Smiles & Faces Orthodontics

This is an area that many general dentists can find challenging. It can be commonplace for kids to grow up being scared of dentists. Unpleasant experiences can often linger for a long while. I can recall parents recounting stories of their childhood unpleasant dental experiences. In this dentist podcast, Dr Andrew Chang and Dr Diane Tay talk about: Why Connecting with your Pediatric Patient is important and why first impressions count. What are clinical tips and tools to make the initial exam easier for them. What are principles of communicating to a child that can be applied to clinical dental practice. This is a clinically relevant topic and we go through many clinical situations. For more information, visit our .

Lots of advances in the restoration of primary teeth and important to consider as parents are keen for alternative, aesthetic options. We also know the importance of maintaining primary teeth for function, aesthetics and space maintenance. Crowns provide a full coronal coverage restoration to help preserve form and function.    Reasons and indications for placement of crowns    following a pulpotomy/pulpectomy for teeth with developmental defects (enamel hypomineralisation) or large carious lesions involving multiple surfaces where a normal restoration is likely to fail high caries risks patients  where longevity of restoration is required  Types of crowns available and What are zirconia crowns made of     Stainless steel crowns, composite crowns, Porcelain fused to metal crowns and Zirconia crowns (Pre-fabricated) Zirconia crowns are made from zirconium dioxide, a very durable type of metal that's related to titanium. They are still classified under ceramic crowns    Pros and cons of zirconia crowns    Pros- strength and aesthetics. Research shows similar durability and strength as SSC. Can be used in patients with nickel allergy or who require MRIs (where SSC may cast artefacts in the scan).  Ferrule Effect.What colour choices do prefabricated have? Cons- extensive prep, technique sensitive, more time consuming, cost. Good colour match but are opaque. Areas of severe crowding? Cannot adjust shape easily. Bond strength where isolation poor? contraindications- severe bruxism,  Cementation: RMGIC or GIC?    Some tips for dentists interested in trying:   take a course  practice, practice, practice  choose your first case carefully  Be careful of back-to-back crowns Ensure excellent haemostasis

In this part 2, Orthodontist Dr Andrew Chang discusses: Treatment Options: No treatment Interceptive Treatment now: Functional Appliances with U maxilla expansion + referral to speech therapist. Wait till permanent dentition, then camouflage with upper arch extractions, U expansion is less effective. Treatment Timing: Is it too early? Primary dentition? If have habits eg: thumb sucking or dummy, best to cease habit first  Mixed dentition: best time for maximum orthopedic effect (CVMS 2: Baccetti 2002): Shape of vertebral bodies of C2-4 and inferior borders of C3-4 Adult. Is it too late? What happens with functional appliances? Compliance and success rate (due to temporary speech disruptions), greater lower incisor proclination. Jaw surgery and risks of morbidity. Adv & Disadv of Early Treatment- Gingival trauma, Upper incisor trauma, psychosocial. Adv & disadv of Late mixed dentition or Permanent dentition Tx: Orthopedic effects best retained. What should dentists be looking out for? Age and Dental Status. Mobile D's and E's at 10-11 yrs may be difficult to retain functional appliances. Habits - ask about thumbsucking, dummy, mouth breathing etc.  Signs of Risk Factors manifesting as gingival trauma, narrow jaw, Upper Incisor trauma. Assessing risk factors through their lifestyles and habits ie: sports, mouthbreathing >7mm Overjets and referral to orthodontist My experience has been parents would prefer to do a combined functional appliance + teeth alignment that address root causes, rather than orthodontic camouflage and adults are not keen on jaw surgery procedures due to significant risks.

In this Part 1 for dentists on skeletal Class 2 malocclusions, Dr Andrew Chang Orthodontist shares with Dr Diane Tay identifying features, risk factors and the differential diagnosis of Class 2 malocclusions. We cover the areas below:   Diagnosis Facial: Small lower jaw Dental ie: Class 2 div 1 or div 2’s Radiographic Assessing skeletal maturation and its importance in success. The Lateral Ceph x-ray Risks factors: Hx of anterior overjet getting larger- why this is the case Difficulty chewing and slow eater. Traumatic deep bites and teeth wear, gingival recession Trauma upper incisors Bullying: psychosocial Open mouth posture and gingival inflammation due to drying of the gingivae Differential Diagnosis: Proclined U incisors, Normal Maxillomand relationships

In this Part 2 of the Q&A with Dr Diane Tay, Sydney Orthodontist Dr Andrew Chang discusses and outlines treatment options for Class 3 based upon the dental developmental stages: Primary Mixed Permanent/adult And the 12-21 yrs age group whom are generally too late for early orthodontic treatment and their jaw growth is not complete. Takeaway messages are: the 6-8 years age group is better to start early orthodontic treatment Early Orthodontic Treatment does reduce the severity of skeletal Class 3's and the incidence of jaw surgery later For the 12-21 years age group, watch for the long face Class 3's. These are difficult to treat. General strategies are to start later, when their jaw growth is complete. 2 situations of when to treat early in this age group are indicated: Accompanying signs of a narrow jaw. Signs of traumatic incisor occlusion ie: wear or teeth mobility.

We are humbled to have both Felicia and her mother share their experiences with us and with their braces. In this episode, we have an open and authentic conversation. They also share their advice and tips for children and parents considering orthodontic treatment. Sorry for the audio quality at times. While we miss seeing them for their regular adjustments, it gives us great satisfaction knowing she does not hold back smiling anymore.

We are humbled to be able to serve our patient's and help them along their smile transformations. Personally, it has been rewarding for me and all the members of our team to play a role in their orthodontic care.  We are grateful to have Zahra how sharing her experiences, having just completed her braces orthodontic treatment.

In this Q&A with Dr Diane Tay, Sydney orthodontist Dr Andrew Chang shares the best time to start treating skeletal Class 3 malocclusions. In this Part 1, he covers: Class 3 Growth and Growth Indicators Simple Radiographic Types of Class 3's Which Class 3's are easy to treat 

In this podcast, Dr Diane Tay interviews orthodontist Dr Andrew Chang on the differences between clear removable aligners compared with braces. The differences between the different clear removable aligner products are discussed as well as the “do-it-yourself” aligner solutions. Highlights are: 2:10: What types of clear aligners are on the market and what are the differences? 4:30: What are the “do it yourself” aligners and do they work? The way that these aligners work to fix crooked teeth often lead to unhealthy bites or smiles. 8:55: What are the differences between clear aligners and clear braces? Which works better? Aligners or Braces? Generally speaking, the larger the gaps or the more crowded the teeth, braces still outperform aligners. Aligners are easier to keep the teeth clean for patients who have difficulty cleaning their teeth ie: Multiple Sclerosis, Cerebral Palsy or where manual dexterity with hands is more challenging. The idea of braces or aligners to fix crooked teeth should not be thought of as a zero sum, as for moderate to severe crooked teeth, combining braces and aligners provides the benefits of aligners and the predictability of braces with difficult movements. A new bathroom renovation applies the same concepts. It is the diversity of the tiles, their designs, tile sizes ie: border & main tiles, underlying waterproofing and use of grout and silicon that provides the attractiveness and functionality of the bathroom renovation.  13:20: Are all aligners the same and do they work equally well? Different aligners have different features. Certain features are important for certain movement types. They are slightly different aligner materials and have different treatment planning softwares. Our experience has been their comfort levels are similar and some aligners work better with certain types of bites.    18:45: I’m wearing aligners. What can I do to help my aligners teeth straightening process go on smoothly? Combine snacks with main meals helps to reduce the time that aligners are out of the mouth. Vary the aligner duration based upon the presence of springiness or gaps between the aligner and teeth 23:20: Simple at home exercises to do are discussed to help your aligner treatment go more smoothly If in doubt, send the practice photos of your teeth and aligners so they can advise before you change to each new aligner. Wear elastics well as advised. 26:45: Are all aligners the same?  

