How To Achieve Your Best Smile

A Q&A with Dr. James Crouse of The Brace Place

Q: How do I know if my child needs braces? What signs should I look for?
A: The simplest way to see if your child needs braces is to take them to the orthodontist for an examination. The American Association of Orthodontists recommends that children be seen for an initial evaluation at the age of 7. This is when the first permanent molars and the upper and lower incisors are in. However, some things that you may notice on your own would include protrusive upper teeth, lack of space for teeth to erupt and crossbites, where the top teeth are trapped behind the lower teeth. Another condition that the orthodontist can help with is narrow arches that may affect your child’s ability to breathe properly. If your child has problems breathing through their nose, the orthodontist may be able to help.

Q: How long will my child have braces?
The short answer is, “It depends.” Early treatment to correct a problem such as a crossbite can be accomplished in as little as a month. Typically, we try to complete early treatment in a year or less. Comprehensive orthodontic treatment is usually finished in two years or less.

Do braces correct more than crooked teeth?
Absolutely. Properly aligned teeth work best and are less prone to future problems, such as TMJ problems, excessive tooth wear, gum problems and tooth decay. In addition, as I mentioned previously, correcting narrow collapsed arches can help a person’s ability to breathe properly.
Just straightening the front teeth and not addressing the bite is like painting a house that is on fire (or at least has termites).

Are there other benefits for my child to wear braces?
You can’t ignore the benefits to a child’s self-esteem. It’s an unfortunate truth that people judge others according to how they look, and people with unattractive teeth are judged to be less intelligent and less honest than those with a nice smile. In addition, bullying is a serious problem, and a child who is being teased about their funny-looking teeth is a tragedy.

How young is too young for a child to wear braces?
The main factor is where they are in their development and if they have a problem that will cause damage if left untreated. I have treated children as young as 4. These children aren’t treated with traditional braces; it’s usually some form of an appliance.

How much do braces cost?
Again, this depends on the severity of the problem, but full orthodontic treatment in this area typically ranges between $6,000 and $8,000. We have many payment options designed to fit almost anyone’s budget. We like to say we don’t want to turn an orthodontic problem into a financial problem.

Are there treatments available to potentially avoid the need for braces in the future?
The goal of early treatment is to correct a problem that will cause damage, such as tooth wear, gum problems or to make future treatment significantly easier. Occasionally, we do early treatment, and when the remaining permanent teeth come in, they don’t require any further treatment. I tell parents they won the orthodontic lottery. I always tell parents they should plan on the child needing full treatment in the future.

It’s now 2020. Braces today seem a bit archaic. Has orthodontic technology advanced since we were children?
Orthodontic treatment has changed greatly in the 30-plus years I’ve been practicing. Back then, the only option for orthodontic treatment was braces. Now, patients have the additional options of lingual braces and Invisalign. Also, 3D digital scanning is replacing the goopy impressions that were needed for appliances, and 3D X-rays (cone-beam scans) make diagnosis and treatment more precise. Today, orthodontic treatment is faster and more comfortable than ever. 

As an adult, how do I know if I need braces?
Do you like what you see in the mirror when you smile? When you bite down, is your bite comfortable, or are you not sure how you should bite? Has your dentist noticed significant wear
of your teeth or gum problems that may be aggravated by your bite?

What takes place during The Brace Place Smile Assessment?
We take photographs of the face and the teeth, and if you don’t have a current panoramic X-ray at your dentist, we take an X-ray. After a discussion of your concerns, I do an examination in which I look at proportions of the face and the alignment of the teeth and the bite. We then discuss the treatment options and decide whether doing traditional braces or Invisalign would be best. The determining factor is your desire. Invisalign is a removable appliance, and if you lose things easily, you may need braces that can’t be removed. I have 9-year-olds who are excellent Invisalign patients and 20-somethings that are non-compliant, so it just depends on the person. With either option, our goal is to get you the results you want as quickly and comfortably as possible. 

KEEPIN’ IT LOCAL Dr. James M. Crouse is a Salisbury native who’s been caring for patients of
The Brace Place since 1994. For more information about Dr. Crouse and his practice,

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