Orthodontic Treatment
Types of Braces/Brackets
Teeth Grinding
Spacing of Teeth
Open Bite
Misplaced Midlines
Orthodontic Care
Proper Diet
Removable Appliances


Orthodontic Treatment


The American Association of Orthodontists recommends that all children, regardless of their orthodontic progression, receive an orthodontic evaluation by age seven. Early examination allows orthodontists to determine the best time for orthodontic treatment, and if necessary, to begin.

Early interceptive orthodontic therapy can minimize the need for more complex treatment in the future.


By the time children reach adolescence, their permanent teeth are either in, or are erupting. Teenagers jaw bones are almost finished growing, making this an ideal time to correct their teeth.

People whose teeth are crooked or misaligned are often self conscious about their appearance. By starting early, you can give your child a healthy smile with a lifetime of benefits. Seeing our patients grow and mature into confident young adults is one of our greatest rewards.


No matter what your age, appearance is an important aspect of your life. You are never too old for orthodontic treatment. In fact, thirty percent of our patients are adults.

Many adults seek orthodontic treatment not just for the sake of their smiles, but to improve the function of their bite.

Adult orthodontics are more convenient and comfortable than ever. Technological advancements have made adulthood a great time to achieve the smile you have always wanted.

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Types of Braces/Brackets

There are a variety of options in styles of braces or brackets, from the raditional metal brackets to a less visible type. Check out the choices and discuss the options at your first visit.

Traditional Metal Braces

Traditional braces or brackets are the most common type and are made of high-grade stainless steel. For patients involved in contact sports and for durability, metal braces are a must. They are much different than the large, bulky appliances of past years. Today’s metal braces are much smaller, more comfortable and less noticeable. You also have the option of adding color to your braces at each visit - a fun way to brighten your smile.


Self-ligating Braces

Dr. Garemani offers the most technically advanced style of “silver” braces today. The newest type is the Damon System. This system uses a slide mechanism, not the conventional elastics, to hold the arch wire in place. This eliminates much of the friction and binding active tooth movement. The brackets provide not only exceptional aesthetics, but quicker treatment time as well!


Clear Braces

Unlike ceramic braces that are opaque, the clear brackets we offer are crystal clear and virtually disappear onto the tooth. The “ice” brackets won’t stain or discolor and are completely transparent. The clear braces are a popular choice for our adult patients and some teens.


Invisalign ®

Dr. Garemani is a Certified Invisalign® Provider. New advances in orthodontics make it possible to have braces that are practically invisible. Invisalign® is a state-of-the-art alternative to traditional braces that is virtually undetectable to other people. Invisalign straightens your teeth without brackets or wires, just a series of customized removable appliances called “aligners.” If you are considering this option for your orthodontic treatment, Dr. Garemani will be able to determine if Invisalign is right for you.

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Crossbites occur when the palate and upper jaw constrict so one or more upper and lower teeth don’t match on one or both sides. Crossbites also occur when teeth are reversed in position. Early correction of a crossbite is highly recommended because it can cause:

  • Excessive wear of the teeth
  • Gum disease, including loss of bone surrounding the tooth
  • Jaw deformity
  • Improper chewing patterns
  • An unattractive smile

Crossbites can be corrected with Braces or other Orthodontic appliances.

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An underbite is when the lower front teeth bite over the upper front teeth. This is the opposite of how a normal bite is supposed to be arranged. It could be named a reverse bite and is sometimes cruelly called a bull dog bite. It's opposite of an overbite and is often referred to as a Class III malocclusion.

In almost all cases, an underbite is caused by nasal obstruction, mouth breathing and a tongue thrust. The tongue has to stay down so it doesn't block air from getting in. Many tongue thrust patients brace their tongues against the sides of their lower jaws and lower teeth when they swallow. This constant pressure causes the lower jaw to overgrow and creates a mismatch between the larger lower jaw and smaller upper jaw. The result is that only the back teeth touch.

In most cases traditional metal braces are needed, but orthodontists are now beginning to use metal braces on the lowers and lingual braces on top. Invisalign treatment for an underbite is usually not effective, because effective treatment may require rubber bands, power chains, and other appliances to get as much movement as possible.

