About Orthodontics & Orthodontists
An orthodontist is a dental specialist who diagnoses, prevents, and treats misaligned teeth and jaws. Beyond straightening teeth, they correct bite problems (like overbites and underbites), close gaps, and improve overall oral function — all of which can have a lasting impact on your long-term health. Typically, an orthodontist uses braces or aligners (clear retainers that move teeth) to treat a variety of alignment and bite problems. Orthodontists treat a wide range of alignment and bite problems using braces or aligners (clear retainers that gradually move teeth into the proper position).
Common signs include crowded or crooked teeth, gaps between teeth, difficulty chewing or biting, a jaw that shifts or clicks, mouth breathing, a lisp, headaches, migraines, ringing in the ears (tinnitus), dizziness, or teeth that don't meet properly when you close your mouth. Many headache and migraine issues are actually a result of a correctable bite problem that can be diagnosed and treated. An orthodontist can evaluate whether treatment is right for you.
Orthodontic options for tooth movement include traditional metal braces, ceramic (clear) braces, lingual braces, self-ligating braces, and clear aligners like Invisalign or Spark. Also, appliances to change jaw size or position include expanders (RPE, MSE, MARPE) and functional appliances (Herbst, PS2, etc). The best choice depends on your case complexity, lifestyle, and what matters most to you — your orthodontist will help guide that decision.
The goals are the same, but the approach may differ. Teens are still growing, which can work in the treatment's favor. For example, if your lower jaw and/or chin is underdeveloped, treatment as a teen (during your circumpubertal growth spurt) can often encourage mandibular (lower jaw) growth and non-surgically correct the lower jaw deficiency, thereby improving esthetics, function, and likely the presence of future sleep-disordered breathing and/or sleep apnea. Adults may need slightly longer and/or more complex treatment times in some cases (jaw growth deficiencies), but today's options — including clear aligners like Invisalign or Spark — make orthodontic care just as effective and discreet for adults.
Early Treatment for Children
The American Association of Orthodontists recommends that children have their first orthodontic evaluation by age 7. Because both primary (baby) teeth and permanent teeth are developing and changing, it is important to monitor this while the child is growing. Early treatment (Phase 1) can address jaw development issues and create space for incoming permanent teeth, which may reduce the complexity of treatment later. In our office, about 20% of the people who come in before all their permanent teeth are in are candidates for treatment. These early treatment cases are typically limited to:
Patients without the above significant issues can safely wait until all their permanent adult teeth are in (or close to erupting/growing in). However, it is recommended to have annual checkups because teeth that appear to be growing in normally can make unexpected deviations, which can significantly impact treatment later. Annual growth and development checkups are strongly recommended even if orthodontic treatment isn’t indicated at that time.
- Significant transverse (width) or anterior/posterior (front to back) deficiencies of the upper jaw (maxilla).
- Secondary deficiencies of the lower jaw subsequent to upper jaw deficiency.
- Severe deviations in the path of the permanent teeth are growing in.
- Premature loss of baby teeth causes a significant reduction in available space for the permanent teeth to grow in properly.
Patients without the above significant issues can safely wait until all their permanent adult teeth are in (or close to erupting/growing in). However, it is recommended to have annual checkups because teeth that appear to be growing in normally can make unexpected deviations, which can significantly impact treatment later. Annual growth and development checkups are strongly recommended even if orthodontic treatment isn’t indicated at that time.
Braces: How They Work & Types
Braces use brackets bonded to your teeth and connected by a wire. The wire applies gentle, consistent pressure that gradually moves your teeth into proper alignment over time. Think of the wires as the engine and the brackets as the steering wheels. Your orthodontist will periodically adjust the wire to guide that movement throughout treatment. We prefer a type of brace called a ‘self-ligating bracket’, such as the state-of-the-art Damon System passive self-ligating brackets that we use at Reynolds Orthodontics, which allows for less frictional resistance when moving teeth, allowing the orthodontist to use lower forces to stimulate tooth movement, thereby reducing local inflammation–making braces or aligners a more comfortable process for the patients, and a healthier environment for the teeth during treatment.
You have several options, and your orthodontist will recommend what fits your needs best. It’s a good idea to explore all treatment options and braces since not every orthodontist offers the best braces, and many, surprisingly, still use outdated technology. We exclusively use advanced Damon System self-ligating braces in our office.
Self-ligating braces: Here, the brace has a door built into the brace, which closes and eliminates the need for the ligature to hold the bracket and wire together (hence the name ‘self-ligating’). There are several types of self-ligating braces. By far the best and most sophisticated are the Damon Braces. We have been using the Damon System since 2001, and have lectured extensively around the world, teaching other doctors the benefits of this system, which include: lower force application, faster and more comfortable treatment, a dramatic reduction in the frequency that permanent teeth are required to be removed (non-extraction treatment), more efficient treatment requiring fewer visits, and less inflammation. But, don’t worry, you can still put the colors on your braces as decoration–they just aren’t needed and don’t increase the friction or force required to move teeth.