Dr Tay interviews Dr Andrew Chang on aligners. A synopsis is below: What are aligners 3:00. What cases are suitable for aligners? Patient Factors Malocclusion factors ie: deep bite, absolute intrusion of incisors in adults. 6:00: Difference between absolute and relative incisor intrusion and marked difference in effectiveness in aligners compared with braces. 8:00: Extraction cases. High need for later partial braces to regain root control 8:30: Attachments: Why attachments are more effective for moderately difficult cases. 11:30: When to choose 1 aligner company over another. What software features to look out for? 13:30: How do braces differ from aligners? Braces work better when needing to allow for PLAN B during Treatment ie: non extraction start. The aligner planning software allows better patient communication and planning of final outcomes, particularly useful in multidisciplinary cases. 21:00: Which cases a dentist should start doing?

This is a podcast for every parent. It is also one which every parent hopes does not happen to their child but should know what to do when it happens. As parents of kids ourselves, we cover topics of teeth trauma in toddlers, children and teenagers.  Questions we cover are: What simple first aid measures can be done? Which types of teeth trauma need to be seen by a dentist soon and which can wait. 

Dr Andrew Chang and Dr Diane Tay discuss the more common teeth development defects of peg laterals (small/narrow upper 2nd front teeth), dens in dente and dens evaginatus.  Common hallmarks of each of the conditions are described, and what to do when seeing teeth like these at the initial examinations. Dens in dente and dens evaginatus can both benefit from early identification and the implications of this and management options for each are discussed.

Dr Diane Tay And Dr Andrew Chang chat about the timing of normal teeth development, then discuss when variations can occur in teeth eruption, physiological and pathological causes and the common presenting patterns.  Clinical implications are discussed, along with timing of intervention and treatment options. Some highlights are: 1) Review of timing of tooth/dental development  2) Some genetic syndromes that are associated with delayed dental development. 3) Why is it relevant- ie: a supernumerary that might be impeding eruption of teeth, cysts etc. 4) When should we be concerned and when do we take radiographs? What radiographs?  

In this podcast for parents of school age children, Dr Diane Tay and Dr Chang outline common myths about certain foods and teeth health, & how to encourage children to drink more water. Examples are outlined of ways parents can make the school lunches a healthier choice for teeth. Tips on brushing effectively and recommendations on toothpaste are also provided. This is an episode all parents will find useful to listen.

Sunken Baby Teeth can be a problem in growing children. This is because they can continue to sink, and cause the adjacent teeth to collapse into this area. This can make its removal and future orthodontic treatment more difficult. In this podcast for dentists, Dr Diane Tay and Dr Chang have a conversation about these infraoccluded baby molars, its causes, and when should a dentist intervene as well as outlining some management solutions. Parents whom have a child with this condition would also benefit from listening in to find out more.

Nailbiting or Thumbsucking will affect the shape of teeth, jaws or one's smile. Prolonged dummy use in toddlers is another example. Dr Andrew Chang and Dr Diane Tay discuss and outline for parents of kids and teens simple remedies they can use at home to help break these habits.  They also chat about how Nailbiting, Thumbsucking or prolonged dummy use can affect teeth or jaw shape and one's smile.

Dr Andrew Chang Orthodontist at Smiles & Faces Orthodontics and Dr Diane Tay of Inner West Pediatric Dentistry return in 2020 to chat about anterior open bites. This conversation is for dentists who have child, teen or adult patients with anterior open bites. Questions that are discussed are: Have you wondered how the age of your patients can affect the simpleness or complex-ness of orthodontic treatment methods? Do you wonder if referring them when they are a child, a teen or an adult makes a difference to their smile outcomes, cost and duration of treatment? While every patient is an individual, and managed as such, this podcast outlines the answers to the above questions. It provides a basis to increase your understanding through identifying: Different causes of anterior open bites. Early treatment in children is focused on addressing causes ie: habits and skeletal discrepancies. When to treat: start early or start late? And when to tell if face growth is complete. Treatment methods for anterior open bites  in teens and adults: moving away from jaw surgery.   

