Appliance Instruction

• Elastics (Rubber Bands)
• Herbst Appliance
• Invisalign®
• Fixed Palatal Expander
• Removable Expander
• Spacers or Separators

Elastics (Rubber Bands)

Elastics or rubber bands are used to get the upper teeth to fit perfectly with the lower teeth. Your braces can only correct any crowding, spacing, or rotations of your teeth—they cannot correct a bite problem. If the bite is “off,” then elastics are needed in conjunction with braces to correct the bite.

Teeth never fail to move when elastics are worn consistently, as directed by your orthodontist. When elastics are worn one day and left off the next, or for only part of the day, tooth movement does not continue as rapidly, and often no change takes place. If you follow the instructions exactly, you will get better, faster and more comfortable results. This leads to the removal of your braces in a shorter period of time.

There is often some initial discomfort when elastics are first worn, but this discomfort disappears after two to three days. If you stop wearing the elastics during the periods of discomfort, slower tooth movement often results, and the discomfort will return when the elastics are replaced. Soreness in the jaw joint area, however, is abnormal. Elastic wear should be discontinued if any problems occur in the jaw joint area. Problems can include pain, clicking or grating sensation, and the inability to open or close the mouth. In case of problems in the jaw joint region, discontinue elastic wear and call our office immediately.

New elastics should be used each day, as the old elastics tend to lose their elasticity with time. It is not necessary to change the elastics more than once a day. Unless otherwise directed, wear your elastics 24 hours a day. The elastics should be removed to brush your teeth, and can be removed when eating, if necessary. In these cases, the same elastics should be replaced immediately.

You should call the office if you are having trouble getting the elastics hooked properly on the orthodontic appliances, if you run out of elastics, or if there is any reason you cannot wear your elastics as directed. Do NOT wait for your next appointment! This can delay your treatment progress! At each appointment, check with us to see if you should continue to wear your elastics (and grab a back-up supply if needed).

Herbst Appliance

The Herbst appliance reduces overbite by encouraging the lower jaw to grow forward and by directing the upper molars to move backward. Although this appliance may seem a bit bulky, it is not visible in the mouth and patients adapt to it quickly and are able to chew and talk. The advantage to this appliance is that it eliminates the need for you to wear headgear or have extractions of permanent teeth. It works around the clock, using continuous force, which makes your treatment more efficient, and you’ll get out of your braces that much sooner! Typically, the Herbst appliance will be in your mouth for 12 months. Once your overbite is corrected, the appliance will be removed and you will spend the remaining time in orthodontic treatment with just your braces.

Here are some tips to ensure that your experience with wearing the Herbst appliance is as efficient and trouble-free as possible:

• It will take several days to get used to the Herbst appliance. Your jaw muscles may become tired and sore. Some difficulty in chewing is to be expected. We suggest a soft diet for the first week until you adapt to chewing. Tylenol or ibuprofen may be taken to help with any discomfort.
• Initially you may have some irritation to the inside of your cheeks until your cheeks toughen up. You can place soft wax over any portion of the Herbst that is irritating you. Saltwater rinses will help too.
• Like all orthodontic appliances, it can be damaged or broken, especially if appropriate care is not taken. Avoid hard, sticky foods that may damage or dislodge the appliance.
• Brush your teeth and the appliance carefully after each meal, and be sure to use a fluoride rinse daily.
• We recommend that you try not to open your mouth extremely wide while the Herbst is in your mouth, otherwise it is likely that the tube and pistons will come apart.
• If the tubes and pistons do come apart, open your mouth until you can easily engage the piston back into the tube and close down slowly and gently, so that it slides in smoothly. Do not bite down forcefully or quickly, as you may bend the piston, making it impossible to slide back in and then you will need to make an appointment to have the piston replaced.
• If you experience pain that increases over time, or if hot or swollen cheeks and a bad taste or odor in the mouth accompanies this pain, we need to see you immediately.

Invisalign®

• Aligners should be worn 20-22 hours a day.
• Do not start the next aligner until the aligner you are currently wearing fits perfectly and is completely seated. You should not see a gap between the tip of your tooth and the aligner.
• Keep your aligners clean by brushing them daily with a toothbrush, toothpaste, and cold water.
• Denture tablets, like Efferdent, are a great way to keep the aligner smelling fresh and looking clear.
• If you eat with your aligners in place, rinse them out with water after eating and try to keep them as clean as possible. Avoid drinking hot beverages, such as coffee, with them in place.
• Do not throw out any old aligners. Keep them around in your additional retainer case, as they may be useful in the event that your current aligner gets lost or broken.
• Please call the office immediately if the aligner is not able to seat properly or it doesn’t appear the teeth are “tracking” with the aligner. Dr. Fodero would like to address the problem with the aligner as soon as possible.

Fixed Palatal Expander

Printable Instructions »

Removable Expander

Your removable expander is designed to help widen your jaw. Your appliance must be worn as directed by Dr. Fodero in order for your treatment to be effective and successful. Try not to be discouraged in these first few days or week—speaking will improve very soon and you will adapt to the appliance. If any problems develop, call the office to schedule an adjustment appointment. Do NOT attempt to adjust your appliance yourself. Failure to wear your expander as directed, even for a short period of time, can cause changes that may require a new appliance be made.

Directions

Turn your expander twice a week. The expander should be worn for the amount of time that Dr. Fodero instructs.

How to Turn the Expander

You will see a yellow arrow embedded in the acrylic of your expander near the screw. Place the “key” you’ve been given in the hole that is farthest from the tip of the arrow. Using the key, push in the direction of the arrow until the key won’t progress further. The hole should now be closest to the tip of the arrow.

What to Expect

• Slight pressure on the back teeth and some temporary soreness
• Speaking and swallowing may be difficult, but will improve within a few days
• A temporary increase in saliva

Taking Care of Your Expander

• You may remove your expander to eat, but do not wrap it in a napkin. It is best to place it in the retainer case you’ve been given to prevent loss or breakage. There is no harm eating with it in your mouth. This is one way to guarantee that you don’t accidentally throw it out. Be sure to rinse it thoroughly after eating.
• Keep your expander clean. You should brush your expander with your toothbrush and toothpaste when you brush your teeth (at least twice a day!).
• To keep your expander extra fresh, you can soak it in a denture cleansing solution for 20 minutes once a week.
• When your expander is not in your mouth, keep it in the retainer case!
• No chewing gum with the expander!
• Keep it out of reach of your dog or cat. It makes a great chew toy.
• Do not boil it or place it in the dishwasher to clean it.
• Do not place it in your pocket or backpack unless it’s protected in your retainer case.
• Notify the office immediately if you lose it, break it, or it doesn’t fit properly (973) 701-2200.

Spacers or Separators

A week or two before you get your braces or another orthodontic appliance, spacers (or separators) will be placed between your back teeth, or molars. These are small elastics that fit between the teeth. They move the teeth apart slightly to make it easier to fit the bands on the day that you get your braces or have impressions made for an appliance. (Note: Bands are metal rings that will be placed on your molars to support the braces or another orthodontic appliance.)

• Spacers will feel like you have food stuck between your back teeth.
• They may cause a little tenderness to your teeth, particularly when you bite down.
• Take ibuprofen as needed to help with any discomfort.
• Do not floss between any teeth where there is a spacer. But be sure to floss between all the other teeth!
• Do NOT eat anything sticky or chewy, such as caramels, taffy, or gum.
• If a spacer falls out, call our office at (973) 701-2200. The spacer may need to be replaced.

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