Ask the Orthodontist
Dental health education continues this month with an interview with local orthodontist Dr. Tara Gostovich DMD! Dr. Gostovich is a leader in NJ orthodontics with years of experience. Her patient – centered approach appeals to to all age ranges as she sees young children, teens, and adults! She sat down with me this week to bust the most common myths, questions, and concerns parents have when considering orthodontic treatment for their children.
Dr. Husain: Tara, so as a pediatrician we recommend screening at 7 years under the AAP guidelines. Can you tell me a little about why that time is so special?
Dr. Gostovich: We like to screen at 7 because the first adult teeth are starting to erupt, so we’re talking about the 6 year old molars and the upper and lower central incisors. By age 7, children have at least the lower centrals if not centrals and laterals, and the upper centrals may be loose or have already come in.
Dr. Husain: So timing really plays a huge part here?
Dr. Gostovich: Absolutely. Underbites need to tackled early. Cross bites need to be tackled early. However, a protrusion where you have to interfere with a growth to balance that out, you want to correlate that with a growth spurt.
Dr. Husain: What are some of the most common questions parents have when they come to see you?
Dr. Gostovich: That really depends on age of patient. For younger kids, age 7-10, families want to know do they need an expander. Families already come in having read about an expander and have questions about it.
So age 7, 8 and 9 the question I often hear is do they need an expander? And that’s one of the things we are looking for, but also evaluating how this patient growing, so we can intervene at the appropriate time.
-If they need help with the bottom jaw growing forward, we need to do that at a growth spurt.
-If we need help with the top jaw growing wider, we need to do that early, between ages 7-10 years.
-If they have an underbite, we need to help with the top jaw growing forward, the younger the better.
For older children, who are really the braces age, parents often ask about options and those are braces versus Invisalign.
Dr. Husain: And how do you determine that?
Dr. Gostovich: Almost anyone can do Invisalign. I would say we have almost 65% of our patients treated with Invisalign.
Dr. Husain: What makes a parent choose braces over Invisalign?
Dr. Gostovich: For the most part, parents think their children won’t wear the Invisalign. You’d be surprised- I think many parents won’t give their children the benefit of the doubt. Our youngest patient using Invisalign is 9 years old, and she’s doing great! A lot of early treatment can be done with Invisalign. Invisalign has a product for early kids (ages 7-10), teen treatment, and adult treatment. Of course, some patients do still require fixed appliances. If they have a significant cross-bite, they should be placed in a palatal expander and do that first. Plus with Invisalign, you can remove it to brush, and patients don’t have those decalcification marks from the braces.
Dr. Husain: So really almost any cases you can do with Invisalign?
Dr. Gostovich: For a patient who would’ve traditionally had a head gear a few years ago, now there are intraoral appliances because kids don’t want to wear the head gear. The intraoral appliances are good, but they are big and bulky... plus the child has to learn to bite the right way and they have to learn to eat with this the right way. You can accomplish the same goals with Invisalign too. You can even treat smaller children with Invisalign to make room for impacted teeth. It can help align the teeth, open the airway.
Dr. Husain: Wow, I didn’t know you could accomplish so much with Invisalign! I know with braces, it’s often a 2 year commitment. What’s the time commitment with Invisalign?
Dr. Gostovich: It’s approximately 1.5 to 2 years. For some patients, depending on the bite, Invisalign may complete treatment sooner than braces especially if they have a deep overbite. For braces, if you have a deep overbite, we can’t put the bottom braces on the first day, because you’ll bite on them.
With braces, in some cases when you need to wear elastics, you have to wait until you get into a strong enough wire that will support the elastic force which may take 9 months to a year. Invisalign may allow them to complete treatment sooner.
Dr. Husain: How often do patients have to return to clinic for treatments?
Dr. Gostovich: Braces patientts come every 6-8 weeks for adjustments. Invisalign is clear and comfortable, but it’s also more convenient because follow up is every 4 months. You don’t have as many problems of soreness, poking wires, special meals, that kind of thing.
Dr. Husain: So it seems like really it’s a win-win, honestly. What are some red flags for parents to be aware to begin thinking, ok should we go see an orthodontist?
Dr. Gostovich: Severe crowding of permanent front teeth, large protrusion, for example if they fell, could be at risk of trauma to teeth.
Dr. Husain: What about red flags for pediatricians to be aware of?
Dr. Gostovich: For sure, excessive habits such as finger or thumb sucking, pacifiers, that kind of thing. If parents are having a hard time trying to break that habit, often it’s a thumb and a wubbie or a thumb and a teddy bear, so if parents try to lose the pairing, they may be more successful. Try to push the wubbie or teddy bear over thumb or finger sucking.
Dr. Husain: I know, I’m so big on weaning the paci early because affecting the palate, the way the teeth come in, that’s huge. Ok, so what’s one piece of advice you feel like is crucial to pass on to patients?
Dr. Gostovich: Retainers are forever. We tell our patients “nighttime for a lifetime!” As we age, we lose tissue volume and the bone remodels, so our gum tissue recedes a bit, you lose support, and the teeth can shift. That’s one thing parents are most shocked to hear since retainers used to only be worn for a year. If you’re not wearing your retainer, the teeth can shift.
Dr. Husain: I think that’s super important...I remember when growing up, retainers were kind of a 1-2 year thing and then ehh, fell to the optional category. I’m glad I learned that!
Dr. Gostovich is located in Marlboro, NJ. She offers complimentary consultations. To learn more about Dr. Gostovich and her practice, visit https://www.tgortho.com/. Call or text 732-617-1211.