Bradley Nirenblatt, D.M.D., PA Specialist in Orthodontics

Braces

The story of the three impacted canine teeth

September 23rd, 2017

impacted canines nirenblattimpacted canines nirenblatt

Here is the story of three impacted canine teeth that Dr. Nirenblatt saved by bringing them carefully into the mouth. Somewhere along their journey to the mouth they got tired and could not travel anymore.  Two were hiding in the upper jaw and one in the lower jaw. They all made it into the mouth safely without damaging any of the other teeth. He also helped close the large diastema (space) between the front teeth. Did you know that the upper canine teeth frequently become impacted because they are the last set of the front permanent to erupt and they have the longest journey to travel?

Teen extraction with tip-edge braces to correct crowding and open bite

June 25th, 2017

Nirenblatt Extraction Case with Tip-Edge

Here is a teenager I treated with Tip-Edge braces and extraction of teeth including her compromised "steel crown". I treated her in 19 visits and closed the large molar space. We will keep her wisdom tooth #17 on that side. We achieved straight teeth, closure of her openbite and elimination of a lifetime of problems from a stainless steel crown.

Posterior Crossbite Treated Without An Expander

April 10th, 2016

"Posterior Crossbite Nirenblatt Orthodontics"

A posterior crossbite is a common malocclusion among patients. This means that the upper jaw is too narrow, lower jaw is too wide or both. An orthodontist is a specialist with 2 years of additional training over a general dentist and has the skills needed to determine the correct mechanics to correct this problem. Many orthodontists use a rapid palatal expander (RPE) to correct crossbites on many of their cases. These work well but are very bulky appliances which split the palatal bone and need to remain in place for six to twelve months. Although this appliance works, there are other ways to correct crossbites in many patients using braces alone with the knowledge of moments, forces and vectors. Remember physics? This is a patient that I treated back in 2010 without an expander. Notice how much wider his upper jaw is. Also his midlines are now perfect. If you have been told that you or your child  need an expander you may be able to be treated without one. Let us know if we can help.

Severe Crowding, Narrow Jaws and Protrusion

April 10th, 2016

"Protruded and CrowdedTeeth Aligned With Braces and Extractions"

Here is an older teen patient that I recently finished who presented with a very narrow jaw, severe crowding and a significant protrusion of teeth. I treated her with extraction of 4 teeth and tip-edge braces in 20 visits. Notice the improvement of her smile; it is wider than it was previously. Her midlines are perfectly aligned and her protrusion and overbite are ideal. For the last 25 years in Charleston, My staff and I have  treated patients of all ages not just kids and teens. Let us know if we can help you with your smile!

Extraction of all Four First Molars and Keeping Wisdom Teeth

January 18th, 2016

When preteen patients have extensive tooth decay on their first molars their general or pediatric dentist will place stainless steel crowns to keep the teeth from fracturing. Crowns do not last forever and typically will need to be replaced every 10 years. There is also the risk of these teeth needing root canals. Rather than keep these compromised steel crowned teeth, it makes much more sense to extract these compromised teeth and keep the wisdom teeth. Many people think that most wisdom teeth need to be extracted and they usually are because of lack of space but if you give them space they will function just fine. This patient was saved a lifetime of dental problems by having braces and extracting the four first molars. I corrected her bite as well. The last x-ray shows perfect root structure of her third molars which erupted later on and did not require any alignment.

Nirenblatt First Molar Extractions Braces Tip-Edge

Nirenblatt Braces First_Molar Extractions Pan Tip-Edge

Nirenblatt Braces First Molar Extractions Pan

Adult Orthodontic Patient With 2 Upper Teeth Extracted

June 20th, 2015

Nirenblatt Braces Class2 Adult Upper Extractions

As a specialist in orthodontics, we treat patients of all ages; not just teens and children. In fact, about 50% of our practice are adults who seek us out to improve their smile. We enjoy treating adults because many of them have waited years to have treatment. Some of our patients tell us that their parents could not afford braces when they were teens. They are now ready to take care of themselves and their appearance. We also have parents that begin treatment after we have treated their own kids. They tell us, "Now it is mommy's turn." For these reasons and more, treating adults is especially gratifying.

