An initial consultation is required for all new patients. Prior to your consultation with the orthodontist a thorough dental and medical history will be taken. The orthodontist will perform a thorough examination of the patient followed by an in-depth discussion regarding clinical findings and the patient's main concerns. Once the orthodontist and patient agree with the treatment aims, the patient is referred for appropriate diagnostic records with a view to commence treatment in the near future. 

Keep in mind, not all initial consultations will result in treatment straight away. The orthodontist may decide that treatment should wait for further growth and development. Or simply because the patient’s teeth and gum health needs to be addressed prior to orthodontic intervention. In this case, we will be in contact with all patients for a recall/follow-up appointment as soon as they’re ready! 

In our practice, a one-off initial consultation fee will be charged for what is usually a full half-hour consultation with the orthodontist. There will be no further fees for recall appointments until the patient is ready to commence active orthodontic treatment.

After the initial consultation, appointments can be made to gather appropriate diagnostic records for further examination. Diagnostic records consist of photographs, study models, radiographs and sometimes special CT images. Digital models and 3D scans using the iTero Element scanner are also used in the fabrication of many active and retaining devices. Once all these records have been gathered, an individualized plan can be made to deal with each patient's set of presenting conditions. 

What are the diagnostic records used for? 

Once these records have been gathered, an individualized treatment plan can be made to manage each patient's set of presenting conditions. Diagnostic records can be used to measure the proportions of the face, assess remaining growth in young patients, and are also great tools for making comparisons throughout treatment and assessing outcomes through different phases of treatment.

Digital study models of the teeth are made in most cases, so that space requirements and shapes of the upper and lower arches can be properly assessed. The model images may also be uploaded for digital measurement and manipulation. 

High-quality calibrated photographs of the teeth and face will be taken before any treatment commences and at different stages during and after active treatment. These photographs are used for detailed assessment of the pre-treatment positions and form of the chin, lips and smile. They are then used for comparison through treatment and for assessing both the outcomes of treatment and post-treatment changes during the retention period.

In some patients, more sophisticated CT scans may be necessary to assess the three-dimensional relationships of various structures within the skull and the face. We have arranged for most radiographic and CT imaging undertaken outside our office at medical radiology practices to be immediately available online within our practice.

Discussion appointments are requested by Michael Woods to discuss progress and to make further decisions regarding treatment. In many cases, Michael Woods will have a full half hour discussion with a patient and his/her family in the consultation room. Discussion topics often include: 

• Treatment planning
• Orthodontic progress
• Reviewing growth development 
• Further examination/discussion of diagnostic records (radiographs, digital scans, CT scans, photographs) 
• Management of wisdom teeth  
• Jaw joint pain

 Parents and patients are free to call at any time to request a formal discussion appointment.

There will be considerable discussion of the presenting esthetic and functional problems and possible solutions at the initial consultation. In many cases, it will be appropriate to commence some sort of active treatment straight away. If the patient and/or family wish to do that, appointments are made to gather diagnostic records (models, photographs and radiographs or other special images) and fit active appliances. In other cases, the patient's name is placed on recall so that future appointments can be made when timing is more appropriate.

In some cases, there will still be unanswered questions after the initial consultation that require the gathering of extra material or the opinions of other general or specialist clinicians. In these cases, a special Discussion appointment may be made - so that further detailed discussion can take place, as necessary. Sometimes that might be done so that the parent who did not bring the patient to the initial consultation is able to see first hand the factors affecting treatment decisions.

Discussion appointments may also be made during treatment to discuss treatment progress - or after braces during the Retention period to discuss the maintenance of bite and alignment or the management of wisdom teeth.

Parents and patients are free to call at any time to request a formal discussion appointment.

