“How much do braces cost?”, and “What does Invisalign cost?”, are questions that I am often asked at parties, my kid’s sporting events, and of course during new patient consultations. Here are a number of factors that go into deciding how much braces or Invisalign cost, along with a number of tips that you may find very helpful in budgeting and planning for braces for yourself or your family.

• Every orthodontist is different, but I give estimates based on the complexity and difficulty of a case. This is why it we do not give quotes over the phone before a consultation and full exam. One child may need several months of treatment, while another may require over two years of treatment in braces.
• Adult treatment in our practice is generally not more expensive than treatment for teens or children. Again, it is case by case, and many adult treatments are surprisingly short and relatively inexpensive.
• Whether you have insurance or not, we offer in house, interest free financing that can spread the fee for braces or Invisalign into monthly payments over the course of your treatment. Most families are pleasantly surprised at how affordable braces are.
• If your family has orthodontic insurance, the insurance contribution will be determined by your specific plan. The good news is that if your orthodontist participates with your insurance provider, your fee will be substantially reduced. It is important to ask your orthodontist if they participate (if they are a provider) with your insurance. We all accept insurances, but if we are a provider for your plan, we are contracted to charge a fee that is often lower than our standard fees. Then you get the insurance contribution on top of the reduced fee. If we do not participate with your plan, we set the fee independent of the insurance company’s influence, but there is often a contribution that the insurance company will pay (although this contribution may be less than if you are seeing a participating provider). Insurance and benefits can be very confusing-please feel free to call our office manager, Julie, to answer any questions that you may have!
• Take full advantage of Health Savings Accounts  (HSA’s) or Flex Spending programs. In addition to Insurance benefits, utilizing these plans can save an additional 20-30%! Timing is often important in setting aside funds for these programs, and we will work with you to make sure you take full advantage of this often overlooked area for savings.
• Whenever possible, Dr. Dan prefers to treat in one comprehensive phase of braces. If your child needs early treatment, and will need two phases of braces, we will set out a financial game plan for the entirety of treatment immediately (for everything)- we don’t like our families dealing with surprises.
• Invisalign has advantages and disadvantages compared to braces. In general it tends cost more than braces, but each case is different, and we try to keep prices comparable.
• Please do not feel shy about discussing any financial concerns with us. We are a private, locally owned practice, and we really want to make the experience of getting a new smile enjoyable and stress-free. Dr. Dan and Julie will make you feel comfortable, and will answer any questions you have!

Dr. Dan Rejman is a Board Certified Orthodontic Specialist and Castle Rock, CO. local. He has the best office manager in the world (his wife, Julie!), who will answer any of your financial questions regarding braces, clear braces, or Invisalign.

Just this week I saw several patients for an initial consult, and because of their age and facial structure, each had an entirely different chance of achieving an ideal outcome with braces or Invisalign (a healthy, functioning bite with optimal aesthetic results). One woman was in her 50’s, and she was wondering if she was too old to have her crowded teeth aligned. Because she had a balanced skeletal structure, I informed her that her crowded teeth could be treated to very ideal and beautiful outcome, and her age would have little influence on this outcome.  Later that day, I was visited by a 20 year old young man who also desired to have his teeth aligned with braces. His lower jaw had grown disproportionately less compared to his upper jaw, resulting in an excess “overbite” (as orthodontists we call it “overjet”). Due to his skeletal structure, combined with the fact that at his age his jaw growth was relatively complete and in a stable position, I had to explain to him that the ideal age to treat his condition has passed. Yes, I could greatly improve his bite and appearance, but because of his age and jaw structure, the finished result would have to be a compromise if treated with orthodontics alone (he would require surgery to re-position his upper and lower jaws into an ideal position). The mother of this patient stated that she heard that he could have his teeth corrected after they had all come in, and unfortunately this led to him not having an exam at a younger age.

The two cases above illustrate the misinformation that patients sometimes hear and believe, whether that information comes from the web, family, friends, or just long held beliefs about teeth that still exist. It also demonstrates that older adults can often be treated to ideal, while if younger patients miss a window of opportunity with their growth (especially through adolescence), the chance of treating to an ideal result is greatly diminished.

The American Association of Orthodontics recommends that children have an orthodontic exam no later than age 7. Although I feel that the majority of children I see at this age do not need early treatment with braces, many issues that parents need to be aware can be seen by an orthodontist at this age. The most common examples include:

1) Excess crowding (only severe cases need early treatment). Most often mild to moderate crowding can be treated at a later age when all the teeth have erupted. As the first example above demonstrates, this can often be corrected ideally from adolescence through adulthood. As mentioned, severe cases do need early intervention.

2) A lower jaw that is not growing enough, or a upper jaw that is growing too much (what is referred to by the public as an “overbite”)  We usually like to wait until the adolescent growth spurt to treat this growth pattern, but if a patient waits too long (like the 20 year old above), the bite often cannot be treated ideally.