How considerations and the management plan differ in children, teenagers and adults. A podcast between orthodontist Dr Andrew Chang and pediatric dentist Dr Diane Tay that covers the issues in detail.   Dr.Andrew Chang: Diane, welcome, it's nice to have you back on our podcast. Dr. Diane Tay: Hi Andrew. Very good to chat to you again. As always. Dr.Andrew Chang: Well, what we'd like to talk to our audience of dentists today and if there is any interested parents out there as well, but mainly for dentists. The topic of supernumeraries or what we call,extra teeth types. And we were going to focus on the area of the upper front maxilla, the upper front teeth region. So maybe Diane, if you could provide our audience an outline of the different classifications or types of uninterrupted supernumeraries that we're going to talk about. Dr. Diane Tay: Yeah, absolutely Andrew, thank you. And yes, you are right for the benefit of the audiences. We know there's many different types of supernumeraries they can be in different positions, different numbers. And so just to clarify to be, particularly, you know, a really interesting topic and there's so much to say about that, but we're just going to limit it to unerupted teeth and anterior maxilla, which is something really common and has an impact. And I think can be reasonably,picked out and you know, and noticed and managed early by dentists. So as we were saying, souvenir is basically it's just a type of dental normally in the numeric form in terms of the number. So there are different types of supernumeraries and generally overall we divide them into what we call supplemental tooth or supervisor supplemental tooth is where it actually has the exact same form, the exact same function as adjacency. Dr. Diane Tay: So they pretty much don't really have any difference in anatomical differences versus supernumerary. More so where is the tooth? It's characterized by an atypical anatomic form and sometimes they can be smaller or different in the anatomy, very very briefly and a very old classification. You can classify them into the more conical shape form, you can classify them as tuberculate or supplemental form. So it's just a different sort of classification depending on the roots. Obviously there's other kinds of which I won't go into, such as composite odontomes etc. But really important to look at them and also determine the position. So it's not just what type of supernumerary it is, but the position of the supernumerary. So sometimes they can be just in a normal position they could be inverted. Dr. Diane Tay: So those ones tend to, and we'll talk about them more but inverted do generally and very rarely they don't erupt by itself. So hence sometimes the management does become different. And being aware that generally these ones will not erupt. We need to decide whether we need to remove them pending other things, which Andrew and I will discuss, just to clarify for a lot of our dentists, because we hear commonly misused terms, but strictly speaking, mesiodens is a tooth that's located between the central upper incisors. So a supernumerary say, you know, how little or to the 11. So that would not necessarily classify as a mesiodens. So it means it's actually one that's located between the upper incisors. Dr. Diane Tay: But I guess most irrelevant in classifications. While important, I guess like you and I, Andrew are very interested in the clinical management. So what are some of the signs that are important to know? And I know from my point of view, I always think the picking up, sort of knowing our, again going all where I was going back to first principles, knowing our dental development, knowing when teeth erupt, when should they exfoliate, always will help us lead to picking up these things early. And again, the earlier these things are picked up, then management always becomes, easier, less complicated. So the first thing I always think about when I'm looking at a patient is this dentition appropriate for their age? And so if you notice that there's somewhat of a delay or a failure of eruption in the permanent incisors. Dr. Diane Tay: So let's say a patient is eight years old and they've lost the lower incisors, the upper incisors, there's absolutely no mobility in the central incisors. Or even if you may see asymmetrical eruption. So, for instance, you may see the 51 has exfoliated and the 61 is still absolutely no signs of mobility, clinical mobility. I would be starting to look into reasons as to why. There is a failure of exfoliation and failure of eruption, of the permanent incisors. Also of course I know is different, but maybe there's an extra tooth in the sequence so you may notice that there may be a supplemental 52. So again, counting the teeth and charting them properly. But another thing that really, is important also if you start noticing a large gap or a diastema between the two front central incisors, often times people tend to think, Oh look there, that must be caused by a labial frenum. And that may be the case. But for me, I always will check if there is, if I'm concerned, it's just taking a very, very simple radiograph and you might find something else that may be present there. I mean, Andrew id be really happy to hear from your perspective or clinical experience of what you think or is there any other clinical signs that you might Dr.Andrew Chang: I've definitely seen your two, the two most common ones that in my experience has been the large gap, between the front central incisors where one incisor has erupted and the other incisor has not formed. So I suppose this leads to the next question is what other, you did mention a periapical, but what other diagnostic age should a dentistfirst of all use to diagnose this? Dr. Diane Tay: Yeah, that's a really good question, Andrew. From my side of things, I guess coming from a surgical standpoint where I'm starting to think, okay, how am I going to manage this. This for me, first of all, it requires management, what do we need to do? We have to remove it. Can we wait? Can we watch and see? So I guess a simple thing which all of us in clinical practice can do to start with is a periapical you could, and I know a lot of us practitioners do have our own OPG machine, which you can do to get an overall view. However, the only thing I would probably suggest is to get a cone beam scan and again a lot of practitioners I know have their own cone beam machine. The benefit or the value of a cone beam x-ray, sorry, a cone beam scan is that it also acts as a surgical means to localize the tooth and guide surgery planning. Dr. Diane Tay: So from a surgical standpoint if I'm going in, it's good to know exactly where the tooth is and also relative, obviously how much with bone is overlying it where to position it, how easy to retrieve it, what the proximity to adjacent structures adjacent developing permanency. So these are all really important to decide on a really separate known because I do have a really keen interest in that other, you know, other in children, managing kids with medical comorbidities and certain syndromes. I think it's also relevant and important to just consider if you do take an X-Ray and you see multiple supernumerary that you have to stop thinking of other systemic causes such as Gardner's syndrome, or cleidocranial dysplasia. I know those things tend to exhibit other signs as well. However, it's just valuable to start thinking about things. And that was just a really side comment I thought I'd make off the top of my head. Dr.Andrew Chang: Yes, yes. All clinical clinician. And I think I do recall with an opg, if it's outside the focal trough and there's multiple supernumeraries, that may not necessarily pick that up. Is that correct? Dr. Diane Tay: Yeah thats right. So, which is why I think a periapical is used if you're concerned that there may be another, you can always do that simple SLOB rule, have a look in and do a few angles to get, but I guess a cone beam CT, which is very easily obtainable these days,and the radiation is very low and comparable now. It's a worthwhile x-ray or diagnostic film to get so you can also use it for your surgical planning as well. Dr.Andrew Chang: So to recap for dentists, if you suspect there's a supernumerary, i.e as in you see a large gap between their front teeth or delayed eruption, you would take a screening, a x-ray like a periapical. And if one is considering in terms of the surgical management or in terms of how do we go about approaching this orthodontically then it would definitely need a CT. From my perspective and what I look at, I definitely require a CT to locate the tooth, so we can see in terms of is it close proximity to the developing adult teeth. Let's say if it's the upper central incisors, which may not be able to erupt because there's an impediment with the supernumerary and the permanent central incisors from erupting. I would want to make an assessment, well what is it's proximity because that would be an indication of what are the risks associated with the exposures in terms of with the surgeon accessing that area. And also in terms of moving that central incisor down. Having a CT provides three dimensional information that it goes far beyond what an OPG can provide. Dr. Diane Tay: I think cone beams are definitely coming up in terms of not being diagnostic and clinical management. Dr.Andrew Chang: So I suppose it now leads into the you did raise an important point. One of the things that you had talked about with the classification, these uninterrupted supernumeraries is that they often atypical as in, does that mean that the crown is usually not like a normal size is usually perhaps smaller or a a funny shape perhaps? Dr. Diane Tay: Yeah. In my experience, usually the unerupted supernumerary tend to be very, they have a very clinical form, the smaller and oftentimes when they're inverted, as I said, they don't actually, they won't erupt until, I guess it is. I tend to advise parents that these are probably the ones that will need to be removed. But again, that goes into looking at what other factors to consider. Dr.Andrew Chang: I suppose this is now a segue into this topic. So we've located the Supernumerary. What are the implications of having a supernumerary and what happens if we don't do anything? What may happen? Dr. Diane Tay: Because parents do want to know, they want to understand, do we often question is really do I need to remove this as is not causing a problem or my child has not complained. What do I need to know? When should I look at managing it? I think the important thing with supernumeraries is because generally of where they are located, they can or tend to cause failure of eruption in incisors, eruption of the permanent and you know, usually the central incisors and sometimes they can also cause ectopic positioning and movement of the permanent teeth or displacement in some way of, of adjacent teeth. And sometimes I've also seen supernumeraries that do not impede the eruption of the permanent teeth. Dr. Diane Tay: And parents say the permanent teeth are coming out. Do I really need to remove the supernumeraries cause it's clearly not blocking the way. However, you also have to consider from an orthodontic, and obviously we value your opinion but from an orthodontic perspective, can supernumeraries interfere with orthodontic teeth movements? And that's where, for me, I always tend to work with orthodontists to treatment plan these things. And I think you and I, Andrew had worked in a few cases very successfully together. Dr.Andrew Chang: I have. So I should talk about in terms of three patients I can recall on this one was that we collaborated on where the supernumerary or that extra tooth was what we call incisal to the adult developing adult front tooth. So it was clearly in the path of the erupting tooth. And,fortunately one of the things is we got to that early. Generally, If the root of the adult front tooth has fully formed, there's a lesser chance of it wanting to erupt by itself. So it becomes a balance of well, do we go in soon knowing that the root of the front tooth has not fully developed, possibly it may be risking its root development by doing this surgical exposure, or do we wait and let the root form a bit longer and then do we expose it,remove the supernumerary and expose the tooth at the same time. Dr.Andrew Chang: So generally, we normally would like to have at least half to two thirds root formation on that central incisor before I go in, as I don't want to make a surgical intervention too early, in terms of removing that supernumerary,if I felt that there was a high risk of interfering with development of the upper central incisor root. Dr.Andrew Chang: In another case where we collaborated. In this case, the girl was a bit older. She was about, 9 if i recall. So,the root was literally almost fully formed. So in this case we made a decision to remove the supernumerary and expose the central incisor at the same time. There was another instance where I saw another patient who was a slightly younger and we clearly had enough space for the adult, cetral incisor that to come down. And I can't exactly recall, it may have been a mesiodens right in between or may have been a supernumerary. But in that instance she had the mesiodens removed and the central incisor erupted without orthodontic intervention. Dr.Andrew Chang: And the last patient that I can recall quite clearly is an adult where the supernumerary in this case it's probably a mesiodens where it was right in between the two front teeth. It was actually located incisal to the upper permanent incisor. So the tooth was inverted and was conical in shape exactly what you described. And it was actually right below the nasal floor. So being an adult, she's very wary of having that removed, so the consideration for orthodontics is would its presence interfere with the zones of movement or the boundaries of movement of the teeth. Dr.Andrew Chang: And in this case we took a cone beam CT & we've verified that supernumerary was actually quite high superiorly and along the palatal aspect and we determined that at that point in time we would be monitoring with another CT in 12 months time, and as you may understand she was very hesitant about having the supernumerary removed. So we went through a discussion of the risks and benefits, the pros and cons,but because it was quite high up, d after running through that with her, e made a decision together to review that in 12 months time with another cone beam CT. Dr. Diane Tay: Yeah i think that explains things really well. You have a really good point about all of them. Dr.Andrew Chang: I mean there's one other thing in terms of implications of having an extra supernumerary is sometimes leaving it too long can lead to displacement, not just of the central, but it can also lead to displacement of the lateral incisor, which may be impeded in its eruption. So depending on where that location of that supernumerary is keeping it in there, f it's located incisal to the adult upper incisors is probably not something I would do, indefinitely, ue to the effects on eruption of the adjacent teeth there. Definitely, if you're going to monitor that, it will need closely monitoring and at some point you need to make a decision to have that supernumerary removed. And working in conjunction with in this case a surgeon or a pediatric dentist and an orthodontist is definitely very helpful as a team effort. Dr. Diane Tay: Absolutely. No, Andrew, I think your cases really classify and very well illustrate what we were looking at and talking about before. So what are important things to consider when we're managing supernumeraries because identifying it is easy, but what are you looking at when you're thinking about how to manage it? So, I mean from my perspective as you correctly saying you illustrated it again, you know, across your cases, the age of the patients shouldn't just be a guide, because we're looking at the root development stage of the permanent incisors. So you're weighing up the risk benefits of surgery of damaging developing permanent teeth & waiting too long and impeding or preventing the spontaneous eruption of the permanent incisors. Dr. Diane Tay: You also have to think and consider as we discussed, the number of supernumeraries, the position, where is it, is it inverted, what type of supernumeraries and which is why we say use the cone beam to determine exactly, the locality and the position and, and proximity to adjacent teeth, we have to consider which tooth is it around, is it an erupted supernumerary or unerupted supernumerary? And also what are the parents' expectations? What's the occlusion like? Is this, you know, is this child likely to require orthodontic movement of teeth so is it something, can you leave it or monitor it. So is the supernumerary actually causing ectopic or displacement of the permanent teeth? In which case then you may need to consider,acting and being more proactive in your approach. Those are some of the things I'll be be thinking about. Was there any other points, Andrew, that you'd like to get from your clinical experience? Dr.Andrew Chang: I think if we had to list out the factors which we covered on, all we touched on. One was the, the age of the patient. We talked about in a child, we also talked about it as an adult. As we talked about it, I can recall a teenage patient who also had a supernumerary where he was in his permanent dentition and he was about 13 or 14, and most of the supernumeraries that I've had in the anterior maxilla tend to be slightly along the Palatal. And I can recall because this patient, while he had crowded teeth but his upper front teeth were also,proclined as well. And when the mum went to see the surgeon because of where the supernumerary was, it was located apical but close to the apices of the permanent central incisors. Dr.Andrew Chang: But because the surgeon mentioned there is a risk of the upper front teeth losing their vitality or nerve, and in case what it means by that if there's any parents listening to this, is that nerve could suffer and a tooth may die or darken, in which case he may require a root canal, as a complication of surgery to remove the supernumerary tooth. But because of that risk, the possibility of that risk, they held off removing this supernumerary. And because the supernumerary was lying more a bit more palatal, we could not bring his upper front teeth back. So we kept them at a forward inclination. In other words, the upper front was sloping forward. So while his teeth were crowded, we straightened them. We didn't really bring them back but of course, then we came to a point where I said, well, we can't move it back. She wasn't happy with the current smile either. Dr.Andrew Chang: So at the end she made a decision, yes, the risks, but based on what the surgeon said, the risk was actually very small. So she went back to the surgeon and found out the risk was actually very small. So then she said, well I made a decision, I mean it's a balance of benefits versus risks. Okay, we'll have that supernumerary out,and turn out in the end the upper central incisors were fine, the vitality was fine and we managed to move the upper adult front teeth back and correct the protrusion and he is very close now to getting his braces off. So it's a balance of where, when we talk about for teenage patients, it's more getting the orthodontist involved and in terms of where the movements of their adult teeth are going to go and would the presence of the supernumerary interfere with them getting an ideal treatment outcome in terms of their smile & orthodontic correction for teenage patients. Dr.Andrew Chang: That's a main consideration for the adults of course there's often may be other medical histories that may affect in terms of surgical risk, and would involve maybe a closer conversation with the oral surgeon. Often adults,need to be more aware of the situation and they tend to be less inclined doing invasive surgery,particularly if its quite high. If a decision is made to keep a supernumerary, close monitoring is important and if the patient goes and for some reason doesn't come back, they need to be aware of that, that a supernumerary needs to be monitored because in a very, very small number of cases there can be cases of cysts. I mean the possibility is very small. It's just something that the patient needs to be aware about. Dr.Andrew Chang: So is there any other important factors I suppose to consider if we had to list it out, we've already covered root development, child, teen and adult management, is this a permanent incisor or primary incisor? Is the supernumerary erupted or non erupted? I suppose the good thing is nowadays with a CT you can easily see the shape and the size and the widths of the supernumerary. Some supernumeraries are generally smaller in size as we touched on. Very briefly and I know this is not really the topic on this podcast it becomes a bit harder when it's a supplemental, when a tooth is already erupted and is quite close in shape to the other incisors. Dr.Andrew Chang: One of the things that I'm inclined to look at is the width, but also the root formation and because sometimes some supernumeraries may have dilacerations in terms of root or dens in dente associated with them. So there's something that I'll be looking at quite closely, in terms of their pulpal status, but the main decision is which tooth could look nicer, both on the clinical point of view or aesthetic point of view and has got a good pulpal health as well. The other consideration for important factors is root development stage. And I know we touched on the risk of surgery and the position of the adult incisors, is a supernumerary causing displacement of the other incisors , patient factors: cooperation and the parent factors as well. Is there anything you want to elaborate on Diane? Dr. Diane Tay: No. Covered points very, very thoroughly and exactly what you're saying with looking out for these things. I think that's a key to success and management of the case. Dr.Andrew Chang: We've touched on these management options earlier by talking about these case studies, but could you briefly outline the management options if you haven't covered any of it? Dr. Diane Tay: We pretty much covered it through our discussion on the cases. But I guess to just really summarize it, mainly first if the option is to monitor, say maybe because the child's only three or four younger, we're waiting to decide what we're going to do or versus if the patient's older to say, then monitoring closely, ensuring you get appropriate radiographs just to manage monitoring for any specific changes such as cone beams would be very good and very clear x-rays or scans. So sometimes it may just involve simple surgical extractions. Dr. Diane Tay: And then let's say the child is six, six and a half, seven, and we know this, a supernumerary that's impeding the eruption of the permanent incisor and you have an over retained say 51 or 61. So you'd want to remove the primary incisor as well as the supernumerary and then monitor the eruption of the permanent incisors. So this would obviously be, and I often at times in the cases I've done before, work together with the orthodontist to determine and finalize the treatment plan: So if I'm going in surgically knowing whether we're just going to monitor the incisor based on the root development as you correctly say Andrew, we're looking at the root development if its about half to a third of roots. Dr. Diane Tay: However, conversely, if the roots, let's say this has been picked up and now the child is 10 or 11 years old and the root of the permanent incisors have already formed, then sometimes what we'll need to do is in addition to removing the supernumerary and the retained primary incisor, then we would really would be looking at doing a surgical exposure and potential bonding of the tooth orthodontically, to bring the tooth down into the arch. Oftentimes I get them to see the orthodontist first to lay down those braces archwires. And prior to surgery, was there anything else Andrew you'd like to add to that? Dr.Andrew Chang: I think we covered that really well. And it's really nice to have you on Diane and I hope the audience took something away today. Dr. Diane Tay: And thank you so much for listening again, and we will have more interesting topics to discuss next time. Thank you.  

