Orthodontics and Braces – PediaCast 450

Show Notes 


  • Dr Kara Morris visits the PediaCast Studio as we consider orthodontics and braces. We answer the questions parents and kids ask: why are braces needed? Will they hurt? How long do they last? Will braces interfere with sports, band or singing? And how much will they cost? We hope you can join us!


  • Orthodontics
  • Palate Expanders
  • Braces
  • Retainers




Announcer 1: This is PediaCast.


Announcer 1: Welcome to PediaCast, a pediatric podcast for parents. And now, direct from the campus of Nationwide Children's, here is your host, Dr. Mike.

Dr. Mike Patrick: Hello, everyone. And welcome once again to PediaCast. It is a pediatric podcast for moms and dads. This is Dr. Mike, coming to you from the campus of Nationwide Children's Hospital. We are in Columbus, Ohio. 

It's Episode 450 for January 22nd, 2020. We're calling this one "Orthodontics and Braces". I want to welcome all of you to the program. 

So last year, we covered a plethora of dental topics on PediaCast with the chief of Pediatric Dentistry here at Nationwide Children's, Dr. Janice Townsend. And together, we explored infant teething and toddler tooth care, that was Episode 423.


Also, tooth care for children and teenagers, so more school-aged children and teens, that was Episode 429. And we also covered dental trauma and emergency tooth care in PediaCast 429. 

We'll put the links to all those past episodes in case one of them catches your fancy. We'll put links in the show notes over at pediacast.org for this episode, 450. 

I'll also include a link to our dental playlist on SoundCloud so you can find all of those episodes plus this one in one handy place. So there'll be a link to the dental episode playlist on SoundCloud, with all of these topics. 

Today, we're presenting an epilogue to our dental series from last year, with an episode on orthodontics and braces. It's a topic that impacts many children and families. Parents have lots of questions like when are braces needed? Are they really necessary? When should we visit the orthodontist? How long is this going to take? How much is it going to cost?


And the kids have questions, too. They want to know, are the braces going to hurt? Will other kids make fun of me? What about sports and band and singing? Will these activities be affected?

All of which are excellent questions. Today, we hope to provide excellent answers to these questions and many others as we consider orthodontics and braces. We'll also talk about how one becomes an orthodontist in case your child or teen is interested in that career path. 

And to help me with the discussion today, we have a terrific studio guest, Dr. Kara Morris. She is a pediatric dentist and orthodontist with the Orthodontic Treatment Program here at Nationwide Children's Hospital. We'll get to her in just a moment. 


First though, I want to mention something that I think is important to a fairly substantial portion of our audience. You know, the target audience here on PediaCast is moms and dads. But I know that we have lots of pediatric providers who also tune in. And I know that because of emails that I get and contacts through the page, the contact page over at pediacast.org and reviews in iTunes, that sort of thing.

And for you, pediatric providers in the crowd, whether you're a pediatrician, a family practice doctor, nurse practitioner, physician assistant, any other medical professional who works with kids, I'd like to draw your attention to an opportunity that we have coming up here at Nationwide Children's on Friday, May 1st, 2020. We are hosting an event, along with the good folks at the Ohio State University Wexner Medical Center, called Communicating Medicine: Practicing Evidence-Based Medicine in an Online World. 

And this one-day conference features lots of engaging speakers and breakout sessions including a deep dive into the rabbit hole of online anecdotes, biases, and echo chambers, the anatomy of a viral post, using Instagram to grow brand recognition and reputation, how to become an interview star, how to avoid getting into trouble with your practice, or hospital or state medical board as you engage online.


And we'll also cover advocacy and diversity and best practices for using social media to advance the common good. We'll also explore how to best grab attention by building an engaging social media profile. 

Now, all of these may sound a little bit self-serving, right? How do I become an interview star? How can I grab attention and shine a spotlight on myself? But remember, medical providers, we need to be engaging if we want to improve health literacy, combat myths and improve health outcomes for children and families everywhere.

So if you are a medical provider or trainee in Central Ohio or even further away, I hope you consider joining us. And if you are one of the ones that are further away, you could always make a weekend of it by visiting our world famous Columbus Zoo and Aquarium. We also have a wonderful Center of Science and Industry, also known as COSI, and a beautiful Franklin Park Conservatory.


A couple of hours drive will take you to Cedar Point and Sandusky, the Rock and Roll Hall of Fame in Cleveland, and the Kings Island and the Newport Aquarium, both are the other direction near Cincinnati. 

And I didn't mention, this is very important, you can also earn Category 1 Continuing Medical Education Credit for attending, because this is an important thing, with practice in the digital age. We're all online, and a lot of where our families are getting information is digital content like this podcast. And so, we have a passion for helping pediatric providers do that in a professional, efficient, and effective manner. 


