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Understanding Early Orthodontic Treatment - by Dr. Kelly Mitchell

May 10th, 2019

What is Interceptive (Early) Treatment?

Parents may be surprised and skeptical if a dentist recommends seeing an orthodontist when their child still has as many baby teeth as permanent teeth.  Having your child seen by an orthodontist by age 7 – a recommendation supported by the American Association of Orthodontists – can help uncover possible dental and jaw growth issues like crowding, crossbites and other more serious concerns.  Treating these problems early can prevent them from worsening as your child grows, possibly reducing time in full braces or Invisalign™ as a teenager and potentially preventing the need for more invasive treatments such as tooth extractions or surgery.

This early orthodontic intervention is called Interceptive or Phase 1 Treatment. Because it’s only indicated for certain problems, not every child who comes to our office will end up needing early treatment.  We definitely will let you know if we feel a single phase of comprehensive treatment at an older age is best. If your child would benefit from early interceptive treatment, we will discuss the options and help you decide on the most optimal path, taking into consideration your child’s emotional readiness and weighing the costs, in both time and money, relative to the benefits.  There is no charge for our initial evaluation.

What is involved?

Depending on whether the problem is dental or jaw-growth related, early treatment may involve partial braces or an orthopedic (growth guidance) device like an expander.  Sometimes it can even be as simple as an active retainer.

Our goal is to address the identified problems with as little intervention as possible, knowing that we’re trying to head something off before it worsens, but we’re not aiming for perfection since so many permanent teeth still need to grow in.  Our guiding principle is to have targeted goals and to accomplish them as quickly and efficiently as possible to save you time and money. This early phase of treatment can take anywhere from 6 to 18 months, ideally no more than 12.

One thing parents must be aware of is that interceptive care is typically the first of two phases of treatment, which is why it is also called Phase 1.  Phase 2 (comprehensive) treatment will occur after the rest of the permanent teeth have grown in. Phase 2 is likely to be simpler and shorter than a single round of full braces would have been because of the progress made in Phase 1.

When is it needed?

One of the reasons we aim to keep interceptive treatment relatively short is that we like to give children at least a 1-year break between phases, preferably 2-3 years.  This usually means that Phase 1 treatment is most appropriate in 7 to 10 year olds. Also, there are growth conditions that respond to treatment much better before age 10, such as underdevelopment of the upper jaw (an underbite tendency).

There are a number of reasons why interceptive orthodontic treatment is recommended.  Some examples include:

  •       Expanding the upper jaw to eliminate crossbites, reduce upper crowding, and improve airway and breathing
  •       Developing upper and lower arches to create room for crowded teeth that are blocked out and may become “impacted”
  •       Restricting or promoting upper or lower jaw growth to correct a bad bite (“malocclusion”) caused by an unfavorable growth pattern
  •       Preserving or regaining space for permanent teeth if baby teeth have been lost prematurely
  •       Retracting protruded upper front teeth to reduce “overjet” and the risk of dental trauma
  •       Placing a “habit appliance” to help eliminate thumb/finger habits or tongue habits that are negatively influencing jaw growth and bite development

How does it help?

Some parents ask why their child should undergo early treatment – won’t the problems improve on their own over time?  When appropriately recommended, Phase I treatment targets problems that don’t get better with growth or that are harder to correct in a single round of treatment later.

For example, the lower jaw continues growing after the upper jaw has stopped, so the adolescent growth spurt may help a child with a small lower jaw, but it will worsen the situation for a child with a large lower jaw or small upper jaw.  That’s why underbites are best corrected before age 10.

In crowded situations, we know that the space available for permanent teeth decreases over time because the permanent molars migrate forward in the mouth as baby teeth are lost.  Unless it’s clear that the crowding is so severe that permanent-tooth extractions are inevitable, it’s helpful to develop the dental arches early to try fitting all the teeth in. This is especially true for children who struggle with airway and breathing issues since the size of the dental arches determines the space available for the tongue.  Our low-dose 3D x-ray technology allows us to measure airway volume to help with that decision.

Studies have shown that improving a child’s self-esteem is also a very valid reason for doing early orthodontic treatment.  Often the teeth aren’t ready for full braces until late middle school or early high school. Children who are self-conscious about their teeth being crooked or protruded benefit significantly from getting their front teeth straight before the sensitive middle school years start.

What happens next?

Following Phase I interceptive treatment, we recommend periodic visits to monitor your child’s dental development and jaw growth.  This allows us to anticipate whether Phase 2 treatment will be needed and what the ideal timing would be. Occasionally, Phase 2 treatment is not necessary because of the correction accomplished in Phase I, but we can't guarantee that.  In any case, Phase 2 treatment should be shorter than single-round comprehensive treatment would have been. We do not charge for these observation visits between phases.

