There are many Orthodontists in Toronto. Why choose us?

Toronto Orthodontist

Since there are many Orthodontists in the GTA (Greater Toronto Area), the question sometimes arises: “Why would I drive or take the TTC to your Sheppard Avenue office when I can just walk down the street (maybe) to see another orthodontist?”

At face value, that’s a logical question.  Here’s the logical answer!

Because we are going to know one another for a significant amount of time, you should pick an orthodontist that’s going to work for you and your specific needs.

When you are comparing Orthodontic offices, here are a few things to consider:

1) Does the Orthodontist do all the work themselves?

You’d be amazed at how many practices, especially in a busy metropolitan area like the GTA, delegate the work to hygienists!  Many corporate style offices book patients in and have them turned around in the fastest time possible, sometimes without even seeing the orthodontist!  At Kellerstein Orthodontics, all the work is done by Dr. Kellerstein himself.  No part of your treatment is delegated to an assistant or hygienist, so you can be confident that you are receiving the best possible treatment from the most qualified provider.

2) Convenient appointment times to suit your busy schedule.

We often book early morning and after work appointments to suit your busy and hectic lives!  We invite you to speak with our reception to see about booking a time slot that best suits your family.

3) Cutting edge, carefully selected technology.

Dr. Kellerstein carefully selects the best new and evidence-based technologies for his patients.  At this office, you will not find every new gadget on the market until that gadget has been shown to benefit patients.  We will never try to up-sell patients with expensive technology unless it will reduce your treatment time, improve your comfort, or show some other tangible benefit. For example, we recently invested in an iTERO scanner which will be in our practice very shortly For more information on iTERO and the many benefits of 3D scanning, please click here.

4) Can you talk with your orthodontist?

It may seem like a strange question, but think about it: How important is it for you to be able to discuss your concerns and questions in a comfortable and supportive environment? Have a look at what some of our patients have to say about our service.  https://www.ratemds.com/doctor-ratings/3341855/Dr-Jeremy-Kellerstein-Toronto-ON.html

==> When shopping around for your provider, ask yourself: do they offer every “latest and greatest” invention, or is their treatment plan based on knowledge and sound medical advice?

==> Are they even a specialist?  Some braces and Invisalign providers aren’t even orthodontists but general dentists!

==> Who will provide the best possible care and who is best equipped to handle any potential problems that may arise?

When you consider that appointments on average are once every 2-3 months, traveling to see us from surrounding neighbourhoods and cities actually makes sense given all the benefits of working with our practice. So make sure you take all these factors into account when deciding about your orthodontic treatment. If you’re not sure, come meet with Dr. Kellerstein for a free consultation and see for yourself our difference!

But Doctor… I just want my 6 front teeth straightened

straighten front teeth

When patients come to my office for a consultation, the first question I ask is what bothers them about their teeth.  Almost always, the answer is that they want their front teeth straightened, preferably as quickly as possible.  They are often surprised (or even frustrated) when the plan I create for them also addresses their back teeth and their bite.

“But doctor,” they ask, “I just want my 6 front teeth straightened.  Why are you making a plan that is unnecessarily complicated and prolonged?  I don’t really care about my bite or my back teeth, so wouldn’t it be cheaper and quicker for you to just do as I ask?”

And the answer is that, yes, it would certainly be cheaper and take less time to just straighten the 6 upper front teeth.  But that doesn’t mean it would be a good idea.  You see, when we move teeth from their natural position into an artificially straight position (which is what orthodontists do), if we don’t account for the bite we could end up creating all sorts of problems.

Straightening teeth without treating the bite can create overbites, underbites or crossbites – all of which can damage the teeth.  It can cause gum problems or jaw aches.  It can cause the teeth to protrude (stick out) or slant and make the smile look unappealing.

The reason we orthodontists care about your bite is not because we want your treatment to take longer or cost more, but rather because we know that if we don’t take your bite into consideration you may not be happy with the final results, and your dental health may be negatively affected.