So again, this is the Communicating Medicine: Practicing Evidence-Based Medicine in an Online World. Again, Friday, May 1st 2020 here on the campus of Nationwide Children's Hospital. I'll be there. I would love to meet you. And I will put the registration link for that conference in the show notes for this episode, 450, over at pediacast.org.

Also, I want to remind everyone, you can find PediaCast in all sorts of places. We are in Apple Podcast, Google Podcast, iHeart Radio, Spotify, SoundCloud, and most mobile podcast apps for iOS and Android. 

Reviews are helpful wherever you listen to PediaCast. We always appreciate when you take a moment to share your thoughts about the show. 

And, we love connecting with you on social media. You'll find us on Facebook, Twitter, LinkedIn and Instagram. Simply search for PediaCast. 

As I mentioned, that contact page is available at pediacast.org. If you'd like to write in to the program. Maybe you have an idea for a future topic for the show or you want to point me in the direction of a journal article or a news story. I'm happy to address those. 


And I also want to remind everyone, the information presented in PediaCast is for general educational purposes only. We do not diagnose medical conditions or formulate treatment plans for specific individuals. If you have a concern about your child's health, be sure to call your doctor and arrange a face-to-face interview and hands-on physical examination.

Also, your use of this audio program is subject to the PediaCast Terms of Use Agreement which you can find at pediacast.org.

So, let's take a quick break. We'll get Dr. Kara Morris settled into the studio and then we will be back to talk about orthodontics and braces. That's coming up right after this.



Dr. Mike Patrick: Dr. Kara Morris is a pediatric dentist and orthodontist at Nationwide Children's Hospital. She's a member of the Cleft and Craniofacial Anomaly Team and the 22q11 Deletion Team, where she cares for children with complex palate and dental needs. She also provides regular orthodontic care at Maple Orthodontics in New Albany, Ohio.

That's what she's here to talk about today, orthodontics and braces. So let's give a warm PediaCast welcome to Dr. Kara Morris. Thanks so much for being here today. 

Dr. Kara Morris: Thank you for inviting me, Dr. Mike. It's fun. 

Dr. Mike Patrick: Really, really appreciate you taking time out of your busy schedule to be here. 

So I think folks have heard of orthodontics but maybe not everyone knows exactly what this means. How is an orthodontist different from a dentist? 

Dr. Kara Morris: Sure. So orthodontists are special in moving teeth, I would say controlled tooth movement. So we choose where we want the tooth to go and try to put it there. So that can be for a variety of reasons. Sometimes it's the position of the tooth, sometimes it's a bite discrepancy.

But to become a specialist in orthodontics, you have to go to additional training after dental school. So I completed an almost three years residency in orthodontics after I finished my four years of dental training. 


Dr. Mike Patrick: Yeah, so undergrad is four years. And then, dental school is four years, and then orthodontics was another...

Dr. Kara Morris: Three years.

Dr. Mike Patrick: Three years after that. But you're also a pediatric dentist as well. And so, did your orthodontic training and your pediatric training happened at the same time? Or do you have to stack those even to train longer?

Dr. Kara Morris: Yes, I went to school for a long time. It's a battery time in plan. But yes, I trained as pediatric dentist first right here at Nationwide Children's. I did a two-year residency in pediatric dentistry and I lived and worked as a pediatric dentist working here and other places for almost ten years. And then I went back and got my orthodontic training also. 

I wanted to do both. I always thought that they complemented each other very well. And that has been maintained, the truth, I think since I've been in practice a few years. 


Dr. Mike Patrick: Do you like your job? Do you like being a pediatric orthodontist?

Dr. Kara Morris: Yeah, I love it. I can honestly say I do love it. You know, there's a special day when your braces come off and the feeling of watching that child sort of appreciate their smile for the first time without braces, it never gets old. It never gets old. 

It's a lot of fun to get to know your patients very well because you're seeing them periodically -- for about two years for some cases -- during adolescence, which is a fun time to get to know kids. They're going through lots of interesting things, different changes, and it's fun being a part of that, too. 

Dr. Mike Patrick: And so this is a career path that you would recommend to others who may be interested in science and maybe dentistry. 

Dr. Kara Morris: Absolutely. If you enjoy detail work, if you like working with your hands, if you like doing lots of little things, seeing lots of patients in a day and meeting with them for a few minutes here and there over a long period of time, I think it would be ideal for you. Working with your hands, very important. 

Dr. Mike Patrick: Yeah, and you have to have some sense of spatial awareness to be a dentist, right? 

Dr. Kara Morris: Certainly. 

Dr. Mike Patrick: I mean you're looking at things through mirrors and you have to figure out which way your hands needs to go. 