Traditional metal braces: These are the most common. They are composed of two parts, the metal brace (think of this as the steering wheel) and the wire (think of this as the engine). They are held together with a ‘ligature’, which applies pressure to the wire and brace to hold the wire and brace together. The ligatures are typically colored, which adds style and fun to the braces. Although the most common, traditional braces are ‘old school’, and there are higher performing, higher tech braces that are more comfortable today. We haven’t used traditional braces in our office since 2005.
Ceramic braces: These braces are made of some clear material (typically ceramic or polycrystalline alumina), which makes them more tooth-colored for a less noticeable look. All ceramic braces–except the Damon Clear braces–require clear ligatures (described above in the metal braces section) to hold the brace and the wire together. The problem with this method is that the clear ligature easily stains, thereby decreasing the overall clear esthetics of the braces after a meal or beverage with significant color (think coffee or spaghetti sauce), leaving the braces looking stained. Again, we use the self-ligating braces (described below), which are superior as they don’t require the clear ligature and therefore maintain their esthetic value throughout treatment.
Lingual braces: Braces placed on the inside (lingual is ‘tongue’ in Latin) of the teeth. Before the advent of clear aligners like Invisalign and Spark, lingual braces were more common. However, they are uncomfortable and technically challenging, slow, and less precise than any other types of braces. As Invisalign and Spark have evolved, they are able to do everything and more that lingual braces used to be necessary for. We rarely find an instance where lingual braces are the best treatment option and therefore consider these nearly obsolete.
Self-ligating braces: Here, the brace has a door built into the brace, which closes and eliminates the need for the ligature to hold the bracket and wire together (hence the name ‘self-ligating’). There are several types of self-ligating braces. By far the best and most sophisticated are the Damon Braces. We have been using the Damon System since 2001, and have lectured extensively around the world, teaching other doctors the benefits of this system, which include: lower force application, faster and more comfortable treatment, a dramatic reduction in the frequency that permanent teeth are required to be removed (non-extraction treatment), more efficient treatment requiring fewer visits, and less inflammation. But, don’t worry, you can still put the colors on your braces as decoration–they just aren’t needed and don’t increase the friction or force required to move teeth.
Traditional metal braces: These are the most common. They are composed of two parts, the metal brace (think of this as the steering wheel) and the wire (think of this as the engine). They are held together with a ‘ligature’, which applies pressure to the wire and brace to hold the wire and brace together. The ligatures are typically colored, which adds style and fun to the braces. Although the most common, traditional braces are ‘old school’, and there are higher performing, higher tech braces that are more comfortable today. We haven’t used traditional braces in our office since 2005.
Ceramic braces: These braces are made of some clear material (typically ceramic or polycrystalline alumina), which makes them more tooth-colored for a less noticeable look. All ceramic braces–except the Damon Clear braces–require clear ligatures (described above in the metal braces section) to hold the brace and the wire together. The problem with this method is that the clear ligature easily stains, thereby decreasing the overall clear esthetics of the braces after a meal or beverage with significant color (think coffee or spaghetti sauce), leaving the braces looking stained. Again, we use the self-ligating braces (described below), which are superior as they don’t require the clear ligature and therefore maintain their esthetic value throughout treatment.
Lingual braces: Braces placed on the inside (lingual is ‘tongue’ in Latin) of the teeth. Before the advent of clear aligners like Invisalign and Spark, lingual braces were more common. However, they are uncomfortable and technically challenging, slow, and less precise than any other types of braces. As Invisalign and Spark have evolved, they are able to do everything and more that lingual braces used to be necessary for. We rarely find an instance where lingual braces are the best treatment option and therefore consider these nearly obsolete.
Yes. Ceramic braces work the same way as metal braces and achieve the same results — they blend in with the natural color of your teeth and appear more aesthetic. They're a great option for patients who want effective treatment with a more subtle appearance. In our office, we recommend and use the self-ligating brackets called Damon Clear. These self-ligating Damon brackets work better and faster and come in both clear ceramic and traditional metal.
Clear Aligners (Invisalign® & Spark®)
Invisalign and Spark use a series of custom-made, clear plastic aligner trays to gradually shift your teeth into place. You wear each set of aligners for one week, removing them to eat, drink, brush, and floss. The process is guided by your orthodontist from start to finish. Each try is about 0.25mm different than the tray before. As you progress through the trays, the teeth move according to the simulated plan, and the teeth gradually become more straight.
With any aligner system, the teeth typically lag behind the simulated plan, requiring the plan to be adjusted periodically throughout treatment. This is called ‘refinement’, which is the process of adjusting aligner treatment during treatment to address teeth that aren’t moving according to plan. Just as adjustments to the braces and wires happen in every orthodontic case, refinements happen in virtually all aligner cases and should be expected as part of normal treatment.
