Invisalign Q&A

If you are considering Invisalign instead of traditional braces to straighten your teeth, you probably want to know more about what it is. Here are some questions we frequently get at Birth-Stewart-Fletcher Orthodontics about Invisalign:

What is Invisalign anyway?
Invisalign is a teeth-straightening system that involves a series of smooth plastic trays, or aligners that fit directly over your teeth. You switch one tray out for the next every two weeks or so. Each tray is a little different, and as a system, they gradually move your teeth into place with the last tray matching your final teeth alignment.

What is the treatment process?
At the beginning of Invisalign treatment, we will take x-rays and impressions of your teeth in order to create a digital 3-D model of how your teeth look now, how they should move, and how they will arrive into their ideal positions. Based on this treatment plan, we will order the trays for you. Once you begin wearing the trays, you will need to come to the office about every six weeks so we can make sure your teeth are moving according to plan.

What are the advantages of Invisalign over traditional braces?
The main reason patients choose Invisalign is because the trays are virtually invisible and don’t call attention to themselves. Invisalign has other advantages as well. Since there are no metal brackets or wires, Invisalign will not cut or scrape the inside of your mouth. Also, you will never have to make an emergency visit to the office to fix a bracket that popped off or a wire that broke.

Should I wear Invisalign all the time?
You should take out your Invisalign trays when you eat, floss and brush. You might also want to take them out for certain activities, such as when playing a contact sport or a musical instrument that requires using your mouth. But aside from such exceptions, you should always wear the trays to make sure your treatment keeps moving along nicely.

Can Invisalign replace traditional braces for anyone that wants it?
Invisalign is not a suitable treatment option in all cases. Come to the office for a complimentary consultation, and we will let you know if Invisalign will work for you.

Is Invisalign treatment any faster than traditional braces?
Not necessarily. Treatment times are about comparable.

What are any disadvantages of Invisalign over traditional braces?
Invisalign is typically a little more expensive than traditional braces. You might speak with a lisp at first until you get used to the trays in your mouth (but that can happen with traditional braces, too). And the fact that the trays are removable are an advantage, but you have to remember to wear them consistently. You also have to be sure not to lose or break them.



Invisalign Q&A

Dental Fun Facts!

Just for fun, we have assembled a list of fun facts about dentistry and orthodontics which you probably never knew:


  • Straight teeth have always been important to people. Rudimentary braces made of catgut and metal have been found in Egyptian mummies.
  • The spinner dolphin has more teeth than any other animal, up to 252 teeth. Compare that to people who have only 32 teeth as adults.
  • Siwak sticks, also called miswak, are a precursor to the toothbrush. They have been used for thousands of years and are still used today in parts of the Middle East and Africa. Siwak sticks are twigs from the arak tree, which fray into bristles when you chew on them and which you can then use to brush your teeth.
  • Dental disease has been with humans since prehistoric times, but the incidence of cavities increased dramatically in Europe in the 1600’s when imported sugar became part of the diet.
  • Bears, who have a large appetite for honey, are the only non-domesticated animal that gets cavities.
  • Contrary to popular belief, George Washington never had wooden false teeth. He did have dental problems all his life, however, and for a time wore partial dentures made of ivory.
  • As of 2011, there are 193,000 professionally active dentists in the United States, according to the American Dental Association. People who live in the District of Columbia have a wealth of dentists from which to choose, because the city has the most dentists per capita in the United States. The state with the least dentists per capita is Arkansas.
  • As of 2012, there are 5,530 orthodontists in the United States, according to the Bureau of Labor Statistics.
Dental Fun Facts!

Cleaning Braces

6 Tools for Cleaning Braces


There’s no sugar-coating the fact that cleaning your teeth when they’re in braces is more involved than when they’re not (and at our office, we don’t like to coat things in sugar anyway). Braces create many new, tiny spaces to trap particles of food while at the same time hindering easy access to areas of your mouth.

But cleaning your teeth while in braces is more important than ever. Tooth decay and puffy gums won’t take a holiday until your treatment is over. We recommend cleaning your teeth at least four times a day, after all three meals and before you go to bed, and it’s a good idea to clean your teeth after any snacks too.