Online Clincheck Pre- treatment scan

Online Clincheck Digitally-manipulated set-up

In most cases, treatment decisions can be made directly within our orthodontic office. There will generally also be direct liaison with the patient's general dentist. The dentist may be asked their opinion regarding gum health or restorative prognosis for particular teeth. They may be asked at times to help by extracting certain teeth, working with patients to improve oral hygiene or to provide planned restorative treatment to build-up or replace excessively small or missing teeth. In all cases, Michael Woods will write a specific request to the dentist for such work to be done.

In some cases, it will be necessary to seek the opinion of, or to work directly with, other specialist dentists or doctors. Most often, this would involve oral and maxillofacial surgeons for the uncovering of blocked, impacted teeth, the surgical removal of wisdom teeth or combined orthodontic and orthognathic (jaw) surgery treatment. In other cases, adults especially may be referred to a specialist periodontist to assess and manage gum conditions before and during active treatment. Specialist prosthodontists may be involved in the provision of crowns, veneers, bridges and implants. Our office will send formal referral letters and copies of our records, as appropriate. More and more, this transfer of records is being managed by email.

In no case, will the patient or family be left to guess the timing of these adjunctive procedures. Appointments for examination, or for work to be carried out, by these other clinicians should only be arranged after the direct request from our orthodontic office has been made.

A First Phase generally refers to a course of orthodontic treatment undertaken before the normal braces period. This might involve the use of various space-holding, expanding or growth-modifying devices.

Upper and lower lingual arches are cemented to the permanent first molars at the back. They simply hold the space from front to back while waiting for various permanent adult teeth to erupt.

Quad Helices and Rapid Palatal Expanders are commonly-used fixed expansion devices.

All these devices are constructed specially for each patient. We first fit orthodontic anchor bands to the first molars. Impressions are then taken over those bands. The bands are removed from the mouth and placed in the impression. Stone models are then made of the mouth and teeth - with the bands in place. The particular device is then formed to the mouth or palate shape - then soldered onto the bands. A week or so later, the completed appliance is inserted and cemented in the patient's mouth. A full set of instructions for use and care is given to the patient and family.

Removal functional appliances (Activators) are commonly used in our office to try to reduce the severity of so-called Class II occlusions - where all the upper teeth are too far forward for the lowers, or vice versa. Impressions of the upper and lower teeth and wax records of the new bite are sent from our office to the laboratory. The completed appliance is sent back to us for insertion into the patient's mouth and adjustment for treatment effect. Our patients generally only wear these functional appliances at home behind closed doors (including sleeping).

Various Headgears - to pull the upper teeth and jaw upwards, backwards or forwards, as necessary, are still used in a few cases. If considered for use in a particular case, recommended wearing will only occur behind closed doors at home (including sleeping).

Removable plates with active springs may be used to simply push one or two upper teeth out over their lower opponents to correct a cross-bite. Generally, these appliances are worn full-time (including eating) for only a few weeks.

A full hour is usually set aside for these appointments. There is much explanation before, during and after placement of the appliances. In many cases, rubber separators will have been placed between the back molars approximately one week before this braces appointment. These separators are removed before orthodontic anchor bands are placed on the first permanent molars. As long as there is space between the adjacent back teeth, there is no reason for the fitting and cementing of those bands to be painful. No local anaesthetics are used in our clinic.

Orthodontic brackets are then placed on the side and front teeth (premolars, canines and incisors). Prior to the bonding procedure, the lips are retracted and the teeth cleaned and prepared. There is plenty of time to do our work carefully and caringly. Patients are able to rest and rinse several times during the bonding procedure. The orthodontic cement and resin used to stick the braces to the teeth are both activated to set with a special blue light.

After the braces have been placed, a flexible arch-wire is generally placed to commence the alignment process. Generally, patients would feel a bit different at first with the braces on their teeth, but it is very unlikely that the teeth or gums will be painful at that stage. Having said that, most patients would be a little sore for the first few days - nothing that couldn't be dealt with by taking some Panadol. The braces are not sharp but they still may cause some rubbing inside the lips during the first few days. Wax balls can be squeezed over any prominent parts, as necessary. Warm to hot salt water mouth-rinses seem to be as good as anything in promoting early healing of the tissues. The rubbing is not something that generally continues further into treatment.