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An overbite occurs when the upper and lower jaw don’t align properly, causing the placement of the bottom teeth to sit unnaturally beneath the top teeth. This can result in:

  •  head and jaw pain
  • migraine headaches
  • bone damage and other painful symptoms

The orthodontic treatment for proper overbite correction generally requires braces. If overbite treatment begins at an early enough age, with the use of an orthodontic appliance, the use of braces can be minimized or even in some cases avoided. It is generally possible to tell what future orthodontic problems lie ahead for a child by age 7. At this age it is a good idea to get treatment to prevent further problems.

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A term used to describe forward tipping of the incisor teeth. In children, this generally occurs in response to thumb sucking or other oral habits. In adults, it may occur following the loss of several posterior (back) teeth, which produces excess tipping force on the anterior (front) teeth—especially the four incisors. Periodontal disease may accelerate incisor protrusion in adults, but is not generally a problem for children.

The treatment is fairly straightforward and can be started at any time. Essentially it consists of using orthodontic braces to correct the alignment of the teeth.

While a number of systems of braces exist, they all involve a combination of wires, brackets and bands which slowly force the teeth to move to their correct location.

Modern orthodontics has made great advances in tooth and jaw restoration and can totally transform a person's looks as well as their function. The results are often a complete metamorphosis of the face.

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Teeth Grinding (Bruxism)

The practical fact of the matter is that nearly every one grinds their teeth at some time or the other during their life. What matters is the degree of the grinding. If the teeth grinding is severe then it can result in:

  • sleep disorders
  • loosening of the teeth
  • fracture
  • excessive wear

With heavy grinding, the teeth tend to wear out faster. In fact, the edges where upper and lower teeth meet may become quite raw and tender. Teeth will also tend to have an evenly aligned appearance because they have been filed down to a straight line. This wearing out can result in the nerve endings becoming exposed, which can then cause the teeth to develop sensitivity to hot or cold. A patient will also find small fractures on the teeth and small pieces chipping off. The condition of your bite also has much to do with grinding. In general, if your bite is comfortable and relaxed, the tendency for teeth grinding is significantly reduced. Another indicator is the headache many people have upon waking up. This is caused by the unnatural tension in the muscles of the jaw. Patients often undergo bite therapy to correct this disorder.

A simple TMJ appliance to reduce the effect of heavy grinding is a mouth guard (also known as a nightguard). This is an acrylic device that fits snugly between the rows of your teeth to reduce the effect of teeth grinding on each other. While a mouth guard is not a true solution to grinding, it certainly ensures that your teeth do not get worn down as fast due to the heavy pressure. Most people adapt easily to the use of a mouth guard and enjoy much better sleep as a result. In summary, the way to treat bruxism is through a three-pronged attack. Reduce stress in your life, correct your bite and ensure that there is no residual strain on your jaw when it is in the natural position and finally, use a mouth guard to minimize the damage.

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Crowding refers to lack of space for the teeth to be normally fitted within the jaws. Due to this lack of space teeth get twisted or displaced. It usually happens when tooth to jaw size does not fit appropriately or the teeth are larger than the space available. Improper eruption and untimely loss of primary teeth also sometimes lead to crowding.

Left uncorrected crowding can:/p>

  • prevent proper cleaning of all the surfaces of your teeth
  • cause dental decay
  • increase the chances of gum disease
  • result in excessive enamel wear
  • make your smile less attractive

MMany patients seek orthodontic treatment to align crooked and crowded teeth. The decision that the orthodontist must make in evaluating such a patient is whether or not he / she can align all of the teeth without extracting / removing any permanent teeth. The factors to consider in making this decision are the severity of the crowding, the bite, the thickness and height of the gingiva (“gums”), and whether or not these teeth are already too pronounced (leaning outwards) in the jaws. Certain patients are best treated with braces and the extraction of teeth in order to correct the alignment of the teeth, improve the bite, improve the health of the gums and enhance the smile.