Dr. Kara Morris: You do.

Dr. Mike Patrick: Not go too deep.


Dr. Kara Morris: Right, of course, that's a very three-dimensional line of work, so we think about things very three-dimensionally. And you spend a lot of time learning to look at things in the mirror in dental school and it gets very second nature after awhile. 

Dr. Mike Patrick: Sometimes I get my left and right confused, and people were like, "You're a doctor!" But when I'm facing the patient, their left is on my right, and so makes you...

Dr. Kara Morris: Yeah, of course, there's plenty of that in dentistry. 

Dr. Mike Patrick: Yeah, I imagine so. 

So you said that orthodontists move teeth. What are some of the reasons that you would need to move teeth?

Dr. Kara Morris: Sure. So probably the most common reason is because we want our smile to look better. We want straight teeth because it's nice to have a straight smile, but certainly there are more functional reasons to do braces also. 

Oftentimes, there'll be what I would call a bite discrepancy or a way that Mother Nature has placed our teeth that cause them to not fit together maybe quite as she intended. So we do things like expanders or other types of treatment to help the bite align in a more organic or natural way, I think. So that's another big cause or reason to have braces. 


Certainly, for other folks, it serves as an adjunct to other things, maybe you chipped the tooth or you bumped the tooth and displaced it, and we want to try to get back into again a more organic position. So we can do sort of smaller sets of braces to help make that happen. 

Dr. Mike Patrick: Some of those bites, like underbite, overbite, crossbite, those terms get thrown out.

Dr. Kara Morris: They do.

Dr. Mike Patrick: But like crossbite is not quite intuitive what that means.

Dr. Kara Morris: Sure, so again, Mother Nature has a plan for our teeth. She had a plan to put the upper teeth in a certain way, in relationship to the lower teeth. And sometimes, that doesn't happen, right? 

And sometimes, it's just luck of the draw. Sometimes, it's because you had a thumb habit or have a thumb habit or you had a long commitment to your pacifier or your pinkie. And that can certainly shift your teeth in a very young age. 


So yeah, underbite and crossbite, somewhat refers to the same thing, just in different places of the mouth. An underbite is how we would describe a crossbite in the front of the mouth, on our front teeth. And a crossbite, often we talk about in relationship to our back teeth. So you can have both, too. 

Dr. Mike Patrick: So overbite, the top front is going to overlie the bottom. But how's it different than an underbite? 

Dr. Kara Morris: So underbite would be let's say lower teeth are in front of your upper teeth. Imagine, lower teeth sort of pushing forward from the upper teeth. 

And then, overbite can be good. We want to see some amount of overbite in our patients. Some sort of upper teeth in front of lower teeth positioning of teeth. Too much overbite is sometimes a bad thing, so we want to hit right in the middle. 


Dr. Mike Patrick: And crossbite then is more of the molars are coming together quite right. 

And then you mentioned it's not just about cosmetics and appearance, but you really can have difficulty chewing, and eating, speech issues, maybe jaw pain, all of these things can go along with poorly aligned bite.

Dr. Kara Morris: They can. 

Dr. Mike Patrick: And so it's important to try to maximize the function there. We also mentioned some medical illnesses -- or conditions I guess I should say -- that you are a part of treating such as a cleft palate, 22q. So these are genetic issues or congenital issues that kids are born with that maybe they do have malaligned teeth as part of that disease process, right?

Dr. Kara Morris: Indeed. So I would say my practice at the hospital, about half of my patients have some type of clefting or craniofacial anomaly, or maybe another type of special healthcare need. Perhaps, they use a wheelchair and it's easy to get into my clinic because of the space that we have in our X-ray equipments, very adaptable to very different types of mobility, which is awesome. 


So yeah, and certainly there are congenital conditions that directly affect your mouth and can impact the way your teeth come through. And children with cleft lip and palate often have irregularity to their arches that need orthodontic treatment. 

Missing teeth is common and the non-cleft population as well as the cleft population. So moving the teeth around and idealizing space maybe for teeth in the future to fill that space where you don't have a tooth -- maybe like with an implant or on the retainer with the tooth on it -- is a big part of what I do.

Dr. Mike Patrick: So all kids ought to see a pediatric dentist, and the earlier, the better, in terms of getting connected with care. 

What about an orthodontist? Do all kids need to see an orthodontist? How do you know if your child needs to see one and when should that happen? 

Dr. Kara Morris: I think the first thing to do would be ask your dentist. Ask that person who is operating as your dental home. And I think having an orthodontic evaluation around the age of seven is a great idea. Orthodontists certainly look at things with a very small, very large magnifying glass, we look at all those details and we can see lots of things.


