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Are thumb and finger appliances necessary?

April 22nd, 2019

Are thumb and finger appliances necessary?

The answer to the question is “Yes!” Let me explain why, when a child is actively growing, pressure from a thumb or finger can actually deform the shape of the upper jaw. Which can cause protruded upper front teeth and crossbites of the back teeth.

Protruded upper front teeth, can easily be damaged in accidents plus the child can suffer from social teasing. Crossbites of the back teeth, can cause excessive wear and fracture of the permanent molars.

If the habit is stopped prior to 3 years old the deformation will usually reverse itself without orthodontic intervention. A sequence of treatment is recommended for the greatest success. First-Talk with your child, let them know that their habit is “hurting their teeth.” Set up a calendar of positive reinforcement (prizes can help meet goals) For example, 2 days without the habit, 5 days without, 10 days, 20 days, 40 days, then 60 days. After that, it is rare to get relapse. I know you’re going to say, “but my child can’t count to 60,” that’s the reason you set up a calendar in a prominent place like the refrigerator. Have them place a mark on the calendar for each day of success. Pre-pick a prize for each goal reached.

If you can tell your child is trying, but not successful then you can try “Stops it,” (make sure no allergies!) from the pharmacy. This when put on the offending digit, gives it a bitter taste which acts as a reminder not to put the finger in the mouth.

Second-If not successful in 2 months with the above protocol, then an orthodontist can help. At our office, I repeat the above regimen with new additions as an outside authority figure, that may be all that is needed to stop the habit. If not successful in 2 months, then we proceed to the fixed (not removable) upper guard.

I find if we try the “benefit method” first then the child is much more accepting of a fixed guard. The appliance is left in for 6 months.

What if the child’s upper jaw has been permanently deformed? At the office of Dr. Michael Sebastian, we combine a thumb/finger guard with an upper expander to not only resolve the habit, but also to correct the skeletal deformation which occurs.

The last thing to consider is a tongue thrust (October 10/2018 Blog). Often, a tongue thrust will result after a thumb or finger habit deforms the upper jaw so even after the habit is resolved the tongue thrust will continue to deform the upper jaw. That is why is imperative to treat the tongue thrust while treating the upper jaw deformity. We have developed a special upper expander which treats all of these considerations.

At the office of Dr. Michael Sebastian, we emphasize the treatment of thumb and finger habits for successful development of the teeth and face.

How Do Clear Aligners Move Teeth?

March 7th, 2019

Clear aligners, Invisible braces, Invisalign

Clear aligners, Invisible braces, Invisalign (a brand name that has become a generic term like Coke even though many companies make clear aligners) are now a part of the Orthodontic tool box used to move teeth to build healthy beautiful smiles.

Like braces clear aligners are designed to move teeth in small increments. Also like braces, aligners need to be planned in a specific sequence in order to move the teeth most efficiently into the correct position. “You can’t move all the teeth at once”. Most importantly, aligners are not a “do it yourself “ technique, the computer technician moves the teeth under the guidance of the Orthodontist. The Orthodontist, not the technician, has the education, experience and skill to move the teeth correctly within biologic limits to ensure the health of the teeth, surrounding gums and jaws.

Once a plan is arrived at, the trays are fabricated to make sequential movements through multiple trays with each tray designed to make specific tooth movements. With each tray, specific teeth are reset into a new position and the tray is fabricated. Over the course of wearing the tray 7-10 days the teeth are gently guided into the desired next step. The trays must be worn 21-22 hours per day to be effective. It’s not like if you wear them less than the desired time the teeth still move but at a slower pace, they don’t move at all! So effectively, the only time they aren’t worn is for eating, drinking and oral hygiene,

The trays are made of a pliable polymer which gently flexes to put pressure on the teeth to be moved. Sometimes this is not enough to effectively move a tooth, so small tooth colored attachments are added to the outside of a tooth to enhance the desired movement. The total number of aligners needed depends on the complexity of the movement.

Advantages of clear aligners include:

  • Unless someone is directly in front of you, they are not noticeable.
  • Some people worry about it affecting their speech, maybe for the first few days while you get use to them but not long term.
  • You can remove them to eat, drink, brush and floss.
  • Less chance of developing gingivitis.
  • If you have an event where you don’t want to wear them, then don’t! Just add an extra day to that tray cycle.


  • Aligners are not the correct solution for every type of crooked teeth. Having an experienced Orthodontist will help you choose the best solution for your unique situation.
  • You can’t drink anything but water with the trays in so if you are an all morning “coffee sipper” they won’t work. The teeth will get stained and if there is sugar in the drink then cavities can develop.
  • The above mentioned attachments can be esthetically unpleasing to some people. For most they’re not.

