First consultation and preparation

Question 1

How many consultations with different orthodontists should I have before starting treatment?

Accepted Answer

There is no single answer to this question. Orthodontic treatment, like any other medical procedure, is about more than the appearance of your smile – it also concerns the health of your teeth. That is why it is important to go into it feeling confident and at ease. See as many orthodontists as you need to find a specialist you trust. Mutual understanding between patient and doctor is essential for treatment to get off to a good start. The orthodontist you choose should explain the proposed treatment in a way that convinces you, and should make you feel comfortable talking to them, so that you feel free to ask all your questions.

Question 2

Is there a difference between a children's orthodontist and an orthodontist for adults?

Accepted Answer

Parents often look specifically for a ‘children's orthodontist’ for their child, which can be confusing, since there are paediatricians and paediatric dentists. It is important to know that orthodontics is not divided into separate specialties for children and adults. Orthodontists are trained to treat patients of all ages. Although more and more adults are having orthodontic treatment nowadays, training in this field is built primarily around treating children who are still growing. Some orthodontists work mainly with adult patients, while others mostly treat children. The most important thing is to ask for a recommendation for a good specialist, rather than looking specifically for a ‘children's orthodontist’.

Question 3

What information will the orthodontist give me at the first consultation?

Accepted Answer

At your first visit, the orthodontist assesses various external features of your face – the profile of the lips, the position of the lower jaw and chin, and the symmetry of the face and jaws. An examination inside the mouth then shows any irregularities in the alignment of the teeth and in the bite. Patients often do not have the necessary X-rays beforehand, and the measurements taken from them are essential for an accurate diagnosis and treatment plan. For this reason, the first consultation gives a provisional picture, and the definitive information is provided after a full analysis. Although some orthodontists share very little information at the first consultation, my personal approach is to discuss in detail everything I observe, while making it clear that the final plan will be drawn up after a detailed analysis.

Question 4

Do I need X-rays before the consultation?

Accepted Answer

You do not have to have X-rays before your first consultation. However, if you are keen to start orthodontic treatment, it is a good idea to have the two basic X-rays – a panoramic X-ray and a cephalometric X-ray. They provide additional information that cannot be obtained any other way, such as whether there are unerupted wisdom teeth and where they are positioned. Some clinics can take X-rays on site, so it is worth asking about this when you book your appointment.

Question 5

Should I see a general dentist or an orthodontist first?

Accepted Answer

The motivation to start orthodontic treatment can come from different places – the patient's own decision, advice from a relative or a referral from a general dentist. Whatever the reason, before starting orthodontic treatment it is important for the teeth to be prepared – this includes a preventive check-up with your general dentist, treatment of any decay (if there is any) and removal of tartar where needed. There is no wrong order – you can see an orthodontist first, who will refer you to a dentist if needed, or the other way round and start with a routine dental check-up.

Question 6

Can I have orthodontic treatment in Bulgaria if I live abroad?

Accepted Answer

If you live in another country, or travel abroad often, but would prefer to be treated in Bulgaria, you need to think about how you'll organise your visits to the orthodontist. The main appointments can be planned in advance, but unplanned visits may also be needed if something becomes uncomfortable. With braces, this can mean a bracket coming loose, an archwire shifting out of place, a broken metal part and similar problems. In such cases it's important to have access to an orthodontist nearby who can help you. If you choose fixed braces, the best option is to find a specialist in the city where you spend most of your time. If you're planning to travel, however, aligners are the better choice, as they need fewer visits and are less likely to lead to urgent situations involving discomfort.

Question 7

Is an orthodontic analysis always necessary before treatment?

Accepted Answer

Every orthodontic patient has a unique combination of irregularities, which makes it impossible to standardise orthodontic treatment to the point where we could tell what a patient needs from an examination alone. Orthodontic analysis involves measuring the angles and relationships of the jaws and teeth on X-rays, and measuring the deviations of the teeth on orthodontic models in the three main planes. All this information, interpreted through the orthodontist's training and experience, gives us the treatment plan. It's a step that can't be skipped.

Question 8

Is having impressions of my teeth taken unpleasant?

Accepted Answer

Impressions for orthodontic analysis can be taken in two ways – the standard way, using impression material, or by intraoral scanning. When we use impression material, we place a type of silicone in the mouth for a few minutes. It can't really be called unpleasant, but in some patients it does cause gagging when the impression of the upper jaw is taken. Patients describe having an impression taken with an intraoral scanner as quicker and more pleasant. No silicone is placed in the mouth, and it doesn't cause gagging or irritation. The patient may notice their mouth drying out slightly during the procedure.

