Matthew David McNutt, DDS, MS, PA
Orthodontics for Children, Teens & Adults

Frequently Asked Questions

APPOINTMENTS

How often would I need to come for appointments?

Treatment intervals for patients undergoing conventional orthodontic treatment are usually 6-8 weeks apart. Invisalign® patients are often seen at longer intervals, while retainer patients are often seen once per year.

Are appointments available after school or work?

We schedule as many appointments during the after school/work time as we can; however, longer appliance adjustment appointments must be scheduled during the day. It helps to note upcoming “days off” from school or to know which classes are easier to miss so that appointments can be made during the day hours.

What happens if I must reschedule or miss an appointment?

Appointments are set up on a 6-8 week interval and a make-up appointment may not be available for some time. Thus, having to reschedule at the last minute can result in prolonging treatment. We are often asked if we can squeeze a patient in, but in many cases this is not possible, as unscheduled patients who are squeezed into the schedule will cause a backup resulting in regularly scheduled patients waiting 15-30 minutes for their appointment. It is our goal to respect each and every patient’s time. Please help us keep this goal by keeping your scheduled appointments.

What can I expect if I arrive to my appointment late?

If you arrive over half way through your appointment, you will most likely be asked to reschedule. We understand that traffic and other issues may cause late arrivals, so we encourage you to come 5-10 minutes early for your appointment. By the time the patient checks in and brushes their teeth, they have used approximately 8-10 minutes of their appointment time. We want you to complete orthodontic treatment in a timely manner, and having to reschedule appointments delays treatment. Please give us a call if you think you might be late and we will try to maintain your appointment while still staying on schedule.

When are you in Clayton and when are you in Cary?

We have a rotating schedule between Cary and Clayton. We are not always open M-F, however we do schedule clinic hours M-F on a rotating basis for your convenience. Dr. McNutt normally sees patients for orthodontic care four days per week on a rotating schedule, which allows for some Friday hours. Patients are assigned a “home” office for treatment, either Clayton or Cary. Patients can be seen in either office on an occasional as needed basis. Most regular appointment can be scheduled in the “after school” hours, but longer appliance adjustments appointments are sometimes required to be scheduled during morning hours. Unfortunately we cannot accommodate patients who require only after school appointments.

During our normal clinic hours we have appointment slots for comfort repairs, for example when a brace is loose or a wire is uncomfortable. These types of repairs are not normally taken care of on the weekend, however, in the event of a rare true dental emergency patients will be seen.

AGE FOR FIRST VISIT

When should my child have an initial orthodontic examination?

The American Association of Orthodontists recommends an initial orthodontic screening by seven years of age. This is the time when the permanent incisors and molars are growing in and enough jaw growth has occurred to enable detection of common orthodontic problems. Treatment from age 7-10 often involves guidance of facial development and tooth eruption (dentofacial orthopedics). Once a problem is detected, the orthodontist can advise the optimum time to begin early intervention.

ORTHODONTIC TREATMENT

When is an adult too old for braces or Invisalign?

Adults who have healthy teeth and supporting gum tissues are never too old for orthodontic treatment. Increasing numbers of adults are taking advantage of the lifelong benefits of orthodontics. These are people who’ve made the choice to spend the rest of their lives with an attractive, healthy smile and the confidence that it brings. We are pleased to present our adult patients with tooth colored ceramic braces or even the newest option, Invisalign®.

RETAINER WEAR AND TEAR

Why are retainers so important?

Retainers are used to maintain the teeth in their new positions while the fibers that hold the teeth to the bone adapt to the new positions of the teeth. It takes months and sometimes years for these gum fibers to re-adapt. That is why we recommend that all orthodontic patients continue retainer wear for an extended period of time. Your orthodontist will set up a schedule of retainer wear for you after your braces are removed. To maintain your teeth as they are the day that the braces are removed, you must faithfully wear your retainers as instructed.

EARLY TREATMENT IN YOUNG CHILDREN

Why is “early treatment” recommended for some children
and not for others?

Certain types of orthodontic problems are more effectively eliminated at an early age, while other types of problems are best treated after all of the baby teeth are lost. All patients present different problems, so it’s always best to have an early evaluation to assess the proper time to start treatment of the patient’s unique condition. The goal of early intervention is to guide the growing jaws and erupting teeth into more favorable positions; therefore reducing the magnitude of the problem, or in some cases, eliminating the need for complex treatment in the teen years. Thus, if the orthodontic problem stems from underlying skeletal imbalances, or if the permanent teeth that have erupted so far are in poor relationships, early treatment may be suggested. In actuality, the majority of orthodontic problems are best treated in the pre-teen to early teen years.

