One of the most compelling and controversial issues in orthodontics today is the "timing" of treatment. Dr. Lash and Dr. Rubin's philosophy is to start orthodontic treatment in the patient's late mixed dentition phase of development (before the patient loses his or her last baby teeth). Treatment timed to begin when the patient has only four to six deciduous teeth remaining involves only one phase of treatment. Reports in the American Journal of Orthodontics and Dentofacial Orthopedics found that 90% of all growing patients can be predictably and efficiently treated in only one phase by starting treatment in this stage of growth. Children can "burn out" when their orthodontic treatment takes too long and they lose their initial interest in their braces. Dr. Lash and Dr. Rubin try to treat their patients in only one phase of orthodontic treatment.

Some orthodontists believe that two phases of orthodontic treatment is better. They prefer to start treatment in the early mixed dentition stage of development when most of the baby teeth still remain. Orthodontic treatment started at this time ususally consists of two phases and the child has braces at a much earlier age. Phase 1 generally involves braces and/or appliances for approximately 12 to 18 months. The braces are then removed and a retainer is placed. In Phase 2, another set of braces is put on after all the permanent teeth have erupted. This second phase of treatment may require a few more years of treatment. Do the benefits of two-stage treatment justify the longer treatment time and increased cost? Dr. Lash and Dr. Rubin will advise this type of treatment only when the specific diagnoses deem it practical and justifiable.

An expander or palate expander is an orthodontic appliance used to widen the upper (maxillary) or lower (mandibular) jaws to correct a crossbite or to provide more space in the upper arch. A crossbite is a type of malocclusion or bad bite where the upper teeth bite incorrectly on the inside of the lower teeth. An expander can be cemented to the teeth or it can be removable. They work by inserting a key in the expander and turning it. This activates a jackscrew and gently puts pressure on the teeth and pushes or expands them outward. Dr. Lash and Dr. Rubin belive that if expansion treatment is necessary, it can be accomplished in two ways. In some circumstances, expansion can be done before comprehensive treatment has begun, with a palatal expansion device. For many patients, expansion can be achieved during regular orthodontic treatment without the use of a special expansion device.

Dr. Lash and Dr. Rubin take the removal of teeth very seriously and will try to treat without extracting permanent teeth whenever possible. The removal of teeth depends on whether the patient has enough room in their jaws to fit all the teeth without making them look too protrusive (the insensitive term is 'buck' teeth). Sometimes there is not a clear-cut answer to the question of whether teeth should be removed because extractions may provide a more stable long term result but at the same time may adversely affect the facial profile. Dr. Lash and Dr. Rubin will thoroughly discuss the effects of tooth removal with you, so that you can make an informed decision.

Often times Dr. Lash and Dr. Rubin will start treatment when baby teeth are still in the mouth. In fact, they will routinely put braces on these teeth and use them to facilitate their treatment objectives. Of course, when the teeth become loose, the braces will be removed which will allow them to fall out.

Each of the teeth is housed in a socket in the jaws and is surrounded by a layer of tissue called the periodontal membrane. Specialized cells found no where else in the body allow the teeth to be moved under pressure. This is what the orthodontist is doing during treatment with the braces-applying very specific directional forces and pressures to the teeth. Unfortunately, the periodontal membrane also contains pain receptors that react to the pressure and can cause discomfort. The pain usually lasts for 24-72 hours and an over-the-counter analgesic (Advil or Tylenol) is recommended. The discomfort should not be so great that it should cause the patient to miss school or his or her daily routine. Dr. Lash or Dr. Rubin should be contacted if you are feeling too much discomfort.

A headgear is only one of the appliances that Dr. Lash and Dr. Rubin use in their orthodontic treatment. They use it when they feels it is the best technique to get a specific job done. They do not ask their patients to wear a headgear in public.

Sometimes the orthodontic problem is associated with a poor position of the jaws. Orthodontic treatment can straighten crooked teeth and can have limited effects on the growth and development of the jaws, but often times the problem is beyond the scope of conventional orthodontic treatment and may fall in the realm of surgical correction. If orthognathic (Ortho=straight, gnathic=jaws) surgery is deemed necessary, Dr. Lash and Dr. Rubin will discuss with you in detail what is involved, and they will coordinate their orthodontic treatment with an oral and maxillofacial surgeon. Orthognathic surgery is a team effort and braces are necessary prior to and after the surgery. The braces are not taken off for the surgery.

In many instances, the orthognathic surgery is also performed with plastic surgery. For example, a patient may need a rhinoplasty (nose job) or a genioplasty (chin) along with correction of the jaws. This can be accomplished at the same time as the orthognathic surgery. Dr. Lash is a member of the team at the Institute of Craniofacial Surgery at Providence Hospital in Southfield, Michigan. This team is headed by renowned plastic surgeon, Dr. Ian Jackson, and all the specialties in medicine and dentistry necessary to diagnose and treat severe facial deformities are represented.

There are many different types of orthodontic appliances available today. No longer must you wear the standard metal of past years. Today, clear plastic and ceramic braces, and invisible removable braces (Invisalign) are available. For those of you who want to show off your braces, every imaginable color is available including gold braces and braces that glow in the dark. Dr. Lash and Dr. Rubin will be happy to discuss the pros and cons of the many different types of braces available today.

After your braces are removed, it is necessary to hold the teeth in position for a period of time to maintain the finished result. Retainers are the orthodontic appliances that are used to accomplish this. They are made for both the upper and lower teeth and can be removable or 'permanent' (cemented directly to the teeth).

Dr. Lash and Dr. Rubin usually see their patients at three-week intervals although this may vary depending on the treatment plan.

Dr. Lash and Dr. Rubin schedule the longer or more complicated appointments in the morning or early afternoon so that they can see patients requiring the more routine appointments between 3 p.m. and 5 p.m. in the afternoon. The appointment to put on the braces takes about 2-½ hours and is usually in the morning. On occasion, you may be asked to miss school for some specific appointment.

Financial Policy: The cost of orthodontic treatment varies depending on the extent of the problem and the length of the treatment plan. Dr. Lash and Dr. Rubin will give you an estimate at your initial consultation and will thoroughly discuss the exact fee before treatment is started.

Payment Schedule: The normal payment schedule consists of an initial payment that is due when treatment starts followed by monthly payments which are spread out over the treatment time. Individualized payment plans can be arranged.

Insurance: We will do all the necessary paperwork and file all your insurance claims so that you receive your full orthodontic insurance benefit. We suggest that you bring your insurance information with you when you come to the office.