But I think starting with your dentist is a great place. And many dentists are very aware of common orthodontic problems that pop up earlier on, even as young as six years of age. And if you ask your dentist if they see any of those things, they can help you time the orthodontic referral that's right for your child.

Dr. Mike Patrick: Is there an ideal time of when you would like to intervene? Or does it really just depend on each kid's mouth than when things are happening. 

Dr. Kara Morris: It depends so much on their unique mouth. As I've told many dental resident, if you've seen one mouth, you see one mouth, right? So everybody is as unique and special and that's great. 

I will say that there's also many roads to Rome. There are many different ways to address a given orthodontic problem and you may talk to two orthodontists and they give you three plans and that's okay. It's all going to get probably to the same correct ideal organic position. Just find the one that makes you feel the most comfortable. 


Dr. Mike Patrick: So like in so many areas in medicine, it's important really to sit down with families and talk about risks and benefits and what your options are and sort of help guide them down the path that's going to be best for their child and their family. 

Dr. Kara Morris: Very much so. 

Dr. Mike Patrick: So what I kind of wanted to do is just to go through some of the things that you treat, the appliances that you use, procedures that you do. 

And the first one that came to my mind was the first that we dealt within our family, and that was when my son had a palate expander when he was very young. What are those about? Why are those sometimes necessary? 

Dr. Kara Morris: Palate expanders are very useful orthodontic appliances and lots of children benefit from having them. The primary reason we would use a palate expander is for one of those crossbites that we discussed earlier. If you have back teeth in particular that don't fit together just properly, the expander helps to widen your upper arch, your upper jaw, essentially so that it fits in the way, again, that Mother Nature intended. 


Now, sometimes, expanders are used for other reasons. Perhaps, we want to gain a little more space for the teeth that you have. Sometimes, they can be used as an anchor for other appliances that we use on orthodontics. But the primary reason would be to fix a crossbite. 

And now, it's important to know there are many types of expanders, too. So the expander that your child has may look different that the child in their class. So there's again, several different types of expanders. Most orthodontist settle down on just one or two varieties.

Dr. Mike Patrick: Ours, we had a key that you had to put in to the center of it, just up against the throat or the mouth. I don't remember now, because it's been so many years ago. But on a regular basis, you would do a half-turn kind of thing. So that's just expanding, putting pressure on the bone. Does that hurt?

Dr. Kara Morris: There can be some pressure involved with the turning of that type of expander, which is called sometimes a rapid palatal expander. Or a Hyrax is a word that is sometimes to used to describe that appliance.


It's a very a gentle expansion, it's to the tune of like a quarter of a millimeter for each turn of that expander. So it's not very much at one time, but some patients will feel some pressure, some discomfort from it. 

The appliance itself is kind of a like a new pair of shoes in your mouth. It has lots of attachments and bells and whistles and it's made out of metal. Most of the time, a large part of it can be metal. You know, just a new place for the soft tissues of our mouth to get used to. 

Dr. Mike Patrick: I remember he would not really complain of pain but kind of an itchy feeling and he almost would sneeze after...

Dr. Kara Morris: Definitely. Yeah, it can kind of tickle your nose. The bones underneath our nose can also impacted by an expander in a positive way. Every now and again, I will say very rarely, some children will even have a nose bleed as accompanying the turns of that type of expander. That's not very uncommon but it something that we see from time to time. 

Dr. Mike Patrick: How long does a palate expander typically stay in place?


Dr. Kara Morris: It varies. I will say usually around three to six months. So after, if your child has one of those expanders that has a key, after all the turns have been completed. 

And that will be unique to your child also. The way your orthodontist prescribes the turns will be unique to your child also. Some children, it's once a day. Some, it's twice a day. Sometimes, it's every other day. So make sure you know how and when to turn your expander.

And then, after those turns are completed, we like to leave it in place to help retain the expansion that we've gotten and help those bones sort of consolidate in the position that they've been moved to, usually for around three months. And that can vary by patient also. 

Dr. Mike Patrick: So moving on to braces, which I think when folks think about orthodontics, it's one of the first things that come to mind, there's so many options these days. How do you go about... Well, what are the options and how do you go about choosing what's best for your child? 

Dr. Kara Morris: So there's lots of different types of orthodontic brackets out there. And the bracket is that tiny, tiny square shaped piece that is actually attached to your child's tooth. That's called a bracket and that's a fundamental part of the braces. 


Of course, the other big part of the braces is the wire that goes between those tiny brackets. So the wires in orthodontics are very similar sort of along the line. It's a wire made out this material or that material and it's this size or that size. 

But brackets can be very unique. There's probably 20 companies that make their own variety of bracket. So they can look different from mouth to mouth. Again, most orthodontist settle down on one style of bracket. And oftentimes, we can offer a bracket made of ceramic bracket, a bracket's that white in color. Most brackets are metal. 