Dr Diane Tay and specialist orthodontist Dr Andrew Chang discuss an interesting topic for dentists on impacted canines in children and early teens. 0:34 There can be a number of implications if impacted canines are not picked up early. Main causes of impacted canines include crowding and genetics. 2:17 A simple definition of an impacted canine is a canine not sitting in the right position and becoming 'stuck'. Affecting the eruption path. If an OPG is taken and there appears to be overlapping. 3:00 Clinical signs to consider include, average age (9-10yrs), feeling of canines, OPG results, flaring of canines, crowding, lateral spacing, assymetrical exfoliation, positions of teeth appropriate for age and a primary canine still present. Aim is to normalise path of eruption. 11:52 Depending on severity of case early interceptive is a way to present surgery and lead to spontaneous eruption. Age has a big impact on successful results. 13:40 Best age to intervene is between 7-9 years. Start with an orthodontic assessment as the more simple orthodontic treatments work best in younger people. 15:25 Dr Chang discusses two patients. A 9-10 year old boy who had a canine that was almost horizontal and was treated in 7 months. Then a teenage girl who had a 4 year treatment plan. 16:55 When impacted teeth are not treated early there can be bone defects and full root development, that will effect spontaneous eruption. Correct timing is critical. 18:55 To manage an impacted canine we need to assess the case and the severity of the impacted tooth. Consider age and cooperation of child, angulation of tooth, collusion of teeth then develop a treatment plan in conjunction with an orthodontist. Surgery and extraction may be required. New treatment options like orthodontic micro screws can be considered. 23:34 Monitoring patients needs to be kept to a minimum to avoid missing the opportunity for less complex treatments. If unsure, you can always check. Irregular dental attendees should always be referred. Dr Diane Tay and Dr Andrew Chang look forward to their next discussion. 

