PATIENT INFO

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What to expect at your first visit

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1. Welcome

There will be a friendly welcome at TWIGGE ORTHODONTICS. The goal of the first visit is to get to know you. Although it is informative, it should be enjoyable too.

After some paperwork, we will go through the relevant medical and dental histories with a focus on your

concern(s).

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2. Assessment

Dr. Twigge will then assess your facial structures, teeth and jaws for balance, symmetry, function and aesthetics.   Dr. Twigge will explain the relevant findings and if orthodontic treatment is recommended now or in the future. He will also discuss relevant treatment options.

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We welcome questions and remember that there is no such thing as a silly question. It is important for us that you understand the nature, cause, prognosis, treatment options and ongoing care relevant to your orthodontic conditions. This is all necessary for written consent to treatment.

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3. Essential Diagnostic Records

It is essential to obtain good quality diagnostic records before treatment can start. These records are diagnostic tools to help determine the best course of action for you. If treatment is recommended; orthodontic photographs, models and radiographs (X-Ray films) will be essential. Occasionally, further investigations may be required. These may be special radiographs such as a Cone Beam CT scan (CBCT) or opinions of other dental specialists. All of the above help diagnose orthodontic conditions and help with treatment planning.

We will refer you to a radiology practice to get specific X-Ray films. Most of the orthodontic films are currently bulk billed under Medicare.

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4. Follow-up Treatment Planning visit

We will schedule a follow-up appointment to discuss your records, finalise your treatment plan and outline the relevant risks of orthodontic treatment. A treatment plan and cost estimation and relevant financial information will be given to you at this visit. This information will be outlined in a formal written report to your general dentist. 

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5. Fees

The initial consultation fee is $100.00 and diagnostic records (models and photographs) are an additional $100.00. Fees are due on the day of the appointment and we accept cash, cheque, Visa, MasterCard and Eftpos. Please forward your receipt to your health fund. Please take note, the consultation and record fees will be discounted from your treatment cost when you start your treatment with TWIGGE ORTHODONTICS.

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6. What to bring

A referral from a dentist is not required. However, please bring along any referral letters and X-Ray films given to you by your dentist.

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Treatment Planning Appointment

 

At this visit Dr. Twigge will discuss your records, review your treatment options and propose a treatment plan tailored to your needs and lifestyle. He will also discuss the relevant risks associated with orthodontic treatment and your retention needs. Questions are welcome. 

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You will be provided with a written treatment plan, consent form and other important information. Please feel free to take the paperwork home to consider with your family. Once we hear back from you and received the signed documents, we will arrange the next phase of your treatment. There are no fees for this appointment.

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Treatment Options

 

Dr. Twigge will discuss your treatment options with you and advise on what type of treatment will give you the most predictable and stable outcome which is also tailored to your needs and lifestyle.

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1. Regular Braces

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Regular stainless steel braces/brackets are the most commonly used brace system and are fixed to the enamel part of teeth with a special type of glue. They are much smaller and more comfortable compared with the traditional "train tracks."  Occasionally, we need to glue thin metal rings/bands that fit around the first permanent molars. It does not hurt to glue the braces onto your teeth. An archwire fits into the brackets to align the teeth. Grey or coloured modules wrap around the bracket to secure the wire in place.

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You can change the colour of your modules at each visit which is usually 6-8 weeks apart! 

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Regular braces are often popular with younger people. Choosing the colour of your modules is fun and can complement your style. It could also be a good choice for the lower teeth which are less visible on smiling.

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With regular braces, teeth move by pushing and pulling and the braces control the alignment, tipping and torquing of teeth. Regular braces are an efficient and effective way to give you a great smile and a good functional bite. 

 

Braces may be required for one arch or for both arches. It will take approximately 60-75 minutes to get your braces on for both arches. We will give you instructions and good advice on how to care for your braces and maintain excellent oral health. Comprehensive treatment (two arches), usually takes 15-24 months to complete. Things that prolong treatment are: poor brushing, poor compliance, breakages and not attending each appointment.