Even though cleaning your teeth when you’re wearing braces is both more difficult and more complicated, it’s not the hardest challenge you’ll ever face in life, and your local drugstore will carry all the tools you need to do it right. Here are 6 products that we recommend:


  1. Toothbrush and toothpaste

Keep these old standbys on hand. Use a soft toothbrush with just a bit of fluoride toothpaste. Make gentle, circular motions while brushing at various angles, and be sure to cover all surfaces: the gumline, behind the teeth, as well as the top, middle and bottom edges of the brackets. You’ll need to replace your toothbrush more frequently than normal.


  1. Floss threaders or Superfloss

These products have a stiffened end that allow you to thread the floss underneath the wires so you can get the floss between your teeth.


  1. Dental picks

Dental picks offer another way for you to get underneath your wires in order to clean between your teeth. These plastic tools come in various shapes and configurations, so try out a few to find the one that you like best.


  1. Proxa brush

Short for interproximal brushes, a proxa brush is like a toothbrush except that the bristles come in a short cone shape. It’s a more precise tool than a normal toothbrush so it’s good for cleaning hard-to-reach spots.


  1. Waterpik

These machines shoot a jet of water at various pressures to “floss” between teeth. Orthodontic tips are available. They can be pricy, but they work more quickly than manual flossing, and they’re quite good at cleaning.


  1. Mouthwash

Finish up cleaning your teeth with a rinse of fluoride mouthwash as extra protection against tooth decay.


Exactly which tools to use will depend on the braces you have and your personal preferences. Our doctors will offer you our advice when you get your braces on, please feel free to ask about any problems you might be having if one particular tool isn’t working for you. You’ll eventually get used to the longer process of cleaning your braces. Allow yourself to be motivated by the wonderful, straight smile that’s gradually taking shape.



Cleaning Braces

Preventing Tooth Decay While Wearing Braces

“I have had braces for about two years. I admit that about 70 percent of the days I’ve had them I haven’t brushed more than once a day,” a teenager says in an online forum. He goes on to wonder if he can hold off tooth decay if he were to brush more often. If he came to us, we’d tell him that the answer is “yes,” but there’s also more he could do.


Since food gets stuck in unseen places on teeth when braces surround them, cleaning teeth requires both frequency and special tools. Here are some suggestions:


  • Brush after every meal or big snack. The less time food sits on your teeth, the less likely it will cause decay.
  • Use a soft bristle brush at a 45 degree angle or an electric toothbrush, which we frequently recommend because it allows you to easily brush each tooth individually. Be sure to brush all sides of your teeth. Fluoride toothpaste is best.
  • Use a floss threader or a proxabrush to clean between braces and under wires.
  • Use a Water Pik. The pressurized pulsating water it emits removes food particles from hard-to-reach places.
  • End your cleanings with a fluoride mouth wash, which helps disinfect under your braces and other spots where a brush can’t reach.
  • Even if you can’t brush after every time you eat, carry mouthwash to use after eating. At a minimum, rinse your mouth with plain water. It’s better than nothing.
  • Have a dental professional cleaning at least twice a year.


The type of food you eat can also increase the likelihood of decay as well as damage your braces. Any food high in sugar or starch can cause decay. Especially, avoid eating the following:


  • Sticky foods such as gum or caramel, which can get stuck on your braces and be hard to remove.
  • Crunchy treats like chips and popcorn, which can bend or break your wires.


Eating hard foods like apples, corn on the cob, and carrots can break your braces. Still, they can be part of a healthy diet, so cut them into small pieces so you don’t have to bite down hard.


If you have additional questions about how to care for your teeth, feel free to ask us when you’re in for your next appointment.

Preventing Tooth Decay While Wearing Braces

Famous Dentists

In the history of dentistry, there have been dentists who invented new tools or methods, started dental schools, made discoveries, or advanced the profession in other significant ways. Many of these dentists remain well known in their field and are still recognized and honored, but some dentists have gone on to become famous, or even infamous, for reasons that have nothing to do with oral health.


One dentist in particular became notorious during the days of the Wild West. Ever heard of “Doc” Holliday? John Henry Holliday was a “doc” because he had worked as a dentist. He is best known for his partnership with Wyatt Earp and their infamous battle at the OK Corral. Holliday became a gunslinger after leaving an active dental practice in Atlanta. He contracted tuberculosis and abandoned his practice for the West’s drier air and gambling dens.