Some aligner providers will offer ‘lower cost’ aligner treatment, but the treatment is limited in the number of trays or refinements required without additional cost. Make sure to explore all aligner options, especially if they are the lower cost options, because they typically offer limited results or require additional fees later for ideal results. Be sure to ask: ‘Are there any limits on the number of aligners in my treatment?’ Also ask: ‘Will my treatment yield ideal alignment and an ideal bite?’
Also, some providers offer treatment that ‘doesn’t address or fix the bite’. This typically indicates the provider is not skilled enough to address bite issues or the treatment is limited in scope (typically lower-cost treatments). The moment you start wearing aligners, your bite changes slightly due to the layer of plastic between your teeth. Not to mention your bite changes as you move your teeth. Every treatment requires some component of bite idealization. With a skilled provider and excellent aligner system, preventing or resolving bite issues is part of all treatments. Remember: a non-ideal bite can dramatically increase wear and tear on your teeth as well as contribute to our cause headaches and migraines. Choose treatments that don’t address your bite at your own risk.
With any aligner system, the teeth typically lag behind the simulated plan, requiring the plan to be adjusted periodically throughout treatment. This is called ‘refinement’, which is the process of adjusting aligner treatment during treatment to address teeth that aren’t moving according to plan. Just as adjustments to the braces and wires happen in every orthodontic case, refinements happen in virtually all aligner cases and should be expected as part of normal treatment.
Some aligner providers will offer ‘lower cost’ aligner treatment, but the treatment is limited in the number of trays or refinements required without additional cost. Make sure to explore all aligner options, especially if they are the lower cost options, because they typically offer limited results or require additional fees later for ideal results. Be sure to ask: ‘Are there any limits on the number of aligners in my treatment?’ Also ask: ‘Will my treatment yield ideal alignment and an ideal bite?’
Also, some providers offer treatment that ‘doesn’t address or fix the bite’. This typically indicates the provider is not skilled enough to address bite issues or the treatment is limited in scope (typically lower-cost treatments). The moment you start wearing aligners, your bite changes slightly due to the layer of plastic between your teeth. Not to mention your bite changes as you move your teeth. Every treatment requires some component of bite idealization. With a skilled provider and excellent aligner system, preventing or resolving bite issues is part of all treatments. Remember: a non-ideal bite can dramatically increase wear and tear on your teeth as well as contribute to our cause headaches and migraines. Choose treatments that don’t address your bite at your own risk.
Invisalign and Spark work well for teens and adults with mild to moderate crowding, spacing issues, or bite problems. More complex cases may sometimes be better suited for braces. However, as aligner treatment has evolved, more and more complex cases are well treated with aligners. The best way to know if you're a candidate is a consultation with an experienced Invisalign or Spark provider.
Yes. Invisalign and Spark can address many bite issues, including overbites, underbites, crossbites, and open bites. However, the effectiveness depends on the severity of the case and the skill and experience of your orthodontist. Your orthodontist will evaluate your bite and let you know if clear aligners are the right fit.
In our office, we direct patients to change their aligners once per week–assuming they are wearing the aligners as directed (20 hours per day). We monitor your progress with in-office visits every 10 weeks.
With aligner treatment, teeth are often not able to track perfectly with the initial plan, so periodic adjustments called refinements are a normal and expected part of the aligner treatment process. Similar to braces that require regular adjustments, most aligner cases need refinements to achieve the best results. It is important to understand that lower-cost aligner options may limit the number of trays or refinements allowed and can lead to additional fees, so make sure to explore all options.
With aligner treatment, teeth are often not able to track perfectly with the initial plan, so periodic adjustments called refinements are a normal and expected part of the aligner treatment process. Similar to braces that require regular adjustments, most aligner cases need refinements to achieve the best results. It is important to understand that lower-cost aligner options may limit the number of trays or refinements allowed and can lead to additional fees, so make sure to explore all options.
After completing Invisalign, you'll be fitted for a retainer to maintain your results. We use a quick and easy 3D scan (no more yucky molds) to make your retainers. Once a scan is on file, you don’t need to come for another fitting (assuming you wear your retainers as directed), and we can mail any replacement retainers to you. Retainers are an important part of any orthodontic treatment because retention, or keeping the teeth in the same place after treatment, is for life! Wearing retainers as prescribed by the orthodontist is crucial to prevent your teeth from shifting back to their original positions over time. Not wearing retainers will cause teeth to shift, even when you are out of treatment for years-remember, retention is for life!
Treatment Timeline & What to Expect
Most braces treatment takes 12 to 24 months, though complex cases may take longer. Aligner and braces treatments typically take the same amount of time–assuming the aligners are worn as directed, ideally 20-22 hours a day. Not wearing the aligners as directed will result in extended treatment times.
Using passive self-ligating braces can often decrease the time needed for braces, especially for complex treatments. The Damon System provides a variety of prescriptions for our doctors to choose from, allowing more sophisticated and efficient treatment mechanics.
