Megan Baitey

Specialty Office Visit Report

Orthodontics is defined as “a branch of dentistry dealing with irregularities of the teeth (such as
malocclusion) and their correction (as by braces)” (orthodontics. (2020). You would get referred to an
orthodontist if you have malpositioned teeth that could cause overcrowding, or if an individual’s bite is
off such as an overbite, overjet, underbite, crossbite, etc. Not treating these kinds of issues could cause
future problems such as jaw soreness, TMJ issues, and dental health issues such as gingivitis or
periodontal disease due to bacteria harboring around hard to reach areas due to the malpositioned
teeth.

On November 18th, I had the opportunity to visit Dr. Thorton’s Orthodontics office. The office is ran by a
bunch of different knowledgeable and friendly staff. The office managers name is Sarah, and she works
on the financial arrangements and insurance billing with the families. The treatment coordinators name
is Cheryl. She introduces the new patients and their families to the office while answering any questions
they may have regarding treatment options, insurance, and financial arrangements. Amy, is the
scheduling coordinator at the office. She greets every patient that walks through the door and creates a
schedule that works for Dr. Thorton and the patients. There are four dental assistants that work there as
well; Ashley, Debbi, Carly, and Alina. They are all in charge of assisting the dentist with any of his needs,
but they also work individually. They take panoramic images as well as cephalometric radiographs. They
also take 3D images and impressions which are needed to create retainers. They put braces on and also
take them off. They change the wire on the braces every time a patient is ready for a new wire. They
provide oral hygiene for the patient each time they come in, and keep the patients chart up to date with
the recommendations the dentist suggests. Ashley is also in charge of ordering and organizing all
supplies, and Debbi is mainly in charge of lab work such as the impressions, creating retainers, etc. Dr.
Thorton has been practicing since 2003. While I was shadowing him, I asked him why he chose
orthodontics. He said he was around a lot of orthodontists in school which made him become more
knowledgeable about it, and made him end up really liking it. After finishing dental school, he had to go
to orthodontic school for another two to three years.

An orthodontics office has a variety of appliances that you can get depending on what issue is needing
to be addressed. These include: Transpalatal bar/nance/lingual arch, bionator, biteplane, bitesplint, fan-
type expander, fixed lingual retainer, forsus springs, braces, headgear, lower spring retainer, palatal
expander, pendulum/pendex, reverse pull headgear, rubber bands, separators, tongue spurs, turbo
brackets, removeable upper retainer, and a utility arch (Types of Appliances - King Orthodontics). There
are also different types of braces that are offered, including: traditional metal braces, clear/ceramic
braces, Invisalign, and clear correct (Types of Appliances - King Orthodontics). Another thing that sets an
orthodontics office apart from a regular dentist’s office is the way they number teeth. At a regular
dentist the teeth are numbered 1-32, but orthodontists number their teeth as followed: upper right (UR)
1-8, upper left (UL) 1-8, lower right (LR) 1-8, and lower left (LL) 1-8.

There is not a specific sterilization technician at this office, so the assistants are all in charge of the
sterilization room. The sterilizing room is next to the clinical chairs. It is similar to what we have at the
clinic, but smaller. It had one ultrasonic, one sterilizer, and a soap and water container for eyewear and
mirrors. There is also a cold sterilization solution that sits for 10-12 hours and is used when instruments
cannot be put in the sterilizer. The sterilizing room has a storage closet attached to it to hold extra
supplies. The clean instruments are stored in an island in the center of the operatory. As far as infection
control procedures go, their office is also similar to how we disinfect and clean at the clinic. They wipe
down the chairs, lights, and tables after removing the barriers. They don’t touch surfaces without
barriers with dirty gloves, and right now because of COVID they have temporary walls between each
dental chair. One thing I did notice that is different than we are doing at the clinic is that they did not
have to wear any hair coverings, face shields, gowns over scrubs, or leather shoes while working.

While observing I got to watch a full banding, a wire change, and a frenectomy. Dr. Thorton was doing
the frenectomy on a little boy probably around the age of 9. He had braces, but his maxillary centrals
were obstructed from the maxillary labial frenum that was in the way of the two teeth coming together.
He performed the frenectomy and made it shorter so it was no longer between the two teeth. I asked
him what the healing process is like for this kind of procedure, and he said its very simple and will just
feel like it does when you burn the hard palate with some hot food. He also mentioned to the patient to
avoid citrus because it might sting, and to blow air under the upper lip occasionally while healing to
avoid the frenum from re-attaching. The soft tissue laser can also be used to cut the gingiva in order to
put a bracket on a partially erupted tooth, so it can pull the tooth down.