 

Occasionally, other appliances are needed before or during braces to help to correct the bite. When the mouth is over-crowded or for specific reasons, teeth may need to be removed to enable all of the teeth to fit together better. 

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2. Clear/Ceramic Braces

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Clear braces/brackets are almost invisible and a clear choice for some patients. They are fixed to the enamel part of teeth with a special type of glue. It does not hurt to glue the braces on your teeth. An archwire fits into the brackets to align the teeth. Tooth-coloured modules wrap around the bracket to secure the wire in place. When placed in the lower arch, the ceramic brackets can cause incisor wear of the the upper front teeth in some cases . Ask Dr. Twigge if this will be a risk factor for you.

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With clear/ceramic braces, teeth move by pushing and pulling forces and the braces control the alignment, tipping and torquing of teeth. Clear/ceramic braces are an efficient and effective way to give you a great smile and a good functional bite. 

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Braces may be required for one arch or for both arches. It will take approximately 60-75 minutes to get your braces on for both arches. We will give you instructions and good advice on how to care for your braces and maintain excellent oral health. Comprehensive treatment (two arches), usually takes 15-24 months to complete. Things that prolong treatment are: poor brushing, poor compliance, breakages and not attending each appointment.

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Occasionally, other appliances are needed before or during braces to help to correct the bite. When the mouth is over-crowded or for specific reasons, teeth may need to be removed to enable all of the teeth to fit together better. 

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3. Clear Removable Aligners

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There are many clear aligner systems available. They are a series of thin "mouth guards" which are almost invisible and need to be worn 20-24 hours per day. They are removable and this makes it easier to clean your teeth properly. They are an option for motivated patients with excellent compliance/self-discipline. Each aligner is worn for 1-2 weeks and is swapped for the next one in the series to gradually move the teeth.

With aligners, teeth move by pushing forces. Blobs/attachments of tooth-coloured composite may be required on some teeth to control individual tooth movements. Clear aligners may under perform when dealing with some orthodontic movements. Refinements or other mechanics may be required which will prolong your treatment time.

The composite attachments are removed at the end of the aligner treatment.

It will take some time to get use to your aligners. Initially, you may salivate more and you can expect a slight lisp when speaking with the aligners in. This will improve over time and with good aligners wear.

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4. Other

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Other treatment or orthodontic appliances may be required before or during braces and used for early/interceptive treatment or for comprehensive treatment.

• Habit breakers (thumb or tongue retraining appliances).

• Molar distalisation (removable or fixed).

• TSADs. Read more.

• Space maintainer or space re-gainer.

• Maxillary expanders (removable, Quad Helix or Rapid  Maxillary Expander). Read more.

• Functional Orthopedics (Class II correctors which are either removable or fixed). Read more.

• Extractions.

• Interproximal Enamel Reduction.

• Referral to the oral surgeon for tooth exposures and when a jaw operation may give you a better dental and facial outcome in combination with braces.

• Referral to a periodontist to manage gum and bone related conditions and for tooth exposures.

• Referral to a prosthodontist or general dentist for restorative care or prosthodontic care in cases where teeth are missing.

• Referral for speech management, ENT problems and jaw joint problems.

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Retention

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This is likely the most important phase of your orthodontic journey.

 

Retention is the art of keeping your teeth beautifully straight and preventing orthodontic relapse. Your face will look different in five or ten years from now and the facial changes are constant. These changes are the result of the interactions between function, soft-tissues and hard-tissues. 

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The orthodontist can get teeth straight, but it is patient`s responsibility to keep the teeth straight. Too many patients get re-treated in their twenties and thirties due to poor retention. Wisdom teeth will not affect the alignment of your teeth if you wear your retainers well. Retention and orthodontic relapse are important topics to discuss even before treatment commences and they are long-term concepts. 

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Upon completion of your orthodontic treatment, your braces will be removed and your teeth will be cleaned and polished. Although the active orthodontic phase of your treatment is now complete, your management it is far from over. 

