Thursday, May 31, 2012

What's new in orthodontics?

Aloha!  In my quest to stay atop the latest and greatest in orthodontic techniques, I ended up in Hawaii at the American Assoc. of Orthodontists meeting.  I listened to lectures, walked the aisles of the exhibition hall, and talked with other orthodontists from around the country.  I left with this overwhelming feeling that the more things change, the more they stay the same.  The difference now I think is that pretty much everything you want to do in an orthodontic office, you can do using some form of computer technology.  The glitch however is that it comes with a price and although it may be exciting to use and look flashy, it is not necessarily "better".   Despite the best efforts of silicon valley's brightest technogeeks, orthodontics still and I think always will involve the careful interaction between human brain, eyes and hands to achieve the proper diagnosis and treatment plan and desired tooth movement to achieve optimal results.  The materials involved whether porcelain, stainless steel, nickel titanium, may change over time, but the end result will always involve a living, breathing, thinking and caring orthodontist.  Mahalo...
 Dr L

Thursday, April 5, 2012

Invest in your career!

A survey by the American Academy of Cosmetic Dentistry reveals that 92% respondents say an attractive smile is an important social asset, while 74% believe an unattractive smile can hurt a person's chances for career success ( Bryan Williams - anchor of NBC nightly news a notable exception).  So in this active political season, make sure you check out your candidate's lower incisors!
 Dr L

Monday, March 19, 2012

Are all orthodontists board certified?

No.  In fact, only about 25% of all practicing orthodontists are certified by the American Board of Orthodontists as Diplomates.  What does this mean exactly?  Prior to taking the board exam, the candidate must obtain a dental degree and a certificate in orthodontics from an accredited orthodontic specialty program.  This takes 6 years after a 4 year college degree.  The orthodontist must then pass a grueling written exam covering  a variety of topics with a reading list to study of several thousand pages.  The hard part then begins.  The orthodontist must then submit treated cases that fulfill certain criteria.  These cases must have full starting and final records and the orthodontist must discuss the chosen treatment plan and results.  The examiners are some of the most highly revered orthodontists in the world and the exam is extremely thorough.  Therefore,  passing this pressure cooker is quite an accomplishment indeed.  I think what board certification shows is a commitment to a higher standard of patient care and treatment results. The willingness to use free time or family time to study, seek continuing education and submit treated cases for scrutiny shows a dedication above and beyond the norm.  Hopefully my patients see the difference!
  Dr L

Monday, March 12, 2012

What will happen if I don't do orthodontics?

I am writing this post because as hard as it is to believe, some potential patients want to know what will happen to their teeth if they don't proceed with orthodontic treatment.  Truth be told, the only evil influences in the fairytale life of your average molar are bacteria and forces.  Bacteria in the form of plaque causing periodontal breakdown or tooth decay and abnormal forces causing teeth to wear, tip, become loose etc. The bacteria part is easy...just brush, floss, see your dentist every 6mos.  Forces are much more complicated.   Teeth and the supporting structures are designed to handle vertically directed  forces and these are important in maintaining good quality bone.  Lateral forces or forces hitting the teeth at angles can be detrimental and lead to breakdown of the attachment and enamel fracture or wear.  This has a domino effect causing shifts in the bite and possibly jaw joint pain, popping and limited range of motion.  Will this happen to every patient?  Probably not,  but difficult to predict.  It is my job and that of your dentist, to help avoid these problems decades into the future.  So brush up McFly and no clenching or grinding!!!
Dr L

Tuesday, March 6, 2012

Internet Consults

I gotta say, I just love the internet.  It is so easy to use and you can learn so much!  At consultations with new patients, I often hear:  "I was reading on the internet and it said to do this..., or not to do that...".  The medical and dental advice you get is great background info written in terms pretty easy to understand.  However, I would caution you that it is sometimes very misleading and usually not case specific.  In other words,  the internet uses generalities that may not apply to you or your child's specific orthodontic needs or treatment.  I have no problem discussing internet findings with my patients as I find it very interesting, but don't be surprised if I add more appropriate info that may be more relevant to the treatment of you or your child's case.  It's like googling  "board game" versus reading the directions for how to play "monopoly".  Having said that - google to your little heart's content... just beware...big brother's watching you! 
Dr L

Thursday, March 1, 2012


I am frequently asked:  "when should my child see the orthodontist for the first time?"  The American Assoc. of Orthodontists suggests age 7 and I agree.  I would also add - whenever a parent suspects a problem.  The reason age 7 is often cited is that the permanent molars are erupting so I can check their fit and evaluate whether or not any jaw growth abnormalities exist.  The permanent four front teeth are usually in or erupting and problems present as overlapping or spaced teeth, front teeth that protrude beyond the lower lip or teeth that are not able to erupt due to lack of spacing.  Jaw or skeletal growth may also be a problem as one jaw may be too far forward or too narrow relative to the other( usually blamed on the father).  You do not have to be referred by a dentist. If I determine that everything looks normal,  your child will be placed on recall and we will see them in a year or two and re-evaluate.  Simple!
 Major Myth :  You should wait until all the pemanent teeth erupt.  This is unfortunately a common problem and the reality is that eruption of teeth does not always coincide with skeletal growth or even age for that matter.  Jaw growth is so important in correcting overbites or crowding, so for some problems, treatment should be timed with the child's growth spurt instead of whether or not all the permanent teeth have erupted.  This will result in a much more esthetic facial and functional result that we can all be proud of !!!   Dr L

Thursday, February 23, 2012

Good news for band students!