And to me, as an orthodontist, I sort of feel like a bracket is a bracket. I've used lots of bracket in my lifetime. I have my favorites and that's okay, yeah.

Dr. Mike Patrick: Yeah, because you kind of get used to what comes back. 

Dr. Kara Morris: Yeah, agreed.

Dr. Mike Patrick: As opposed to what stays in place. And those are just glued?

Dr. Kara Morris: They are. They are attached with a special dental cement that's strong, but not too strong, somewhat similar to maybe a white filling material or a sealant that you've maybe had placed on your tooth or a child's tooth. 


Dr. Mike Patrick: Is that damaging to the tooth when you pull it off?

Dr. Kara Morris: Generally not. The science is really good. They study it very very well, like what is the type of what they call bond strength that we need to attach to healthy enamel. After I remove the bracket, there's always a thin layer or a bit of residue of the dental adhesive left on the tooth and then I polish that away with one of my dental hand pieces. 

Dr. Mike Patrick: One of the terms I came across as I was looking at information for this interview is this idea of an invisible brace. It's not really invisible, though, right? That sounds too good to be true.

Dr. Kara Morris: It does. It's fun to watch to watch sort of trends in orthodontics trying to make things more and more cosmetic. And the ceramic bracket, those sort of semi-clear brackets have been a step in the right direction. You can find orthodontist that will actually place braces on the back sides of your teeth. There's not too many of them but that's a product that's available. 

Invisalign or types of clear aligners that are used to align teeth is something that you might see a lot of. There's companies that advertise on Facebook and other types of social media called SmileDirectClub. These types of aligners that will move your teeth.

And I will say the ones that are dispensed by your orthodontist or your dentist are the ones that tend to work the best in sort of safest environment. 

Dr. Mike Patrick: Yeah, and then, they're going to be able to deal with those with the most knowledge because they're the ones that they're used to dealing with.

So it's easy for folks to Google and try to find the best thing but you want something that your orthodontist feels comfortable with.

Dr. Kara Morris: Absolutely, yeah.

Dr. Mike Patrick: I would imagine the ones on the back of your teeth would be technically more challenging to place. 

Dr. Kara Morris: Very much so, yeah. I had some experience with that some time ago. The ones that are on the back side of your teeth are very difficult to place and more challenging. And if you think about where your tongue rests, it's right behind your teeth, on the top and the bottom. So having one of those metal brackets on the back can be uncomfortable to some tongues.

So I think choose what orthodontic product you think will work best for your child and your own mouth, if you're an adult. Lots of adults get braces, too.

Dr. Mike Patrick: Are there symptoms involved with braces? Do they hurt?


Dr. Kara Morris: Yes, I think when the braces are first placed, I will use an analogy again, it's like a new pair of shoes or maybe like a new pair of sandals with lots of straps. In the beginning of the summer, it kind of rubs your heel or your foot in a way that is uncomfortable in a big way. But then, by the end of summer, they're your favorite shoes and you wear them every day and there's no problem. 

Braces are like that. The placement of the appliances themselves is sort of irritating to the soft tissues of our mouth. But the people that I work with are so good at providing wax and other things that you can do to help that transition period as you get used to your new appliances. 

So that's thing one. Thing two is as your teeth move, there's usually a dull ache associated with it. And that tends to be the worse in a few days after you had your braces adjusted. 

So the soreness from orthodontic adjustment is usually something that's tolerable. We want you to eat soft foods. Maybe cold foods like ice cream is good and smoothies. And sometimes using an over-the-counter pain medication like ibuprofen or Tylenol can help also. 


Ninety-nine times out of a hundred nobody misses work or school because of their braces. Or it's something you can cope with on a day-to-day basis. 

Dr. Mike Patrick: But if the pain seems exaggerated or is lasting longer than you think, so if your parent radar goes off, it's never a problem to give the orthodontist a call and say like, "Is this normal?"

Dr. Kara Morris: Absolutely call us. 

Dr. Mike Patrick: You don't get tired of them calling day after day?

Dr. Kara Morris: Never. No, I love seeing my... I mean, I don't want to see any patient that's in pain more than I need to. But yeah, absolutely, give your orthodontist a call. Sometimes, it's a poky wire or there'll be a loose bracket or a loose wire that's particularly at loose ends. And we definitely want to address that for you.

Dr. Mike Patrick: How do families go about  caring for the braces, then? You just brush yourself like normal? And what about flossing? And how do you go about just dental hygiene with those in place? 

Dr. Kara Morris: So all of the measures that you take under normal circumstances, you want to do with your braces. You know, you want, times ten though, you want to use the force and clip those teeth as clean as humanly possible while you have braces. 