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At TWIGGE ORTHODONTICS we issue you with a set of clear retainers at the end of your treatment as a standard protocol. This is included in the cost estimation and part of your comprehensive orthodontic treatment. We will review your retention and retainers for the next two following your braces treatment. Routinely, we will review your retention and retainers at 2 months, 5 months, 12 months 18 months and 24 months. Retainer checks, repairs and replacements will incur a fee after this two year period. 

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Wearing retainers is the patient`s responsibility! The clear retainers come with different names, but they are essentially the same thing (Essix retainer, Pressure-Formed Retainer, Vacuum-Formed Retainer or Thermoplastic retainer). These retainers are nearly invisible, they fit snug and comfortable and they are easy to wear and care for. They have the additional benefit of being removable which gives you the freedom to enjoy your smile without additional risks. They are usually worn full-time for a few weeks then night-time. The long-term goal is to wear the retainers enough to keep them straight. This could be wearing the retainer a couple of nights per week. 

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Some cases/situations require alternative types of retainers. Dr. Twigge will discuss your retention needs with you. 

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Bonded/fixed wires behind the upper and/or lower front teeth are excellent at keeping teeth straight. However, they do break, have added responsibilities and they have additional  risks.

At TWIGGE ORTHODONTICS we place bonded wires at an additional cost and with discretion. 

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Comprehensive instructions will be given to you when we insert your retainers. 

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More information.

Retention and Relapse Document.

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Consent

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1. What is Medical Consent?

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Consent to medical treatment, such as orthodontic treatment, is an important agreement between the patient/guardian/parent and the orthodontist before commencing a specific course of treatment.

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2. When is Medical Consent valid?

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• The practitioner provides relevant and clear information about reasonable treatment options.

• The information addresses the nature, risks and consequent ongoing care related to all reasonable treatment options.

• The likely consequences and risks of not proceeding with the treatment are explained.

• The treatment options address the patient`s chief concern.

• The patient/guardian/parent can communicate adequately in English and can legally give consent. An official translator will be required if there is inadequate communication in English. 

• The patient/guardian/parent understands the information provided as well as the risks and benefits of the treatment choices, which enables him/her to make informed decisions. In other words, information should be remembered and explained to someone else).

• It is freely given. It can also be withdrawn voluntary at any time.

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At TWIGGE ORTHODONTICS we value the consent process and will ask your written consent before commencing orthodontic treatment.

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Transfer Policy

At TWIGGE ORTHODONTICS we understand that it may be necessary to change orthodontists in the event of moving. We are more than happy to continue your treatment if you started your treatment elsewhere. However, this may involve additional planning and Dr. Twigge will discuss this with you at your consultation. 

 

Please bring along any orthodontic records  such as photographs, models and radiographs from you previous orthodontist. A treatment summary letter from your current orthodontist is always helpful. 

 

The Australian Society of Orthodontists prescribe a formula to calculating the cost of treatment for transfer patients. Therefore, please bring along a detailed history of your orthodontic financial statements so that we can calculate the outstanding fees. 

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Conversely , we will be glad to assist you with the transition to a new orthodontist if you were to transfer away from us. We may be able to recommend a new orthodontist to you and there is a national directory of orthodontists to refer to (read more). 

Please make contact with your new orthodontist as soon as convenient to avoid additional delays in your treatment. We will supply you with a treatment summary and a copy of your orthodontic records.

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Click on the link below for advice on what to do when changing orthodontists:

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Transfer of patients - Australian Orthodontic Society.

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What to expect when your braces go on?

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1. General

It is normal for teeth to feel tender a few hours after having braces fitted and when they get adjusted. This will last for a few days to a week. You will not lose sleep though and you can take pain medication if permitted/required, such as paracetamol. This initial tenderness is due to the newly applied pressure which slowly pushes your teeth into alignment. This is not an emergency.

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2. Diet

We recommend you review your diet and consider things that can damage your braces and break down the integrity of your teeth (breakages can slow down your treatment progress). A balanced diet is recommended. Avoid snacking on carbohydrate and sugary snacks between meals. 

