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Whenever we bite down, we’re applying force with our jaw muscles. Functional appliances direct these forces to create healthier tooth and jaw alignment. They’re used to help correct bite problems and to encourage symmetrical jaw growth.

Functional appliances aren’t always necessary. Because every child’s teeth and bite are different, orthodontic treatment at our Chula Vista or El Cajon, CA office is carefully tailored to your child’s individual needs.

• For the child with minor tooth misalignment, traditional braces or aligners might be all that’s needed.
• For the child with a minor malocclusion, or bite problem, an orthodontist might use elastics (rubber bands) to bring teeth into healthy alignment.
• For the child who has a more serious malocclusion, involving both tooth and jaw alignment, an orthodontist might recommend a functional appliance.

A severe Class II malocclusion can be caused when the upper jaw or teeth are positioned too far forward, and/or the lower jaw is too small or positioned too far back. Common Class II malocclusions include:

• Open bite—the front teeth don’t touch when the back teeth bite down, or the back teeth don’t touch when the front teeth close.
• Overbite—some overbite is normal. A deep overbite occurs when the upper teeth significantly overlap the lower teeth.
• Overjet—the upper front teeth protrude further horizontally than they should.

Today’s functional appliances come in a variety of designs to treat Class II malocclusions. They can be fixed or removable. They can be used with or without braces. Some are designed to expand the upper palate to make sure there’s room for all the permanent teeth. What they all do is advance the position of the lower teeth and jaw to create a healthier, more comfortable bite.

Fixed devices are attached to the teeth and meant to be used full-time. These include the Forsus™ device, the Herbst® appliance, and the MARA appliance.

• Forsus Device

This appliance works with braces. A spring coil rod is most often attached to bands on the first molars on the upper jaw. It’s then connected to the arch wire on the lower jaw. Just like elastics—but more effective!—these spring coil rods provide gentle forward pressure that encourages the lower jaw and teeth forward.  

• Herbst Appliance

The Herbst appliance also applies forward pressure to the lower jaw using telescoping rods connecting the upper and lower teeth. The rods expand as the mouth opens, and telescope together as it closes, positioning the lower jaw further forward while the upper jaw is held back. The Herbst can be worn alone or with braces, and can also be used to expand the upper palate.

• MARA Appliance

The MARA (Mandibular Anterior Repositioning Appliance) uses an adjustable “elbow” piece connecting bands on upper and lower molars to guide the lower jaw and teeth forward when the jaw closes.

Removable appliances such as Bionator and Twin Block appliances can also improve Class II malocclusions. They are meant to be worn for a specific number of hours each day, and can be taken out for sports or other activities as needed. Because it’s essential to get all the necessary hours in, removable appliances require commitment!

• Bionators

A bionator is made of wire and acrylic, and it looks a lot like a retainer. The wire fits around the upper front teeth. It’s attached to a smooth piece of acrylic that sits behind the upper teeth and is shaped to guide the lower jaw forward when biting down. The bionator can also be adjusted to expand the upper palate.

• Twin Block Appliance

The twin block appliance uses two separate pieces made of wire and smooth acrylic. Both pieces are modeled to fit precisely over the upper and lower arches. The acrylic “blocks” fit over the biting surfaces of the teeth, working together like a 3D puzzle. When your child bites down, the upper blocks slide into place behind the lower blocks, pushing the lower jaw and teeth forward. The top plate can also be adjusted to expand the upper palate if needed.

Because these appliances are best used while a child’s bones are still growing and developing, dentists and orthodontists recommend an orthodontic evaluation by age seven. Early treatment with a functional appliance can help correct serious bite problems before or together with braces. In some cases, functional appliances may reduce the need for headgear or surgery.

Todays’ orthodontic technology has made functional appliances more comfortable and efficient than ever before. Talk to Dr. Sanjay Kuruvadi to discover how an individualized treatment plan and a custom appliance can give your child a healthy bite and a lasting smile.