3) A lower jaw that is growing too much, or upper not enough (known as an “underbite”). It is extremely important to identify this pattern early, and treatment for this pattern often begins at a very young age. Very severe cases are often not treated at all until a patient is ready for a combination orthodontic/surgical correction. The important thing for these cases is early identification, and to try to avoid the need for surgery if possible.

4) An upper jaw that is too narrow. A narrow maxilla is often the cause of crossbites, and if it causes the lower jaw to shift to one side or contibutes to abnormal eruption of teeth, we will often treat this condition early. Expansion of the upper jaw can accomplished before the the two sides of the maxilla fuse together. This fusion usually occurs earlier for girls (early to mid teens) than in boys (mid teens).

The take home message here is the importance of early identification of issues that may exist, and informing parents of the ideal age to address these issues. Even though the majority of children do not need early treatment, some do and the window for achieving a correction is relatively small. For the others, it is important for parents to know the “game plan” for the future treatment of a child’s individual facial skeletal structure. Just as important is letting parents know when treatment is largely aesthetic in nature, and if there is little concern over an “ideal” age for elective treatment.  Always feel free to contact me if you have any questions regarding your child’s teeth or facial growth!

Dr. Dan Rejman is currently the only Board Certified Orthodontist in Castle Rock or Castle Pines, Colorado. He has been a Board Certified Diplomate of the American Board of Orthodontics since 2007.

You may have noticed bright white staining on some peoples teeth after they have their braces removed. These white areas are often permanent, and as an orthodontist it is very disappointing to see after after all the work we have done to get the alignment of the teeth so ideal. It is extremely important for patients and their parents to understand how these stains form, and what can be done to prevent them.

White spots occur on teeth by a process called decalcification,  which will start on any tooth surface where plaque is allowed to sit for an extended period of time (often only several days). Dental plaque’s composition includes a large number of bacteria called Streptococcus Mutans, and Lactobacillus. When these bacteria reproduce and accumulate on the teeth, they appear as a white sticky film (like the bacteria in Petri dishes in school!). This plaque commonly forms and grows near the gum line and around braces if the bacteria are not removed. As living organisms, these bacteria feed on the sugars and carbohydrates that you place in your mouth. After feeding, these bacteria multiply and excrete acid as a waste product for up to 20 minutes. It is this acid excretion that dissolves enamel, and causes a loss of minerals in your teeth.

The white spot that forms is actually the first sign of tooth decay from the loss of minerals from your teeth. Often the outer layer of enamel is hardened from flouride, and the decalcification occurs below the surface of the tooth deeper into the enamel. This is why once damage occurs it is most often a permanent stain on the tooth. Left untreated, this stain can progress to a cavity and will need restoring (or “filling”) by a dentist.

Braces themselves do not cause staining or plaque to form, but they do present a physical barrier to brushing and increase the surface area for plaque to accumulate. This is why from your very first consult with us, we stress them importance of excellent hygiene and brushing technique. It sounds simple, but by just removing this plaque by proper brushing twice a day, these permanent white stains can totally be avoided. But as a father of two kids in braces, I know that most children are not “programmed” to think about medium to long term consequences of leaving plaque on teeth. Since myself and my staff often only see a patient every 6-7 weeks, monitoring the child’s plaque removal must involve the parents (this is probably the most important take home point in this article- I am an orthodontist and my own children need constant checking!) After teeth are perfectly clean, it only takes several days for plaque to build up, and in several weeks can start to permanently stain the teeth!

Several important things to remember:

When brushing, technique is just as important as time spent brushing! Parents often tell me that they see their kids brushing often, but at their orthodontic appointment there is heavy plaque. This is due to a pattern of brushing that consistently misses the same places over and over again. Even if some areas are spotless, the missed areas will form these permanent decalcification stains.

The most common areas that are missed when brushing teeth are near the gingival margin (where the teeth meet the gums), the sides of one or all of the braces on your teeth (which is why the white stains are often shaped in a halo- the braces have protected the enamel under the braces while the plaque surrounding the braces leaves a distinctive mark), and the upper lateral and canine on the side of a child’s dominant brushing hand.- this is usually where they “flip” the tooth brush. These are all points that we cover in depth after the braces are placed, when we review brushing and flossing. Please ask any of us at Meadows Orthodontics if you have any questions!

Once stains are present, they usually cannot be removed. There are several products on the market that claim to reduce white spot lesions, but the research on them have been largely non-conclusive to date. Prevention remains the best option! Other than plaque removal, reducing the amount of processed sugar ingested greatly reduces the chance of staining, as this removes plaque’s food source. The biggest offenders are sugar drinks, including soda, sports drinks, and even sipping on too much fruit juice. Fluoride rises (such as ACT) for at risk patients can often help. We also have a fluoride releasing protective sealant that can be applied for higher risk patients.

Remember, every patient is unique, and each child needs their own level of attention and motivation to ensure their teeth are protected as much as possible while they are wearing braces.

Dr. Dan Rejman is a Board Certified Diplomate of the ABO, and practices at Meadows Orthodontics in Castle Rock, CO.