Surgically Facilitated Orthodontic Treatment (SFOT) combines a minor gum surgery procedure (usually with very little to no downtime) plus orthodontic treatment and can dramatically reduce treatment times. This treatment is more expensive as it requires special scheduling and expertise by the orthodontist, as well as an additional surgical procedure, but no other approach can match the speed of surgically facilitated tooth movement.
Your orthodontist will give you a realistic timeline after evaluating your teeth, bite, and jaw during your initial consultation.
Using passive self-ligating braces can often decrease the time needed for braces, especially for complex treatments. The Damon System provides a variety of prescriptions for our doctors to choose from, allowing more sophisticated and efficient treatment mechanics.
Surgically Facilitated Orthodontic Treatment (SFOT) combines a minor gum surgery procedure (usually with very little to no downtime) plus orthodontic treatment and can dramatically reduce treatment times. This treatment is more expensive as it requires special scheduling and expertise by the orthodontist, as well as an additional surgical procedure, but no other approach can match the speed of surgically facilitated tooth movement.
Your orthodontist will give you a realistic timeline after evaluating your teeth, bite, and jaw during your initial consultation.
Most Invisalign and Spark treatments take 6 to 18 months, though mild cases can finish sooner. We take on more complex aligner cases involving significant overbite corrections, which can take up to 2.5 years (though this is less common). Your orthodontist will outline an estimated timeline based on your specific alignment needs during your consultation. Remember, not wearing your aligners as directed (20 hours per day) or skipping your scheduled appointments will slow your treatment.
Expect some mild soreness with each adjustment appointment. The feeling is similar to the soreness you experience after a workout or sports practice. After each adjustment appointment you will experience some soreness, which typically resolves within a few days. You'll need to avoid hard, sticky, and chewy foods, maintain careful oral hygiene, and attend regular check-ups every 6 to 10 weeks.
If you don’t avoid hard/sticky foods the braces can break, and extra appointments will be necessary for repairs. Typically, most patients have 1-2 extra repair visits as chewing and eating are destructive processes, and the braces aren’t immune to being damaged. However, more than 1-2 extra visits aren’t necessary for most patients if they exhibit a small amount of caution and care when eating.
The process is very manageable with a little planning. Our office schedules your next visit before you leave your current visit, so getting a convenient appointment is easy.
If you don’t avoid hard/sticky foods the braces can break, and extra appointments will be necessary for repairs. Typically, most patients have 1-2 extra repair visits as chewing and eating are destructive processes, and the braces aren’t immune to being damaged. However, more than 1-2 extra visits aren’t necessary for most patients if they exhibit a small amount of caution and care when eating.
The process is very manageable with a little planning. Our office schedules your next visit before you leave your current visit, so getting a convenient appointment is easy.
Costs, Insurance & Payment
Braces costs vary depending on the type of braces, the complexity of your case, and the length of treatment. A personalized estimate is provided after your consultation. Many practices offer flexible payment plans and work with dental insurance to make treatment affordable. Most orthodontic practices also offer no-interest payment plans and work with third-party financing options to help cover what insurance doesn't. Our office uses OrthoFi, offering the most affordable payment plans in orthodontics. Most of our plans have zero interest, and some extended plans have low-interest. Most payment plans can easily fit in the $200-$300 per month range.
In Novi, Northville, Troy, Rochester, Rochester Hills, West Bloomfield, Bloomfield Hills, Lake Orion, Sterling Heights, Pontiac, and the surrounding areas, braces costs fall into these ranges:
In Novi, Northville, Troy, Rochester, Rochester Hills, West Bloomfield, Bloomfield Hills, Lake Orion, Sterling Heights, Pontiac, and the surrounding areas, braces costs fall into these ranges:
| Treatment Type | Typical Cost | Key Notes |
|---|---|---|
| Retainers | $200–$400 | Used after treatment to maintain results |
| Phase 1 Treatment | $3,000–$5,000 | Early/interceptive orthodontic treatment |
| Limited Aligner Treatment | $3,000–$5,000 | Minor corrections or touch-ups after relapse |
| Comprehensive Braces Treatment | $6,000–$8,000 | Cost varies based on case complexity |
| Invisalign / Spark Aligners | $6,000–$8,000 | Similar cost to braces; not ideal for complex or TMJ cases |
| Advanced TMJ & Migraine Cases | $10,000–$15,000 | Highly complex; requires specialized training; many offices don’t offer |
| MARPE (Mini-Implant Assisted Expansion) | $10,000–$15,000 | For adult jaw expansion; helps with airway and sleep issues |
| Bimaxillary Advancement Surgery (MMA) | $8,000–$10,000 (orthodontics) & $20,000+ (surgery) | Used for severe sleep apnea; can significantly improve symptoms |
| Surgically Facilitated Orthodontic Treatment (SFOT) | $8,000–$10,000 (orthodontics) & $5,000–$10,000 (surgery) | Speeds up treatment; often completed in under 6 months |
Don’t forget: orthodontics qualifies for HSA and FSA savings programs, which allow braces and aligners to be paid for in pre-tax dollars! This can result in huge savings, so make sure to check with your plan provider and fund your accounts in anticipation of orthodontic treatment. The best way to pay for orthodontic treatment is to take advantage of an insurance benefit, then pay for the rest in pre-tax dollars.