While watching the full banding procedure the assistant first started off by polishing all the teeth to
remove all of the plaque that would prevent the brackets from attaching to the teeth. There is no
fluoride in the prophy paste because that can affect the bonding of the bracket to the teeth. Then she
applied a cheek stretcher and tongue suction to avoid any saliva from getting on the teeth. Then the
teeth were etched and primed and ready for the brackets to be placed. The etch is applied for about five
seconds on each tooth. The brackets came with the glue already attached inside a packet that labeled
each bracket according to the tooth it belongs on. This is to make it easier for the assistant when
applying the brackets, since the sizes vary according to the tooth. She then placed the brackets in the
center of the teeth without using a light to set the glue. She removed any excess glue that was around
the bracket to help avoid any dry glue that may attract bacteria. Dr. Thorton then made the adjustments
to the brackets to be sure they were placed appropriately to the patients’ mouth. After he was done
with that the assistant used the light for twelve seconds on each tooth to set the glue. According to Dr.
Thorton, patients that just got their braces on typically start with a 0.14 10 th of an inch round wire and
work towards the thicker wires (0.16, 0.18, TMA, then stainless steel). The wire is placed using a wire
gert, and once the wire is placed the patient gets to choose the color of the “O” ties they would like. The
assistant then places them around the bracket with the mathieu plier to hold the wire in place.

The patient that I watched get the wire changed was a young boy who was about halfway through his
treatment. Dr. Thorton looked at the progression of his teeth by viewing his original photos vs how his
teeth currently look. He then decided how he wanted the bands adjusted, and whether or not to move
to a thicker wire. He used the marking stick to show the assistant where he wanted new bends and
adjustments in the wire. The old wire was removed by first removing the “O” ties with the orthodontic
explorer. The wire is usually adjusted every one to two months, and a panoramic radiograph is taken
about halfway through treatment to see the progress that has been made. The panoramic machine is
also used to check for root resorption. Dr. Thorton said if there is root resorption happening then a
panoramic image would be taken more often to help monitor, and see how to best further treat the
patient without increasing the resorption. The assistant has to be very careful that the wire is placed
correctly or the wrong teeth will shift. They also do not bond the second molars until later
appointments, or until the patient is ready for thicker bands due to irritation or risk of the wire popping
out of the bracket. If a tooth is positioned more posterior than another tooth in the arch then a cross tie
is used if the band isn’t engaged enough with the bracket. If there is excess crowding that is not allowing
a tooth to move forward toward the other teeth on the arch then an open coil spring band is used to
help create more room.

The software the office uses is specific to orthodontics, and it is called orthoedge. It shows patient
radiographs, chart notes, etc. just like other dental office software. However, it had a cool feature that
shows the patient videos after they get their new braces on. These videos show proper homecare which
the assistant shows the patient while they watch the video. There are also videos that show what foods
to avoid such as popcorn, peanuts, gum, ice, kettle chips, and chewy candies. It’s a great visual for the
patient and even showed what happens to appliances when they become damaged by these different
foods. Orthoedge also has a point system which allows the patients to earn prizes after getting so many
points. They can earn points from having good home care, being on time to appointments, etc.

Home care is very important in orthodontics, just like in general dentistry. Dr. Thortons office requires
patients get their teeth cleaned and get any restorations done prior to getting braces. They also
recommend the patient keeps up with their regular maintenance cleanings as well. As far as home care
recommendations, they suggest the patient uses ACT fluoride mouth rinse to help prevent white and
brown spots on the teeth. They tell the patient to tip the toothbrush at an angle toward the braces
coming from both the bottom and top of the braces. There are different options available for patients to
floss including: a proxabrush, platypus flossers, and orthogamy; depending on what works best for the
patient’s dexterity.

Orthodontics has many instruments that are not used in general dentistry. A tucker/ ligature director
helps put the wire into the brackets. Hemastat puts the “o” ties on the brackets. Detail pliers bend the
wires prior to placement. Retainer check plier adjusts the retainer. Separating pliers floss the separators
between the teeth. Lingual debonding pliers’ places turbans on the lingual surface of anterior teeth. The
clarity debonding pliers breaks brackets on the mesial and distal surfaces, while the regular debonding
pliers breaks brackets on the occlusal and gingival surfaces. The hammer head bends wires distally. The
surgery hook plier adds the hook to the wire. The smart clip disengaging tool takes the wire out, and the
torqueing pliers bend the wires. The tie pencil engages the bracket. AEZ removes composite. They also
use band removing pliers, spatulas to mix fugi, bite sticks, and scalers as well, according to one of the
assistants at Dr.Thortons office.

I think visiting an orthodontics office was a great resource for me, especially for when I clean patients’
teeth that have braces or other appliances. I was given some pamphlets that I can share with my
patients to help emphasize proper home care for them. I am now a little more familiar with the
procedures performed at an orthodontics office and when a referral to them might be needed. I hope to
have more confidence in my home care instructions, cleaning abilities, and do’s and don’ts when it
comes to patients with orthodontic appliances.

Contact information for office: https://www.thornton-ortho.com/.

Address: 622 E. 22nd Ave. Suite C. Eugene, OR 97405

Phone: (541) 686-1732

Fax: (541) 686-1537

 References

orthodontics. (2020). The Merriam-Webster.Com Dictionary. https://www.merriam-

webster.com/dictionary/orthodontics

Types of Appliances - King Orthodontics | Danville Paris St. Joseph IL. (2005). King Orthodontics.
https://www.kbraces.com/types-of-appliances