Orthodontics

"Never put the referee in a position to determine the outcome." -Coach Keith Maurer

The first step into the wrestling world for a beginning wrestler involves a soft, cushioned step as his toe hits the mat for the first time in the wrestling room. This brief comfort is quickly countered by a rush of warm air that hits the lungs and instantaneously conveys the level of intensity that will change the life and viewpoint of that young wrestler forever.  The wrestling room becomes the arena in which the mind and body will be tested, pushed, and challenged in ways the new wrestler never thought possible. Most athletes quickly realize the value of sports like wrestling in teaching the important ideals of goal-setting, determination, tenacity, leadership, and teamwork. Coaches, teammates, practices, pressure, success, and failure forever change the athlete who experiences them in the arena of competitive sports.

The most important lesson a wrestler learns is the power of self-determination, a sentiment of which is encapsulated in the opening quote by Coach Keith Maurer (current Hazleton Area High School Head Coach and Penn State Wrestling alumnus).  In fact, every coach who sat in my corner (my father, Chris Shaud, Joe DeLuca, Jeff Sweda, Dave Shafer, Joe Clifford, and many others) reinforced this value. When a match is won or lost, it is typically very clear which wrestler was able to impose his will during that match. In the very rare instances when a match is close and lost as a perceived result of a bad call by the referee, Coach Maurer's quote taught us that only one person is, in fact, responsible for allowing the match to be close in the first place.

The brand of self-determination crafted on the wrestling mat includes personal responsibility, ownership of success and failure, avoidance of excuses, and inspiration to never consider yourself a victim of circumstance. Continuous learning, focus on improvement, relentless hard work, reliance on teammates and mentors for support, and wrestling hard until the final whistle are powerful habits that are easily transferred and applied to the wrestling match of life.

Wrestling will teach the beginning wrestler mentioned previously many lessons but none more powerful than the art form of self-determination. In the art of wrestling as in the art of life, when the artist paints a masterpiece, each brush stroke represents a decision made by the person holding the brush in front of the canvas. The freedom and the clarity that result from owning all of our outcomes are very powerful. Thank you to my wrestling coaches, teammates, and mentors for teaching me this life-changing lesson.

"Never put the referee in a position to determine the outcome." -Coach Keith Maurer

Misconceptions exist about the general experience of having braces and are typically based on recommendations, procedures and technologies from decades ago.  New research has enabled advanced technologies that have made the orthodontic experience much better than it would have been even 5 or 10 years ago. This is great news for everybody.

“Can I chew gum with braces?”

This is one of the most common questions we have in our practice. The short answer is yes, if the gum is sugar-free and contains xylitol. Several recent scientific studies have shown that gum with xylitol (examples- Trident, Icebreakers, and many others) have a multitude of benefits:

1. Reduction of Tooth Decay
2. Aids Enamel Remineralization and Repair
3. Increases Salivary Flow
4. Increases Comfort During Tooth Movement

Always follow your specific orthodontist’s recommendations when it comes to the care of your braces.  Each patient’s case or type of braces being used may vary. There are specific cases (TMJ pain/discomfort) when gum chewing is not recommended. However, at DCO, we generally recommend that our patients chew a sugar-free gum that contains xylitol 2-3 times per day.  Invisalign patients may chew gum as well when aligners are removed. The best timing for chewing gum during orthodontic treatment is immediately after a meal.

So, at DCO, you have the OK to chew away!

DCO: The Humanized Digital Experience

We are all deeply familiar with the capability of digital technology to revolutionize the way we do things. Twenty years ago, we all would have had trouble believing that most of society would be connected via mini, hand-held computers that magically merged with our phones.  At that point, we were still grappling with the concept of the internet and hoping that the world did not end on “Y2K.”  As we know, in many arenas and in many ways, digitization has spelled dehumanization of experiences for customers.

At DCO, we are constantly seeking to combine the awesome capabilities of digital technologies to enhance the personal experience patients have while in treatment.  Each patient is assigned to a DCO Experience Concierge whose sole mission is to guide individuals through the treatment process. The DCO Experience Concierge ensures seamless coordination, high-quality service, and a personal connection throughout treatment.