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Spacing of Teeth

The cause of spacing may be heredity or some personal habit like tongue thrusting, thumb sucking, abnormal swallowing, etc. Another cause in adults is advanced gum disease, leading to loss of supporting bone and the teeth spreading out.

The spaces can be closed with braces and other orthodontic appliances by moving the teeth together and properly aligning them within the arch.

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Open Bite

Open bites occur when the upper front teeth don't meet or even cover the lower front teeth.
The cause can be genetic, but more often is due to oral habits such as thumb sucking or unusual positioning of the tongue./p>

Open bites make proper chewing difficult as it is impossible to bite off food. They may cause speech impediments as well as difficulty to close the lips leading to mouth breathing, and drying and inflammation of the gums around the front teeth.

Although many treatment modalities are used in an attempt to correct an open bite, particularly, an anterior open bite, the success rate of achieving correction, proper overlap of the incisors is 80%. In other words, there are 20% of patients who do not have correction of the open bite.

The orthodontic treatments for open bite are used singly, or in combination. These are: oblique headgear, clenching exercises, vertical elastics, posterior bite blocks, and orthognathic surgery.

TThere are many possible explanations for the instability of open bite corrections, but the most important is the non-adaptability of the tongue. Most open bites are associated with a tongue thrusting, or reverse swallowing pattern. Therefore, even after initial removal of orthodontic appliances, and the open bite has been correct, the open bite may relapse, return, due to the tongue thrusting pattern.

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Misplaced Midline

The center lines of upper and lower teeth don't align.

This can easily be corrected with braces or Invisalign can be the ideal solution in many such cases. And while Invisalign works for most orthodontic problems, only Dr. Garemani can tell you if this will work for you.

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Please feel free to contact the office if you are experiencing any discomfort or if you have any questions. Below are a few simple steps that might help if you are unable to contact us or if you need a “quick fix”.

Loose Bracket

Occasionally, a glued bracket may come loose. You can remove the loose bracket and save it in an envelope to bring to the office or leave it where it is, if it is not causing any irritation. Call the office as soon as possible in order for us to allow time to re-glue the bracket.

Poking Wire

If a wire is poking your gums or cheek there are several things you can try until you can get to the office for an appointment. First try a ball of wax on the wire that is causing the irritation. You may also try using a nail clipper or cuticle cutter to cut the extra piece of wire that is sticking out. Sometimes, a poking wire can be safely turned down so that it no longer causes discomfort. To do this you may use a pencil eraser, or some other smooth object, and tuck the offending wire back out of the way.  

Wire out of Back Brace

Please be careful to avoid hard or sticky foods that may bend the wire or cause it to come out of the back brace. If this does happen, you may use needle nose pliers or tweezers to put the wire back into the hole in the back brace. If you are unable to do this, you may clip the wire to ease the discomfort. Please call the office as soon as possible to schedule an appointment to replace the wire.  

Poking Elastic (Rubber Band) Hook

Some brackets have small hooks on them for elastic wear. These hooks can occasionally become irritating to the lips or cheeks. If this happens, you may either use a pencil eraser to carefully push the hook in, or you  can place a ball of wax on the hook to make the area feel smooth.  

Sore Teeth

You may be experiencing some discomfort after beginning treatment or at the change of wires or adjusting of appliances. This is normal and should diminish within 24-72 hours. A few suggestions to help with the discomfort:

  1. Rinse with warm water, eat a soft diet, take acetaminophen (Tylenol) or ibuprofen (Advil) as directed on the bottle.
  2. Chewing on the sore teeth may be sorer in the short term but feel better faster.
  3. IIf pain persists more than a few days, call our office.

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Orthodontic Care

You will be shown the proper care of your braces when your orthodontic treatment begins. Proper cleansing of your mouth is necessary every time you eat. Teeth with braces are harder to clean, and trap food very easily. If food is left lodged on the brackets and wires, it can cause unsightly etching of the enamel on your teeth. Your most important job is to keep your mouth clean. If food is allowed to collect, the symptoms of gum disease will show in your mouth. The gums will swell and bleed and the pressure from the disease will slow down tooth movement.

BRUSHING: You should brush your teeth 4-5 times per day.