Clear aligners can be used to treat teens as well as adults. In fact, the oral hygiene is much better in teen clear aligners than braces. As long as the teen doesn’t try to drink beverages containing sugar, such as soda, fruit juices and sports drinks with their trays in, then the oral hygiene is never a problem with clear aligners which is a plus.

Braces versus clear aligners is a choice which you should not make alone. We are here to help you at the orthodontic office of Dr. Michael Sebastian.

"Do it yourself"

February 25th, 2019

Questions to consider when thinking about using online teeth straightening services

I don’t know if you have seen all the advertisements popping up from “Do it yourself” teeth straightening companies like Smile Direct Club, Candid Co., Smile Love, SnapCorect, Orthly, etc.

If you know of someone who is considering using this route to align their teeth, then you might offer these questions for them to ask prior to starting treatment. These questions were developed by the American Association of Orthodontics to help consumers make a well informed decision.

As part of your treatment, are comprehensive diagnostic records like x-rays taken before your treatment?


  • Does the treatment and fee include x-rays of your teeth and jaws?
  • Does the treatment and fee include a clinical examination of your jaw alignment, teeth, bite, and the relationship of your teeth to the skeletal structures?
  • Does the treatment and fee include taking photographs of your face, facial profile, mouth, and teeth?
  • Does the treatment and fee include taking digital scans or other impressions of your teeth?

NO - Are you comfortable starting orthodontic treatment without comprehensive diagnostic records? If you still want comprehensive diagnostic records taken, are you alright going to another dental professional to take them? If yes, what will that cost?

As part of your treatment fee, do you receive any in-person visits to a dentist’s or orthodontist’s office during your treatment?


  • How many?
  • What occurs during these in-person visits?
  • Is there a licensed dentist or orthodontist in the office to supervise the visits?

NO - Are you comfortable with orthodontic treatment that does not involve any in-person visits with a dentist or orthodontist?

Is only one treatment type offered (such as invisible aligners or a certain appliance)?

YES - How do you know that is the best treatment option for you, given your unique situation and oral condition, compared to other treatment models (such as braces)?

NO - How is the decision being made for the best treatment model for you, and who is making that decision?

If a dentist or orthodontist is involved with your treatment, do you know the name of the dentist or orthodontist who will be specifically involved with your case (for example, is it available on the company’s website or elsewhere)?


  • What are his or her education and credentials?
  • In what state is he or she licensed?
  • In what state does he or she practice?
  • What do other patients being treated by him or her have to say

NO - Are you comfortable not being able to research your dentist’s or orthodontist’s background, credentials, patient reviews, etc. before you begin treatment?

How do you know if your teeth and gums are healthy enough for orthodontic treatment?

  • Who is making that decision and how long is it being determined?
  • If the decision maker is a dentist or orthodontist not associated with your treatment, who pays for that assessment?

Who can you speak with at the online orthodontic company about your orthodontic treatment?

  • · What is his or her education, background, qualifications and/or experience with orthodontics?

Who is responsible for detecting any issues that may occur during your orthodontic treatment?

  • Is it you?
  • If it is a doctor not associated with your treatment, who pays for those check-ups?

If a doctor is involved with your orthodontic treatment, how can you contact him or her over the course of your treatment?

  • How can you contact him or her if an emergency arises?

If an emergency arises, does the company have a dentist or orthodontist in your area that you can see in-person?

  • If not, who would cover the costs associated with seeing a dentist or orthodontist in your area?

These are some of the questions which any consumer should ask prior to starting treatment. Moving teeth is not a simple process and requires the oversight of a skilled dental professional.


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Airway Orthodontics

March 3rd, 2015

“My child, Cody has always slept with his mouth open and snored. I remember sitting in his room watching him struggle to get a good night sleep because he couldn’t breathe properly. He started his treatment with Dr. Sebastian in October of 2013. Within months, I saw a change! Even during the day, I would notice he was keeping his mouth closed to breathe and by the time his treatment was finished, he had completely stopped snoring!! It has been amazing to see such a simple appliance make such a huge difference in the life of my child!! Thank you Dr. Sebastian for your dedication to each child you treat.”

As you can see from this testimonial, the importance of early treatment is imperative. Utilizing this technology, we are convinced that orthodontics must be more than just about a healthy bite.  We continue to use our sleep questionnaire and visual examination of the soft tissue skeletal appearance, ability to breathe through nose and tonsil size. We have also begun a tracking system that will allow us to better follow the progress of our Phase I patients who are experiencing any airway problems.

80% of symptomatic airway children go un-diagnosed, so the problem is not going to just “go away” on its own. Dentists and orthodontist should be at the forefront of this effort because we are the ones seeing these children on a regular basis and it fits into areas in which we are intimately involved. Our goal is to help the next generation “breathe a little easier”.

As always, we appreciate your continued support and trust in our office. If I can answer any questions you may have, please do not hesitate to contact our office.