Orthodontists do everything they can to save teeth, but sometimes, a tooth is so damaged by accident, injury, infection, or decay that extraction is the only option. Or perhaps your child’s wisdom teeth are starting to come in—and starting to cause problems. Or, when this is the healthiest alternative, an extraction might be necessary for orthodontic reasons.

While there are several possible reasons an extraction might be necessary, one thing is true for any extraction: you want to make sure that your child is as comfortable as possible and heals as quickly as possible after the procedure.

Aftercare and recovery time isn’t exactly the same for every extraction. Whether your child’s tooth is a baby tooth or a permanent one, whether it’s a single tooth or several, whether it’s erupted or impacted, whether a local anesthetic or sedation is recommended—these factors and more can make a difference in recovery time.

Dr. Sanjay Kuruvadi will provide you with clear, specific instructions for helping your child to a speedy recovery after an extraction. We’d also like to offer you some general aftercare ideas to make sure your child is as comfortable as possible while recovering.

• Bleeding

Some bleeding is normal after an extraction. Follow your dentist or oral surgeon’s instructions carefully to minimize bleeding at the extraction site. Your child will probably need to keep a gauze pack in place for as long as directed to reduce bleeding and to help a clot form. If bleeding is heavier than expected or goes on longer than expected, call our Chula Vista or El Cajon, CA office.

• Swelling

Swelling is a normal response to extractions. Your dentist might suggest cold compresses to help reduce swelling immediately after the extraction. If you don’t have an ice pack, ask whether a bag of frozen peas or corn can substitute.

With any cold compress, it’s important to protect your child’s skin from injury. Follow your dentist’s suggestions for application and be sure not to exceed the time limits recommended. And don’t apply a compress directly to your child’s face—wrap a towel or cloth around the bag or pack to protect the skin.

• Careful Cleaning

The area around the extraction shouldn’t be disturbed or touched. The blood clot that forms after an extraction protects the area from irritation and infection caused by food particles and bacteria. If a clot is dislodged accidentally, it can lead to a condition called dry socket, which can be very painful.

This means no brushing near the extraction site, and no heavy rinsing or spitting for as long as directed. If your child is younger, you might need to help with brushing over the days following to make sure those sturdy bristles don’t get close to the extraction site before it’s healed.

• Soothing Foods

Have a supply of your child’s favorite comfort foods handy while healing, such as cream soups, mashed potatoes, scrambled eggs, gelatin, yogurt, and smoothies. Hot and cold foods can be irritating, so stick to cool or lukewarm foods for the first few days. Encourage your child to drink lots of liquids, but nothing carbonated. And do wait until any numbness wears off before giving your child chewable foods to avoid biting tongue or cheeks.

Remove spicy favorites from the menu, which can be irritating, as well as chewy, crunchy, or jagged foods like crackers, since tiny, sharp bits of food can make their way inside the site. Remind your child to chew on the side of the mouth opposite from the extraction site. And, since suction is an all-too-easy way to dislodge the clot over the extraction site, no straws!

• Schedule Recovery Time

Make sure your child rests and takes it easy after the procedure. Exercise, lifting, even bending over can dislodge a protective clot, so re-schedule any physically demanding sports and activities until your child is given the dental all clear.

• Medication

If your child has been given a prescription for pain medication or antibiotics, follow the instructions as directed. Dr. Sanjay Kuruvadi might recommend age-appropriate over the counter pain relievers to have on hand. For severe or continuing pain, call your orthodontist or oral surgeon right away.

• Coordinate Dental Schedules

Orthodontic extractions, if needed, will be scheduled into your child’s orthodontic treatment plan. Treatment can begin or resume when the extraction site has healed.

If an emergency extraction is necessary, call our Chula Vista or El Cajon, CA office so we can be aware of the situation and can coordinate with your child’s dentist or oral surgeon to keep treatment on track as much as possible.

An extraction can be worrying for both patient and parent, so talk to your orthodontist for the best ways to make this experience a positive one for your child before, during, and after treatment.