BRUSHING AND FLOSSING IN BRACES

How often should I brush?

During orthodontic treatment it is very important to maintain excellent oral hygiene in order to keep the teeth and gums healthy.  Patients should brush their teeth after each meal and snack.

Should I brush at school & work after lunch?

For children going to school and adults at work, it is very important to brush after lunch.  Brushing twice a day is not enough.  Allowing food to sit around your braces after lunch and then waiting until after dinnertime to brush will be very unhealthy for your teeth.

How should I brush my teeth?

When you brush your teeth, we recommend a two step brushing technique.

  • Step one: Brush and clean your braces and orthodontic appliances.  Use your tooth brush without any toothpaste. Toothpaste foams up and can make it difficult to see plaque left on the braces.  Focus on removing plaque, food and build up from around your braces.  Pay special attention to removing plaque that is trapped between your braces and the gum line.
  • Step two: Brush normally with toothpaste, taking care to brush all surfaces of the teeth.  Spend at least 2-3 minutes brushing.

How should I floss my teeth?

We expect all of our patients to floss their teeth everyday. The best time of day to floss is in the evening after dinnertime.  Flossing with braces can be difficult and requires a special technique.

A floss threader is used to place the floss under the wires between your teeth so that you can floss under the braces. Floss threaders are not single use and each one can be used repeatedly until it frays or splits.

  1. Pull out a long piece of dental floss  and feed it through the threader, folding the floss in half.
  2. Slide the tip of the floss threader under the wire between the teeth.  Grasp the end of the threader with your fingers after it has passed under the wire.
  3. Pull the dental floss through the contact between your teeth and floss out the food between your teeth.  Then pull the floss out from under the wire.  Repeat this process until the teeth are flossed.

As you will learn, flossing properly takes time and effort.  We do expect our patients to floss every day.  Realistically you may not have time to floss your entire mouth each day, so our compromise is that our patients will alternate flossing the top and bottom teeth on a daily basis.  Stick with it even if you find flossing to be difficult in the beginning.  Flossing becomes easier and easier over time.

In rare cases, teeth can be so crowded that you are unable to floss between a couple of teeth.  That is OK.  As the teeth straighten out you will be able to floss between them.  When you are flossing, avoid tugging too hard or pulling on the wires.  This can lead to damaging your braces or cause braces to come off your teeth.  A proxy brush is also useful to clear away food that may become stuck between your teeth or under your braces.  Gently place the brush under the wire and clean away food debris.

Do you grade my brushing & flossing?

Yes.  At each orthodontic appointment we check your brushing and flossing, and we assign a letter grade.  Just like in school, we want everyone to earn an ‘A.’

What if I arrive for my appointment and I have food or plaque on my teeth?

If you have food on your teeth, brush your teeth at our tooth brushing station before sitting down in the dental chair to be seen by the doctor.  If you do not, your hygiene grade will automatically be lower, and we may get behind schedule because we will ask you to go back out to the tooth brushing station.

What if I am not doing a good job brushing or flossing my teeth?

If a patient is not brushing well or not flossing well, we will review the trouble spots and give you advice on how to improve.  When necessary we will also include parents so that they can help keep things on track at home.

Should I use a fluoride or anti-bacterial mouthwash?

From time to time the doctor may also recommend a daily fluoride mouth wash or a daily antibacterial mouth wash.  Check with the doctor if you have any questions about mouthwash.

What are the potential consequences for poor brushing and not flossing?

There are consequences for patients who choose not to follow the rules of brushing and flossing.  When plaque is left on the teeth, especially around braces, bacterial growth will set in.  Colonies of bacteria will eat the plaque and the bacteria produce waste material which is very acidic.  This will slowly de-mineralize  and weaken your teeth, leading to permanent chalky white spots or cavities that will need to be fixed by your family dentist.  The more sugary foods you have in your diet, the worse this may become.  Also, your gums may become infected with bacteria, resulting in a gum disease called gingivitis.

What steps do you take when a patient’s mouth starts
to become unhealthy due to poor brushing and not flossing?

  • In the event your mouth becomes unhealthy, your Dr. McNutt may require:
  • Seeing the family dentist for extra dental cleanings.
  • Fluoride varnish treatments or prescription toothpaste to help repair tooth enamel.
  • Removal of the wires from your braces for 2-3 weeks so that you can brush and floss without anything in your way (which may extend your time in braces by 2-3 months because teeth will begin to move back).
  • Removing braces altogether and stopping treatment.
  • Remember, a healthy mouth is a happy mouth.


EATING WITH BRACES

How will my diet be affected by braces?