In this podcast for parents of children and teenagers, kids dentist Dr Diane Tay and orthodontist Dr Andrew Chang talk about Stuck "Fang" or Canine Teeth. How parents can identify them, Problems they cause and how seeing an Orthodontist from 7-9 years old helps. Highlights are: 0:53: How to identify if your child has a stuck "fang" tooth, and why it is important to be detected early. 2:20: Canines erupt normally between 10-12 years old and canines that are delayed erupt later. 2:45: Delays in loss of baby canine teeth falling out or signs of overlapping teeth can lead to stuck fang teeth. 3:55: Stuck fang teeth usually do not have any pain but are difficult to brush. Bleeding gums are also common. 5:30: Other signs of a stuck fang tooth are where an adult canine tooth has erupted and the baby canine tooth on the other side is still present for a very long time. 6:00: What are the problems with stuck adult canine teeth? Stuck canine teeth can eat into adjacent teeth and permanently damage them, as well as causing lengthy and complex orthodontic treatment. 8:35: So I've identified a stuck canine tooth in my son or daughter, what should I do? Seeing an orthodontist early is important. 10:00: Dr Chang shares stories of stuck canine teeth in 3 separate patients where: 1. Early orthodontic treatment with an upper plate in a 10 year old allowed the wonky canine to come down by itself. 2. a teenager where the wonky canine had already damaged neighbouring adult front teeth 3. By seeing and managing a wonky canine early in a 9 year old, the wonky canine which was pressing unto the front adult teeth, moved safely into its correct position in 7 months. 13:30: Assessment by an orthodontist from 7-9 years old is helpful and recommended. 

If you are a parent of children, an orthodontic assessment for children from the age of 7-9 years can help detect and manage early crowding problems before they become more severe and difficult to treat. The topic of abnormally erupting adult 1st molars is one example of this, and where this problem can worsen with time.  Below is a podcast for dentists on this topic.  We welcome back kids dentist Dr Diane Tay where orthodontist Dr Andrew Chang and her discuss the topic of abnormally positioned adult 1st molars. This can often be seen in 7-9 year old children where an adult molar is taking a very long time to come down. Highlights include: 0.50: How can dentists identify an ectopic permanent 1st molar? 3:00: Is the dentition (developing teeth and their eruption) appropriate for the age? Consider the general timing of eruption patterns and symmetry. 4:26: What are the causes of Ectopic adult 1st molars? Most are mesioangular and usually they are upper teeth.Typical clinical presentation is described and almost always leads to space loss. The baby 2nd molar often can become loose and fall out without any pain. 7:20: If left unobserved, space loss can get more severe and lead to impaction of the underlying adult 2nd premolar.  8:00: No consistent pattern seen in causes. Look at OPG x-ray to check for age and symmetry. 10:00: Why dentists play a very important role in early detection of ectopic 1st molars, and early referral to a specialist orthodontist and how late detection makes orthodontic treatment longer and more complex. 11:30: What considerations to look out for when managing ectopic 1st molars.  - Age and Cooperation - Occlusion. Is crowding present? - Is it an upper or lower 1st molar? -Is the permanent 2nd premolar present? - Patient factors: Severity of impaction of molars. For  16:30- For mild impactions, can place elastic separator. For moderate to severe impactions, consider a metal separator, over a period of 3 months. 21:00- For severe 1st molars, upright these teeth first, using an expander or one with a Haltermann loop. If narrow jaw, combine with expansion. 24:30- Does disking of baby 2nd molars work? 26:00- Why close monitoring is needed, to monitor the ectopic 1st molar, and let the parent know what can happen if the child fails to attend final observation checks.  Dr Andrew Chang principal orthodontist of Smiles & Faces Orthodontics and his qualified caring team has been creating beautiful healthy smiles for the Western Sydney community over the past 10 years. For more information, please visit

In this 2nd part series, we talk further about how are space maintainers placed, cements used, chairside techniques to which space maintainers are made, when should they be placed, and why dentists play a very important role in early identification of the need for a space maintainer. We also talk about what severe space loss can do to the underlying adult teeth, ectopically erupting deciduous 2nd molars, space regaining techniques, and troubleshooting the most common space maintainer issues.  Highlights are: 1:15: How are space maintainers placed? 2:20: What cements are used to seat space maintainers and how to incorporate this as a fissure sealant? 4:40: Dr Tay shares thoughts on whether impressions are needed for space maintainer. 5:20: Dr Chang shares 2 different methods by which space maintainers are made. 7:45: How soon should a space maintainer be placed after a baby tooth is removed? Why it should be soon after otherwise space regaining techniques would be needed over just regular space maintenance. 10:50: Why dentists play a very important role in early identifying the need for a space maintainer. Dr Chang shares more complex space regaining methods once space loss has been a mild to moderate amount. 12:10: What severe space loss can do the the underlying adult teeth that is yet to erupt and potential complications that can happen to neighbouring adult teeth. 13:50: Ectopically erupting baby molar teeth underneath adult 1st molars. 14:30: Space regaining if needed, is often followed up by a space maintainer after. 16:10: Space maintenance also important to prevent need for balancing molar extractions. 17:05: What things to look out for when placing space maintainers in the mouth. 19:45: Minor diet modifications required when fixed space maintainers are placed. 21:40: Troubleshooting the most common space maintainer issues. 