The “Back to School” ads are out already? Halloween candy’s showing up in stores? Just a minute—summer isn’t quite over yet! While the days are still sunny and warm, let’s look at a few cool ways to keep your smile bright with some healthy dental options:

• Healthy Drinks

Hot summer days mean it’s time to hydrate. But sodas, fruit drinks, and sports drinks can have a lot of added sugars, which can mean added cavities. They can also be quite acidic, and acids break down tooth enamel. So, what to reach for on a hot day? Water!

Water is a good choice whenever you’re thirsty. Water is essential for healthy bodies and for healthy teeth and gums, too. Water helps wash away food particles which feed the cavity-causing bacteria in plaque. Acids in our foods and drinks break down tooth enamel, and water helps balance out those acids. If you have fluoridated water, fluoride makes enamel stronger and even helps reverse early decay.

• Healthy Gear

It’s great to get outdoors again for sports like biking, water skiing, baseball, or hoops. And it’s great to keep your teeth safe while you’re active. A mouthguard will help protect your teeth and mouth from contact when you’re playing contact sports. If you wear braces, Dr. Sanjay Kuruvadi can craft a mouthguard that will protect both your mouth and your braces!

If you’re just out of braces or aligners, don’t forget to wear your retainer. Retainers keep your teeth from moving out of position while your jawbones rebuild strong bone tissue around them. Make sure that healthy smile you worked so hard for stays looking its best.

Your appliances protect you, so return the favor and make sure your appliances stay healthy by cleaning them after use and storing them in their protective cases.

And remember to replace another piece of protective equipment regularly—your toothbrush. If you haven’t replaced your toothbrush for several months, it’s time to go shopping. Toothbrushes wear down over time, especially if you wear braces, and, after three months or so, can’t clean plaque as effectively. Which reminds us . . .

• Healthy Habits

Even as we take advantage of the end of summer with last minute camping, or travel, or action-filled weekends, one thing should stay on schedule—regular brushing and flossing.

You should be brushing twice a day, for two minutes each time. If it’s hard to time yourself, try playing a favorite two-minute song or using a timer or even a brushing app. And don’t forget to floss! Floss gets into spaces where bushes can’t to remove plaque. Floss once a day to keep your teeth their cleanest. Be proactive if your orthodontist suggests more frequent brushing and flossing while you’re wearing braces.

Finally, don’t neglect your orthodontic care. Keep up with appointments at our Chula Vista or El Cajon, CA office. If you wear aligners, wear them all the hours recommended. If you have bands, replace them daily and whenever they start to feel loose. If you have an appliance, use it as directed. The more you keep to your orthodontic schedule, the faster you’ll be enjoying your healthy, beautifully aligned smile.

Summer’s almost over, but these healthy tips work in fall, winter, and spring, too—for a smile that’s sunny and bright all year long!

We’re all friends here, so if you sometimes feel a bit nervous before your orthodontic appointments, no judging! Ask us about any worries you might have. We are happy to explain procedures, equipment, and your orthodontic options so you know exactly what is going on during treatment. And if X-rays are a concern, we can put your mind at ease here as well.

What Exactly Are X-rays?

Sometimes patients feel reluctant about the process of imaging because X-rays are a kind of radiation. But the fact is, radiation is all around us. We are exposed to radiation naturally from our soil and water, sun and air, as well as from modern inventions such as cell phones, Wi-Fi, and air travel.

Why is radiation so common? Because matter throughout the universe constantly gives off energy, and the energy that is emitted is called radiation. This radiation takes two forms—as particles (which we don’t need to consider!) and as traveling rays. This second type is known as electromagnetic radiation, created by photons traveling in regular waves at the speed of light.

We are exposed to electromagnetic radiation every day, because, whether we can see them or not, these different wavelengths and frequencies create various forms of light. Radio waves, microwaves, infrared, visible, and ultraviolet light, X-rays, and gamma rays are all part of the electromagnetic light spectrum.

