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FAQ:  Braces

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Braces breaking: My son had braces put on 2 months ago. His braces have broken off 4 times; where the bracket comes off the tooth.

What would cause this and what do you recommend? The dentist acts like it is no big deal; but it is getting very frustrating taking him in all the time. ...Visitor from NJ

Let me explain to you just a little about broken brackets so you have a better understanding about the problem you are dealing with and then I will answer your question.

I know this is very frustrating for you because of the extra time spent to repair the braces, however it is very frustrating for the orthodontist also.

As an orthodontist this is the number one issue we face in our practices. Most practices will see anywhere from 50 to 100 patients a day. It is our goal to limit the number of broken brackets in a given day to about 2%-3%, which works out to be no more than 1 to 3 brackets a day. It has been calculated that each broken bracket costs a practice approximately an extra 15 minutes in chair time and $120 to repair each bracket.

So you can see that if every patient came in with a broken bracket it could be devastating as far as time management is concerned and additional overhead. As orhodontic specialists, we go to great lengths to control the number of broken brackets each day, so I am a little concerned when your dentist acts like it is no big deal.

What causes broken brackets?

There are two factors that an orthodontist can control:

1. Teeth must be cleaned properly prior to placing braces on the teeth
2. Teeth must be kept completely dry while cementing the braces on the teeth

These are really the main factors an orthodontist can control to achieve the greatest bond strength so the braces can withstand the normal forces of mastication (chewing). We know this is absolutely imperative to prevent the least number of broken brackets in a given day.

There is one factor that we cannot control and I will be quite honest, that if you are seeing a competent orthodontist, it is usually the main reason brackets come off a tooth.

Dietary habits affect the endurance of braces. Eating hard, sticky foods, chewing ice, chewing pencils or the use of mouth guards during sporting activities are also suspect.

In our practice we allow up to two broken brackets during a child's treatment time and begin charging $30 thereafter. The $30 charge usually stops the occurence of broken brackets with a given child. Most of the time the children will be completely honest about what they were doing when a bracket was broken and 99% of the time it was because they were chewing or eating something hard or sticky.

However, there is a small percentage that will never accept responsibility. I will be quite honest that in my 15 years of practice these are children whose parents get the most upset and always tend to blame it on the orthodontist rather than the child.

What I recommend:

1. Make sure you are seeing a professional who is thoroughly competent in orthodontics. Where orthodontists are available, you may want to consider seeing a specialist. This could be a factor as it relates to proper training in placing braces on teeth.

2. Ask your orthodontist if the brackets are breaking because of a poor bond failure to the tooth. If a bracket is cemented on the tooth properly there will be cement left on the tooth.

3. Finally, if the bond is good, than I suggest talking with your child to find out exactly what he/she is doing when a bracket is broken. You may have to begin an incentive program to prevent further breakage and additional orthodontic appointments.

Editorial Staff

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