In this 1st part podcast, pediatric dentist Dr Diane Tay and orthodontist Dr Andrew Chang talk about space maintainers in children. When are space maintainers placed? Types of Space maintainers? Highlights are: 1:30- Are space maintainers always required when a baby tooth is removed? 2:50- Why the age of the child is important when determining the space maintainer management plan. 3:40- Distal shoe space maintainers. Dr Tay and Dr Chang share their thoughts on this and discuss alternate options to manage this. 7:00- Dr Tay shares what considerations to look out for when placing a space maintainer. 9:38: Dr Chang shares his thoughts on when to place a space maintainer and his preferred design. 12:00- Does a space maintainer need to be placed when a 1st primary molar has been removed? 14:55- What types of space maintainers to place if the 1st permanent molar is partly erupted and the 2nd primary molar has been lost? 17:00- Dr Chang shares his thoughts on other indications of space maintainers and timing for placement where need to hold the leeway space, and design of different types of space maintainers and when. 20:00- What are de novo space maintainers? Visit for more information about Dr Andrew Chang. to learn more about Dr Diane Tay  

Some highlights are: 1:00: What are some causes of a baby tooth to be lost early? 3:47: What are signs parents can look out for that suggest a baby tooth has been lost early?  4:50: Other causes of losing a baby tooth early 6:45: What are the side effects when a baby tooth is lost early. 7:10: How future orthodontic treatment can be made more complex from a baby tooth lost early, with increased risk of cost, surgery and prolonged treatment times. 10:50: Why spacers (space maintainers) can help. 11:20: Spacers are comfortable, with minimal effects on speech and easy to keep clean. 13:50: How long does a spacer stay in for?

Excerpts from this PODCAST between orthodontist Dr Andrew Chang and pediatric dentist Dr Diane Tay are: 2:00- Well positioned baby teeth or crowded baby teeth are a concern. 3:00- Adult front teeth erupting behind baby teeth are a sign of crowded adult teeth. 3:50- Baby teeth nice and straight in a 4-6 year old are a sign of crowded adult teeth in future. There should be gaps between the baby front teeth. 4:50- Does removing baby teeth when baby teeth are crowded help to allow adult front teeth to erupt? 5:40- Crowded baby teeth in a 6 yr old is managed differently from a 10 yr old. 7:20- Does removing baby teeth early or late affect how the adult tooth comes through? 8:00- For front teeth, some improvement can be expected but it would not come into alignment. 8:40- In a 10-12 yr old, when you see double rows of baby and  adult teeth, removing back baby teeth would help with the adult teeth erupting. 9:40- For front teeth, removing a baby front tooth early often "robs Peter to pay Paul" later. 10:40- For shark teeth, space maintainers or expanders are a useful tool to gain more space for adult teeth to erupt when the mouth is crowded. 11:20- My child's teeth are crowded. When is the right age to see an orthodontist? 11:50- Why 7-8 years old is an optimal age to see an orthodontist.

Dr Chang, orthodontist at   does a deep dive with Dr Tang, periodontist at Blacktown Specialist Dental into causes, treatment and options for middle aged adults with crooked teeth. Some highlights are: 1:24: What is gum disease? 2:11: What untreated gum disease can lead to and why gum treatment before starting orthodontics is important. 3:56: Does gum disease affect 1 tooth, a few teeth or most teeth? 5:01: Why gum disease is best treated early? 5:31: Dr Chang shares a personal story on why teeth are important during the middle aged years. 6:56: Can brushing teeth well prevent gum disease? 7:26: Why severe gum disease is best treated with your periodontist or general dentist. 9:31: If I have gum disease and crooked teeth, how soon can I have my teeth straightened?  11:01: Role of smoking in gum treatment and response to gum treatment. 12:26: What are the teeth straightening options for adults with crooked teeth and a past history of gum problems? 13:26: Why periodontists prefer aligners over braces as the preferred method of teeth movement. 

Kids with Special needs Needing Dental Treatment or Orthodontics Notable excerpts from this podcast are at: 3:02- What pediatric or kids dentists do first when seeing kids with special needs? 4:22- What options are available for anxious kids requiring dental treatment? 8:02- What orthodontists can do for children with special needs and whom can benefit from orthodontic treatment? 9:42- The 3 goals that guide our orthodontic treatment planning and decisions. 10:12- Why the best treatment solution is often in collaboration with parents. 10:32- Orthodontic treatment options for children with special needs. 14:17- Best solutions arise from helping parents to make a guided informed decision in collaboration with the parent, doctor and the child. For links to other podcasts, check out our and leave us a review there.

This episode was recorded in early January 2019 but due to commitments, released in early Feb 2019. The aim is to bring awareness to parents of overbites and what may happen if overbites remain uncorrected. See below for contents to scroll to the podcast section topic that may interest you. 1:00: How can a parent know their child has a large overbite? 2:20: What are the problems that an overbite can cause? 3:00: What habits can cause an overbite? 4:45: Why overbites rarely self-correct? 5:25: When is the right time to correct an overbite? 5:55-8:10: What strategies can parents do to address habits that cause an overbite to worsen? 8:20: Positive reinforcement works better when addressing finger and thumbsucking habits. 9:25: Teeth injuries can be one of the greatest long term problems caused by an overbite. 11:25: Orthodontic treatment options to manage an overbite. 13:00: Orthodontic treatment success depends on cause of the overbite. 13:40: Treatment complexity may increase with age, so timing of treatment soon with large overbites is important. 14:50: Summary

We would like to welcome back kids dentist, Dr Diane Tay, where I chat with her about soft or weak enamel in children. In some children, as the adult teeth come through the gums, they have visible white and or brown spots on the teeth. These teeth can be sensitive and can break down very quickly over a course of 6 months. Highlights of our talk are as follows: 3:15: Which teeth are usually affected? 4:00: What is the problem with soft/ weak enamel teeth? 4:25: Why early identifying these teeth soon is important, and why the back molars are much more badly affected. 7:25: Problems trying to fix these soft/ weak enamel teeth. 8:55: Why they usually affect the 1st molars much more than the other molars. 9:30: Why involving an orthodontist is beneficial to allow optimum planning to keep as many sound and healthy teeth. 11:40: Good brushing and avoiding sweet sticky foods and fizzy drinks would help maintain the health of these teeth. 13:50: What causes this? can this be prevented? Why early detection and seeing a dentist soon is important to strengthen these teeth.