Many dental insurance plans include an orthodontic benefit that covers a portion of braces and aligner costs. Coverage varies by plan.
In metro-Detroit, if you have orthodontic insurance, most insurance plans average $750 to $1500 of coverage. It is reasonably common to see plans that have more coverage, but uncommon to see plans that cover more than half of the cost.
Most orthodontic practices also offer no-interest payment plans and work with third-party financing options to help cover what insurance doesn't. Our office uses OrthoFi, offering the most affordable payment plans. Most plans have zero interest, and some extended plans have low-interest. Most payment plans can easily fit in the $200-$300 per month range.
Don’t forget: orthodontics qualifies for HSA and FSA savings programs, which allow braces and aligners to be paid for in pre-tax dollars! This can result in huge savings, so make sure to check with your plan provider and fund your accounts in anticipation of orthodontic treatment. The best way to pay for orthodontic treatment is to take advantage of an insurance benefit, then pay for the rest in pre-tax dollars.
Although Medicaid has dental coverage, the State of Michigan does not have a Medicaid program for orthodontics. Even if you have Medicaid dental coverage, Michigan does not have Medicaid for orthodontic treatment. Our offices offer very flexible payment plans with extended financing options to help make world-class orthodontics more affordable for all families.
Don’t forget: orthodontics qualifies for HSA and FSA savings programs, which allow braces and aligners to be paid for in pre-tax dollars! This can result in huge savings, so make sure to check with your plan provider and fund your accounts in anticipation of orthodontic treatment. The best way to pay for orthodontic treatment is to take advantage of an insurance benefit, then pay for the rest in pre-tax dollars.
Yes. Most orthodontic practices offer no-interest or low-interest payment plans that allow you to spread the cost of treatment over monthly installments. Many also work with dental insurance and third-party financing options to help make care accessible.
We accept most dental insurances and partner with OrthoFi to provide a variety of flexible and extended payment terms. Most interest-free plans are between $200-$300 per month.
Orthodontic emergencies include anything that is causing acute pain and discomfort for a patient. A broken bracket, a poking wire, a lost aligner, or personal oral injury situation. Call your orthodontist's office right away. Many practices offer same-day or next-day emergency appointments to get you back on track quickly.
Our office will fit you in on the same day (if you call during business hours) and has an after-hours phone monitored on evenings and the weekends/holidays by our experienced team and doctors. If something happens, we can call, text, or FaceTime with you to provide solutions. We will even have someone meet you at the office on holidays and weekends when necessary.
Also, OrthoNu provides an upgraded patient comfort kit that provides several items that can help with orthodontic emergencies and comfort: OrthoNu Treatment Starter Kit
Our office will fit you in on the same day (if you call during business hours) and has an after-hours phone monitored on evenings and the weekends/holidays by our experienced team and doctors. If something happens, we can call, text, or FaceTime with you to provide solutions. We will even have someone meet you at the office on holidays and weekends when necessary.
Also, OrthoNu provides an upgraded patient comfort kit that provides several items that can help with orthodontic emergencies and comfort: OrthoNu Treatment Starter Kit
Choosing an Orthodontist & Your First Visit
The best orthodontist combines specialized training and board certification with modern technology, a patient-centered approach, and a proven track record of results. Look for clear communication, transparent pricing, personalized treatment plans, and a practice where you feel comfortable and informed.
In metro-Detroit, HOUR Magazine publishes an annual ‘Top Dentist’ list, which is voted on by other doctors in the community. Drs. Bonamici and Reynolds have frequently made the list. In fact, Dr. Reynolds is the only orthodontist to be voted to the HOUR Magazine ‘Top Orthodontist’ list every year since the list was first published in 2009.
In metro-Detroit, HOUR Magazine publishes an annual ‘Top Dentist’ list, which is voted on by other doctors in the community. Drs. Bonamici and Reynolds have frequently made the list. In fact, Dr. Reynolds is the only orthodontist to be voted to the HOUR Magazine ‘Top Orthodontist’ list every year since the list was first published in 2009.
The right orthodontist for you in metro-Detroit is board-certified, experienced with your type of case, and focused on your individual needs. Reviews, credentials, and a free consultation are your best tools for finding the right fit.
In metro-Detroit, HOUR Magazine publishes an annual ‘Top Dentist’ list, which is voted on by other doctors in the community. Dr. Reynolds and Dr. Bonamici are named the Top Orthodontists every year. In fact, Dr. Reynolds is the only orthodontist to be voted to the HOUR Magazine ‘Top Orthodontist’ list every year since the list was first published in 2009.