Your diet directly affects the health of the supporting gum and bone tissues around your teeth. If you are careful about the type of food you select and the way you eat your food, your teeth and gums will stay healthy throughout treatment, and your orthodontic appliances will remain in good working condition.

How should I eat with braces?

When it comes to eating, how you eat is as important as what you eat.The braces on your front teeth are bonded to the surface of your teeth. These braces may shear off when biting into hard food.

  1. In general, try not to bite into any food with your front teeth.
  2. Cut up your food into smile bite size pieces, or tear all food into small pieces.
  3. Take care to chew your food slowly and carefully with your back teeth.

How should I eat crunchy fruits and vegetables with braces?

Unfortunately, a lot of what we normally think of as “healthy food” is very hard on braces.  Since it is very important to maintain a healthy diet, fresh fruits and vegetables that are hard and crunchy should be either cut into small bite-sized pieces or cooked until tender.  Corn on the cob is a favorite for many people, and should be cut off the cob.

How should I eat meat that is on a bone?

When eating meat, always cut it off the bone.

Should I avoid sticky and chewy foods?

Any food that sticks to the teeth or that may get stuck around your braces or appliances should be avoided in general.  These types of foods usually have high sugar content as well.  Sugary foods that become lodged between the teeth and the braces will increase the risk of cavity formation (tooth decay).

Can sticky and chewy foods damage my braces?

Yes.  Most patients also have braces bonded on the back teeth.  Some patients have bands on the back teeth and these bands go all the way around each tooth. These bands are more resistant to breaking than the braces on the front teeth.  However, sticky foods may pull at the bands and eventually break the cement seal.  Once the cement seal is broken, plaque begins to leak in and may cause tooth decay.  Sticky or chewy foods can also damage the braces and the wires.

Which foods cause the most problems with braces and should be avoided?

Take a moment to look over some examples of food to avoid.  You might call this the ‘common sense’ list.  We cannot possibly list every type of food to avoid.  If you want to eat something that is similar to the foods on this list, common sense would say, you probably should avoid eating it: Hard candy, sugary bubble gum, Starburst, Sugar Daddies, Laffy Taffy, Tootsie Rolls, Gummy Bears, Caramels, Jolly Ranchers, corn chips, tortilla chips, popcorn, jerky, ice cubes, hard nuts, hard pizza crust, and corn on the cob (cut it off).

Are there types of drinks that should be avoided with braces or Invisalign?

Absolutely yes!  There are several types of sugary drinks you should avoid altogether during orthodontic treatment.  Sugary drinks will lead to decalcification marks and possibly tooth decay.
Examples are:

  • Most sports drinks (they typically have sugar and are less healthy than the commercials would have you believe).
  • Energy drinks, which are typically very high in sugar and have unhealthy levels of caffeine as well.  Dr. McNutt strongly recommends against consumption of these drinks in general for anyone.
  • Sodas of any kind…even diet soda…diet soda is even more acidic than regular soda and damages tooth enamel.
  • Sweet tea…even this sacred Southern treat is not recommended.
  • Adult Beverages like coffee and wine may stain the teeth and around orthodontic appliances.


CARING FOR YOUR BRACES

 

How important is patient cooperation during orthodontic treatment?

Successful orthodontic treatment is a “two-way street” requiring consistent, cooperative effort by both the orthodontist and patient. To successfully complete orthodontic treatment, the patient must carefully clean his or her teeth, keep appointments as scheduled and occasionally wear rubber bands, headgear, or other appliances as prescribed by the orthodontist. Damaged appliances and unhealthy gum tissue can lengthen the treatment time and may undesirably affect the outcome of treatment. The teeth and jaws can only move toward the desired position if the patient follows home care instructions as prescribed.

Why did one of the braces come off my tooth? Why did one of my wires break or come loose?

If the braces and wires are not attached properly to the teeth, they are not under control and may move in the wrong direction.  Patients who avoid eating the foods we have discussed may still cause something to come loose.  This is almost always because the patient is not cutting food up into small pieces and chewing slowly and carefully.  In an average week a patient will go through several thousand chewing cycles.  Being a little too rough will eventually lead to the straw that breaks the camel’s back…and something will come loose. It is also possible that a patient is grinding their teeth while sleeping and inadvertently caused a problem.

Should I avoid chewing on non-food items?

Unless we have prescribed ‘chewies’ for you as an Invisalign patient, the answer is yes!  Patients should also avoid chewing on things like pencils, pens, and finger nails…as this may damage your braces or aligners.

Dr. McNutt, do you have any advice to share with your
younger patients and teens?