See the evolution of two of our patients below: 

One of our cases was my son, Mitch, who had 6 months of partial upper braces to correct his upper protrusion and make room for his blocked out upper canines.  He also had his upper baby canines removed and currently wears a retainer at night.

Another great case was  our patient Ella. You can see her Phase 1 and Phase 2 evolution:



Signs That a Child is Suffering From Sleep Apnea

February 4th, 2019

Signs That a Child is Suffering From Sleep Apnea

Does your child seem drowsy during the day? Does he or she snore or wake up breathless in the middle of the night? They could have Obstructive Sleep Apnea (OSA) - a chronic condition where breathing stops periodically during sleep because soft tissue is relaxing and obstructing the airway. These periodic stops can happen as many as 20-30 times in an hour and cause a lack of oxygen to the brain, waking up your child so that they restart proper breathing. All that waking up can leave one pretty sleepy the next day - even if they don’t remember waking up!

Untreated, obstructive sleep apnea can affect school work and overall alertness as well as raise your child’s risk of serious health problems down the road. These include:

  • High blood pressure
  • Stroke
  • Heart disease
  • Diabetes
  • Chronic acid reflux
  • Obesity
  • and even Depression

According to the American Academy of Otolaryngology (ENTs) sleep disordered breathing affects approximately 12 percent of children.

Luckily, sleep apnea is treatable. It just needs to be diagnosed. That’s where you come in: if your child has any of the following symptoms, bring them to see us for a free consultation and sleep apnea test at Mitchell, Bartlett and Bell Orthodontics.

Here’s what to look for:

  • Insomnia or difficulty sleeping (tossing and turning or night sweats)
  • Loud snoring at night
  • Waking up at night short of breath
  • Long pauses in breathing
  • Chronic mouth breathing during sleep
  • Snorting or choking sounds during the night (indicating a restart of breathing)
  • Extreme drowsiness throughout the day
  • Changes in mood, misbehavior or decline in school performance
  • Hyperactivity or inattention (in some cases children who are diagnosed with ADHD are actually not hyperactive but rather are showing the clinical symptoms of OSA.

Orthodontists are leading specialists in spotting Sleep Apnea early because of our familiarity and expertise in working with the soft tissue in children’s mouths. As both orthodontists and parents, Dr. Kelly Mitchell,  Dr. Brian Bartlett, and Dr. Carrie Bell make a point of asking all parents if they’ve noticed any of these symptoms when they first consult with new patients.

If your child is exhibiting any of these symptoms, bring them in for a free consultation. We can help with a treatment plan and make sure your kids are sleeping soundly!

While Sleep Apnea can have very serious side effects, it is treatable. The most important thing you can do is pay attention and have your child evaluated.

Please reach out to us today if your child is exhibiting any of the above signs. At Mitchell, Bartlett and Bell Orthodontics we offer complimentary consultations and have 2 convenient locations in Greensboro and Kernersville.


WAIT! Don’t Order Orthodontic Treatment Online Before Reading This

November 2nd, 2018

WAIT! Don’t Order Orthodontic Treatment Online Before Reading This

It’s easy to do so many things these days with the click of a button. Order shoes! Get a ride across town. Watch your favorite blockbuster movie! It seems like every day there’s a newer and easier way to do almost everything. We’ve been programmed to accept that anything can be ordered online and delivered right to our front door. However, at Mitchell, Bartlett and Bell Orthodontics, there is one thing that we believe has no easy replacement: orthodontic treatment. There is no match for a trained, experienced professional when it comes to your oral health.

The American Association of Orthodontists (AAO) agrees. They recently issued a Consumer Alert listing key questions to ask about direct-to-consumer orthodontic companies. You can download a print-friendly version here.

The issue is that many direct-to-consumer orthodontic companies don’t involve the in-person evaluation and/or in-person supervision of your treatment that we provide at Mitchell, Bartlett and Bell Orthodontics. In-person supervision and expertise is important because there is more to creating a healthy, beautiful smile than moving the visible portions of your teeth. If not done correctly any dental work can lead to potentially irreversible and expensive damage such as tooth and gum loss, changed bites, and other issues.