Unfortunately, there are products on the market that are designed to just straighten the front teeth without addressing the bite.  These are usually offered by general dentists who lack the orthodontic training to understand why they are not a good idea.  Such products include “6 month smiles” which promises straight teeth after 6 months, but makes no guarantees about the bite.  They also include Invisalign, if done by non-experts who are not able to correct bites with aligners.  Dentists offering these services don’t often explain to patients why they SHOULD care about their bite, or what can go wrong if the bite is not addressed.

In today’s customer-driven market, patients expect to get what they ask for without necessarily knowing the implications of their requests.  They may find a practitioner willing to treat only their front teeth, but eventually discover that doing so leaves their teeth in a worse state than they started with.  Think about it this way – if straightening your front teeth without correcting the bite was a good idea, orthodontists would be happy to do it for you!  We love happy patients!  But if our training and expertise tells us that doing so would not be a good idea, patients would be wise to listen.

My Child is a Thumb-Sucker. Should I Worry?

When people find out that I’m an orthodontist, they often ask me questions about their children’s habits – and specifically about thumb sucking.

Thumb sucking is common among children.  In fact, fetuses are often seen sucking their thumbs when ultrasounds are performed during pregnancy.  At a young age, thumb sucking does not pose a threat to the teeth. However, if thumb sucking continues into later childhood it can lead to orthodontic problems – namely, it can cause the teeth to become crooked, it can affect the growth of the jaws, and can cause severe problems with the bite.  The longer the habit continues, the worse the problems become and the more difficult they are to correct.  So, depending on your child’s age, thumb sucking may be more or less of a concern.

What can thumb sucking do to the teeth?  THIS:

Thumbsucking
The bite of a 14 year-old thumb sucker – note the extreme mal-alignment and lack of proper bite

So, should you be worried about your child’s thumb sucking habit?

Here is an algorithm to help you decide:


Don’t worry about it. Thumb sucking is perfectly normal at this age, and will not likely result in damage to the teeth or bite

Don’t worry about it.  Thumb sucking is perfectly normal at this age, and will not likely result in damage to the teeth or bite

thumbsucking-ages-_ages 3 - 5

Don’t be overly alarmed, but gently encourage your child to stop the habit, without shaming or pressuring.  If the habit is stopped before age 5, there will likely be no permanent effects on the teeth and bite.  Consider a sour-tasting nailpolish to help the child stop the habit.

thumbsucking-ages-_ages 6 - 9

Thumb sucking at this age will likely affect the teeth and bite, and the habit should be stopped as soon as possible.  Visit the orthodontist to consider a habit-breaking device (see below).

thumbsucking-ages-_ages 9 +

Thumb sucking will lead to severe problems that will require braces, tooth extractions, or even jaw surgery to repair.  Prompt action is required.


What will the orthodontist do?

If your child is over 6 years old and is having trouble stopping the habit (or sucks while sleeping), the best course of action is for the orthodontist to make a thumb-crib appliance.  This appliance consists of a metal mesh which spans the roof of the mouth and is cemented in place.  It is invisible (hidden on the inside of the mouth), and is not sharp or painful.  With it in place, if the child attempts to suck his thumb, it no longer fits comfortably in place.  And because it no longer feels soothing, the thumb sucking habit will stop. The appliance is cemented in place for at least 6-8 months to prevent the habit from recurring.  If the habit is stopped early enough, the damage that it caused to the teeth and bite should largely reverse itself, or be correctable with braces.

Thumb sucking thumb crib appliance
Example shows a Thumb Crib Appliance which is used to help children who habitually suck their thumbs to break the habit.

So whether or not you should worry about your child’s thumb habit largely depends on the age of the child.  Please use the algorithm I’ve provided, and share it with your friends.  The more parents are aware of how and when to treat thumb habits, the better the outcomes will be for their children.

Invisalign from your Dentist: What Could Go Wrong?