And that is a challenge. That's a challenge for my patients and that's a challenge for their parents. If you think about how a brace sort of is laid upon your tooth, it's a perfect place for food and other things to get trapped around that bracket, the tiny part that's attached to your tooth. 

And if you don't clean around that bracket, you can certainly get cavities around the bracket. Maybe you don't get a cavity but maybe you get some decalcification or the beginnings of a cavity around the bracket, and you don't want any of that.

So each time you come in to your orthodontist, I know with my team spends a lot of time with our patients showing the areas that they might be missing, trying to improve things. I think the best thing you can do is spend that two minutes twice a day. So quality is in the quantity of brushing when you have braces. So spend some time. 

Dr. Mike Patrick: Yeah, although flossing, you may not be able to floss, right, if there's a wire connecting to teeth?


Dr. Kara Morris: It is tricky to floss and we will always show you how to use adjuncts with your floss. These little floss threaders or tiny floss picks that can help you get underneath the wire, it does take a lot of time. So it might not be a practical before-school activity. But what I tell families is on the weekends, when you really have a little more time, it never hurts to get in there and do your floss, especially those back teeth. 

Dr. Mike Patrick: And then, you want to avoid certain foods when you have braces, too. What are the big no-no's?

Dr. Kara Morris: Why don't we talk about the foods you can eat, right? No. 

Dr. Mike Patrick: Yeah.


Dr. Kara Morris: Crunchy food, carrot sticks, pretzel rods, pizza crusts, gosh, it tastes so good but it's so tough on the outside and everyone kind of tears in to their pizza crust, so those are tricky. Popcorn, most hard candies.

So Halloween comes around. These are the food I would say you could eat -- M&Ms, they sound pretty nice, Reese pieces, smaller bites of things. Soft foods are always okay, those types of things.


Dr. Mike Patrick: Yeah. And the sticky stuff, you want to definitely stay away from.

Dr. Kara Morris: Definitely, yeah. No caramels, taffy, Starburst, those aren't great for your teeth under normal circumstances, but certainly, when you have braces. 

And so, what would happen then is if you did bite in to the wrong food, the appliances can break or fracture. And that's not the end of the world, and almost every child has a few broken brackets or pokey wires throughout the course of their treatment. It's not the middle-of-a-night emergency, but it is something you'd like to minimize, so go easy. 

Dr. Mike Patrick: What do you do with those broken wires especially when it is the middle of night? 

Dr. Kara Morris: I will say it depends on the patient. Certainly, we have shown parents how to clip a pokey wire themselves. You can use a clean nail, scissors. And I have many families that are very hands-on with that. 

But don't ever get out of your league. If you feel like you have to address it, I think contacting your orthodontist and they'll see you as soon practical, I think, for everybody involved. Broken brackets again, it's not a middle-of-the-night emergency. It's almost always something that can wait a day or two to be seen.


Dr. Mike Patrick: And they have the wax, if you have a broken wire that's sticky or that's poking, then you may want to put a little piece of wax on it, right? 

Dr. Kara Morris: Indeed, yeah, wax is really functional. So it's great to always have some of that on hand. It's available at every drug store. I'm sure it's available at most retailers, too. Yeah, and just putting a small patty of wax over the sort of offending part of your braces is a good sort of Band-Aid solution until you can get in. 

But I tell you the wax won't stick to wet surfaces, so what I tell my folks to do, when they want to put wax on is brush their teeth maybe right before bed, brush your teeth well, and then do the reverse flow. You know, when you kind of suck the air off of your teeth so they get kind of dry and then place that wax and it will have better adherence. 

Dr. Mike Patrick: Yeah, good tip.

What about activities? I think a lot of kids will have this question and parents have the question like playing sports or musical instruments. Does it get in the way? Or even singing, does it get in the way of doing those things? Or are they at higher risk of damaging things if you're playing football?

Dr. Kara Morris: I want all my patients do all the activities that they would ordinarily choose to do even with braces. 


Let's talk about music first. So there are some instruments where you get a little more lip action, lip-tooth action. But it's something you can adapt to. So my trumpet players play the trumpet just fine maybe a few weeks of getting used to things. 

If you had a special concert coming up or a performance that you wanted to pay particular attention to, maybe just have your braces put on after that, if you had the ability to be flexible, because it will be an adjustment for you. 

If we move into sports, for contact sports, we always want to see you wearing a mouth guard. That will protect your teeth and the brackets themselves. So choosing to wear a mouth guard with your braces is fantastic idea. 

As far as singing or speaking, I've lots of kids who are really involved in drama and theater, doing braces. Most of the time, it's not too big of a burden. We don't see a lot of effects to the speech or like a development of like lisping other than that palate expander that we talked about earlier, that goes right on the roof of your mouth and can be somewhat of a difficult transition. 