A decade after Holliday passed, Harry J. “Doc” Sagansky was born in Boston in 1898. After graduating in dentistry at Tufts University, he opened his practice at a pharmacy, which was also a secret liquor store during Prohibition. Sagansky eventually became involved in illegal gambling, nightclubs, and loan sharking. He served jail time for attempting to bribe a city official and was hauled into court during organized-crimed hearings in the 1950s for being a major figure in “the largest racket kingdom” in Boston. He has the dubious distinction of being the oldest organized crime figure to be sentenced to Federal prison at the age of 91.


Another dentist, Thomas Welch, started his career as a Methodist minister but decided to attend New York Medical College in 1856. While building a successful dental practice in New Jersey, he invented a non-alcoholic grape juice to be used instead of wine in religious services. Welch’s grape juice became popular in the 1890s (and remains popular to this day), while Welch continued to practice dentistry.


Some other dentists that became well known include:


  • Zane Grey – He chose New York City to begin his dental practice because he wanted to be near publishers. He eventually became famous for writing over 80 western novels.
  • Annie Elizabeth Delaney – A 1923 graduate of Columbia University, she was the second African American woman to be a dentist in New York, but she is better known for her best-seller, Having Our Sky, which also became a Broadway play.
  • Paul Revere – He is famous for alerting Boston citizens that “The British are coming…,” but he was a dentist who also made dentures for his patients.
  • Charles Murray Turpin – Turpin, a Pennsylvania dentist, served 15 years in Congress in the 1930s. Three dentists are currently Republican members of the U.S. House of Representatives: Brian Babin (Texas), Paul Gosar (Arizona) and Mike Simpson (Idaho).
  • Steve Arline – Arline, a pitcher in the National League in the 1970s, was known for his baseball career of 463 strikeouts. Arline practiced dentistry after retiring from baseball. Another successful pitcher, James Reynold Lonborg (better known as “Gentleman Jim”), also became a dentist later in life.
  • Alfred P. Southwick – This Buffalo, New York dentist is credited with creating the first electric chair.


Most dentists seem mild-mannered and friendly, but as you can see, they sometimes hide hidden talents and notorious secrets.

Famous Dentists

Dental Implements

Tired of Your Toothbrush? Try a Twig.

These days, you have multiple products to choose from to clean your teeth and maintain good oral health. Do you want the bristles of your toothbrush soft, medium, or hard? And is your toothbrush electric or manual? What types of toothpaste, mouthwash, and dental floss do you prefer?

Having all of these options may seem unnecessary or even a bit silly, but it’s something to be thankful for. Our ancestors, who were without these modern-day conveniences, did their best to keep their mouths healthy using items that would be considered quite strange today.

Take toothbrushes, for instance. Throughout history, many cultures—including ancient Babylonians, Egyptians, and Chinese—used twigs or sticks to clean their teeth. Often, one end of the twig would be frayed into loose strands similar to the bristles on a toothbrush. The other end might be sharpened into a point at the end, not unlike a toothpick. Such “chewing sticks” are still used in many places around the world and are often taken from trees whose material is known (or believed) to have tooth-protecting properties. In some predominately Muslim parts of the world, this stick is known as a miswak and is taken from an arak tree. In Africa, this species of tree (salvador persica) is known as a “toothbrush tree.”

Dental floss also looks a lot different than it once did. There’s speculation among some historians that prehistoric man may have used a type of floss (possibly made from horse hair) for between-teeth cleaning, but nothing conclusive about that has been found. The invention and popularization of modern dental floss is credited to an early 19th century dentist, Dr. Levi Spear Parmly. Dr. Parmly, who lived and practiced in New Orleans, advocated for the use of waxed silk for flossing teeth in his book, A Practical Guide to the Management of Teeth. Though this idea took a while to catch on, by the end of the 19th century many prominent companies of the time—Johnson & Johnson among them—were marketing, packaging, and selling their own varieties of dental floss. The silk used during that time was later replaced by the nylon floss we see today.

Contemporary forms of toothpaste and mouthwash are especially different from what they once were. The ancient Egyptians mixed up their own versions of toothpaste using items as varied as rock salt, spices, honey, herbs, dried flowers, and even goose fat! Toothpastes made just a few hundred years ago utilized burnt bread and soap as key ingredients. A version of mouthwash popular in ancient Greece included olive juice, milk, and vinegar. Elsewhere, rinsing with tortoise blood was done as a way to counteract toothaches.

Many of these methods for maintaining dental health seem laughable to us now, but for many cultures it was all they knew. Modern dentistry has come a long way since then, with technologies and products based on science rather than lore. Maintaining a proper teeth-cleaning routine is certainly a lot more convenient, effective, and tastier than it used to be.

