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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. Kevin Mancini 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 Hampstead, NC and Jacksonville, NC 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. Kevin Mancini 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 Hampstead, NC and Jacksonville, NC 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.

Maybe you’ve known people with braces and aligners—maybe you’ve worn them yourself!—so if braces or aligners are in your teen’s future, you have some idea what to expect and when to expect it.

But quite often, orthodontic issues require more treatment than braces alone can provide. When misalignment affects not only the teeth but the jaw as well, treatment can be more effective when it begins earlier and makes use of a different kind of appliance—the “functional appliance.”

During the years your child’s bones are still rapidly growing and forming, around the ages of eight to 14, functional appliances can help guide tooth movement and encourage jaw growth and development. One of the most widely used of these devices is the Herbst® appliance.

What does the Herbst appliance do?

There are several types of malocclusions, or “bad bites” treated by Dr. Kevin Mancini. A common condition called a Class II malocclusion occurs when the upper jaw and teeth project too far forward over the lower jaw and teeth. Signs of a Class II malocclusion might include an overjet (protruding upper teeth), and/or a small or recessive lower jaw.

While correcting this malocclusion often enhances facial symmetry, which can be very important for a child’s confidence, correcting a Class II malocclusion also promotes jaw and dental health. Misaligned teeth are more difficult to clean, which can lead to decay and gum disease. Bite problems can cause persistent jaw pain and damage to the teeth. And, with an overjet, a child’s upper teeth are more at risk for injury.

The Herbst appliance was developed to treat this kind of malocclusion. It moves the lower jaw and teeth forward to create a balanced, healthy smile.

How does the Herbst appliance work?

The Herbst appliance is fixed in place with stainless steel bands or crowns that are secured to four teeth in the rear of the mouth, often the first molars on each side of the upper and lower jaws. The band or crown on each lower tooth is equipped with a small bar that extends toward the front of the mouth.

An arm on each side links the bands or crowns on the upper teeth to the front of the bar assemblies on the lower teeth. Each arm consists of a rod that fits smoothly into a tube. The telescoping action of the rod and tube allows the mouth to open and close normally. When the mouth is closed, the arms on both sides telescope shut, forming compact cylinders that hold the jaw forward.

While a child’s bones are still growing, the lower jaw’s new forward position can stimulate further bone growth and remodeling to maintain the jaw in that forward position. The Herbst appliance also has a restraining effect on the forward movement of the upper jaw. The result is a steady, noticeable improvement in the relationship between the upper teeth and jaw and the lower teeth and jaw.

Is the Herbst appliance hard to take care of?

The Herbst appliance is fairly low maintenance, but, like any orthodontic gear, it should be treated with care.

• It’s important to watch your child’s diet, because sticky, crunchy, and chewy foods can damage the appliance. Save the caramels for a post-treatment celebration!
• Carefully cleaning around the appliance is necessary, because a buildup of bacteria and plaque leads to consequences like bad breath, gum disease, and tooth decay. A water flosser can make reaching and cleaning tight spots easier if a brush alone isn’t effective.
• If the Herbst appliance is damaged, some minor fixes might be doable at home with instructions from your treatment team. But if a band or crown comes loose, or if there’s a problem you’re unfamiliar with, call our Hampstead, NC and Jacksonville, NC office right away.
• To help avoid the need for minor (or major) fixes, playing with the appliance with fingers or tongue, nibbling on pens and pencils, chewing on ice, or any other risky habits should be strictly off limits.

When it comes to your child’s health, you always have high expectations. Dr. Kevin Mancini and our team have all the answers you’ll need about what to expect from this phase of your child’s orthodontic treatment, and just why the Herbst appliance is the very best option to create a future of attractive, healthy smiles.

We often think of braces as a rite of passage for kids in middle and high school. So you might be surprised when your child’s dentist recommends a visit to see Dr. Kevin Mancini years earlier than you anticipated. In fact, dentists and orthodontists generally suggest a visit to the orthodontist by age seven at the latest.

Why see an orthodontist so early?

After all, your child is still growing, and many adult teeth haven’t come in at that age. And that’s the whole point.

Around this age, your child will probably have a mix of both baby and adult teeth, so your orthodontist will be able to assess whether there’s enough room for the permanent teeth to erupt without crowding or spacing problems. And malocclusions, or bad bites, caused by problems with jaw size or symmetry can be addressed while young bones are still forming and developing.

If your child has a first appointment coming up on the calendar, here’s a heads up on what often happens during a first visit, and potential problems your orthodontist will be on the lookout for.

What can you expect at a first visit?

The first visit is designed to evaluate how your child’s teeth and jaws work together now, and to look for potential future problems with tooth alignment and jaw structure and development.