  1. Brush back and forth across……between the wires and gums on the upper and lower to loosen any food particles.
  2. Next, brush correctly as if you had no brackets or appliances on.
  3. Start on the outside of the uppers with the bristles at a 45 degree angle toward the gum and scrub with a circular motion two or three teeth at a time using ten strokes, then move on.
  4. Next, do the same on the inner surface of the upper teeth.
  5. Then, go to the lower teeth and repeat steps 1 & 2.

Look in a mirror to see if you have missed any places. Your teeth, brackets and wires should be free of any food particles and plaque.

Note: If your gums bleed when brushing, do not avoid brushing, but rather continue stimulating the area with the bristles. Be sure to angle your toothbrush so that the area under your gum line is cleaned. After 3 or 4 days of proper brushing, the bleeding should stop and your gums should be healthy again.

FLOSSING: Use a special floss threader to floss with your braces on. Be sure to floss at least once per day.

Appliance Care

Clean the retainer by brushing with toothpaste. If you are wearing a lower fixed retainer be extra careful to brush the wire and the inside of the lower teeth. Always bring your retainer to each appointment. Avoid flipping the retainer with your tongue, this can cause damage to your teeth. Place the retainer in the plastic case when it is re-moved from your mouth. Never wrap the retainer in a paper napkin or tissue, someone may throw it away. Don't put it in your pocket or you may break or lose it. Excessive heat will warp and ruin the retainer.

Elastics Care

IIf elastics (rubber bands) are worn intermittently, they will continually "shock" the teeth and cause more soreness. Sore teeth between appointments usually indicate improper wear of headgear or elastics or inadequate hygiene. Wear your elastics correctly, attaching them as you were told. Wear elastics all the time, unless otherwise directed. Take your elastics off while brushing. Change elastics as directed, usually once or twice a day.

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Proper Diet

Avoid Sticky Foodsbr> such as:

Candy bars with caramel
Fruit Roll-Ups
Gummy Bears
Candy or caramel apples   
Avoid Hard or Tough
Foods such as:

Pizza Crust
Ice cubes
Hard Candy
Corn Chips  
Cut the following foods into small pieces and chew with the back teeth:

Corn on the Cob
Chicken wings
SSpare Ribs

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Removable Appliances

Aligners — an alternative to traditional braces for adults, serial aligners are being used by an increasing number of orthodontists to move teeth in the same way that fixed appliances work, only without metal wires and brackets. Aligners are virtually invisible and are removed for eating, brushing and flossing.

Removable space maintainers — these devices serve the same function as fixed space maintainers. They're made with an acrylic base that fits over the jaw, and have plastic or wire branches between specific teeth to keep the space between them open.

Jaw repositioning appliances — also called splints, these devices are worn on either the top or lower jaw, and help train the jaw to close in a more favorable position. They may be used for temporomandibular
joint disorders (TMJ).

Lip and cheek bumpers — these are designed to keep the lips or cheeks away from the teeth. Lip and cheek muscles can exert pressure on the teeth, and these bumpers help relieve that pressure.

Palatal expander — a device used to widen the arch of the upper jaw. It is a plastic plate that fits over the roof of the mouth. Outward pressure applied to the plate by screws force the joints in the bones of the palate to open lengthwise, widening the palatal area.

Removable retainers — worn on the roof of the mouth, these devices prevent shifting of the teeth to their previous position. They can also be modified and used to prevent thumb sucking.

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Retainers are custom-made devices, made usually of wires or clear plastic, that hold teeth in position after surgery or any method of realigning teeth. They are most often used before or after dental braces to hold teeth in position while assisting the adjustment of the surrounding gums to changes in the bone. Most patients are required to wear their retainers every night at first, with many also being directed to wear them during the day - at least initially. They should not be worn while eating food or drinking staining or acidic beverages (e.g., Cola products and coffee).

When your braces come off it Is very tempting not to wear your retainers. To keep your teeth from shifting and avoiding having to wear braces again, it is crucial to wear your retainers as often as your orthodontist tells you.

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Dr. Reza Garemani - A+ Orthodontics
Van Nuys, North Hollywood, Northridge Orthodontist

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