An article published in the American Journal of Orthodontics Feb. 2012 evaluating the effects of playing a wind instrument on the occlusion (bite)  revealed the following results:  1)  playing a wind instrument ie.  clarinet, saxaphone etc. does not significantly affect the position of the front teeth...  yea!   2)  playing a brass instrument with a large cup-shaped mouthpiece (trombone, tuba) might pose a small (microscopic) risk of developing a bite problem.   These subjects were all in professional orchestras, so I'm guessing the number of years and hours a day that the aforementioned reed or mouthpiece was in position greatly exceeded that of your average treasure coast middle schooler!  So play on... as long as you don't also suck your thumb, you should be in good shape!  Dr L

Rest in peace Clarence Clemons

Tuesday, February 21, 2012

Whatever gets you here

A recent exchange with one of my 68 year old male patients discussing his crowded lower incisors resulted in the following confession:  "you know I wouldn't be here if my wife wasn't making me!"  Thank you Marys everywhere - we love you at Legler Orthodontics!  Dr L

Monday, February 20, 2012

How long do I have to wear my retainers?

I'm glad you asked!  When orthodontic treatment with braces or invisalign is completed and there is no more active tooth movement, the goal then focuses on holding the teeth in that new, corrected position without them moving back from whence they came.  The reason they move is because the collagen fibers that connect teeth to gum tissue and bone needs time to turnover or refresh. The bone also requires at least 12mos to mature.  Therefore we emphasize fulltime 24-7 retainer wear (removed for meals) for the first 3 mos when those collagen fibers are really stretched to the max.  After 3 mos they can be worn at night only.  For how long you ask?   I hate the phrase:  "for the rest of my life".  That's a little daunting, so I just say indefinitely or at least as long as you want to insure straight teeth.  The problem is this:  we don't know when or what will cause your teeth to shift in the future.  It could be a variety of things attributed to the aging process with the end result being a change of forces on your teeth causing them to shift, drift or tip.  Sometimes it's a slow process, other times it seems to happen overnight.  My practice consists of 30% adult patients who all noticed their teeth looking or feeling worse than they did in years past.  So whether it's a colorful acrylic retainer, bonded wire or clear "invisible" retainer, wear it regularly and you will sleep better knowing you're treating your teeth with the attention and respect they deserve.  Your smile will show it! 
Dr L

Wednesday, February 15, 2012

Is all Invisalign the same?

Invisalign, or treatment with clear plastic aligners, can be a great way to straighten your teeth and improve your smile.  Many patients tell me that this method is a perfect fit for their active lifestyles.  An important thing to understand however, is that invisalign is just a high tech dental lab.  I must accurately diagnose the patient's dental problem and convey the correct treatment plan to the lab tech.  This tech will digitally position the teeth.  This is where it gets tricky.  In order for my expected result to be achieved, I have to communicate back and forth with this tech, usually 8-10 times, refining the tooth movements to achieve the best functional and esthetic result possible.  Just because the lab tech moves a tooth a certain way in the virtual world, does not mean this will actually happen in the patient's mouth.  What a bummer!  As an orthodontist who has been moving teeth for 22 years, I feel confident with my knowledge of the force systems necessary to move teeth effectively.  I have been using Invisalign now for 11years and and after completing over 200 cases, I feel it is an excellent way to provide teens and adults the orthodontic treatment they desire in a manner that is appropriate for their professional or social realm.

Credit for this blog goes out to:  Miss March- my 10th grade typing teacher, Mrs. Raviv- my 10th grade English teacher (both at Mtn. Brook high school).  Also thanks to Al Gore for inventing the world wide webb.   Dr L

Tuesday, January 31, 2012

February is Dental Health Month!

Greetings from Dr L: 
As I am polishing my powerpoint presentation to provide a truly life changing experience to the treasure coast's elementary inhabitants,  I do want to blog a brief summary of my message to the students: "NOT BRUSHING YOUR TEETH WILL COST YOUR PARENTS A LOT OF MONEY".  This will be followed by an explanation of what it means to the average 5th grader:  "YOU WILL NOT GET AS MANY CHRISTMAS/BIRTHDAY PRESENTS." This of course is the only part the kids may or may not retain but here are a few other nuggets: 1)  brush at least 2x a day and floss/waterpik once a day.  Mom or dad please spot check your younger kids to make sure they are doing a good job and not just  veneering the chrome faucets with a saliva-toothpaste-oreo cocktail.  2) Fluoride mouthwash (ACT ) is great once a day to make soft enamel harder and prevent whitespots or decalcified areas.  3)  visit your dentist at least once a year but hopefully every 6 mos.  4) your child should see Dr Legler at age 7 if you suspect any bite issues, jaw alignment problems, space for permanent teeth to erupt , or just look out of place.  Thanks and have a fantastic February!  Dr L