Different types of radiation on this spectrum have different wavelengths and different frequencies, and produce different amounts of energy. Longer wavelengths mean lower frequencies and less energy. Because X-rays have shorter wavelengths and higher frequencies than, for example, radio waves and visible light, they have more energy.

How Do Dental X-rays Work?

An X-ray machine produces a very narrow beam of X-ray photons. This beam passes through the body and captures images of our teeth and jaws on special film or digital sensors inside the mouth (intraoral X-rays), or on film or sensors located outside the mouth (extraoral X-rays). These X-ray images are also known as radiographs.

Why are X-rays able to take pictures inside our bodies? Remember that higher energy we talked about earlier? This energy enables X-rays to pass through the softer, less dense parts of our bodies, which are seen as gray background in a radiograph. But some substances in our bodies absorb X-rays, such as the calcium found in our bones and teeth. This is why they show up as sharp white images in radiographs. 

There are many different types of dental X-rays used in orthodontics, including:

• Occlusal X-rays, which show the entire arch of teeth in the upper or lower jaw.
• Panoramic X-rays, which use a special machine to rotate around the head to create a complete two-dimensional picture of teeth and jaws.
• Cephalometric X-rays, which show the patient’s entire profile, and the position and development of the teeth and jaws.
• Cone Beam Computed Tomography, an external device which uses digital images to create a three-dimensional picture of the teeth and jaws.

Why Do We Need X-rays?

You might have noticed that these X-rays, unlike, for example, typical bitewing X-rays, don’t take images of individual teeth. That is because orthodontists deal with the teeth in relationship to each other and to the structures around them.

Beautifully aligned teeth and a healthy bite are the visible result of your orthodontic work, but there’s a lot going on above and below the surface that needs to be discovered and taken into account before your treatment even begins. X-rays help us evaluate:

• The size, shape, and position of your teeth, including impacted teeth and wisdom teeth
• The size, position, and health of your roots throughout treatment
• The size and shape of your jaw bones, and how they affect your teeth alignment and bite
• Your progress during different phases of treatment

How Do Orthodontists Make Sure Your X-rays Are As Safe As They Can Be?

First of all, the amount of radiation you are exposed to with a dental X-ray is very small. In fact, a typical panoramic X-ray provides roughly the same amount of radiation we are exposed to through our natural surroundings in just one day. Even so, Dr. Sanjay Kuruvadi and our team are committed to making sure patients are exposed to as little radiation as possible.

Radiologists, the physicians who specialize in imaging procedures and diagnoses, recommend that all dentists and doctors follow the safety principal known as ALARA: “As Low As Reasonably Achievable.” This means using the lowest X-ray exposure necessary to achieve precise diagnostic results for all dental and medical patients.

The guidelines recommended for X-rays and other imaging have been designed to make sure all patients have the safest experience possible whenever they visit the dentist or the doctor. We ensure that imaging is safe and effective in a number of ways:

• We take X-rays only when they are necessary.
• We provide protective gear, such as apron shields and thyroid collars, whenever needed.
• We make use of modern X-ray equipment, for both traditional X-rays and digital X-rays, which exposes patients to a lower amount of radiation than ever before.
• When treating children, we set exposure times based on each child’s size and age.

And now that we’ve talked about some things you might like to know,

Please Let Us Know If . . .

• You are changing orthodontists and have had previous orthodontic X-rays taken. Ask to have your older X-rays sent to our office so we have a complete record of your orthodontic history. (With digital X-ray technology, this transfer can be accomplished with e-mail!)
• You’re pregnant, or think you might be pregnant. Even though radiation exposure is very low with dental radiographs, unless there is a dental emergency, dentists and doctors recommend against X-rays for pregnant patients.

X-rays play an important part in helping us make sure your orthodontic treatment provides you with a lifetime of beautiful and healthy smiles. If you have any concerns, contact our Chula Vista or El Cajon, CA office. When it comes to making sure you’re comfortable with all of our procedures, including any X-rays that might be necessary, we’re happy to give you all the inside information!