As an orthodontist, people are always telling me about their friends who are getting Invisalign, and often it is being done by a general dentist.  Whenever I hear such a story, I mention that I hope the person at least got the opinion of an orthodontist before starting treatment.  And my question usually elicits surprise – what’s wrong with a dentist doing Invisalign?  What could go wrong?

A lot can go wrong, actually. Invisalign is just a tool to straighten teeth and, like any tool, what matters is the skill and training of the user, not the tool itself.  Many people don’t realize that in order to become a certified Invisalign provider, all a dentist needs to do is complete a single, 10 hour course.  That’s it!  And even if dentists take a few continuing education courses in Invisalign, they still have nowhere near the training of an orthodontist, who has trained for over 3000 hours in the use of braces and Invisalign even before graduating!

“Ok”, you might ask, “dentists are not as trained as orthodontists.  But Invisalign is Invisalign, right?  What’s the difference if I get it from my dentist or my orthodontist?”  And the answer is that there is often a huge difference in the quality of the result, depending on who does the treatment.  Because in order for Invisalign to properly correct your teeth and bite, the treatment needs to be planned by a doctor who understands orthodontics.  If not planned properly, the Invisalign will not move the teeth as predicted.  What could go wrong?  Patients can end up with un-esthetic results – protrusive teeth, asymmetric teeth, teeth that won’t fully straighten, etc.  Patients can end up with gum disease, jaw aches, and unstable results.

I’ll give you an example from my own practice.  I recently got a referral from a general dentist who offers Invisalign to his patients.  He had been treating this particular patient with Invisalign for almost 2 years, and he told me that somehow the teeth were just not behaving.  He had taken multiple moldings of the teeth over the years, and asked Invisalign for corrections, but the teeth were just not getting any better.  He hated how his teeth looked, and had difficulty chewing because his back teeth did not bite together properly.  This was how the patient’s teeth looked after 2 years of Invisalign.


Crooked upper teeth.
Slanted lower teeth.
Back teeth don’t touch when biting, patient had trouble chewing.

I told the dentist that this patient would require 1-2 years of braces to correct the problem, and that it was not correctable by Invisalign.  And the dentist was shocked.  He asked me “if this case was not treatable with Invisalign, why did Invisalign accept the case?” And my reply to him was, “because Invisalign is not the doctor, they are just the manufacturer.  They rely on us to tell them what to do, not the other way around.”

And this is what is so crucial to understand about Invisalign –

it is not a magical solution for effortless tooth-straightening.  It requires the skill and training of an orthodontist to tell the Invisalign company how to move the teeth.  Otherwise, the plan that Invisalign generates might not be realistic.

What can go wrong if your treatment is not done by an orthodontist?

You can potentially waste 2 years of your life, thousands of dollars, and end up with a worse problem than you started with, as this patient learned to his dismay.

Look on every street corner and you will find a general dentist with an Invisalign sign in the window.  But if you are hoping to get Invisalign, make sure that you choose an orthodontist.  Because Invisalign doesn’t straighten your teeth.  The doctor using the Invisalign does.  Your dentist is not an orthodontist….even if he does Invisalign.

When should I ask my Dentist for a Referral?

