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How do I choose an orthodontist?

A 2. There are many factors you could consider and you may see them all by referring to the document called "Factors to consider when choosing an orthodontist." Having practiced more than twenty years, I would suggest that some factors are more important then others and they are: Choose an orthodontist who has an office that is convenient to your work or home, who is a specialist in the field of orthodontics, and who has a pleasant office staff. Choose the orthodontist that has practiced the greatest number of years and when possible be guided by a friend who has completed orthodontic treatment and is very pleased with both the result, the doctor and his staff. Make certain that he is competent in treating with all kinds of braces including clear-transparent, lingual (behind-the teeth), and removable braces. A doctor will often speak lightly of a treatment method that they do not use in their practice. If the doctor is on the staff of a hospital that also bespeaks well of him/her.

How much do braces cost?

A 3. That depends. If you have just one tooth out of its correct position the treatment might only take 3-5 months and cost $650- $1250 to correct. On the other hand, if you had many teeth that were crooked in both your upper and lower teeth that might require 18-24 months to correct and cost between $3,700 and $5,000. Speaking generally you may be quoted a fee that is all-inclusive (molds x-rays, treatment (putting on the braces, monthly adjustments, removal of the braces) and retainers (simple removable devices that hold the teeth in their straightened position after the braces are removed. University trained specialists in orthodontics command fees that range from $3,600 - $5,600 for traditional bonded metal braces. Here are some factors that will determine the fee you are quoted:

a. The number of teeth to be straightened.

b. The crookedness of the teeth to be straightened.

c. Whether one or both jaws need to have teeth straightened.

d. Whether you have type I (normal) jaws; type II, (buck teeth); or type III, bull-dog like jaws.

e. Whether teeth need to be removed. (0-4).

f. Whether it is one phase or two phase (treat-rest treat) treatment plan.

g. Whether the upper jaw bone needs to be widened (a non-surgical procedure).

h. Whether the upper jaw needs to be widened (a partly surgical procedure).

i. Whether the patient is a child or an adult.

i2. How young the child needs to be started to begin correction of the problem.

j. The number of expected monthly adjustments to complete the treatment.

k. The kind of braces to be used: removable, traditional bonded metal, clear- transparent or lingual (behind and in back of, or on the inside of the teeth) and the most recently introduced braces, "Invisalign,"  the "no-braces" braces.

Dr. Rothstein routinely uses clear-transparent with tooth -colored wire usually at no additional expense. Lingual braces are the most expensive and may cost in the range of $6,985 to $9,885 depending on the problem and whether both upper and lower teeth need to have them. these braces are very beneficial for especially sensitive, easily embarrassed patients with very special needs, who can afford them. For those who would like to know about the experiences of a number of patients who have been treated with lingual braces you can turn to Dr. Rothstein’s newsletter especially devoted to LINGUAL BRACES. You may also call these lingual braces patients and speak directly to them if you like. To learn everything you need to know about lingual braces: [CLICK HERE]

Are there a variety of payment methods?

A 4. Most offices try to provide a payment schedule that is sufficiently flexible to accommodate almost everybody’s financial situation. Dr. Rothstein for example, offers a variety of payment plans that include: total payment at the start of treatment with a discount to make it more attractive or an initial payment of between 25% and 45% followed by monthly payments over a period of between 12 and 18 months. Upon occasion the fee may broken up into equal monthly payments with no initial payment. Dr. Rothstein also accepts payment from the major credit cards, by money order and certified check. He will accept personal checks under certain conditions

Will my health insurance cover the cost of braces?

A 5. That depends. If you already have health insurance you may have dental insurance included as part of the coverage. However, orthodontic treatment may not be part of the coverage. Insurance coverage for orthodontic treatment comes in many forms Dr. Rothstein takes almost every kind of insurance imaginable. Some of these work by allowing Dr. Rothstein to charge a fee that is not above a certain amount and that is called "fee for service" plan. Others work by paying (indemnifying) the insured person a fixed amount of money (usually somewhere between $800 and $1,600) no matter what the doctor’s fee is. Still others say "we will pay you 50% (65%-75%) of the "usual and customary" fee the doctor charges you. If you have health insurance you can simply consult you benefits pamphlet for your dental-orthodontic benefits. If however, that pamphlet is lost or too difficult to understand, get on the phone and call the benefits department of your insurance company and ask: "Am I covered for dental benefits and do I have coverage for orthodontic treatment? If the answer is yes you would then inquire: :What is the total amount of my benefit under my plan"? Make sure you get the name of the person who gave you the information and the date because clerical people at insurance companies have been known to give misinformation. Since Clerks are sometimes wrong the best way to be100% certain that you have or do not have an orthodontic benefit is to complete one of the claim forms you have and bring it with you when you have your consultation examination at the orthodontist’s office. The office will then submit the form to your insurance company telling them the proposed diagnosis and treatment plan. The insurance company usually takes 4-6 weeks to reply, but when they do they will respond with your total benefit, if any, and how they will pay the benefit out to either you or the orthodontist. For example, they may make an initial payment of between $300 and $800 and then a monthly payment for 18-24 months of between $30 and $100.