Dental Implements

National Stress Awareness Month

Less Stress, Better Teeth

Let’s not forget teeth during National Stress Awareness Month, which comes around every April. Stress is most often associated with conditions like heart attacks, insomnia, and ulcers, but stress can also cause damage to your oral health.

Several oral conditions are often closely linked to stress. Outbreaks of common mouth sores, such as canker sores and fever blisters (cold sores), are thought to be the result of stress, at least in part. Stress may also lead to behaviors that can in turn cause dental problems such as eating sugary foods, failing to brush or floss properly, or chewing on pens, fingernails or other items that will damage your teeth.

Stress can also cause people to grind their teeth, either during the day or while they are asleep. This condition, which is known as bruxism, is one of the most significant dental conditions that stress can bring on. If left untreated, bruxism can lead to a range of problems, including damage to your teeth and dental work, as well as pain throughout your head, neck, jaws, and ears.

If you believe that your oral health is being adversely affected by stress, you should schedule an appointment with your dentist or orthodontist. They might suggest mouth guards, recommend over-the-counter remedies, or prescribe more targeted forms of treatment.

And if you think that stress might be having a negative effect on your overall health and well- being, you don’t have to live life all tense and wound up. There are lots of ways to alleviate stress in your daily life:

  • Go for a walk
  • Meditate or do yoga
  • Do any form of regular exercise
  • Take a few deep breaths whenever you feel tense
  • Slow down your life and figure out what you can cut out of your schedule
  • Structure your cell phone usage so you’re not always connected
  • Hang out with friends and family

There are countless other suggestions too. Just find ways to relax that work for you!

National Stress Awareness Month

Adults Wearing Braces

Mom and Dad (and Grandma and Grandpa) Are Getting Braces Too

Although orthodontists will say that no one is ever too old to wear braces, for most of us, it is surprising to learn that actor Danny Glover started wearing braces at age 59. Actress Faye Dunaway was age 61 when she began 18 months of treatment. Dunaway said that she was inspired by Tom Cruise, who at age 40 showed off his ceramic braces in 2002.

Today, more than one million adults in America wear braces. Statistics from the American Association of Orthodontists show this reflects a 58 percent increase in the number of adults (defined here as people over the age of 18) in orthodontic treatment, while the number of children and teenagers increased only 15 percent during that same period (1994-2010).

Advances in orthodontics are one of the primary reasons that so many adult patients seek treatment. Options today include clear removable aligners (Invisalign), tooth-colored ceramic braces, lingual braces that fit on the tongue side of the teeth, and veneers, which are wafer-thin shells of porcelain bonded to the front side of teeth. Even when metal braces are recommended, they are much smaller than those used 15 years ago.

Some adults choose to get braces at the same time their children do to correct similar problems: crowded or crooked teeth, overbites and underbites, and misaligned jaws. Such problems can create oral health issues, and it’s not only movie stars who want to have pretty smiles. One lawyer who chose to get his teeth straightened said he wanted juries to pay attention to the words coming out of this mouth and not to his crooked teeth.

Why didn’t these adults address these problems before they were 18? Maybe their families couldn’t afford the cost at the time, or perhaps these adults did have braces as children, but they didn’t follow up or wear their retainers properly. In addition, teeth can shift as you age, and an accident may cause dental issues.  Regardless of the reason, it is never too late to start orthodontic treatment.

Adults Wearing Braces

The Tooth Fairy and the Mouse

When a growing child loses his or her first tooth, what should you do with the tooth? In America of course, the parents put it under the child’s pillow for the Tooth Fairy to collect in the middle of the night. On the face of it, the Tooth Fairy seems like a cute but insignificant little tradition. In actuality, it reflects a rite of passage that extends across just about all cultures worldwide.

The specific traditions regarding what to do with children’s baby teeth vary from country to country. Sometimes the tooth is thrown somewhere—up into the sun, into a fire, or over a roof. Sometimes it’s buried. Sometimes it’s hidden where animals can’t find it, and other times it’s given (either symbolically or literally) to an animal to take or swallow. In some cases, the mother swallows the tooth, and in other cases the child does.

The loss of the child’s tooth signifies the boy or girl is taking an early step into adulthood. This step can be scary for the child, and ritualizing the disposal of the tooth can bring comfort. Other children are excited about losing their first tooth, because they can’t wait to grow up. However the kid feels about it, all cultures agree that doesn’t seem right to let the moment pass without performing some sort of custom.