Other topics covered are: Do all wisdom teeth need to be removed? Is it better removing wisdom teeth sooner or later?  Do all wisdom teeth need to be removed?  For those of you considering orthodontic treatment, I also cover should wisdom teeth be removed before, during or after braces. What is the difference between seeing a dentist or an oral surgeon to remove wisdom teeth.  For more information about orthodontic treatment, braces, Invisalign or hidden braces, visit here.  

In this episode, topics covered are: What is an orthodontist? What is a kids or pediatric dentist? What is the right age to see an orthodontist? What is the right age to see a kids dentist. Dr Chang chats about some of the teeth and bites that parents see which can benefit from orthodontic treatment. Some myths about orthodontics are discussed, as well as what can happen if teeth and bite issues are seen late. Dr Chang is an orthodontist who practices in private practice in Blacktown, in western Sydney. For more information, visit They also chat about what happens if a baby tooth has been lost a while and the adult tooth has not come through yet. Should a parent be worried about this? Dr Diane Tay is a specialist pediatric dentist who practices in private practice in Parramatta and St Peters in Sydney. For more information, visit  In this episode, she also chats about some common teeth issues she sees in kids including chalky teeth and teeth decay.  

Dr Andrew Chang interviews Dr Teck Tang, of the Specialist Dental Centre, Sydney. He is a well regarded specialist gum dentist, an expert in the field of maintaining healthy gums. In this Part 2, what's covered are: Waterpiks, a high speed water irrigator, a useful accessory for teeth cleaning. How our diet can play a positive role. Snacking, juice and soft drinks are discussed. How a simple modification about how we consume soft drinks / fruit juice can minimize harmful effects on teeth. Why one should not brush their teeth immediately after drinking soft drinks. What are some signs of unhealthy gums? What do bleeding gums in orthodontic treatment mean? Why focusing on cleaning the lower front teeth is so important when wearing braces? Why regularly seeing your dentist during orthodontic treatment is so important in maintaining healthy gums. Puffy or inflamed gums can make treatment time longer. To discover how to achieve your beautiful smile, visit us at . We also offer complimentary orthodontic and Invisalign consultations and are based in Sydney, Australia. Call us at 02-8814 9941  

Dr Andrew Chang interviews Dr Teck Tang, of the Specialist Dental Centre, Sydney. He is a well regarded specialist gum dentist, an expert in the field of maintaining healthy gums. What's covered in Part 1 are: Which is better? A manual toothbrush or an electric toothbrush during orthodontic and Invisalign treatment? What type of electric toothbrush should I consider getting? Why a soft bristled toothbrush and small toothbrush head size is important. How often should a toothbrush be changed? Does the tooth paste type make a difference? Whitening, Fluoride, Charcoal toothpastes and toothpastes for sensitive teeth are covered. Why herbal toothpastes are not suitable. Why other brushes should be used in addition to your toothbrush like piksters and superfloss, when you are having braces.  To discover how to achieve your beautiful smile, visit us at . We also offer complimentary orthodontic and Invisalign consultations and are based in Sydney, Australia. Call us at 02-8814 9941

In this podcast, Dr Andrew Chang introduces Dr Rochelle McPherson, a leading professional in the field of Oral Facial Myology. The podcast also goes into child thumb sucking how parents are able to help their child stop this habit. Main Sections: 00:00 Dr Andrew Chang Introduces Dr Rochelle McPherson 00:51 Dr Rochelle McPherson introduces both herself and Oral Facial Myology 01:30 Buck teeth and a child's thumb sucking habit. What are ways to prevent this? 04:30 Negative reinforcement is shown not to be a great way to stop thumb sucking. Use positive reinforcement instead. 05:00 Dr Rochelle McPherson gives personal insight into how she helped children stop thumb sucking. 07:05 How to tell the kids about thumb sucking and its negative impact on their teeth 09:10 Dr Andrew Chang gives his personal insight on giving children positive feedback to stop thumb sucking. 10:00 Dr Rochelle McPherson gives more advice such as giving children quit days. 12:30 Using rewards for kids and will it work for them? 15:44 The importance of stability for children and their development 16:25 How long will it take for the child to break their habit? 19:35 Importance of observing the environment and how it may impact the child's habit. 21:05 A summary of the previous points. 22:50 Resources for more questions. To discover how to achieve your beautiful smile, visit us at . We also offer complimentary orthodontic and Invisalign consultations and are based in Sydney, Australia. Call us at 02-8814 9941

In this podcast, Dr Andrew Chang from Smiles & Faces Orthodontics talks about the importance of early underbite treatment in Orthodontics. Topics covered include: 1. Why is it important to treat an underbite early? 2. How do you treat an underbite early? 3. What is the best age to have my child's crooked teeth checked? 4. How long does early orthodontic treatment take? 5. My child is in high school. Is it too late to undertake orthodontic treatment? 6. What are the benefits in my child having their teeth corrected? For an obligation free orthodontic consultation with the Smiles & Faces team, call us on 02-8814-9941 or visit us 24/7 at  to schedule a free initial consultation appointment.

To discover how to achieve your beautiful smile, visit us at . We also offer complimentary orthodontic and Invisalign consultations and are based in Sydney, Australia. Call us at 02-8814 9941

To discover how to achieve your beautiful smile, visit us at . We also offer complimentary orthodontic and Invisalign or ClearCorrect consultations and are based in Sydney, Australia. Call us at 02-8814 9941

To discover how to achieve your beautiful smile, visit us at . We also offer complimentary orthodontic and Invisalign consultations and are based in Sydney, Australia. Call us at 02-8814 9941

In this podcast, Natalie explains how propel can be an excellent addition to your Orthodontic Treatment.

Title: Importance of Early Orthodontic Treatment: 'Buck Teeth' 'Overbite' and 'Overjet' In this 10 Minute Interview with Dr Andrew Chang, topics covered include commonly asked early orthodontic treatment questions. Why is it important to treat an overbite early? How do you treat bucked teeth ie: an overjet? Early orthodontic treatment versus orthodontic treatment later in life. What is the best age to have my child's crooked teeth checked? How long does early orthodontic treatment take? My child is in high school. Is it too late to start orthodontic treatment? What are the benefits in my child having their teeth corrected? How can I get more information about treating my child? For an obligation free orthodontic consultation with the Smiles & Faces team, Call us or 02-8814-9941 or visit us 24/7 at   to schedule a free initial consultation appointment.  Thank you for your time, we look forward to meeting you soon! For the video of this interview, visit our website at http://www.greatsydneysmiles.com.au

Here, both Dr Andrew Chang and pediatric dentist, Dr Diane Tay talk about the current issues that affect the dental world and what are the treatments for such issues.

POD-CAST TRANSCRIPT After braces are removed, removable clear plastic retainers are issued as part of your treatment to help keep the teeth straight. In some instances, a Retainer Splint may be recommended by Dr. Chang. This is ideal particularly for patients who grind or clench their teeth. Some signs and symptoms of grinding or clenching include making teeth noises at night, waking up with tender jaw muscles or headache in the morning and worn down teeth. Teeth that continue to wear down from the force of grinding and clenching are at risk of becoming sensitive overtime, and may be prone to fracture. Jaw joint problems may also develop from grinding and clenching. The Retainer Splint is made of a durable acrylic material and is ideal for long term use to protect teeth from wearing down from grinding and clenching. It also helps to keep the teeth straight. Dr. Chang will advise you if this is suitable for you or your child. If you are concerned about grinding or clenching or experience any jaw pain or discomfort, please do not hesitate to approach our staff or contact us on 8814 9941 or info@greatsydneysmiles.com.au. We can provide you with tips and guide you to get the treatment you need.