In metro-Detroit, HOUR Magazine publishes an annual ‘Top Dentist’ list, which is voted on by other doctors in the community. Dr. Reynolds and Dr. Bonamici are named the Top Orthodontists every year. In fact, Dr. Reynolds is the only orthodontist to be voted to the HOUR Magazine ‘Top Orthodontist’ list every year since the list was first published in 2009.
Start by verifying board certification and specialized training. Look for experience with your specific treatment needs, modern technology, flexible financing, and an office environment where you feel welcome.
A reputable office should be able to show before-and-after cases similar to yours that demonstrate effective and beautiful orthodontic treatment outcomes. It may be worth questioning their experience if they lack post-orthodontic treatment results. Taking advantage of a free consultation is a great way to evaluate an orthodontic practice before making a decision.
A reputable office should be able to show before-and-after cases similar to yours that demonstrate effective and beautiful orthodontic treatment outcomes. It may be worth questioning their experience if they lack post-orthodontic treatment results. Taking advantage of a free consultation is a great way to evaluate an orthodontic practice before making a decision.
Most orthodontic practices offer a complimentary initial consultation. This gives you a chance to meet the doctor, get a full evaluation, understand your treatment options, and review costs — all before making any decisions. The national average for treatment recommendation at a new exam is 82%. In our office, we recommend treatment about 42-45% of the time. Just because you are there, ready to pay for treatment, doesn’t mean the timing for treatment is correct as well. Starting too early can, many times, add unnecessary additional appointments to your treatment. Be sure to find a provider who is concerned with both if you need treatment and also with when is the best time to start treatment to make your experience maximally efficient.
In our office, the initial visit starts with a brief tour of the office so that you are familiar with the environment.
The new consultation experience is personally guided by one of our Treatment Coordinators who will reach out to you in advance of your appointment to help set expectations for the appointment experience and provide you with the necessary health and insurance forms that need to be filled out before the appointment. Taking a few minutes to fill out the forms before you come in will allow us to verify your insurance benefits so that you can have an accurate treatment fee presentation during your appointment.
Once settled in the Treatment Coordinator room, you will have a full set of digital photos taken as well as a low-dose iCAT digital scan taken to evaluate your teeth, jaws, and airway. Many times, a 3D iTero scan may also be taken to provide a 3D model of your teeth for reference and 3D simulation. The treatment coordinator and the doctor will review the digital records and, if necessary, present you with the orthodontic treatment plan, timing, and costs.
The new consultation experience is personally guided by one of our Treatment Coordinators who will reach out to you in advance of your appointment to help set expectations for the appointment experience and provide you with the necessary health and insurance forms that need to be filled out before the appointment. Taking a few minutes to fill out the forms before you come in will allow us to verify your insurance benefits so that you can have an accurate treatment fee presentation during your appointment.
Once settled in the Treatment Coordinator room, you will have a full set of digital photos taken as well as a low-dose iCAT digital scan taken to evaluate your teeth, jaws, and airway. Many times, a 3D iTero scan may also be taken to provide a 3D model of your teeth for reference and 3D simulation. The treatment coordinator and the doctor will review the digital records and, if necessary, present you with the orthodontic treatment plan, timing, and costs.
Airway Health, TMJ, Headaches & Benefits Beyond Straight Teeth
Yes. Misaligned bites can contribute to jaw pain, TMJ issues, tension headaches, jaw muscle pain, migraines, dizziness, and even ringing in the ears (tinnitus). Bite problems create muscle hyperactivity as your body subconsciously tries to position your lower jaw in a way that avoids the collisions created by a poor bite. Over time, symptoms can compound into life-altering discomfort and pain. And, unfortunately, many times the cause of this pain goes misdiagnosed as most providers are not trained to look for the bite problem, which causes TMJ pain.
Our doctors are experts in bite-related TMJ and migraine treatment and consistently treat complex TMJ and headache patients in our practice. Correcting the bite through orthodontic treatment often relieves these symptoms over time. A thorough evaluation will determine if your symptoms are related to your bite.
Our doctors are experts in bite-related TMJ and migraine treatment and consistently treat complex TMJ and headache patients in our practice. Correcting the bite through orthodontic treatment often relieves these symptoms over time. A thorough evaluation will determine if your symptoms are related to your bite.
Snoring and mouth breathing are not considered normal in children and may be linked to poor airway or jaw development. Orthodontic treatment can help improve the structure of the jaws and create more space for proper breathing, but in some cases, a sleep study or ENT evaluation may also be recommended.
Teeth grinding, restless sleep, hyperactivity, or daytime fatigue can sometimes be signs of poor sleep quality. In some children, this is related to airway issues. An orthodontic evaluation, which includes comprehensive airway imaging and evaluation, can help determine if jaw position or bite alignment may be contributing.