This patient required removal of two upper bicuspid teeth in order to align her teeth and improve her overbite. Her smile looks fuller after her treatment and there has been no flattening  of her profile. Adult treatment requires more skills than treating just teens and children due to cessation of bone growth.

We have been treating adults in addition to teens and children for more than 20 years. Let us know if we can help you!

Seven Year Follow Up Of My Orthodontic Patient

May 20th, 2015

Nirenblatt Braces Crowded Teeth Orthodontist

I was fortunate to have this young man return to my office for a new retainer 7 years after I finished his case. Everything looks great and even better than they did when I finished him without removing any teeth  in 2008! I continue to use Tip-Edge Braces on my patients for the best result.

Adult Orthodontic Patient Treated With Tip-Edge Braces

May 20th, 2015

Nirenblatt Braces Crowded Teeth

I just finished this young lady in her 40's. I helped her general dentist improve her bite so that she can have her back teeth replaced. I also improved her smile by intruding her upper front teeth to reduce her "gummy smile".

Early Orthodontic Treatment for Underbites

March 25th, 2015

drnirenblatt Braces Early Treatment Underbite

Most children do not need "early braces". However, when children have an underbite early treatment is needed to prevent the lower jaw from growing into a sideways position. If treatment is delayed until the typical 12 years of age then there is an increased likelihood that the child's bite will not be fully corrected without jaw surgery. This is a patient that I treated early for her jaw problem and then again later at age 12 to align her teeth. This is a successful "2 Phase" treatment.

Invisalign and Propel in 9 Months

December 4th, 2014

drnirenblatt propel invisalign

Here is a patient that I just completed with Invisalign. Recently, I started offering patients the technology of Propel in addition to Invisalign. Using the Propel device, I make micro-perforations in the bone around the most crowded teeth. This will create increased bone cell activity to allow faster tooth movement. This is not a drug but a stimulation of the bone around your teeth. This offers not only a faster treatment time but also will allow very rotated or crowded teeth to move a lot easier.

Patient question: What can I eat with braces?

January 18th, 2013


We love when patients ask us this question! Now that you’re wearing braces, it’s just as important to maintain a good oral hygiene regimen as you did before your orthodontic treatment began. The first few days in braces are going to be more difficult to eat than normal. There will be a slight discomfort when you first get your braces on, so the act of chewing will make it slightly more painful.

Here are a few soft foods that do not require you to do much chewing and are easy to chew on when your teeth are sore.

Ice cream, yogurt, pudding, cool soups, Jell-O, scrambled eggs, cream of wheat, baked potatoes, soft cooked pasta, soup, bananas, cottage cheese, smoothies, macaroni and cheese, pancakes, soft cheeses, and milk are all foods you can eat safely without having to worry about pain or breaking your brackets.

Be sure to always check with us if you have questions about a particular food item by either giving us a call or asking us on Facebook!

The Evolution of Braces

November 29th, 2012


Did you know that even in ancient times, people wanted to improve the look and function of their smiles? We think of modern orthodontic appliances as sleek, efficient technology, but this was not always so! Take a look at the highlights in the evolution of braces.

Ancient Times: From Greece to Rome

• According to The Angle Orthodontist, Aristotle and Hippocrates first thought about methods for straightening teeth between 400 and 300 BC.
• The Etruscans, in what we now know as Italy, buried their dead with appliances that maintained spaces and prevented collapse of their teeth and jaws during life. Archaeologists have discovered mummified remains in various locations that have metal bands wrapped around the teeth.
• A Roman tomb has also been discovered in which the teeth were bound with gold wire, including documentation on the wire’s use as a dental device.

18th Century: A French Development

• The French dentist Pierre Fauchard is acknowledged as the father of modern dentistry. In 1728 he published a book that described various methods for straightening teeth. Fauchard also used a device known as a “blandeau” to widen the upper palate.
• Louis Bourdet was another French dentist who published a book in 1754 that discussed tooth alignment. Bourdet further refined the blandeau and was the first dentist to extract bicuspids, or the premolar teeth between canines and molars, for the purpose of reducing tooth crowding.