 My name is Iza and I am one of the Oral Health Therapist here at Smiles & Faces Orthodontics. In this podcast. I will talk about a bit of myself and what I do in the practice . To become an Oral Health Therapist I studied a 3 year Bachelor’s Degree in Oral Health at the University of Sydney and graduated in 2012. So this is now my 4th year in the industry. Before this I also completed a 3 yr Bachelor’s Degree in Medical Science at Sydney University and was working as a dental assistant. I absolutely love the dental industry knowing that we can make a difference to our patient’s smiles. As an Oral health therapist, I am trained to work along side an orthodontist, so I work with Dr Chang and do a variety of procedures from taking impressions, preparing for putting on braces and taking them off, helping out with braces or plates adjustments, Invisalign procedures as well as giving oral health and dietary instructions to mention a few.  As an Oral Health Therapist,I am also a dual qualified dental hygienist and therapist, specialising in treating gum conditions and oral health education as well seeing kids under the age of 18 for dental treatment.  Being a mum myself to a 12 month old, I am passionate about working with kids and helping them to feel at ease and enjoy their dental visits.   I attend ongoing dental courses to keep up-to-date and to ensure that we carry out the best practices for our patients. For our future patients, I look forward to seeing you and for those we have been seeing, it’s a great pleasure to share your orthodontic journey with you and we kindly thank you for your referrals. If you have any questions, please feel free to call our practice or email Dr. Andrew Chang, Thank you for listening.  

This podcasts is for patients who are currently in active orthodontic treatment, with braces, Invisalign, orthodontic plates or retainers. Most orthodontic breakages are not emergencies. In this podcast, I talk about some suggestions to make it more comfortable for you, the patient, if this happens and some self care tips you can do. There are also plenty of resources on our website at https://www.greatsydneysmiles.com.au/orthodontic-insights/smilesfacesblog  Disclaimer: Please note this is general advice and does not take into account your individual circumstances. Please consult a professional before doing these self care tips at home. If you like this, please go to iTunes and give us a rating on iTunes. Thank you.To your beautiful and healthy smiles, Yours Truly, Dr Andrew ChangPrincipal OrthodontistSmiles & Faces Orthodontics    

Have you completed or about to complete orthodontic treatment? Are you wearing orthodontic retainers. If so, you would find this short podcast by Dr Andrew Chang and his team at Smiles & Faces Orthodontics very useful. This is a short podcast of about 4 minutes.  Some highlights are: 1:27- Using a whitening mouthwash 3:02- How to avoid pets, particularly dogs, from chewing your retainers. Natalie offers her insights on this. 3:32- Why a clear mouthwash in better than a coloured one when cleaning your retainer Seeking more information or interested in a  complimentary orthodontic consultation on how to improve your smile? Visit our website at https://www.greatsydneysmiles.com.au      

If you are an adult or an older teenager with crooked teeth or are currently in braces or Invisalign and about to finish treatment, you would find this podcast packed with helpful tips. Dr Andrew Chang answers FAQ’s. Highlights are: 3:00- Advice to patients who have had braces before when in their childhood, but teeth have shifted. 3:43- The options available for you. Note: braces is not necessarily the only option to restraighten teeth. 5:21- What you should ask your orthodontist before you have your teeth straightened, and the main cause of teeth shifting after orthodontic treatment. 6:06- Solutions for patients to minimize teeth shifting after orthodontic treatment. 6:36- How long does a fixed orthodontic retainer stay in place. 7:11- You commitment to maintaining fixed orthodontic retainers (if you have one) 9:41- My top teeth are pretty straight, but my lower teeth are crowded. What options are available for me?

In this podcast, I interview A/Prof McIntosh, a Pediatric Ear, Nose and Throat(ENT) Specialist in Queensland Australia, on the effects of blockages of the upper airways in growing children. While this interview is more suited for dentists,members of the public may find the section on costs, and the Medicare and private health insurance rebates with an ENT consultation and ENT procedures useful (at 15:30). It has certainly impressed upon me the role of many different factors in the causes of crooked teeth, of which one of them is the airways & breathing and their influence. Some other highlights are: 3:10- When would a child benefit from seeing an ENT specialist? 3:50- What are some signs and symptoms of sleep apnoea in a child? Teeth grinding on the molar teeth is a common sign. 7:10- Options for managing upper airway blockages in children. 10:03- Why to reverse the neurological effects of sleep apnoea in children (improved mental concentration, memory and behaviour), early referral to an ENT specialist is important so the appropriate medical intervention can be assessed and undertaken early. 13:30- To significantly influence facial growth, adenotonsilectomy (removal of the tonsils and or adenoids) should be undertaken early ie: 6 years or younger.   21:30- Why sleep apnoea in adults and growing children should be managed very differently 23:20- Why functional appliances can also help sleep apnoea in the Class 2 growing child with a large front teeth overlap, and small lower jaw. 26:10- Other surgical and non-surgical methods to correct sleep apnoea (apart from removal of the tonsils or adenoids)    

Dr Andrew Chang of  interviews 2 experienced speech therapists, Julie and Celine of Western Sydney Speech Pathology and they share their insights. Some highlights are: 1:18- Effect of orthodontic appliances on speech therapy exercises. Are there any? 4:17- Benefits of seeing a speech therapist (asides from speech pronunciation) and why listening plays an important role in the correction of stuttering. 6:58- How speech exercises work and why tongue retraining exercises after the age of 5 are important for certain open bite corrections. 8:38- How to motivate older kids to complete speech therapy exercises (if they are currently in this treatment) 9:33- Speech therapy is more successful in younger children than in older children as breaking previously acquired habits is easier. 10:31- Duration of speech therapy exercises- 10 mins a day is often satisfactory 15:08- The end goal for speech pathology exercises are why setting microgoals are much more successful. 16:08- Effects of dummy and finger sucking on speech development and orthodontic development. 18:45- Cost of speech therapy, Medicare rebates and private health insurance rebates.  If you are considering having a beautiful and healthy smile, with you own natural teeth and  are yet to start orthodontic treatment, please call us on 02-8814-9941 or visit us  at http://www.greatsydneysmiles.com.au to schedule a complimentary obligation free initial orthodontic consultation.   

Join orthodontist, Dr Andrew Chang, of Smiles & Faces Orthodontic Blacktown as he shares with you 4 essential tips to completing orthodontic treatment on time or earlier. Some highlights are  0:00- 1st tip: Role of diet 2:45- Can chewing gum be eaten during braces? Which type of chewing gum is most suitable? 3:15- Which chewing gum can be helpful during braces treatment. 4:45: 2nd tip: Identifying loose braces- when is the best time for this? 5:45: 3rd tip: Good teeth cleaning habits 6:45: How to consume fruit juices/ energy drinks/ soft drinks in a teeth safe manner 8:25: 4th tip: Importance of good elastic wear (when required) If you are considering having a beautiful and healthy smile, with you own natural teeth and  are yet to start orthodontic treatment, please call us on 02-8814-9941 or visit us on  to schedule a complimentary obligation free initial orthodontic consultation.