Orthodontic FAQ

Frequently Asked Questions

You’ve got questions, and Small and Piers has answers!

Here are some frequently asked questions about orthodontic treatment.  Of course, our team here at Small and Piers Orthodontics is also glad to answer your questions directly!  Call us at 828-433-1242 in Morganton or 828-322-1250 in Hickory with any questions or to schedule your free new patient examination.

What is an orthodontist?

An orthodontist is someone who specializes in the proper alignment of the teeth and jaws for ideal dental and facial harmony.  All orthodontists are dentists, but only 6% of dentists are orthodontists.

In technical terms, the AAO defines orthodontics as the “dental specialty that includes the diagnosis, prevention, interception and correction of malocclusion (that’s a fancy way of saying crooked teeth and misaligned jaws), as well as neuromuscular and skeletal abnormalities of the developing or mature orofacial structures.  An orthodontist is a dental specialist who has completed at least two additional years of graduate training in orthodontics at an accredited program after graduation from dental school.”

Dr. Small and Dr. Piers are both specialists in Orthodontics and Dentofacial Orthopedics, which means they have completed not only dental school, but also a 2- or 3-year residency in orthodontics. Beyond their DDS degrees and orthodontic certificates, Dr. Small and Dr. Piers have each also completed a Master of Science (MS) degree in Orthodontics.  A Master’s degree is not required to become an orthodontist, and it indicates a higher level of training in carrying out and interpreting orthodontic research.  Dr. Piers has pursued additional training and examinations to become a Board-Certified Orthodontist, a recognition given to only 30% of orthodontists.

How old should a child be to schedule an appointment for an orthodontic screening?

The American Association of Orthodontists (AAO) recommends an initial evaluation at age 7. By this age several key permanent teeth should have erupted and our doctors are able to evaluate the alignment of both the erupted and unerupted teeth.  While some treatments should begin at this early age, the great majority of our patients do not require early treatment and enter our “growth observation” program at no cost.  Growth observation allows us to determine the optimal time for orthodontic treatment to begin (if any treatment is needed).  Specifically, that means treatment can start not only when it can lead to the best possible results, but also when it will be fastest, least complicated, most comfortable and most affordable.

Do I need to have my family dentist schedule my appointment with the orthodontist?

No. Some of our new patients come to us from dentist referrals while others come to us as referrals from our previous patients, online reviews, Google searches or social media!

Can teeth straighten out as they grow?

Generally not. This is because after a certain age, the space available for the front teeth does not increase as a person grows.  In most people, after the permanent lower canines erupt (sometime around age 10), the space available for the front teeth decreases with age.

My bite is so bad that my dentist said I would need jaw surgery. Is that true?

That’s certainly the case sometimes, but with the advent of Temporary Anchorage Devices (TADs), many bites that could previously only be treated with surgery can now be treated with orthodontics supported by skeletal anchorage with TADs.  Dr. Piers and Dr. Small are both experts in the placement and use of TADs, meaning that we can tackle many complicated problems right here in-office that previously required surgery and a hospital stay.

Will I need to have any teeth removed for orthodontic treatment?

Removing teeth is occasionally required for an ideal orthodontic outcome. Fortunately, Drs. Small and Piers are experts in the use of many new techniques which greatly reduce the need for removal of teeth, including the use of different orthodontic appliances, the latest expansion technology and Temporary Anchorage Devices (TADs).

How long will it take to complete my treatment?

Every patient is different, and the time required to complete your treatment will vary based on your individual teeth and jaws. Treatment can last from 6 months to 3 years, but standard treatment takes about 24 months.  Keeping all of your appointments, following instructions and keeping your teeth thoroughly clean can sometimes shorten your treatment.  We will be able to provide you with a much more specific timeframe at your initial examination.

How often do I have to come in for appointments?

Every 6-8 weeks is common, but each patient is different and we always adjust the schedule to fit the needs of each patient.

How much will orthodontic treatment cost? How does my insurance work? Are financing options available?

We’re dedicated to creating financing options that make a beautiful smile possible for anyone who enters our office. Once we complete our examination and review your insurance coverage, we can give you a good estimate of the total investment required.

Should I still see my family dentist during orthodontic treatment?

