal ligaments and bones to begin treatment. If you have suffered shifting teeth or bone loss due to periodontitis, talk to us. We will let you know at your visit to our Clarksburg, Gaithersburg, and Hagerstown office if you are a good candidate for orthodontic work, and which type of appliance is best for your periodontal health.

We are happy to talk to you about the best way to achieve an attractive smile and a healthy bite if gum disease has been a problem in the past. Most important, we want to make sure that your teeth and gums are their healthiest even before you begin orthodontic treatment. Preventing and treating gum disease will provide the foundation you need for a lifetime of beautiful smiles.

By no stretch is it rare for your gums to hurt during and after flossing. Even some bleeding is to be expected. This is especially true if you have not flossed in a long time. However, if your gums do indeed hurt when you floss, and unbearably so, there are some things you can do.

Be Gentle

Perhaps the most obvious way to combat gum soreness and bleeding is to be gentle. One of the most common occurrences of these gum problems is over-aggressive flossing. In other words, if you are too rough on your gums while flossing, either because you are out of practice or because you are in a hurry, soreness and hurting is to be expected. Instead, try taking your time and be gentle. Also, if you are just starting out, be patient and consistent, your gums will become more conditioned over time.

Use an Alternative Method

If being consistent and gentle does not work, there are other alternative methods of flossing that you can try. You can also try a water floss machine, or what is sometimes called a water pick. The device essentially shoots water into the crevasses between your teeth, and in other areas of your mouth, in order to dislodge food and plaque. These oral instruments also come with different attachments that allow you to reach many of the hard to see and reach areas of your mouth. And lastly, you can always buy floss that is not as abrasive to your gums. There is floss that comes with soft and gentle coatings that will do less harm to your gums while they are adjusting to the good oral hygiene habit you are creating.

Flossing is one of the easiest parts of oral hygiene to overlook. When you first start out, it is common that you may want to stop because of the pain it can initially cause. However, if you try one, or all, of the above mentioned methods, you will give yourself the best chance of being success with your flossing, and it won't hurt as much.

For more flossing tips, schedule an appointment at our Clarksburg, Gaithersburg, and Hagerstown office and askDr. Groisser or a member of our team!

Some experiences are great, and we look forward to enjoying them again and again. Others have wonderful outcomes, but you feel no need for a sequel. If you’re wondering whether you need to revisit orthodontic treatment, you’re probably in this second group.

After all, you put in your time as a teenager. All those days in bands and braces, all the adjustments, all that cleaning with little tiny tools in little tiny places. That was a lot of work, and you reaped the rewards of your conscientious orthodontic habits with beautifully aligned teeth and a healthy, comfortable bite.

But now you’ve started to notice that your teeth aren’t quite as beautifully aligned, or your bite’s not quite as comfortable. So, what’s happened? Let’s look at some possibilities, and whether a return to the orthodontist’s office is in order.

• You’ve Lost a Tooth

If you’ve lost a tooth because of injury or decay, that gap is an open invitation for surrounding teeth to move in to fill the void. Whenever you lose a tooth, consider an implant. Implants function, look, and maintain healthy spacing just like natural teeth.

One thing implants can’t do? Move like our own teeth will during orthodontic treatment. Your natural teeth can move because they are held in place within the bone by flexible periodontal ligaments. Implants, on the other hand, are anchored directly to the bone for stability.

If you’re considering new or further orthodontic work and want to replace a lost tooth with an implant, it’s a good idea to talk to Dr. Groisser to discover the best timing and scheduling for your procedures.

• You’ve Gained a Tooth

Problems with your alignment can also arise if you add a tooth or teeth. If you’re in your late teens or early twenties, wisdom teeth could be in your near future. And a new tooth can throw off the spacing and alignment of your existing teeth.

Talk to Dr. Groisser about your options if your wisdom teeth are about to make an appearance, and if it looks like your tooth and bite alignment might be affected.

• You’re Getting Older

Our teeth naturally tend to shift as we age. Teeth move forward, causing crowded or crooked front teeth—especially on the lower jaw. There’s even a medical term for this phenomenon: mesial drift. While we don’t know exactly why this drifting occurs, we can treat it.

Adults make up a large—and growing—segment of orthodontic patients. If your teeth have lost their ideal alignment over time, a visit to our Clarksburg, Gaithersburg, and Hagerstown office is a great way to bring your youthful smile back. And you’ll probably find your treatment much shorter and more comfortable than it was decades earlier!

• You Haven’t Been Wearing Your Retainer

Remember that word “conscientious” in the second paragraph? You need to wear your retainer conscientiously, for as often and for as long as recommended by Dr. Groisser.

If you’ve been ignoring a damaged retainer, or you keep forgetting to look for your lost retainer, or you have a perfect, undamaged retainer sitting unworn on your dresser, your teeth can start to shift out of their hard-won alignment within a short time.

Does this mean it’s back to months of bands and adjustments and appointments? Maybe not! See us as soon as you notice any changes in your teeth or bite. When caught early, shifting teeth can be treated much more easily.

What can we do to help you regain your best smile? A lot!

• Treatment Planning

When you need to accommodate implants, wisdom teeth, or other dental work which could affect your tooth alignment, Dr. Groisser can work with your dentist to make sure your alignment isn’t disturbed in the process. They can also map out a treatment schedule which coordinates your other procedures with any orthodontic treatment.

• Retainer Evaluation/Adjustment

Your retainer is probably a passive retainer, meaning it keeps your teeth in place instead of moving them. If you notice your alignment shifting, or if your retainer is uncomfortable when you try to put it on after a lapse in nightly wear, ask us about a replacement.

• Active Retainers

An active retainer helps move teeth into alignment rather than simply keeping them in place. A new active retainer might be just what you need to correct a slight shift.

• Aligners or Braces

If you have some serious shifting going on, we might recommend a second round of treatment with clear aligners or braces. But there’s good news here, as well! Treatment to correct an orthodontic relapse usually takes less time than it did originally, and treatment options are more comfortable and less noticeable than ever before.

Talk to Dr. Groisser about an orthodontic sequel if you have any concerns about changes in your bite or alignment. You might need only a simple retainer adjustment or a short time in clear aligners or traditional braces to make your smile its best and healthiest once again. And this time, remember to wear your retainer to make sure there’s no need for Orthodontics—Part III!