So same thing, difficult transition to speak. You get used to it over time but you're going to notice some effects to your speech initially. 


Dr. Mike Patrick: Yeah, something to think about. And in terms of how long are braces typically in place, or again is this dependent on the kid and the mouth? 

Dr. Kara Morris: It is dependent on the child and the mouth, for certain. So some children, I would say a year is sufficient and others it's two to three years in treatment. Some children need to have braces two times. Once while they have some baby teeth and then a second phase when they're a little closer to the teenage years. 

And again, that's very dependent on the child's unique mouth. And also, you know what, people want a lot of things. Some of what we do as orthodontist is kind of up to the parent and what the child kind of wants to see for their teeth. 

Dr. Mike Patrick: After the braces, what's the role of retainers. And I suspect that this is an area where compliance, people kind of following through with what they're supposed to do. Once the braces are off, you sort of think things are done and over, but that's not exactly right. 


Dr. Kara Morris: It's not, you know. There's no good science that says that any orthodontist can do one thing and make sure that those teeth are no spot forever. So when braces come off, we want them to stay there as best as possible and retainers really help us achieve that. 

And there are different styles of retainers. One orthodontist may choose a retainer that's clear. And another may have some that has wires. Some orthodontist will use a fixed retainer that's adhered to the back sides of the upper and lower front teeth and other orthodontist choose not to use those. 

I think the important message is lifetime commitment to your retainer is probably a good thing to consider. I can't say if you wore your retainer perfectly for six years and then you stopped wearing it, that your teeth won't shift. It's just not the way it works. 

I'm lucky. I had my braces for two years as a 13-year-old in Portland, Ohio and I wear my retainers very diligently till I went to college and I haven't worn my retainers in a long time. I don't have any retainer in my mouth right now but I know a few of my teeth have shifted, but they're mostly okay. 


Your child may not be that lucky. So while they're in your house, I will make sure they're wearing their retainers just like the orthodontist.

Dr. Mike Patrick: What are some signs that they may need a new retainer?

Dr. Kara Morris: Sure. So retainers are made out of different things. So perhaps a clear overlay retainer you may have, just making sure that it's in good condition, there's no factures in it. It's not perforated. The pink and metal retainers that are commonly called a Hawley retainer, just making sure that it still fits appropriately. It's not loose, and again, no cracks or fractures. 

Dogs love retainers. We have a long list of naughty dogs that have gotten a hold of retainers even when they're in the cases. So making sure that the retainer cases is sort of out of reach young children really and then also pets. 

Dr. Mike Patrick: What other procedures and appliances are in your toolkit?

Dr. Kara Morris: Sure, so heaven's sakes, we use some headgear often at times. And you know headgear is something that I think has gotten, I think it's like everybody's favorite orthodontic sort of appliance to make fun of but it can really do a world of good. 


Dr. Mike Patrick: So the thing of nightmare for some kids, right?

Dr. Kara Morris: I know, right? If there's going to braces in the movies. You know, Katy Perry, she wears her headgear in her video. But yeah, so headgear can help your child's bite. You know, if your child has a significant bite discrepancy, headgear at night time can really help move it into that bite until a position that's very beneficial for your child. So if your orthodontist suggests headgear, try to give it a listen and see how you think your child will benefit from it. 

We use lots of rubber bands and elastics in our practice also. That can help for smaller bite discrepancies. There's lots of different types of fixed appliances that aren't expanders but also can move teeth, generally to help settle bites and help with those bite discrepancies. And that's a long list and every orthodontist often has its favorite one. 


Dr. Mike Patrick: Yeah, for baby teeth, oftentimes, kids are running around and fall and run into things. And so, it's fairly common that a baby tooth ends up getting lost. So then you get the space that can be there for quite awhile. Is that something that you need to maintain that space or do you just let nature takes its course?

Dr. Kara Morris: It depends. For goodness sakes, it depends. It depends on what type of tooth has been lost. So there are many children who lose a back tooth, maybe because of cavity. Let's say it had a bad cavity in it and your dentist had to extract the tooth. 

And oftentimes, placing kind of a small retainer or something that's called a space maintainer to maintain that space for that tooth is indicated. And your dentist will know if your child needs a space maintainer or not. 

In the front, if your child loses a tooth, it may be from an injury or maybe the tooth just exfoliated and you've been waiting patiently as a parent for four or six months for the front tooth to come down and it hasn't, you generally don't maintain space in the front of your mouth. And we try to avoid replacing teeth in the front, especially when teeth are just being lost because of normal exfoliation. 


Every child is missing their teeth in the front for a small period of time throughout their life. Unfortunately, some children wait on those permanent teeth to come through the gums a little longer than others, so that gummy smile is very common. 