19th Century: Orthodontics Defined
• Orthodontics started to become a separate dental specialty during the early 19th century. The first wire crib was used in 1819, marking the beginning of modern orthodontics.
• During this period, gold, platinum, silver, steel, gum rubber, vulcanite, and occasionally wood, ivory, zinc, and copper were used — as was brass in the form of loops, hooks, spurs, and ligatures.
• Edward Maynard first used gum elastics in 1843 and E. J. Tucker began making rubber bands for braces in 1850.
• Norman W. Kingsley published the first paper on modern orthodontics in 1858 and J. N. Farrar was the first dentist to recommend the use of force over timed intervals to straighten teeth.

20th Century: New Materials Abound
• Edward Angle developed the first classification systems for malocclusions (misaligned teeth) during the early 20th century in the United States, and it is still in use today. Angle founded the American Society of Orthodontia in 1901, which was renamed the American Association of Orthodontists in the 1930s.
• By the 1960s, gold was universally abandoned in favor of stainless steel.
• Lingual braces were the “invisible” braces of choice until the early 1980s, when tooth-colored aesthetic brackets made from single-crystal sapphire and ceramics became popular.

Today
As we arrive in the present, you need only look at your own braces to see how far we’ve come. Your treatment plan was probably created with a 3D digital model, and we’ve likely used a computerized process to customize your archwires. Perhaps you have clear aligners, self-ligating brackets, or highly resilient ceramic brackets with heat-activated wires.

Orthodontics has come a long way from the days of Aristotle, and even the bulky wrap-around braces of just 60 years ago. Regardless of your specific treatment plan, the development of high-tech materials and methods has made it possible for your orthodontic experience to be as effective, efficient, and comfortable as possible.

Sources: Angle.org, ArchWired

Besides Straight Teeth, What are the Benefits of Braces?

October 26th, 2012

Everyone wants a naturally aligned and beautiful smile, and it is no secret that orthodontic braces can help deliver one. However, there are greater benefits to wearing braces than just having straight teeth. You’ll gain many oral health benefits in addition to the cosmetic ones.

Tooth Decay and Gum Disease

Crooked or crowded teeth may overlap each other and create tight spaces in between. These can make it very difficult to brush and floss effectively, allowing bacteria and plaque to build up, and eventually leading to tooth decay and gum disease. With orthodontic treatment, your teeth will become properly aligned and spaced, which allows for more effective brushing.

Difficulties with Speech

Your teeth play an essential role in speech. When they are out of line or lean too far forward or backward, this can affect your speaking patterns, and possibly cause embarrassment and frustration. Braces can readjust the positioning of the teeth to allow for clearer, more professional speech.

Bone Erosion

Bone and gum tissues begin to erode when there are no teeth to support. This is also true for poorly aligned teeth that leave gaps and spaces or place too much pressure on the jawbone due to a bad bite. With braces, the bones and tissues are less likely to erode and can continue to support the teeth in their new alignment.

Digestion

Your teeth play an important role in digestion. Before food ever enters your stomach, it has been partially digested by the teeth. If teeth are severely out of line, however, they may not play their role in breaking down food as effectively as they should. With braces, your teeth will be straightened into optimal alignment for eating and chewing.

Rubber Band Horoscopes: What Your Color Says About You

October 18th, 2012


One exciting part about wearing braces is getting to choose the colors of your rubber bands. Orthodontists place elastic bands, or ligatures, over each bracket to secure the archwire in place. These rubber bands may be individual or connected, depending on your mouth’s needs. You have the option of choosing the color of your elastics, which are changed about once every month at every visit. Our offices keep a color wheel handy to help you choose which ones suit you best!

Children and teens often enjoy picking different colors each month to express their creativity and coordinate their braces with outfits. Decorating your mouth with your favorite colors is fun for kids and takes some of the stress out of wearing braces. Adults who wish for subtlety have color options that blend in with the metal brackets and archwire. Common choices for adults include silver, clear, and gray tones.

Common Color Combinations for Rubber Bands

With individual ligatures for each bracket, you may choose different color combinations for special events. You can have alternating colors or place an entire rainbow over your teeth. Here are a few options to consider:

• School spirit colors
• Favorite sports team colors
• Patriotic colors
• Holiday themes

Some patients choose only one color to match their mood, personality, or favorite outfits. The palette of choices allows you to make bold statements with your braces or go for subtler tones that blend in with the metal structures. Keep in mind that bright colors make your teeth look whiter, while lighter shades, such as yellow and white, may cause your teeth to appear less bright.