 

Things to avoid:

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Hard, crunchy and sticky treats or foods:

Beef jerky, popcorn, muesli bars, refrigerated chocolate, mints, corn chips, crackling, nuts, un-cut apples and carrots, meat on bones, pizza or bread crust, ice cubes and lollies (Redskins, Minties, toffees, Warheads, lollipops etc.). 

 

Drinks with a low PH:

Sports drinks, energy drinks, ice teas, fruit juices and soft drinks. Rinse your mouth thoroughly with water after these types of drinks.

 

Sugary treats:

Sweets at meal time are better as long as it is occasional. We strongly discourage sugary snacks between meals.

Examples are: cake, cordial, flavoured milk, chocolate, yogurt with added sugar, biscuits and lollies. 

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Carbohydrates:

Avoid carbohydrates as much as possible because oral bacteria use carbohydrates to produce tooth-damaging acid. 

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Habits:

Nail biting, biting on pens and opening your water bottle with your front teeth can break your braces.

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For more information, please click here. 

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3. Oral hygiene

 

We recommend you brush your teeth for 5 minutes in the morning and also at night with a toothbrush with a small head and soft bristles. An electric toothbrush is excellent. We recommend you brush your teeth after every meal to prevent plaque build-up around the brackets.

 

It is important that you brush each tooth individually and to brush each side of the brackets, especially on the gum side. It is not how long you brush your teeth, but rather how well you brush your teeth that makes the difference. We will show you the correct style of brushing and give you a bag of goodies to care for your teeth and braces. We will show you how to use super floss and interdental brushes to detail your cleaning.

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Remember that you will wear the bristles of your brush more quickly with braces, so please replace it more often. 

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It is a good idea to use plaque disclosing tablets/agents to highlight the areas around your braces that require better brushing/plaque removal.

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We recommend you visit your dentist six monthly for check-ups and cleans.

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For more information, please click here. 

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Common Problems and Management

 

Problems with your braces may cause injury to you, compromise your treatment and prolong your treatment. Therefore, it is important to manage problems/concerns with your braces as soon as convenient.  Some problems are more urgent than others. 

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1. Broken bracket

This is when a metal or ceramic bracket is no longer attached to the tooth and can slide on the wire. This could be due to interferences with your bite and poor food choices (see section on diet).

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What to do:

• Please give us a call so that we can arrange a time to replace the bracket. Please do not leave it until your next appointment as this can delay the progress of your treatment.

• Place wax over the bracket to secure the bracket and reduce irritation.

• This is not an emergency unless the broken bracket is the last bracket in your mouth (typical on your molar) and the wire is digging into your soft-tissues. 

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2. Missing module/ligature

This is the grey, clear or coloured rubber rings we place over the bracket wings to secure the wire into the bracket. They can be single rings or joint together (chain).

 

What to do:

• Please call us so that we can replace the module or ligature.

• This is not an emergency and we can see you in as soon as convenient. 

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3. Broken archwire

This is the metal wire that joins the brackets together. This does not happen often.

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What to do:

• Remove unsecured/lose segments of wire by pulling it out. 

• Please give us a call so that we can replace the wire as soon as possible. Please do not leave it until your next appointment as this can delay the progress of your treatment.

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4. Sharp ends of the wire

Archwires go through the molar tubes at the back. They will either finish within the tube or go through the tube and bent to be more comfortable. During treatment, the wire may poke through the molar tube as your teeth straighten.

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What to do:

• If the wire-end feels blunt and not causing significant discomfort, please place wax over the wire-end and leave until your next appointment.

• If the wire-end is causing trauma/ulceration to your cheek tissues, please give us a call so that we can mange this as soon as possible. Place wax over the end to reduce irritation in the meantime.

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5. Sore lips and cheeks

Initially, your lips and cheeks may feel fragile when your braces are fitted. This is due to irritation from your braces.

 

What to do:

• Apply orthodontic wax regularly over the trouble-making brackets.

• Lubricate your lips with balm.

• Avoid playing with your braces.