What are "clear" braces? Are they more expensive?

A 6. Clear-transparent braces consist of brackets (mini-handles) that are made of a very hard clear-transparent plastic material and tooth-colored wire that attaches to the brackets to make the teeth move. Dr. Rothstein is one of a very few orthodontists that know how to use the tooth-colored wire. His patients are grateful because these braces are barely visible and that takes a lot of the embarrassment out of wearing braces. These braces are just as effective as metal braces, but far more attractive to look at. These braces are especially appropriate where lingual braces are not affordable, but you don’t want sacrifice good appearance because you are really sensitive about having metal braces on your teeth. The clear braces are more fragile then the metal braces, but not so fragile that they break off easily. One must however, as with all kinds of braces, stick to a diet that does not include crispy, crunchy or crusty or sticky foods. Clear braces in most cases are used routinely in Dr. Rothstein’s office at no additional charge. Click here to see pics.

What are "lingual" braces? Are they more expensive?

A 7. Lingual braces look and work exactly like the braces you see on the front of teeth except that they are bonded (glued) to the back of the teeth where they cannot be seen unless you want to show them to your friends. They are the braces of choice for the treatment of certain kinds of bite problems (like very "deep" overbites) . Dr. Rothstein is one of a small number of doctors who is proficient in using them. In fact, in Dr. Rothstein’s practice there are always present between 4 and 8 patients who are currently wearing them. They very user friendly and patients who are especially sensitive and easily embarrassed find them to be the appliance of choice. They cost an additional $2,500 - $3,500 depending on whether you choose them for the upper teeth alone or for both the upper and the lower teeth. If you are interested in learning more about lingual braces you can download a newsletter Dr. Rothstein recently published containing the experiences of  8 of his patients who were treated with lingual braces. You may even call them should you have the desire for direct communication regarding their experiences. (click here for a picture of lingual braces on a patient)

Ans 7A. What are "Invisalign" braces?

"Invisalign" is the  "no-braces" braces. It is almost like a bleaching tray  (a very clear, thin, durable, one-piece  fitted covering that goes over the teeth) which acts to move teeth as braces do, and is undetectable and can be removed in an instant if needed. Furthermore, There are no dietary restrictions as with regular braces where you must adhere to a a soft diet and you must avoid foods that are crispy, crunchy and crusty lest you break off the brackets that have been bonded on your teeth. I have been using the technique in my practice since November of "99. You should keep in mind that it was introduced to the orthodontic profession in late 1997 and as of July of '99  there are still only a few finished cases that can be cited to evaluate its effectiveness. I use it for patients who have a big issues with the usual brackets and wires that are typically attached to the teeth (even if they are attached to the back of the teeth as they are with lingual braces). It is a useful instrument for the correction of bite problems where the problem can be described as "mild-moderate" spacing or crowding. It has not been perfected for problems whose correction requires removal of teeth except in those cases where removal of one lower front tooth is needed. It takes about the same time as regular braces to complete the treatment, and costs about 25% more than regular braces. You can find much additional information by [CLICKING HERE]. I could put you in contact with a patient who is wearing them now. Cordially, Dr. Ted (Ps. see info regarding lingual braces on my site as well. [Read what patients who used Invisalign had to say about it.]