Common signs of sleep apnea may include snoring, mouth breathing, restless sleep, bedwetting, hyperactivity, or daytime fatigue. While a formal diagnosis requires a sleep test prescribed by a medical doctor, orthodontists are trained to identify potential airway concerns and can refer you for further evaluation if needed.
A narrow palate can contribute to crowding in the upper jaw, which can also affect lower jaw development, tongue posture, tooth alignment, and the airway. This can lead to crowding, chronic loud snoring, breathing pauses, gasp/choke sounds, mouth breathing, and restless sleep. Daytime symptoms often appear as hyperactivity, behavioral issues, poor school performance, or morning headaches. Early orthodontic treatment can help widen the palate and increase nasal patency (the ability to breathe through your nose) to support better breathing and alignment. Also, growth enhancement or guidance of the lower jaw (mandible) can be an effective way to improve breathing, function, and facial esthetics.
Improvement of breathing begins with proper diagnosis. If the breathing issues are related to the airway obstruction, then elimination of the obstruction will decrease or eliminate the breathing issues. The most common places for airway obstruction are:
Visiting an orthodontist can actually help with several things:
- Nasal Septum
- Nasal Turbinates (bones in the nose that help air flow)
- Maxillary Sinus congestion
- High or vaulted hard palate causing a significant constriction in the nasal airway
- Soft palate tissue—especially if tissue is excessive or lacks sufficient muscle tone
- Adenoids
- Tonsils
- Tongue posture
- Underdeveloped anterior-posterior position of the upper (Maxilla) and/or lower (mandible) jaws.
Visiting an orthodontist can actually help with several things:
- If the orthodontist uses a CBCT x-ray machine, they can visualize all of the components of the airway and diagnose if any obstruction is present (and refer to other specialists—like an ENT—if necessary).
- Orthodontists can modify jaw growth (in growing individuals) and jaw position (for non-growing individuals) by using a multi-disciplinary approach, including an oral surgeon and/or ENT, to improve palatal obstructions and breathing issues related to a retruded upper and/or lower jaw. Timing is critical for young children as it becomes increasingly difficult to improve hard palate obstruction by expanding the maxilla (upper jaw) after age 10. Also, modification of lower jaw growth happens during the circumpubertal growth spurt (puberty), which occurs at 11-13 years old in females and 12-15 years old in males. Failure to provide these treatments during the appropriate growth windows will result in more invasive, complex treatments that typically involve surgeries. These more invasive treatments, while effective, are better off avoided if it is possible to treat with less invasive, growth-modifying treatments.
Bedwetting (nocturnal enuresis) is related to sleep apnea through the physiological stress responses to low oxygen and disrupted sleep. When you have sleep apnea, lack of oxygen causes high blood pressure, triggering the release of hormones (atrial natriuretic peptide) that produce more urine. Basically, your body is trying to remove excess fluid trying to decrease the pressure on the heart. Also, decreased oxygen causes deep exhaustion that prevents arousal, leading to bladder emptying. So, basically, after prolonged deprivation of quality sleep, you become so exhausted that you sleep through your normal body signals to wake up to pee.
Untreated sleep apnea leads to severe, long-term health risks due to chronic oxygen deprivation and broken sleep cycles. Key complications include high blood pressure, heart disease, stroke, type 2 diabetes, and severe fatigue. It also causes cognitive decline, depression, and a high risk of accidents.
Cardiovascular Consequences
Cardiovascular Consequences
- High Blood Pressure (Hypertension): The drop in oxygen levels forces the heart to work harder, often leading to chronic hypertension.
- Heart Disease & Arrhythmias: Elevated risk of heart attacks, heart failure, and irregular heartbeats (atrial fibrillation).
- Stroke: Significantly increased risk of stroke due to vascular strain
- Type 2 Diabetes: Disrupts glucose metabolism, often causing insulin resistance.
- Obesity & Metabolic Syndrome: Poor sleep alters metabolism, making it harder to manage weight and promoting fat storage.
- Liver Issues: Linked to non-alcoholic fatty liver disease
- Neurological and Mental Health
- Cognitive Decline: Reduced memory, attention, and executive function, sometimes increasing the risk of Alzheimer's or Parkinson’s.
- Mood Disorders: Long-term irritability, anxiety, and depression due to chronic fatigue.
- Accidents: High risk of driving and work-related accidents due to severe daytime drowsiness.
- Reduced Quality of Life: Persistent fatigue, morning headaches, and social strain.
- Children/Teenagers: Potential for behavioral problems and lower IQ.
The most common treatment that helps with airway issues is maxillary transverse width modification–commonly referred to as palatal expansion. This can be done with
a traditional expander in younger children (4-10), and with MARPEs (mini-implant assisted rapid palatal expanders) in non-growing individuals (typically 11 and older).