Our practice has carefully and deliberately selected technologies that add value to the personal experience of each patient.  Below are three examples:

1. 3D Printing-  A true win-win for patients is technology that improves treatment quality, enhances treatment efficiency, and provides a more comfortable experience. Three-dimensional scanning and printing has allowed us to be extremely precise in creating a digital 3D model of our patients’ teeth to aid us in accurate diagnosis and treatment.  We are able to work with laboratories to 3D print and create accurate appliances like expanders for children and Invisalign aligners for teens and adults.  The upsides to this technology are a huge increase in patient comfort through the elimination of the need for impressions and the improved accuracy of our diagnosis and treatment.  The downsides are none.

1. Digital Workflow- Your healthcare experience will no longer be defined by having to fill out 15 paper forms while the reception staff sits behind a glass partition.  At our practice, from beginning to end, the DCO Experience Concierge is always with the patient along the way, answering questions and lending support. Our digital treatment experience is built around elimination of unnecessary steps, clear communication, and paperless management of each patient’s personalized treatment. We use sophisticated digital diagnostic, practice management and treatment planning software that allows us to make things simple for our patients while leaving a green footprint.  Among these technologies are digital radiographs and three dimensional model generation which provides enhanced comfort to patients, appliances that fit more precisely, and creates efficiencies to allow for fewer visits during treatment for each patient.

1. Invisalign- Clear aligner treatment (Invisalign) has enabled us to make treatment virtually invisible. Additionally, it allows for flexible for adults and has improved the quality of life, function, and confidence for many who would not pursue orthodontic treatment otherwise.  Invisalign’s innovations are centered around using 3D models to virtually move teeth and manufacture clear aligners to be worn sequentially at each stage of tooth movement.  Invisalign's digital technology dovetails perfectly into 3D printing and scanning technological advancements that we have harnessed in other areas of our practice.  Adults are now free to pursue orthodontic treatment with extremely little impact on their lifestyle or work schedule.

The future is here and it is exciting!  At DCO Orthodontic Specialists, we have harnessed the power of digital technology to enhance human interactions, not replace them.

**Pictured above: DCO patient Sofia (8yrs old) completing early treatment (also called Phase 1) which consisted of upper and lower expanders to make more room for her permanent teeth. Dr. Cassarella also helped to positively motivate her to stop sucking her thumb.  Her treatment represents a typical 9-12 month intervention that corrects the course of a child’s facial and dental development to reduce complexity in the early teenage years.

For most parents, orthodontic treatment is one of the most significant and impactful healthcare decisions you will make for your child. You may wonder when is the most ideal time for your child to be examined by an orthodontist. The short answer, as recommended by the American Association of Orthodontists (AAO), is age 7. The WHY behind this simple answer is one of the most fascinating aspects of orthodontics. In my experience in practice as an orthodontist, I find that many parents and even dentists are not aware of some of the profound benefits of early evaluation of a child for orthodontic treatment. Bringing your child to see an orthodontist at age 7 for a baseline examination can reduce future length, cost and complexity of treatment and also lead to the most ideal end result. Many children do not have the need for orthodontic intervention at a young age, but for those who do, the positive impact that can be made is very significant. It can also help to set your child on a pathway to healthy facial, dental, and psychosocial growth and development.

Below are the top six benefits to early orthodontic treatment:

1. Improvement of Airway
Few parents consider the impacts that jaw development may be having on their child’s airway. There has been recent research that has used 3D imaging techniques to demonstrate the extent to which expansion of the upper jaw can significantly improve the size of airway and volume of airflow during breathing. This occurs by orthopedically increasing the width of the nasal airway. In children who snore at night, have early signs of sleep apnea, or are mouth breathers, early orthodontic treatment can present an opportunity to improve quality of life in ways that you may have never considered. This includes better quality sleep and associated performance in school, improvement in overall health and better performance in athletics. 

2. Improvement of Confidence and Self-Perception
In certain cases, space between teeth, crowding of teeth or severe bite problems may begin to impact a child’s confidence. One study actually showed that some teachers unknowingly had lower expectations for children with severe bite and tooth alignment problems. If a small orthodontic intervention can change the confidence and self-perception of a young child, one may ask the question- what greater benefit can there possibly be?