Absolutely! Regular checkups with your family dentist every 6 months are even more important while you’re wearing braces than when you’re not.  If there are any cleaning issues during orthodontic treatment, your family dentist will play an important role in helping to keep your teeth and gums healthy.

Do you do orthodontics for adults?

More and more every year!  According to the AAO, 1-in-5 current orthodontic patients are over the age of 21.  Adult treatment is the fastest-growing part of our practice, and currently about 25% of our patients are adults.  Many of our adult patients prefer the esthetic treatment options we offer, including Invisalign®, clear braces, and our gold or “champagne”-colored braces.

Can Invisalign® fix my teeth, or will I need braces?

That depends on you — and your teeth!  Invisalign® and other clear aligner treatments have made massive technological strides in the past two decades, and this has allowed us to treat cases with Invisalign® that could previously only be treated with braces.  The majority of the cases we see in our practice are now good candidates for Invisalign®.  With that said, you can rest assured that if your individual case can be treated more quickly, efficiently or effectively with one treatment modality over the other, whether that be braces or Invisalign®, we will always let you know at your initial exam.

What is Invisalign®, and how does it work?

Invisalign® is a type of “clear aligner” treatment which uses esthetic, nearly invisible aligners or trays paired with tooth-colored “attachments” to align your teeth.  All clear aligner treatments start with a 3D scan of your teeth.  This scan is then uploaded so that Drs. Small and Piers can use their detailed knowledge of orthodontic esthetics and the biology of tooth movement to create a computer-generated setup of your healthy, beautiful new smile.  An initial or “working” series of customized trays is then manufactured and sent to our office, and we schedule your bonding appointment.  At this visit we will bond attachments to several key teeth in your mouth and give you the first 4-12 aligners.  Each of these aligners is numbered, and you will wear them 22 hours a day for 1-2 weeks (depending on your treatment plan) before you move to the next aligner in the series.  This continuous, comfortable and discreet straightening process will continue over the course of your treatment until we’ve created your gorgeous, healthy new smile.

What are the benefits of Invisalign® and other clear aligner treatments?

There are many!  Clear aligner treatment is more esthetic than braces, and it’s a great choice for someone who wants a discreet way to improve their smile.  Clear aligners also tend to be more comfortable than braces.  This is primarily because they don’t use brackets and wires and are customized just for you, meaning they follow the contours of your teeth and are less likely to irritate your lips and cheeks.  Clear aligners can also be removed to eat and drink, which means you won’t have all the dietary restrictions you’d have with braces.  (In other words, you don’t have to give up all your favorite crunchy and sticky foods!)  Being able to remove your aligners also makes it easier to brush, floss and keep your teeth clean during treatment, and means there’s no reason to worry about playing sports or a musical instrument.  If you’re in a hurry to get a great new smile for a big life event like a wedding, you can also whiten your teeth DURING clear aligner treatment to achieve a straighter, whiter smile all at once.  As a rule, clear aligners tend to be more convenient for people with a busy schedule, since each appointment is shorter than a braces appointment, and there are fewer appointments overall.  (You can just switch to the next aligner in the series instead of coming in for a new archwire.)  Perhaps most importantly, clear aligners allow for excellent communication about treatment goals.  We’ll be able to show you and your family a computer-generated setup of that beautiful new smile before we get started so that we can make sure we’re all on the same page from the very beginning.

How often should I brush my teeth during treatment?

Orthodontic patients should brush their teeth at least three times each day.  Brushing after each meal and before going to bed is ideal. We will provide you with a whole host of orthodontic cleaning aids, and we will also teach you how to floss your teeth with braces.  We may also provide you with a prescription for a special fluoride toothpaste, if necessary.

Can you explain the different parts of braces?

Sure!  We use these words all the time, and the following terms may be helpful when you need to describe something to us (or when we’re describing something to you!):

The “band” is the thin ring of metal with a bracket attached that is cemented around the tooth.  This is what anchors the orthodontic wires that move the teeth.  Bands are generally only placed on back teeth such as molars and premolars these days, and then only in rare, specific cases.  (Fun fact: Forty years ago, bands used to be placed around every single tooth!  This may be why your parents or grandparents don’t remember braces too fondly.)  Today braces are much more comfortable, because we mostly use…

“Brackets” or “braces” which are bonded directly to each tooth!  These braces are much smoother and less bulky than they used to be, so they are kinder to your lips and cheeks.  Each bracket has a slot that holds the archwire.