What Your Rubber Band Color Says About You

• Red tones indicate that you are ready for action and take charge of your life with aggressive, forward-thinking steps.
• Blue tones are calm and relaxing. You are conservative and exhibit integrity when dealing with situations.
• Green tones represent growth and balance. You are level-headed and look for opportunities to grow emotionally and spiritually.
• Purple tones attract creative energies. You like to have fun and use your imagination in every aspect of your life.
• Orange tones indicate that you are optimistic and thrive in social situations where communication is open.
• Pink is a romantic color that represents a caring personality. You also enjoy having fun with silly games and endless laughter.

Foods That are Safe for Braces

September 14th, 2012


Orthodontic braces are used to straighten the teeth, which not only creates a more pleasing appearance, but also helps prevent tooth decay and other oral health problems. Braces are only effective when they are properly cared for, however. Certain foods, for example, are better suited for individuals who have braces, as opposed to hard and sticky foods that can cause damage. So what types of foods should you or your kids eat to protect dental appliances?

The best foods to eat with braces are those that are not high in sugar and do not require excessive chewing. For breakfast, try eggs, yogurt, bacon, wheat toast, or oatmeal. Lunch may steer toward a banana rather than an apple, a salad without nuts, and a glass of water. If you are looking for some after-school snacks for your kids, consider baked tortilla chips with salsa and guacamole, or try string cheese with fruit.

A healthy dinner can include most types of vegetables, so long as they are cooked to an appropriate softness. Pair that with a lean protein, such as fish or chicken, and follow up with dessert. Just be sure to brush afterward!

Post-Tightening Foods

As braces begin to adjust the alignment of the teeth, our office will periodically tighten them to continue the alignment process. After tightening occurs, the teeth may be sore and sensitive to certain foods. During this time, it is best to eat soft foods. Examples include:

• pudding
• mashed potatoes
• soup
• ice cream
• cottage cheese
• peas
• pancakes
• pasta

Foods to Avoid

According to the American Dental Association, anyone who wears braces – whether fixed or removable – should avoid excessive snacking and should aim to eat a healthy and balanced diet. It is also important to avoid foods that could cause damage to the braces, such as:

• hard candies
• gum
• nuts
• popcorn
• certain raw vegetables (for example, carrots)

Considerations

Regardless of what types of foods you eat with braces, it is important to keep the crevices between the teeth and around the braces very clean. That means brushing and flossing after meals to prevent the build-up of plaque and decay. Not only can failing to do so damage the teeth, but it can also cause discoloration.

Preventing Decay While Wearing Braces

August 9th, 2012


Having braces can present some new challenges when it comes to oral hygiene. Preventing tooth decay can be a big challenge simply because of the tendency for braces to trap food under the wires and between the teeth and the brackets. Here are a few tips to keep your teeth healthy while wearing your braces:

1.Eat Braces-Safe Foods
Keeping your teeth from decay starts with a proper diet. Foods that are high in sugar or starch can cause more plaque, which is difficult to remove during your brushing. There are certain foods that should be avoided while wearing your braces. First, sticky foods like caramel or gum can get stuck in your braces and be difficult to remove during brushing. Next, hard foods such as nuts and candy could bend wires or even break a bracket. Foods that are firm or hard to bite into like apples, carrots, or corn on the cob should be avoided. As much as we like to snack on them, those crunchy treats can harm your braces. Things like chips, ice, and popcorn can also bend or break your braces. On the other hand, bananas, mangoes, milk, water, poultry, and pasta all tend to be low in enamel-busting acids.

2. Proper Brushing
You want to place your toothbrush at a 45-degree angle against the gums in order to clean the whole tooth, and brush gently in the area between the wiring and the teeth. Use a softer toothbrush with fluoride paste for best results. Rinsing every day will help, too. Rinsing is important regardless, but especially important when you have braces as you need to disinfect the entire mouth, including those spots under the braces where your brush can't always reach.

3. Ask About Special Cleaning Tools
There are also special brushes, or other tools, to get under and clean your braces. You can find many of these items at your local pharmacy.