Dr. Mike Patrick: Orthodontic care can be expensive. Is there insurance that helps to cover this? And what about Medicaid, do they cover any of these procedures?

Dr. Kara Morris: So if we start with commercial insurance plans, almost always there is an orthodontic benefit as part of your overall dental benefit for your child. And perhaps, even for yourself. It's important to know that lots of orthodontic benefits do not extend into adulthood. So they will lapse at age 21. So you may not have orthodontic coverage for your own braces as a parent or as an adult, but your children probably do up until a point. 

And it's usually something called a lifetime benefit. So it's a certain amount of money that you can spend towards braces for the child's lifetime. So that's generally how commercial orthodontics insurances work. 


Things like Medicaid often have orthodontic benefits also. It's certainly on a case by case basis and not every child will get coverage through Medicaid for braces, but it's definitely out there. 

Dr. Mike Patrick: You would think especially if there's really a bite that's causing a particular issue, it's not just a cosmetic thing, but there really a medical issue at play that hopefully someone would help pay for this.

Dr. Kara Morris: Yeah, I agree. I'm in full support of that. Other things that often get covered are things like impacted teeth. If you have a tooth that hasn't come in to your child's mouth, particularly a front tooth, that tends to get coverage. If your child again has one of those big bite discrepancies or significant cross bite, oftentimes that can get covered to. 

It's a pretty formal process to apply for orthodontic coverage through Medicaid but certainly here at the hospital, it's kind of what we do. We're happy to help. 


Dr. Mike Patrick: Yeah, absolutely. Especially in private practice, there are probably some creative payment options available for families and it's going to really be different from office to office. 

Dr. Kara Morris: It is, yes. Absolutely. It is not an insignificant sum of money even after insurance benefits had been applied. And almost always, there's that kind of a month-to-month payment plan that can be established with whatever orthodontist.

Dr. Mike Patrick: I remember those days.

Dr. Kara Morris: Yeah, yeah, and I think that's appropriate. Especially for families that have multiple children in braces at one time, it can be difficult, but often worth it. 

Dr. Mike Patrick: Yeah, absolutely. So tell us about the Orthodontic Program here at Nationwide Children's. Is it mostly the kid who have cleft palate and more complex issues or do you do regular braces here, too? 

Dr. Kara Morris: Yeah, we do everything. My orthodontic treatment program, I work with another, my partner, her name's Ana Mercado. And we have a wonderful team of technicians, lab technicians, and administrators that help us run our Orthodontic Treatment Program. 


So our primary mission is to serve the needs of our cleft and craniofacial populations here at the hospital. But again, I see lots of children who do not have cleft, lots of children from the surrounding community and outlying suburbs, lots of children of employees here at the hospital which has been a real treat for me. So, yeah, I will say, probably as I said before, about two-thirds of the total population within our clinic have a cleft or cranial facial anomaly or some other type of special healthcare need. 

But we have lots of fun, all of us. It's a good group.

Dr. Mike Patrick: Great. Well, I will put a link in the show notes for this episodes for this episode, 450, over at pediacast.org, to the Orthodontic Treatment Program here at Nationwide Children's Hospital.

Dr. Kara Morris: Thanks. Awesome.

Dr. Mike Patrick: So folks who are interested in learning more about your program and what you do, that will be available for them to take a peek at.

And we'll also add this episode to our playlist of dental episode over on SoundCloud. We had several of them. Dr. Janice Townsend is a pediatric dentist, in fact, chief of Pediatric Dentistry here at Nationwide Children's. She joined me last year for three shows, one on infant teething and toddler tooth care. Another one on tooth care for school-aged children and teenagers, and then we also did one on dental trauma and emergency  tooth care.


And I'll put links to all of those episodes in the show notes and they're also be available in that dental playlist on SoundCloud as well. 

So Dr. Kara Morris, pediatric dentist and orthodontist here with the Orthodontic Treatment Program at Nationwide Children's Hospital, thanks so much for stopping by and chatting with us. 

Dr. Kara Morris: Thank you, Dr. Mike. It's been fun. 



Dr. Mike Patrick: We are back with just enough time to say thanks once again to all of you for taking time out of your day making PediaCast a part of it. Really do appreciate that. 

Also, thanks to Dr. Kara Morris, pediatric dentist and orthodontist from the Orthodontic Treatment Program at Nationwide Children's Hospital. Really appreciate her stopping by and sharing her expertise with us. 

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Thanks again for stopping by. And until next time, this is Dr. Mike saying stay safe, stay healthy, and stay involved with your kids. So long, everybody.



Announcer 1: This program is a production of Nationwide Children's. Thanks for listening. We'll see you next time on PediaCast.

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