The animal most associated with these traditions is a mouse. Mice have strong teeth that continually grow, and parents wish to transfer the idea of strong, healthy teeth to their children. In France, it’s not a fairy but La Bonne Petite Souris, or “The Good Little Mouse,” who sneaks under kids’ pillows to trade a tooth for cash or candy. In Spain, the mouse is named Raton Perez (or some variation on this). He looks under the pillow too, but sometimes, the tooth is left in a glass of water on the nightstand. In the morning the water and tooth are gone and replaced by coins or a small gift. In South Africa, instead of under a pillow the tooth is left in a slipper on the floor, sometimes with a piece of cheese.

Asian countries, from China to Japan to Vietnam to India, favor the tradition of throwing the tooth somewhere, and while it’s in the air, they might ask for the tooth to be replaced by the tooth of, yes, a mouse. In Iraq and Egypt and other Middle Eastern countries, the tradition is also to throw the tooth.

Some of these traditions can be traced back hundreds and hundreds of years, but the Tooth Fairy tradition in America is relatively new. Its first appearance in print appears in 1927, and it is believed to have started a few decades before that. Americans at the epoch were becoming enamored with the figure of a kindly, motherly fairy, as seen in everything from Glenda the Good Witch in The Wizard of Oz to fairy godmothers in classic Disney movies. The Tooth Fairy herself seems to be a mixture of this sort of fairy and European mouse traditions.

How about the money she leaves? Well, since losing a baby tooth symbolizes the path to adulthood, the giving of cash is part of that transition. Money belongs in the realm of adulthood, not childhood. A child can make his or her own decisions about what to do with the Tooth Fairy’s gift, whether buying something independently of Mom or Dad or saving it for the future.

February 28th is National Tooth Fairy Day, but the next time a child you know loses a tooth, you can hide it for the Tooth Fairy to find, give it a mythical m

The Tooth Fairy and the Mouse

Dental Hygiene History

The First Doctor to Preach Dental Hygiene

Everyone today cleans their teeth (or at least knows that they should). We do it at home with a daily regimen of brushing, flossing and rinsing, and then we supplement home care with periodic professional dental cleanings. But the idea that it’s important to clean your teeth is a fairly new one in the annals of history. The very concept of modern dental hygiene is only around 100 years old and was launched into being by a Connecticut dentist named Alfred Civilion Fones.

Dentists in the early 20th century were primarily occupied with pulling out rotten teeth. They didn’t concern themselves much with preventing teeth from becoming rotten to begin with. Furthermore, at the time it was still a recent discovery that bacteria have something to do with tooth decay. But Fones knew from his experience and insight that cleaning teeth of plaque, bits of food, and other matter would be instrumental in preventing decay, in making gums healthier, and in allowing his patients to keep their teeth.

He recruited and trained his cousin, a woman named Irene Newman, to work in his office where she cleaned patients’ teeth and scraped plaque. Essentially, she was the first dental hygienist. The idea actually was pretty outlandish at the time, that people would go to the dentist for preventative cleanings, but it was hard to argue with Dr. Fones’ excellent outcomes. The idea of dental hygiene began to catch on, so in 1913 Fones opened the first school of dental hygiene ever, located in his town of Bridgeport, Connecticut. He’s the one who also coined the very term “dental hygiene.”

Almost three dozen women enrolled in the school’s first year. After finishing two years later, the graduating class went out in the world and cleaned teeth at dental offices and in public schools. Soon enough, the practice of dental hygiene developed official standards. Laws were passed to regulate the field, and Newman became the president of the first dental hygiene association in 1917.

The dental hygiene school closed, however, because Fones preferred to spend his time traveling to preach the gospel of dental hygiene instead of focusing on a small set of students. He spoke at dental schools with his data as support to convince others in his profession of the preventative benefits of clean, well-maintained teeth. Other dental hygiene schools opened, and the one Fones first founded eventually re-opened as well.

Fones and Newman thought public outreach to be an important aspect of their work. They encouraged hygienists to go into schools and communities to clean teeth professionally and to teach people how do to it at home. So this evening when you’re brushing your teeth, remember that this habit that is ingrained in your daily routine might not even be part of your life if it weren’t for the efforts of a doctor and his cousin 100 years ago.

Dental Hygiene History