The Top 10 Questions To Ask

The AAO advises that when researching orthodontic treatment (including treatment models from direct-to-consumer companies like SmileDirectClub, SmileLove, Candid Co., SnapCorrect, Orthly, etc), you should consider many key questions, some of which include:

  1. As part of your treatment, are comprehensive diagnostic records like x-rays taken before your treatment?
  2. As part of your treatment fee, do you receive any in-person visits to a dentist’s or orthodontist’s office during your treatment?
  3. Is only one treatment type offered (such as invisible aligners or a certain appliance)?
  4. If a dentist or orthodontist is involved with your treatment, do you know the name of the dentist or orthodontist who will be specifically involved with your case (for example, is it available on the company’s website or elsewhere)?
  5. What are the possible risks (financial, health, etc.) associated with your orthodontic treatment?
  6. Who is responsible for detecting any issues that may occur during your orthodontic treatment? Is it you? If it is a doctor not associated with your treatment, who pays for those check-ups?
  7. If a doctor is involved with your orthodontic treatment, how can you contact him or her over the course of your treatment? How can you contact him or her if an emergency arises?
  8. If an emergency arises, does the company have a dentist or orthodontist in your area that you can see in-person? If not, who would cover the costs associated with seeing a dentist or orthodontist in your area?
  9. If you are injured or have another dispute involving your orthodontic treatment, how is it handled (litigation, arbitration, etc.) and what rights do you have?
  10. Does the treatment model comply with the dental laws in your state? To check your state’s dental laws, click https://www.aaoinfo.org/state-laws-and-regulations. Information for your state dental board can be found at https://www.aaoinfo.org/aao/state-dental-board-info.

Where You Receive Your Health Care Is A Very Important Personal Decision
Remember that orthodontic treatment is not a product or device – it is a professional, medical service. Dr. Kelly Mitchell received her dental and orthodontic degrees from UNC-Chapel Hill, Dr. Brian Bartlett from Northwestern University Dental School and The Ohio State University College of Dentistry, and Dr. Carrie Bell from University of Mississippi and University of Tennessee. Each doctor has spent years providing orthodontic treatment to their patients and has received numerous awards and honors. (See our site for details!)

Before making any decision about orthodontic treatment, consider doing some research and having a complimentary in-person consultation at Mitchell, Bartlett and Bell Orthodontics. We recognize that all our patients are unique and deserve to receive orthodontic care that reflects their individual needs. Our experienced and talented team is committed to working with you and your family to create a comfortable, stress-free, and rewarding orthodontic experience every time you visit our practice.

Contact us today for a free consultation at either of our 2 convenient locations: Greensboro or Kernersville or click below to schedule an appointment!. We’re happy to answer all questions and we'll make sure you or your child receives the right treatment plan for them.


5 Reasons To Ask About Damon Clear

July 11th, 2018

Mitchell, Bartlett and Bell Orthodontics values education and we (Doctors Kelly Mitchell, Brian Bartlett and Carrie Bell) want to make sure all our patients and their families feel informed about their options for treatment plans. To that end, we often find ourselves explaining what the Damon system is and the benefits in using DamonSmile for orthodontic treatment. Given that Damon Smile is such a big part of our practice (along with Invisalign) we’ve put together some of the reasons why the Damon system could be a great choice for you or your child! Take a look below:

  1. A Clear Smile. Facebook, Instagram, Snapchat users, rejoice! If a clear smile is important to your child, Damon Clear can be a great choice. The brackets are clear with a thin metal wire that runs through them. Pretty hard to spot in a selfie!
  2. Less Pain. As opposed to traditional brackets and elastic ties which hold wires in place in order to gradually move teeth to the correct positioning, the Damon System uses a slide mechanism to maintain archwires within the bracket. Less friction allows teeth to move more freely, quickly and comfortably.
  3. Fast. While treatment time can vary, clinical studies demonstrate that Damon System treatment is up to six months faster than traditional braces. Often appointments will be less frequent as well! Plus, there are no additional parts which means there is no need to worry about lost, misplaced or forgotten clear aligners. You and/or your busy teen can get in and out of our offices and back to your busy schedules.
  4. Easy to Clean. Traditional braces use elastomeric rings (or ties) to hold wires in place on their brackets. Unlike those traditional systems, Damon Clear braces are much easier to keep clean.
  5. 100% Approved! As opposed to other invisible aligners everyone is a candidate for the Damon System. Damon Clear works 24 hours a day, seven days a week to perfectly align ALL teeth for a phenomenal smile that enhances your entire facial appearance.

Put all these benefits together and there is a clear reason to ask about Damon Clear. It’s why we love being able to offer this treatment course to our patients. At Mitchell Bartlett and Bell Orthodontics, we recognize that all our patients are unique and deserve to receive orthodontic care that reflects their individual needs. Our experienced and talented team is committed to working with you and your family to create a comfortable, stress-free, and rewarding orthodontic experience every time you visit our practice.

Call us today at any of our 2 convenient locations: Greensboro or Kernersville or click below to schedule an appointment!

Member American Association of Orthodontics American Dental Association invisalign provider Damon Smile more than straight teeth
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