Yes! For our younger patients, please respect your parents time and money.  They may need to bring you in for extra visits if you are not following the rules.  They may have to take extra time off from work or other activities and the gas they put in their cars is not free!

Should a patient with braces who is participating in sports wear a
protective mouth guard?

Patients and parents often ask about sports mouth guards.  Patients who participate in sports during orthodontic treatment should wear a protective sports mouth guard.  Please do not use a custom ‘boil and bite’ mouth guard, as it may get locked in around the braces.  We can advise you on which store bought sports mouth guards work best and we also make orthodontic sports mouth guards in our office upon request.

MINIMIZING DISCOMFORT

Will my braces or Invisalign hurt my lips, cheeks or tongue?

Discomfort of the lips, cheeks and sometimes the tongue, is to be expected at the beginning of orthodontic treatment.  After the braces are on, your lips and cheeks no longer rest against the smooth surface of your teeth.  Usually it takes about a month for your lips and cheeks to toughen up and get used to braces or appliances.  Until then you may be a little sore.What do I do if I get a sore spot in my mouth? Occasionally a small sore or ulcer may form.  If this happens, apply some orthodontic numbing medicine on the sore spot.   You may also place a small amount of orthodontic wax over the braces in the area that is bothering you.  Warm salt water swishes may also help soothe the sore area and help it heal more quickly.

What do I do if something is poking me in my mouth?

Occasionally a wire might poke the lips, gums or cheeks.  Applying some orthodontic wax is a good solution.  You may also apply some orthodontic numbing medicine on the sore spot.  Sometimes you will be able to slide the wire back around into the proper position yourself, but be gentle.

Only use the wax if you really need it.  If you use the wax early and often the wax will become a crutch, and your teeth will move more slowly with wax gunked around them.

Will my braces or Invisalign make my teeth sore?

As the teeth begin to move, patients will feel some soreness around the teeth, especially the front teeth if they are crowded.  This soreness will likely start about 12 to 24 hours after braces are adjusted or after you start wearing a new set of Invisalign aligners.  Soreness will likely last anywhere from 2 to 5 days.

If my teeth are sore, can I take medicine to help?

The following medications, provided the patient is not allergic and there are not contraindications in the patient’s medical history, work very well to minimize soreness:

  • Generic Ibuprofen (which is equivalent to Advil or Motrin) may be taken 2 to 3 times daily.
  • Generic Naproxen (which is equivalent to Aleve) may be taken up to 2 – 3 times daily.
  • Acetaminophen (Tylenol) may also be used, but it is not quite as effective as the the Ibuprofen or Naproxen.

Dr. McNutt will answer any questions you may have about the proper dosage and when to take the medicine throughout the day.

Should I take any medicine when I first get my braces on?

We recommend taking your medicine for the first 4 to 5 days, starting with the day you get your braces or appliances on.  Remember, you may not be sore right after getting your braces on, but you probably will be by the next day.  Follow this helpful advice and you will be much more comfortable.

What should I do if my teeth are sore while I eat?

You may notice the soreness most when you are eating a meal, and the front teeth may be especially sensitive.  Here is a helpful tip.  Chew a piece of sugar-free gum for about 30 minutes prior to sitting down to eat.  You should use the teeth that are the most sore to chew the gum.  This will help work out some of the soreness and you will be more comfortable when you eat.  Note that frequent or extended periods of gum chewing are not advised, as this will put orthodontic appliances through a lot of wear and tear.

Should I avoid chewing gum while in braces or should I chew gum?

After you start treatment the doctor will see you for adjustment appointments about every 4 to 8 weeks depending on your type of treatment.  You may notice after adjustment appointments, your braces will feel tight for several hours.  This tightness is usually followed by a period of a few days when your teeth may feel sore.  Believe it or not, it’s actually a good idea to chew gum immediately after an appointment, or whenever your wires feel especially tight.  Why?  Chewing will result in an increase in blood circulation around the roots of the teeth.  This helps to clear out the biochemicals that are associated with soreness.  Keep the gum chewing period to a minimum, and by all means, chew only sugarless gum.

COMFORT REPAIRS

Should we call the orthodontic office if something breaks or
comes loose with my braces or Invisalign?

Occasionally accidents happen and something will come loose or will be damaged during treatment.  For children and teenagers, make sure you immediately tell your parents if something ever comes loose or breaks.  Contact us so that we may advise you on when to visit the office for a repair.  When a patient arrives for an adjustment and surprises us with loose or broken appliances, we may not have time in our schedule to both repair and adjust the braces.  Letting us know in advance is the best way to keep treatment moving forward on time.

What should I do with a brace, a wire or a part
of my orthodontic appliances comes off in my mouth?