3. Identification of Severe Crowding or Bite Problems
Many parents of patients recount their own orthodontic treatment experiences which consisted of extraction of permanent teeth. In most children, the future need for extraction of teeth can be avoided by making adequate space for permanent teeth as they grow and develop by using expansion appliances. Early identification of crowding and expansion treatment also can prevent permanent teeth from becoming impacted in the future, and thus decrease future treatment time and complexity.

4. Facial Growth Assessment
One of the most important considerations that is made by the orthodontist is the initial examination of a child’s facial structure. Children who are growing rapidly can undergo very simple and easy orthopedic growth modification treatments that can help the child’s own growth be the corrective force in treating problems relating to facial growth, jaw size and jaw position. In some cases, particularly in underbites, these easy procedures can possibly prevent future need for jaw surgery for your child.In other cases, it can help to prevent developing facial growth asymmetry from becoming a long-term, complicated problem.

5. Reduction of Risk of Trauma to Teeth
In children who have protruding teeth, particularly the upper front teeth, early orthodontic treatment can reduce the risk of damage to these teeth during activities, sports or if your child sustains any facial trauma.

6. Assistance in Stopping Thumb and Finger Habits
Thumb or finger sucking habits, particularly those persisting after age 6, can have lasting effects on the development of the jaws and teeth. Often times, one or two conversations between your child and the orthodontist can provide the motivation and encouragement needed for your child to overcome this challenge.

Timing is everything and knowledge is power. Having your child examined by an orthodontist at age 7 will ensure that treatment needs are recognized early and that treatment is recommended at the most ideal time. This can give your child a better experience, fewer complications and the most ideal outcome.

“May you growup to be righteous. May you growup to be true.”

Bob Dylan (Forever Young)

During my first few weeks of dental school, I took some time one afternoon to find the Department of Orthodontics to explore my interest in pursuing an orthodontic speciality training program after the completion of dental school.  To my surprise, I did not find a Department of Orthodontics listed in the school directory.  I learned eventually that orthodontic education and training took place in the Department of Developmental Biology.   As a newly minted dental student I found this confusing, but years later the semantics became accurate and meaningful.  Orthodontists have specific and intensive training in human growth and development for important reasons.  The comprehensive understanding of normal human physiology, growth, and development is what arms us as clinicians to detect and correct that which is abnormal and problematic.  An orthodontist is trained to possess profound expertise in skeletal, dental, and some aspects of psychological development.

Each day in my office, I am challenged to diagnose and treat developmental problems.  Sometimes the cause of the problem may be abnormal growth of the mandible (lower jaw) or maxilla (upper jaw).  Other times, unerupted, missing, or malpositioned teeth may be the primary cause for concern.  It is not unusual to treat a seven year old child and a 65 year old adult in the same afternoon.  You can imagine the variety and complex nature of the problems that fall within these parameters.  Skeletal problems (problems of the jaws) many times require a different treatment approach than those of a purely dental nature (problems of the teeth).  The seven year old child and 65 year old adult both require the same excellent standard of care, but meeting that standard requires a drastically different approach in treating and communicating to the patient.  For instance, the primary psychological focus of treatment in a 65 year old is rendering treatment in a dignified way that does not interfere significantly with the patient’s lifestyle.  For a seven year old, the primary focus may be alleviation of anxiety about the new office, exam chair, instruments, and appliances that the patient has never seen before.
Successful treatment begins with highly accurate diagnosis or discovery of the underlying problem.  In order to understand the cause of orthodontic problems, orthodontists engage in extensive study of the normal pattern of growth of the dentition and facial skeleton.  In addition, we focus on understanding psychological development in order to motivate and communicate with patients of diverse developmental statuses.   The challenge of utilizing knowledge of development to improve confidence and quality of life is one of the most rewarding aspects of practicing orthodontics in my view.   Despite Bob Dylan’s wishes in the aforementioned quotation, growth can sometimes be abnormal and causes functional and esthetic problems for people of all ages.  Orthodontists are armed with sophisticated technology to identify these problems and work with the patient to select individualized, viable treatment options to improve quality of life by means of functional, esthetic and self-confidence enhancement “when the winds of changes shift.”