 

6. Ulcers

Ulcers are sores that occur due to excessive rubbing of any orthodontic component. Essentially, the integrity of the soft tissues have been compromised. Ulcers normally heal spontaneously within 10-14 days.

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What to do:

• Avoid playing with your braces.

• Place wax over the component causing the irritation.

• Gargle with lukewarm salty water or with a mouth rinse containing chlorhexidine gluconate as an active component. These rinses are anti-bacterial and helpful when you have an ulcer.

• Give us a call so that we can remove the source of the irritation.

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Appointments

We understand that most people have busy schedules.

Some visits during treatment are shorter and some are necessarily longer. Shorter appointments are commonly scheduled in the afternoon and after schools hours. Longer appointments are commonly scheduled during school hours to accommodate as many families in the afternoon 

Our appointment schedule is designed to achieve to following:

• To see you on time.

• Have enough time for the necessary treatment.

• Promote good communication (listen, discuss, give information about your treatment and answer questions).

• Work with you around school and work time.

 

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FAQs

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1. Who is an orthodontist?

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An orthodontist is a dentist that had additional 3 year specialist training in orthodontics at a reputed university. In addition, an orthodontist does braces day in and day out which makes the orthodontist the most experienced person to do your orthodontics.

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Orthodontics is a specialist field in dentistry that specialises in:

• Facial and dental growth and development.

• The functions of the oral and masticatory systems.

• The diagnosis and management of orthodontic conditions which include skeletal, dental and soft-tissue structures and functions. 

• Apply orthodontic mechanics.

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More information.

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2. What is the difference between a dentist and an orthodontist?

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An orthodontist is a dentist that had additional 3 year full-time university  training and does braces or clear aligners all the time. Therefore, the orthodontist is most qualified and experienced clinician to manage orthodontic problems.

 

More information.

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3. Is a dentist referral required to see an orthodontist?

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No, it is not required. 

It is recommended, that all patients should see their dentist regularly to ensure optimal oral health. It is a good idea to have a check-up and clean prior to having orthodontic treatment. 

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4. How long will I need my braces on for and why so long?

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Braces routinely takes 15-24 months to complete. This can be longer for complex cases. Ask Dr. Twigge to estimation your treatment duration.

 

Why so long?

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• It takes 15-24 months, because braces move teeth slowly which also minimises risks. Therefore, tooth movement is time-dependent and low forces are required.

• The orthodontist control teeth in three dimensions (alignment, tipping and torquing).

• Enough time should be spent to detail and finesse the position of teeth and to create great smiles. The total time required to complete treatment may exceed the estimated time. Things that prolong treatment time and influence the quality of the end-result are:

  • Excessive or deficient bone growth,

  • Inadequate co-operation with elastic wear, 

  • Poor oral hygiene,

  • Broken appliances and

  • Missed appointments.

 

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5. Are there risks associated with orthodontics?

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Yes. Most of the risks are general risks that apply to all orthodontic patients. There are a few specific risks that may not apply to you.

• Pain and discomfort.

• Ulceration.

• Decalcifications/spots on teeth.

• Decay.                 

• Root resorption/shortening.

• Teeth can become non-vital.                                           

• Atypical jaw growth.                                                                  

• Teeth fusing to bone (ankylosis).

• Non-compliance during treatment.

• Poor retention and orthodontic relapse.

• Gingival inflammation, infection, overgrowth and periodontal breakdown.

 

For more information, please ask Dr. Twigge about your specific risks. You can also find more information by clicking on the following link. 

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6. What is a Cone Beam CT scan?

 

A  Cone Beam CT (CBCT) is occasionally used in orthodontics to provide 3D images of the anatomical structures of the lower face which includes the upper and lower jaws. This specialised imaging is used to complement conventional 2D imaging such as the OPG and the Lateral Cephalogram and is not required for all orthodontic patients.

The 3D acquisition helps identify pathology, jaw joints (Tempero-Mandibular Joints or TMJ) and the position of teeth relative to each other and other structures. Therefore, it is an excellent diagnostic tool that is helpful for treatment planning for some orthodontic patients.