Save anything that ever comes off and bring it to your next visit!  If a part of your braces slides off the wire into your mouth, carefully retrieve it and save it in a plastic bag.  The braces are very expensive to replace.  Bring it with you to your next orthodontic appointment so that we can re-apply it to your tooth.

What should I do if something shifts and my braces start
poking me in my mouth?

Occasionally a wire might poke the lips, gums or cheeks.  Applying some orthodontic wax is a good solution.  You may also apply some orthodontic numbing medicine on the sore spot.  Sometimes you will be able to slide the wire back around into the proper position yourself, but be gentle. Contact us by phone to schedule a repair.

What is your policy on scheduling repairs?
If a brace or wire comes off over the weekend is it an emergency?

When ever an issue arises, please contact us so that we may quickly schedule a comfort repair during regular business hours.  If something happens on the weekend please leave us a message at the office so that we may schedule a comfort repair early in the business week.  True orthodontic emergencies are very rare.  Typically braces that have come loose or wires that are poking are not considered emergencies and are not repaired on weekends.

In the event of a true orthodontic dental emergency, what should I do?

In the event of a true emergency, dial 911 on your telephone and seek immediate medical assistance.  An orthodontist is available by phone after business hours for extra-ordinary situations.  Call the office and you will be prompted with instructions to reach the doctor.  True orthodontic emergencies are very rare.  Typically braces that have come loose or wires that are poking are not considered emergencies and are not repaired on weekends.

ORAL HEALTH

Do I need to see my general dentist for while in orthodontic treatment?

Our practice is limited to orthodontics, so we must work hand in hand with your general dentist to maintain the optimum health of your teeth and gums. We encourage you to maintain regular 6 month check-ups and cleanings with your dentist. Adults who have a history of periodontal (gum) disease may also need to see a periodontist (gum specialist) on a regular basis throughout orthodontic treatment.

COST OF TREATMENT

What is the average cost of orthodontic treatment?

There really is no average cost, as treatment needs differ from patient to patient. In our office, we schedule a one hour appointment to obtain pertinent dental history, to complete a thorough orthodontic examination, and to discuss the options of treatment and the length of treatment. The cost of treatment depends on the complexity and length of the treatment indicated.

INSURANCE AND FINANCIAL POLICIES

How does my orthodontic insurance work?
What is your insurance financial policy, will you file my insurance for me?

Once we receive information regarding your insurance company and your specific policy, we will submit the necessary insurance forms for your treatment. Typically insurance benefits will be sent directly to our practice. If after contacting your insurance company, you still have questions or problems regarding payments, we will help you obtain the needed information. Keep in mind that having dental insurance coverage does not automatically mean there is orthodontic coverage.

HOW DOES ONE BECOME AN ORTHODONTIST?

Orthodontists are specialists in moving teeth and aligning jaws.  All orthodontists are dentists first. Out of 100 dental school graduates, only six go on to become orthodontists.

There are three steps in an orthodontist’s education: college, dental school and orthodontic residency program. It can take 10 or more years of education after high school to become an orthodontist. After completing college requirements, the prospective orthodontist attends dental school. Upon graduation, the future orthodontist must be accepted as a student in an accredited orthodontic residency program, then successfully complete a minimum of two academic years of study. The orthodontic student learns the skills required to manage tooth movement (orthodontics) and guide facial development (dentofacial orthopedics).

  • Only those who have successfully completed this formal education may call themselves “orthodontists.”
  • Orthodontists limit their scope of work to orthodontics only.
  • Orthodontists are uniquely qualified in the diagnosis, prevention and treatment of orthodontic problems. They dedicate their professional lives to creating healthy, beautiful smiles in children, teens and adults. Well-aligned teeth are more than attractive: they make it possible to bite, chew and speak effectively. Orthodontic care is often part of a comprehensive oral health plan.
  • Orthodontists use a variety of “appliances,” including braces, clear aligner trays and retainers, to move teeth or hold them in their new positions. Because of orthodontists’ advanced education and clinical experience, they have the knowledge and skills necessary to recommend the best kind of appliance to meet every individual patient’s treatment goals.

Only orthodontists are eligible for membership in the American Association of Orthodontists.

Cary Orthodontics

Cary OrthodonticsOffice Address
301 Ashville Avenue,
Suite 101 Cary NC, 27518
Phone (919) 887-6350
Fax
(919) 887-6351
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Clayton Orthodontics

Clayton OrthodonticsOffice Address
400 Tew Court, Suite 108
Clayton NC, 27520
Phone (919) 553-4512
Fax (919) 553-6097
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