Question 9

Does a scan with an intraoral scanner expose me to radiation?

Accepted Answer

An intraoral scanner is high-tech equipment that allows us to obtain a 3D impression of the jaws and teeth. It is an indispensable part of aligner treatment. Scanning the teeth means capturing them with a large number of images per minute. The device is essentially a camera designed for use in the mouth. No X-rays or other kinds of radiation are used during scanning, so there is no radiation exposure. It's completely safe for children, pregnant women and all patients.

Question 10

Do I need a CBCT (3D X-ray) of my jaws before treatment?

Accepted Answer

The standard X-rays required before starting orthodontic treatment are a panoramic X-ray and a lateral cephalometric X-ray. In some cases, there's information we need in order to draw up an accurate treatment plan that these two X-rays can't provide. The orthodontist may then ask for a 3D scan of a particular area or of the whole jaw. This isn't a routine X-ray, because it involves a higher radiation dose, and it's only done when necessary. Such a scan is needed, for example, to locate impacted teeth – teeth that have stayed trapped in the bone – to prepare for placing dental implants (not orthodontic ones), before removing deeply impacted wisdom teeth (only in some cases), when there's a cyst in the bone, and so on.

Question 11

My orthodontist is steering me towards aligners, but I'd prefer braces. Should I go to another orthodontist?

Accepted Answer

When you start orthodontic treatment, one of the most important things is to find an orthodontist you want to work with and whom you trust. If your orthodontist is recommending a particular treatment, they should explain why that type of treatment is more suitable for you, so that you can make a sound, informed decision. If you don't trust the opinion of the orthodontist you've chosen, then it makes sense to look for another one.

Question 12

Is there an age limit for orthodontic treatment?

Accepted Answer

Orthodontic treatment, whatever the appliance, can be started at any age. The important conditions, of course, are the patient's own wish to have it and the health of the teeth, gums and bone. Above a certain age, the likelihood of gum problems increases. It's important to pick these up in time so that steps can be taken to treat them. If the teeth and the surrounding tissues in the mouth are healthy, there is no contraindication to orthodontic treatment.

Question 13

Why are photos taken before treatment starts?

Accepted Answer

X-rays provide information about the structure of the bones and the roots of the teeth, while dental impressions show the teeth's position, size and relationship in the bite. Photographs are an additional assessment tool and help us evaluate the relationship between the dental arches and the soft tissues, such as the lips and cheeks. They make it possible to analyse the symmetry of the teeth relative to the face, how much of the teeth shows when you smile (some people, for example, show more gum), how the dental arch lines up with the smile line, and other key relationships. For this reason, photographs are an integral part of diagnosis and of drawing up a treatment plan.

Question 14

How important is the treatment plan, and does the success of treatment depend on it?

Accepted Answer

When you start orthodontic treatment, you should only do so once your orthodontist has presented you with a plan. The plan is drawn up from an analysis of all the information about the patient – dental models, X-rays, photographs and, if needed, additional consultations with other specialists. The plan is very important for achieving the result you want from orthodontic treatment. It gives the patient clarity about what to expect, what can change in their smile and what difficulties are expected in aligning the teeth. The plan also protects the specialist, giving them confidence that the patient understands the treatment ahead and has correct, realistic expectations. The other side of orthodontic treatment is the technical execution of the plan, which depends on the orthodontist's skill, knowledge and experience.

Question 15

Can I continue my treatment with a different orthodontist?

Accepted Answer

You might look for another orthodontist to continue your treatment because you are moving (to another city, for example), or for similar reasons on the orthodontist's side (illness, a long unavoidable absence from work and so on). In that situation, the orthodontist undertakes to suggest a replacement who will take over your case. Of course, you can also seek another opinion on your treatment if you have lost confidence in your current orthodontist. That is your right, and you can change orthodontist during treatment. You may be told that the appliance currently in your mouth will need to be replaced as a condition of continuing treatment. This is because there are many types of braces on the market and each orthodontist chooses which ones to work with. To continue your treatment with the braces already in place, we need to use the same type in our own practice, so that we can rebond a bracket if necessary and have the right set of archwires for that type of braces. The difficulty in finding an orthodontist to continue your treatment comes from the fact that the specialist you choose probably doesn't use the same braces, and it is not financially worthwhile for you to have a whole new set of a different type fitted. With Invisalign aligners, changing orthodontist is not a problem – you simply need to choose another provider of the same type of aligners.

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