A CBCT can only be requested by a dental specialist, such as an orthodontist, under Medicare and a co-payment applies. In other words, the Medicare rebate applies only if you are referred by your orthodontist or another dental specialist.

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7. What is a Temporary Skeletal Anchorage Device (TSAD)?

 

A TSAD is a temporary, small titanium screw placed in the bone between teeth or in the roof of your mouth to provide additional anchorage/control with your braces. They are not invasive and placed using local anesthetics. They are removed when they have served their purpose. 

 

 

8. Is there a relationship between orthodontics and jaw joint problems?

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Many people experience jaw joint problems (Tempero-Mandibular Disorders or TMD) without a history of orthodontic treatment. TMD consists of a range of disorders which are multifactorial in nature which include the bite, joints, muscles and other related structures. Stress-related conditions can aggravate TMD symptoms. TMD is common in young female patients.

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Your jaw joints are adaptive and can accommodate a range of bites. Therefore, small bite changes can be accommodated by the joint system without negatively impacting the joints. However, it is important to have a balanced occlusion without gross interferences. Orthodontic mechanics can aggravate TMD symptoms for some patients; however, Orthodontics is considered neutral and does not cure or cause TMD.

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TMD can be managed but not necessarily cured. Therefore, please do not embark on orthodontic treatment if your main goal is to cure your TMD. Many TMD patients grind or clench their teeth during the day and mostly at night. Management of TMD may include the reduction in day-time and night-time grinding/clenching, exercises, wear of appliances or other treatment modalities.

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9. What is functional orthopedics?

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Functional orthopedics is when appliances are used to correct problems with jaw relationships, especially when there is a deficient lower jaw size. It is only achieved when patients are actively growing and when the appliances are worn full time. The correction is a result of changes in: the position of teeth and the bone that houses the teeth, soft-tissue and joint adaptation and occasionally a little extra bone growth.

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10. What is maxillary expansion?

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There are a few sutures between the upper jaw and other facial bones. One of these sutures is in the middle of your palate. These sutures can be stretched when patients are young and before these sutures interlock more. In older patients expanders can be used if the back teeth are tipped towards the palate. In severe cases an expander is used with a surgical procedure. There are many maxillary expander types (removable, Quad Helix and Rapid Maxillary Expander).

The aim of the expander is to give more width to the upper jaw in a number of circumstances. You will feel pressure when the expander is activated without significant discomfort. Dr. Twigge will explain how these appliances work, how they are activated and cared for and what to expect if you require an expander.

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11. What is a removable plate?

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A removable plate has metal cribs to hold on to certain teeth for retention and an acrylic base for stability and anchorage. It normally has active components such as springs to move certain teeth. It may also have acrylic ramps in the front or the back for specific situations. A removable plate is good when simple, gross tooth movements are required, but not ideal when fine control is required or for complex cases. It can be used for retention and sometimes before or during active orthodontic treatment. 

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12. Do I need to wear a mouth guard for contact sport?

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Absolutely! Your braces can cause significant more soft-tissue trauma if you get hit in the mouth. In addition, your teeth can get injured and in some cases the injuries are more complex to manage. A custom made, professional mouth guard may not work as your teeth will move during braces treatment and the appliances may be in the way.

 

None of the commercial mouth guard products, available for braces, are ideal. They come in small, medium and large sizes and range from heat moulded products to off-the-shelf products with space to accommodate the braces. Ask Dr. Twigge about your options.

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13. What is the best age for orthodontic treatment?

The ideal treatment timing will be different for most people and it depends on the type of bite, growth and development. The best age is determined on an individual basis. Some cases should be treated earlier or later than the average age. Therefore, it is recommended to screen for orthodontic problems at the age of 7-8 years.

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14. Additional  resources

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a. Orthodontics Australia.

b. British Orthodontic Society.

c. Australian Society of Orthodontists.

d. New Patient Form.

e. Orthodontic Benefits and Risks Document.

f. Privacy Policy Document.

g. Retention and Relapse Document.

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