At the end of the braces appointment, there is usually a discussion with the patient and/or their family regarding instructions and recommendations for tooth-brushing, selective eating and control of discomfort. Active patients will also leave our office with Michael Woods' personal mobile telephone number. If there are unexpected painful episodes or appliance breakages, the main office telephone number should be called. But, if it is thought that the particular problem cannot wait until the office is open, the mobile number should be called. Please leave a message and Michael will return your call as soon as possible - usually straight away.

There really is no difference in the braces-on appointments for children and adults (whether ceramic or steel). There would be some difference for those adults being fitted with braces on the inside of the upper teeth. The customised braces are delivered to our office in special insertion trays (like partial mouthguards. The bonding surfaces of the teeth are prepared in the normal way and the trays then firmly pressed into the mouth - so the braces are stuck on the teeth in the computer-derived positions.

Cleaning 

It’s extremely important to keep your teeth clean during braces treatment. Brushing your teeth twice daily as well as using interdental brushes/piksters to clean underneath the wire is very important. Poor oral hygiene can cause permanent discolouration and white marks to develop on your teeth. Having braces means you have to be extra cautious!  It can be difficult to detect food and plaque sitting underneath the wire and around the brackets so using plaque disclosing tablets will help show you areas that you need to improve on brushing. The dental team at Michael Woods orthodontics will also ensure optimum oral hygiene is maintained by checking your oral hygiene at every visit and advising you on how to improve.

Eating 

You can still enjoy your favourite foods with braces, however it’s also important to avoid frequent snacking and high sugar foods. As it is more difficult to clean your teeth around the braces, you may be creating an environment that encourages plaque and bacteria to thrive if you don’t maintain a healthy diet. Breaking brackets and bands can slow down your treatment which means some types of food should be avoided throughout the duration of your treatment. Food such as chewy foods (caramel,liquorice), crunchy food (nuts/pretzals) should be avoided. We would also recommend cutting up apples and raw carrots into smaller pieces rather than forcefully biting into it. This will help you achieve the best results in the shortest time possible.

Adjustment appointments are required every 6 weeks to replace wires and change colour modules. Adjustment appointments allow Michael Woods an opportunity to evaluate tooth movement and make necessary adjustments. It is important to attend all appointments to progress efficiently to the desired ideal result. Adjustment appointments are generally short appointments.

You will feel light pressure when the braces are removed however no pain. The Therapist will use pliers to remove the brackets and bands, thoroughly clean your teeth and remove glue, and then take a mould for your new retainers.

What to expect in a "2 stage Deband" –

Monday Evening – Squeeze: The night before your braces are removed, Dr Woods may give your teeth an extra “squeeze” with elastics to make sure your teeth are interlocking as well as they can. It is advisable to eat a main meal before this appointment. You can still drink soup or milkshakes and other fluids through a straw overnight. You can still talk but it will be through lightly clenched teeth. We will try to make this appointment as late as possible in the afternoon.

Tuesday Morning – Deband: At this appointment, you will see our therapist for the removal of your braces.

Retention after active treatment is essential for all orthodontic patients. Dr Woods will be selecting the retainers that best suit your treatment needs. Instructions will be given on how often they should be worn. In most cases, the retainers are to be worn full time for the first 9-12 months after the removal of the braces. They should only be removed when you are eating, playing sport, cleaning your teeth or going out somewhere very special. We will provide you with a retainer case, which you should take with you everywhere you go. 

When the retainers are not in your mouth, they should be in the case!

Retainers are frequently left in restaurants, chewed up by pets or simply misplaced. If you lose or break your retainers you will generally need new impressions for new retainers. There may be a charge for new retainers. 

Patients will continue to come for follow up appointments over the next few years. In most cases, retainer wear is reduced over that time to the minimum amount required to hold the teeth in their straight position. All our patients are welcome to see Dr.Woods at any time!