The “archwire” is the removable, thin wire that fits into the bracket slots. This is what guides the teeth into place.

The “elastomeric ligatures” are the plastic rings that tie the archwire into the brackets.  We also call these “color ties,” because you can choose any color you want to—even clear!

The “hooks” are the tiny metal projections on the braces that are used to attach the rubber bands.

The “rubber bands” are the elastic loops stretched between your upper teeth and lower teeth to correct problems with your bite.  These are often the key to fixing overbites, underbites, open bites or crossbites, and they’re so important that we use them with Invisalign®, too!


What do I do if a bracket or band becomes loose?

If a bracket or band comes loose, just call our office to schedule a comfort or repair visit. If a band becomes detached from the wire, please try to bring it with you to your next appointment.

What do I do if the archwire breaks or a hook or ligature is lost?

Please call our office and let us know about the problem. We will review your records and let you know what to do next.

What do I do if a wire is sticking out or poking my mouth?

Here’s a pro-tip: with the eraser of a pencil, try tucking the wire in, OR dry the wire with a napkin and place orthodontic wax (given at your first appointment) over the end of the wire.  If a bracket or hook is causing you discomfort, wax can be applied to that as well.  If you still aren’t feeling better, please call our office so that we can schedule a comfort visit.

What do I do if my mouth is sore?

Rinsing your mouth with warm saltwater can help to relieve the initial soreness at the beginning of treatment.  Mix one tablespoon of salt into 8 oz warm water and then swish for 60 seconds and spit.   You can do this three times a day.  Advil (ibuprofen) or Tylenol (acetaminophen) can also be taken as directed by Drs. Small and Piers.

How can I ensure the success of my orthodontic treatment?

This is a great question!  Orthodontics is a lifestyle, and a successful course of orthodontics typically involves a few lifestyle changes. Here are a few tips for success:

  1. Don’t miss any of your scheduled appointments.
  2. Bring any retainers, appliances or clear aligners like Invisalign® to each of your visits.
  3. Keep your teeth clean with regular brushing and flossing and try to brush your teeth after each meal and snack.
  4. Keep any removable appliances, retainers or Invisalign® aligners as clean as possible.
  5. Schedule and attend your regular cleaning and check-up visits with your general dentist every six months.
  6. Wear your elastics (rubber bands) as instructed.
  7. Maintain a healthy diet, rich in Vitamin C.
  8. Follow all instructions given by our treatment team.

Can you schedule all of our appointments for after school?

Unfortunately, we can’t schedule all appointments for every student during after-school hours. A few longer appointments, including the initial “bonding” appointment and final “debonding” appointment, must be scheduled during school hours.  Fortunately, this frees up the after-school hours for adjustment appointments, which will make up the majority of your visits.  Thanks to this arrangement, and because most appointments are scheduled 6-8 weeks apart, most patients miss minimal school due to their orthodontic treatment. We promise to make a sincere effort to meet your scheduling needs.

Can I return to school the day I receive my braces?


Can I drop my child off for an appointment?

Yes. We understand all of our parents have busy schedules (most of us are parents, too!), and we’re happy to help you make the most of your time. We do ask that you check your child in and that you return as soon as the appointment is complete.

Are there foods I should not eat while I have braces?

Yes. In general, we will ask you to avoid crunchy and sticky foods that can break off your brackets.  (A more comprehensive list of those foods can be found here.)  Pro tip: If you’re using Invisalign® or another clear aligner treatment, you can eat whatever you like — just remember to take out your aligners first!

Can you play a musical instrument while wearing braces?

Typically, yes, but a little more practice may be needed to get used to it. If you have any problems in playing your instrument, ask Drs. Small and Piers for strategies specific to your instrument.

Can I play sports while wearing braces?

Yes! We recommend a mouthguard for any sports and will provide orthodontic-specific mouthguards to protect our patients who are wearing braces or other appliances.  We’ll even try to match up your mouthguard with your school colors!

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