The other day I was talking with a friend, and he told me, “I have a great dentist.  He does EVERYTHING – root canals, orthodontics, gum surgery, even wisdom teeth.”  I’ve heard comments like this before, and they make me realize that there is a misunderstanding among the public when it comes to dentistry, which does not exist in medicine.
No one would ever say “I have a great family doctor.  He does EVERYTHING – brain surgery, appendix removals, even liposuction.”  Most people understand – at least in medicine – that no one can be an expert at everything.  Family doctors have their areas of expertise, but what makes a family doctor truly great is in knowing when to refer you to a specialist to get the best possible care.  The same is true in dentistry.
Many people are unaware that specialties exist in dentistry.  Dental specialists are:
  • Orthodontists (experts in straightening teeth, correcting bites, aligning jaws)
  • Oral Surgeons (experts in removing teeth, surgery on the jaws)
  • Endodontists (experts in root canals)
  • Periodontists (experts in treating gum disease)
  • Pediatric Dentists (experts in treating children, patients with behavior problems)
  • Oral Radiologists and Pathologists (experts in diagnosing complex problems of the jaws)
These specialists are dentists who, after finishing dental school, completed another 2-4 years of additional training, specifically in managing their area of expertise.  Thus, an orthodontist has MUCH more training than a general dentist in using braces and Invisalign.  An oral surgeon has MUCH more training at removing wisdom teeth and performing surgery on the mouth.  And so, patients who require these procedures would be well-advised to seek a referral to a specialist.
So why don’t dentists automatically refer patients to specialists?  Well, many of them do exactly that.  But some dentists take continuing education courses, training to perform procedures previously only done by specialists.  And with their additional training, they don’t always see the need to refer patients elsewhere.  Or sometimes they know that a specialist will charge a higher fee for a given procedure, and they will offer to do the procedure themselves to save the patient money.  It becomes difficult, from the patient’s perspective, to know whether to ask for a referral or not in such cases.
To help with the decision making, here is a short (and by no means comprehensive) list of problems for which I would recommend that you seek a referral, no matter how much continuing education your dentist has done:
  • Extraction of impacted wisdom teeth (or any complicated extraction)  (Oral Surgeon)
  • Gum surgery, including grafts and crown lengthening (Periodontist)
  • Gum disease with 5mm or more of pocketing or recession (Periodontist)
  • Root canals of molars (Endodontist)
  • Bone grafting surgery prior to implants (Periodontist or Oral Surgeon)
  • Implant placement where more than 2 implants are to be done, or where the implants are not in the front of the mouth (Periodontist or Oral Surgeon)
  • Orthodontics of any kind, whether braces or Invisalign (Orthodontist)
Although there are general dentists who offer the above procedures in their offices, I think that in a city as well-served by specialists as Toronto, there is no good reason not to see the best-trained person for these highly complicated procedures.  Doing so will give you the best chance for an excellent result and the lowest chances of failure or complications.
You see, a dentist might pull wisdom teeth, but if something goes wrong during the procedure the patient will be sent to an oral surgeon who is trained to handle complications.  Would it not be wise to see that oral surgeon right from the start, knowing that the procedure is a complex one?
A dentist might be a certified Invisalign provider (all that takes is a single, 10 hour course), but if something goes wrong and the teeth or bite do not align, dentists often lack the training to correct the problem.  At that point, they will refer you to the orthodontist you could have seen to begin with, and perhaps avoided the problem altogether.
Dentists are your first line of defense against problems of the teeth and mouth.  They are an integral part of your health-care team, and are the people best suited to help you with cavities, mild-to-moderate gum disease, dealing with missing teeth, and handling esthetic concerns in your mouth.  But for patients with more complex problems of the mouth, seeking a referral to a specialist is just as advisable as seeking a referral to a medical specialist for any other part of your body.

What are the top trends in orthodontics for Adults today? Discreet.  Comfortable and Convenient.