Note: If you have a narrow maxilla, you almost always have a narrow lower jaw (mandible) as well. Consequently, the lower teeth will need to be uprighted in conjunction with upper expansion to ensure the maximum amount of upper expansion will occur without creating significant issues with how the top teeth fit into the lower teeth. As the lower jaw is one solid bone (compared to the upper jaw which has a center growth plate that can be stretched to solicit more maxillary growth), a lower ‘expander’ is a misnomer. In our opinion, lower braces are a much better option to upright the lower teeth compared to a larger and bulkier lower ‘expander’, which only serves to upright the teeth and is a lot more cumbersome with speech and eating.
Also, front-to-back (anterior/posterior) deficiencies in the upper and lower jaw can decrease the volume of the nasal and oral airways, cause tongue posture issues, and create airway obstructions. Treatments to advance deficient upper and lower jaws that are available for growing individuals include:
Non-growing individuals can be treated with a variety of jaw-modifying procedures. Some of the procedures utilized today include:
Note: If you have a narrow maxilla, you almost always have a narrow lower jaw (mandible) as well. Consequently, the lower teeth will need to be uprighted in conjunction with upper expansion to ensure the maximum amount of upper expansion will occur without creating significant issues with how the top teeth fit into the lower teeth. As the lower jaw is one solid bone (compared to the upper jaw which has a center growth plate that can be stretched to solicit more maxillary growth), a lower ‘expander’ is a misnomer. In our opinion, lower braces are a much better option to upright the lower teeth compared to a larger and bulkier lower ‘expander’, which only serves to upright the teeth and is a lot more cumbersome with speech and eating.
Also, front-to-back (anterior/posterior) deficiencies in the upper and lower jaw can decrease the volume of the nasal and oral airways, cause tongue posture issues, and create airway obstructions. Treatments to advance deficient upper and lower jaws that are available for growing individuals include:
-
Protraction facemask to move the upper jaw forward
- Works until age 10, then doesn’t really work well as the growth plate closes, preventing true jaw expansion.
- Combination with MARPE is a new approach to maxillary advancement, which is showing initial promise but requires much more research to determine true efficacy.
-
Jaw-growth modifications to help the lower jaw grow forward
- Involves ‘functional appliances’, which are devices designed to encourage the growth of the lower jaw. Herbst, PowerScope (PS2), MARA, twin block, Frankel, bionator, Forsus, and many other appliances can be used to encourage mandibular growth.
- Must be attempted early in the circumpubertal growth spurt for maximum effectiveness
- 11-13 for females
- 12-15 for males
Non-growing individuals can be treated with a variety of jaw-modifying procedures. Some of the procedures utilized today include:
- MARPE: Mini-implant Assisted Palatal Expansion: Expansion in adults can improve airway obstruction related to a high, vaulted palate and lower tongue position secondary to a narrow palate. Several temporary implants (TADs) are placed through the expander into the palate, which allows slower, but effective, improvement in maxillary (upper jaw) width. As expansion of the upper jaw at any age creates a space between the upper front teeth, MARPE’s are used along with braces or aligners to improve airway function while maintaining or improving dental esthetics. Also, as expanding the upper jaw changes the bite, treatment of the lower teeth is typically necessary with MARPE treatment.
- MMA: Maxillary and/or Mandibular Advancement surgery. This is a multidisciplinary treatment involving an orthodontist and an oral surgeon to correct upper and/or lower jaw anterior/posterior deficiency by moving the upper and/or lower jaw(s) forward. This improves airway volume and muscle tone, which can dramatically improve sleep apnea and airway resistance.
- Weight loss: Body Mass Index is another significant factor in sleep-disordered breathing. Diet modification and/or GLP-1 modifying drugs such as Ozempic and Wegovy are also an important factor for normal airway function.
If you or your child is experiencing symptoms of sleep apnea, seeing an ENT or an orthodontist immediately makes the most sense. As stated above, the key is to have an accurate diagnosis of the obstruction, plus an understanding of its severity (typically through a sleep study to quantify the number of hypopneas and apneas). Typically, a good orthodontist would include airway evaluation as part of their complete orthodontic exam.
At our office, a thorough assessment of the airway is part of the comprehensive orthodontic exam. In order to fully visualize the airway–and any obstructions–a cone-beam CT scan (CBCT) is necessary. Don’t worry, the radiation dose for these scans is typically very low, even though it provides total visualization for airway obstructions.
As part of an airway-focused or airway-aware consultation, you should have imaging plus a questionnaire to help gauge if any airway-related issues are present and to help assess the scope and severity.
In addition, you should also receive information as to how the teeth and bite relate to the structure of the jaws, and if orthodontic treatment should be limited to moving teeth or if including jaw growth modification in growing patients or surgical considerations in non-growing patients.
As part of an airway-focused or airway-aware consultation, you should have imaging plus a questionnaire to help gauge if any airway-related issues are present and to help assess the scope and severity.
In addition, you should also receive information as to how the teeth and bite relate to the structure of the jaws, and if orthodontic treatment should be limited to moving teeth or if including jaw growth modification in growing patients or surgical considerations in non-growing patients.
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