Ans 7C.  I'm thoroughly confused! There seems to be so many kinds of braces now. How do I choose?
You should be. There are so many choices now you have to be a rocket scientist to make the right choice.
Doc: Let me tell you. Follow me.  In a nutshell it works like this:  When your issues are all about keeping the cost as low as possible you will need to choose typical metal braces bonded on to your teeth.  When your issues are mainly concerned with vanity (you don't want the braces to be visible) you choose "Cosmetic" braces: 1. braces that are bonded to the the front of your teeth that are "clear" (preferably with tooth-colored wire) or 2. The OrthoClear "shell" or "aligner technology" braces which are "almost completely invisible plastic shells that, are removable at will. Consequently, there are no brackets or wires bonded to your teeth and consequently no eating restrictions to prevent detached brackets. If however, you need to have 2-4 teeth removed this kind treatment technology is HIGHLY NOT RECOMMENDED. Finally the king of braces is Lingual. Providers of lingual braces are scarce as hen's teeth :-) because expertise takes years of practice to be proficient in treating cases. With lingual braces nothing can be seen except your own natural teeth becoming straighter like magic with each passing month. They cost the most. Speech and tongue soreness can be problems during the first 4 weeks and in general might take 3-5 more treatment time and the appointments might be scheduled for 30 minutes not 15. Ps. A good orthodontist can do all of them. Most of my patients take upper and lower clear braces or upper OrthoClear and lower Clear braces or upper lingual and and lower clear braces.  YES YOU CAN MIX THE BRACES WHEN YOUR ORTHODONTIST IS GOOD.  I'm a good orthodontist :-). LONG EXPERIENCE AND A GOOD REPUTATION ARE THE MAKINGS OF A GOOD ORTHODONTIST.

8. How long does orthodontic treatment take?

A 8. Assuming that you cooperate fully and follow Dr. Rothstein’s instructions, brush your teeth regularly, keep up a soft diet (in order to avoid breaking any of the parts of the braces like the brackets or the wire), keep your appointments as instructed and keep up healthy gums, your orthodontic treatment can usually be completed in 14-18 months if no teeth need to be removed. Younger children usually take longer because they are not adept at cooperating in the above-mentioned matters consequently, their treatment may take 18-22 months. In those cases where teeth do need to be removed to achieve the best result the treatment may take between 6-10 months longer.

Can I go directly to an orthodontist, or does the dentist have to send me?

A 9. You do not need to go first to the dentist’s office. If you think you have a problem related to the way your teeth appear (crooked, spaced, rotated, over-bite, under-bite, open bite, cross-bite) you can go directly to an orthodontist’s office. Look in your Yellow Pages telephone directory under Dentist-Orthodontists. The Yellow Pages is an excellent way to choose an orthodontist because you can see at a glance whether they offer the more special treatment methods like clear-transparent and lingual braces or whether they treat TMJ (see question 26) and if they accept various treatment plans. In addition, if they are close to public transportation, that will also be noted. You can also call any dentist’s office and ask the receptionist if they can recommend you to an orthodontist. Dentists are usually willing to give you such assistance, just try it. Most orthodontists belong to the AAO (American Association of Orthodontists), so you can also call that organization at 800-S-T-R-A-I-G-H-T and they will provide you with the names and addresses of orthodontists who are members of the AAO in any zip code.

How do I know if I really need braces?

A 10. There are three basic reasons that you can receive orthodontic treatment: The first and most usual is that your teeth look crooked to you and you are embarrassed by your smile and therefore you never smile. The second reason is that your crooked teeth may be causing harm to the other teeth, gums or bone that holds the teeth in, as well as to the joint that permits your mouth to open and close (the "TMJ, see question 26"). The third reason is that your dentist needs to treat some dental problem you have, but (s) he can not proceed before another problem that requires orthodontic treatment is completed. Most orthodontic treatment is provided because people are concerned about their looks, therefore if you are concerned about your looks, you need an orthodontist who will tell you all the ways, even the non-orthodontic approaches if any to the enhancement of your smile. Sometimes you may need an orthodontist because you sense some kind of discomfort in your bite, but your are not certain why you are having the discomfort. In those cases it may be wise to see the general dentist first because (s) he may be able to identify the cause of your discomfort which may not require an orthodontist at all. In any case, you may proceed directly to an orthodontist who will at least diagnose the problem and advise if orthodontic treatment will benefit you. I would advise you to get a second orthodontist’s opinion as well.

What is an "Informed Consent" document?

A 11.  When a potential patient is about to begin a course of therapy/treatment the would-be patient must be informed by the doctor of all the choices that the patient has including the option of no treatment and the consequences of no treatment.  The patient must be told the potential dangers of the treatment proposed. Only with that information can the patient make an intelligent choice whether or not they should go ahead with the treatment. The doctor must let the patient know what factors may cause the treatment to end unsuccessfully. It is the patient who then being informed of all factors related to the treatment gives his consent to having the treatment.  [I want to see Dr. Ted's Informed Consent document.]

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