First, Dr. Kevin Mancini will carefully examine your child’s teeth, jaws, and mouth. Your child will be asked to bite down several times to see how the teeth and jaws fit together, and if there’s any discomfort. Other helpful diagnostic tools could include:

• Scans or X-rays to evaluate jaw structure and the position of teeth which haven’t erupted yet
• Photos of your child’s teeth and face
• An impression of your child’s teeth

If there’s no immediate need for treatment, we might recommend periodic checkups at our Hampstead, NC and Jacksonville, NC orthodontic office to follow the growth and development of your child’s teeth and jaws. If interceptive (early) treatment is your child’s best option for a healthy smile, your orthodontist will explain any immediate orthodontic issues and design a treatment plan tailored to your child’s specific needs.

What are the benefits of early treatment?

Interceptive treatment not only helps correct current orthodontic problems, it can help reduce the need for more complicated treatment in the future, when all of the adult teeth have arrived and bones are fully formed. Among its many benefits, early treatment can:

• Prevent crowding

If your child has a small upper palate, it can be gently enlarged while the palate is still growing with the help of a palatal expander. This will give the upper teeth the space they need to come in without crowding.

• Provide space

If primary teeth are lost too early, other teeth can shift out of alignment to fill the empty space. A space maintainer can be custom-made to keep the spot open until the right tooth is ready to erupt. If primary teeth are overstaying their welcome, Dr. Kevin Mancini might recommend extraction to allow the adult teeth to erupt in the proper place.

• Create jaw symmetry

Malocclusions can develop because the upper or lower jaw is too narrow, too far forward, too far back, or the jawbones don’t fit together properly. Dr. Kevin Mancini might suggest the use of a functional appliance such as the Herbst® appliance or headgear to help guide symmetrical bone development while your child’s young bones are still growing and forming.

• Protect teeth

Children with overjets, or protruding upper teeth, are more likely to suffer chips, cracks, and other trauma to those vulnerable front teeth. Functional appliances can help bring the upper and lower jaws into alignment as needed, and braces can move the teeth into alignment.

Every journey to a healthy smile begins with a first visit. And you don’t need to wait until your child is seven. Any time you’re concerned about an orthodontic issue is a good time for a consultation. Talk to Dr. Kevin Mancini about what to expect at your first visit to help create a comfortable experience for your child as you begin this journey together.               

By and large, the human body is a marvel of symmetry. But, of course, no one is perfect. You might have noticed one ear is a bit higher than the other. That you wear a shoe a half-size bigger on your left foot. That one shirtsleeve always looks longer.

Or that your smile looks off-center. This dental asymmetry could be caused by a condition known as “midline misalignment,” and, unlike that left foot, you can do something about it!

The dividing line between our center teeth, upper and lower, is called the midline. If we draw an imaginary line down the middle of a face, from the forehead to the nose to the midpoint of the chin, that line should go right between the front teeth. When it doesn’t, because the teeth have shifted past the midpoint, it’s often due to a condition called midline misalignment.

This kind of misalignment, also known as a deviated midline, can have several causes:

• Baby teeth that are lost too early

Baby teeth do more than promote healthy eating and speech development. They also reserve space for permanent teeth. If a primary tooth is lost too early, permanent teeth might “drift” to fill the empty space, causing the midline to move as well.

• Thumb sucking that goes on too long

As a child gets older, and certainly when by the time permanent teeth start to arrive, aggressive thumb sucking can lead to numerous orthodontic problems, including a deviated midline, as the teeth shift in response to that continuous pressure.

• Missing adult teeth

When you lose a tooth through decay or trauma, or when an adult tooth simply never develops, the remaining teeth can shift over to fill the open spot.

• Spacing issues

Crowded teeth, teeth with significant gaps between them, very large teeth, very small teeth—all of these issues can affect spacing and midline alignment.

• Crossbite

A crossbite is a kind of malocclusion, or bite problem. When you have a crossbite, the teeth don’t fit together properly, with upper teeth fitting inside lower teeth, instead of aligning on the outside where they belong. A deviated midline can indicate a posterior crossbite, where the top back teeth slant inwards or fit inside the bottom back teeth.

A tiny bit of midline shift one way or the other might be nothing to worry about, but if one front tooth is literally the center of attention, or if your teeth are noticeably out of alignment, it’s a good idea to talk to our Hampstead, NC and Jacksonville, NC orthodontic team.

Because there are several potential causes for midline misalignment, Dr. Kevin Mancini will carefully analyze your individual situation to determine where the problem lies: with the teeth, the bite, or, rarely, the jaw itself.

Dr. Kevin Mancini will also offer you your best dental treatment options. A shift of a few millimeters might be treated with clear aligners or traditional braces. A crossbite could require braces or aligners coupled with elastics (rubber bands) to bring your bite into alignment. A palatal expander can help correct a serious crossbite.

Why visit Mancini Orthodontics because of a little asymmetry? Because a deviated midline is more than a cosmetic concern. If you have a malocclusion to begin with, or if your misalignment leads to changes in chewing habits, which cause new bite problems, you might be facing jaw pain, chipped and cracked teeth, headaches, and all the other unpleasant consequences of malocclusion.

By and large, perfect symmetry in life is unattainable. But if you want a smile that is well-balanced and healthy, talk to us about all the treatments available to make sure your smile—and not a single tooth—is the center of attention.