4. Regular Teeth Cleaning
It's important to keep your routine appointments with your dentist and dental hygienist for a thorough cleaning twice a year or as directed. The exact frequency of these visits will be up to your dentist as some types of braces are more demanding of a regular cleaning than others.
As long as you practice good oral hygiene and follow these basic tips, you should have no problem keeping your teeth from decaying while you wear braces.

Elements of Braces

July 27th, 2012

When coming to our office to have braces put on, you may find yourself feeling a bit intimated and nervous about the experience. We hope to help you feel more at ease by explaining exactly what the different parts of braces are, and what they do.

Parts of Braces

• Elastic Tie — This is a very small rubber band, and it holds the archwire in place.
• Archwire — This is the main part of the braces. It is a wire guide that tracks the teeth. The wire may be moved from time to time during treatment to continue straightening a patient's teeth.
• Loop in Archwire — This is not in all braces. If it is used, it is to close a gap left from a tooth extraction.
• Bracket — This piece of equipment holds the archwire in place. Formerly, many patients used colored rubber bands to keep the brackets in place, but now since most brackets are cemented on, this is no longer necessary.
• Headgear Tube — This is a hollow area near the back bands, which allows the headgear to fit into the braces. This is only used on patients who require headgear.
• Coil Spring — If needed, this would fit between a bracket and the main archwire. Its purpose is to open up the space between the teeth. This is not necessarily used on all patients.
• Tie Wire — This is another piece of equipment that is used to keep the archwire in place. It is a thin wire that wraps around the bracket.
• Band — This is a metal band that fits completely around a tooth. It is used to help adhere brackets to the tooth.
• Hook — This is the piece of equipment that is used to attach the elastics, also known as rubber bands, around the bracket.
• Elastic — These elastics are used to connect one point of the appliance to another. The purpose is to apply pressure, and encourage the teeth to move into the proper positioning.

By defining each appliance we hope you or your child will be less apprehensive about getting braces put on. At the end of your treatment, you will have a bright, straight smile to show off to all of your friends.

Top ten tips for keeping your BRACES sparklin’ clean!

July 13th, 2012




Keeping your teeth clean is more important than ever when you have braces! Food bits have more spots than usual to hide in your mouth, so you must be diligent in order to avoid bad breath, swollen gums, discolored teeth and cavities. If you remove plaque regularly during treatment, you'll experience better results and shorter treatment time. Keep plaque at bay with these top ten tips:
1. One tooth at a time. When you brush, take time with each individual tooth – at least 10 seconds each – and pay careful attention to the spots where your teeth touch your braces.

2. It’s all about the angles. Brush the tops of your teeth and braces with your brush angled down toward where they meet. Brush the bottoms of your teeth and braces with your brush angled up.
3. The tooth, the whole tooth, nothing but the tooth. While the front surface of your teeth may seem like the most logical to clean, it’s equally important to clean the inner surface of your teeth (tongue side) as well as the chewing surface. And be sure to clean along your gum line – a key spot for plaque buildup.
4. Step 1: eat, step 2: clean. While you’re in treatment, it’s important to brush after every meal. Bits of food can easily get caught between braces and teeth, and these food bits interact with bacteria in your mouth to cause decay. The longer food is in contact with your teeth, the greater opportunity for plaque to form. If you are eating somewhere that you can’t brush, thoroughly rinse your mouth with water.

5. Like a Boy Scout, always be prepared. The easiest way to be sure you can brush after every meal is to get in the habit of taking a toothbrush, toothpaste and floss with you wherever you go. Designate a special container just for your teeth-cleaning tools and keep it in your purse, backpack, or laptop case.
6. Remove the moving parts. If you have elastic bands or headgear, remove these parts before you brush or floss.
7. Fluoride is your friend. Fluoride helps prevent cavities. Be sure to brush with fluoride toothpaste, and rinse with fluoride mouthwash.

8. Pointy brushes reach tiny places. Interproximal brushes (sometimes called proxa brushes or interdental brushes) are cone-shaped and come in very handy for reaching spots around your braces that standard brushes can’t.
9. Find the floss for you. Regular floss works for some patients, but others find it easier to work with a floss threader, which helps you get the floss into tight places. Other patients like an all-in-one product called Superfloss, which comes with a stiff end for easy threading, a spongy section for cleaning wide spaces, and regular floss for narrow spaces.
10. Make time for the pros. It’s your job to take care of the everyday cleaning. But make sure to visit your dentist regularly while in treatment, to get the deep, thorough cleaning that only a professional can provide. If you need help finding the right Dentist for you, feel free to contact our office - we’d love to help!

We hope this helps, and remember to give our team a call if you ever have any questions!

“Am I Too Old for Braces?”

May 18th, 2012

Absolutely not! Orthodontic treatment for adults is becoming more and more common. In fact, the number of adults getting braces has actually climbed 24 percent since 1996! More adults than ever are realizing that orthodontic treatment is not just for kids, and can help improve the aesthetics and health of a smile of any age! In a society where appearance matters and can help make the difference between getting a job or a promotion, adults are choosing wisely to invest in orthodontic treatment.

Some of the most common reasons our adult patients come to us considering orthodontic treatment include:

  • Teeth that are crowded or spaced apart, sometimes as a result of tooth decay or gum disease
  • Pain or pressure from crooked teeth or a misaligned jaw
  • A bad bite or malocclusion, causing teeth to fit together incorrectly

Most of all though, adult patients come to our office seeking a healthier mouth and a more confident smile! Orthodontic treatment at our office can be successful at any age, and adults especially can appreciate the benefits of a beautiful smile.

As an adult patient, we recognize that you have different needs than our younger patients, and we will work with you to ensure you receive the most appropriate treatment and that your needs are met with understanding and respect from us.

If you’ve been thinking about getting that perfect smile, we would love to have you visit for a consultation. We understand you have a busy schedule, and will work with you to find a time that is convenient for you. Please visit our website or give our office a call to schedule your appointment today!

HOW TO: Floss with braces

September 8th, 2011

Dr. Bradley Nirenblatt will tell you that keeping your teeth clean is more important than ever when you have braces. Food bits have more spots than usual to hide in your mouth, so you must be diligent in order to avoid bad breath, swollen gums, discolored teeth and cavities. If you remove plaque regularly during treatment, you'll experience better results and could possibly reduce your treatment time.

Here is a very concise video explaining the proper way to floss your teeth with braces. Give Nirenblatt Orthodontics a call if you have more questions about flossing. Enjoy!

Now that I have braces, what can I eat?

August 25th, 2011

You just got braces at Nirenblatt Orthodontics and Dr. Bradley Nirenblatt has informed you that during your orthodontic treatment you will want to avoid eating anything sticky, hard, crunchy, or chewy. What does this leave for you to eat? Lettuce? Nothing?

Luckily, our friends at the American Association of Orthodontists, or AAO, created a variety of “braces-friendly” recipes that will allow you to enjoy your favorite treats without interfering with your orthodontic care!

Recipes include main dishes, side dishes and even yummy desserts! After all, a healthy diet provides essential nutrients and helps the patient achieve the best possible results from orthodontic treatment.

If you have any questions about the recipes listed or about the foods you should be avoiding during your orthodontic treatment, please give us a call or ask us on Facebook!

Enjoy!

Braces 101 with Dr. Nirenblatt

July 8th, 2011

If you ever sustain damage to your braces and need to call Nirenblatt Orthodontics, we can help you more effectively if you can tell us exactly which piece is in trouble! Here’s a handy diagram and corresponding list of all the parts that make up your braces.

Elastic Tie: Tiny rubber band that fits around the bracket to hold the archwire in place.

Archwire: The main wire that acts as a track to guide the teeth along. It's changed periodically throughout treatment, as teeth move to their new positions.

Loop in Archwire: Frequently used for closing space left by an extraction. Many archwires don't have a loop.

Bracket: Small attachment that holds the archwire in place. Most often, a bracket is cemented directly onto the tooth's surface, eliminating the need for a band.

Headgear Tube: Round, hollow attachment on the back bands. The inner bow of the headgear fits into it.

Coil Spring:
Fits between brackets and over archwire to open space between teeth.

Tie Wire: Fine wire that is twisted around the bracket to hold the archwire in place.

Band: A thin ring of metal fitted around a tooth and cemented in place. The band provides a way to attach the brackets to the tooth.

Hook: Welded or removable arm to which elastics (rubber bands) are attached.

Elastic (Rubber Band): Small rubber band that is hooked between different points on the appliance to provide pressure to move the teeth.

Hope this helps! Give us a call if you have any questions!

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