Invisalign braces discreet
Orthodontics haven’t been just for teens or children for many many years.  It’s commonplace for adults to want treatment so that they can straighten their teeth, improve their smile and give them both aesthetics and confidence in their professional lives.  But adults have different needs when it comes to braces.  Often their daily lives are rather hectic and caring for traditional braces the same way a teenager would have to do is not always achievable with the various responsibilities they have.  This is why, while there are several options available to adults, Invisalign has become extremely popular with them.  Invisalign’s smile straightening system is extremely easy for adults to work with and has virtually zero impact on their busy lifestyles.
Patients, especially adults, expect their orthodontic options to be attractive, pain-free and easy to work with. It is precisely these kinds of demands in the marketplace that gave rise to the trends we see in Orthodontics prevalent today.  As such, the top three emerging trends in orthodontics, which drive many of the products and services available to patients  1) Discreet, 2) Comfortable and 3) Convenient
Find out how Invisalign is a market leading technology when it comes to these three orthodontic trends.
#1 — Braces have to be discreet.
Let’s face it, most adults don’t like the look of braces.  But what about if you could have invisible braces?  Invisalign doesn’t work like traditional braces which employ the use of brackets and wires to shift the teeth into position over time.  Instead, Invisalign aligners are virtually invisible (think of something like a clear mouthguard that snaps over your teeth).  The aligners are also removable and they fit snugly over your teeth, snapping into place.  As far as orthodontic solutions go, they are by far the most discreet and this reason above all else is why they are such a favourite with adult patients especially.
Trend #2 — Orthodontics have to be comfortable.
In the past, orthodontic treatment functioned with heavy forces moving teeth into place.  They were regarded as uncomfortable and something no one looked forward to going through.  That simply isn’t the case any longer.  Now you can have your teeth straightened with minimal concern for comfort as most if not all systems are designed to maximize your personal comfort.  Invisalign is by far one the most comfortable to work with.  The aligners themselves are smooth and made of a BPA free plastic that can in fact be removed for mealtimes, thus reducing both the daily maintenance required.   Not only are the aligners smooth, but they are extremely comfortable to wear, custom fit to your mouth for a very snug fit and making all aspects of hygiene a breeze.
Trend #3 — Orthodontic treatment has to be convenient.
Today’s patients need a convenient option.  No one has time for cumbersome solutions nor are they going to sacrifice their lifestyle and valuable time.  Invisalign as a concept is all about convenience. The simple fact that the aligners can be removed puts the system in a class all on it’s own.  Think about it, you can simply remove the aligners for those very special occasions, and then just snap them back in afterwards.  The system also necessitates the least amount of subsequent visits to the orthodontists office, giving you more time to address the many responsibilities of your busy day.
Discreet, Comfortable and Convenient.  These really do capture the essence of the Invisalign straightening system.   We would be remiss if we didn’t mention that the system is not appropriate for every situation though.  If you are interested in learning about whether you are a candidate for this option, contact our office and Dr. Kellerstein would be happy to sit down with you and go through all the various benefits and treatment options with you in person.

Self-Ligating (“Speed”) Braces. So what’s the difference?

With traditional braces, the average treatment time is about 18 months and for some people, that is entirely too much time wearing braces.  One of the most common questions people ask me is how they can accelerate their treatment to be finished with their braces sooner.  My answer is that we can use several new technologies to accelerate the treatment without compromising on safety or quality.  One such technology is “self-ligating braces.”

Traditional braces use tiny elastics to connect the braces to a wire that moves the teeth.  But these elastics cause friction between the braces and the wire, acting like “brakes” to slow down the movement of teeth (see video below).  With self-ligating braces, these elastics are not used and the braces are free to slide along the wire.


Listen to Dr. Kellerstein explain exactly how Self Ligating braces work in this brief video.  For more videos, please be sure to visit our youtube channel or visit our before and after gallery here to see more examples of smile transformations with orthodontics.


There are many brand-names for self-ligating brackets on the market – Speed braces, Damon braces, Empower braces, just to name a few.  They all work similarly well, in spite of what their advertising campaigns might tell you.

Now, self-ligating braces don’t always reduce treatment time – it depends on the problem being treated.  But they certainly work faster in cases where spaces must be closed – either because gaps were naturally present between the teeth, or because teeth had to be extracted.  For such cases, self-ligating braces can reduce treatment time by 4-6 months.

So if your goal is to straighten your teeth as quickly as possible without compromising on the safety or quality of the finished results, talk to us about self-ligating braces.  Combined with other options such as Indirect Bonding and Acceledent, we can get you the best results in the least time possible.

So what makes your teeth crooked anyway?

We see a large number of patients who complain that their teeth are crooked and they want to have  better smiles.  Naturally they come to see an orthodontist such as myself to help correct this issue, and when they visit they often ask “so why are my teeth crooked in the first place?  What caused this to happen?  Is it genetic?”
While it’s true that genetics do play a role in the development of your teeth and if your parents had an overbite or an underbite you might very well inherit the same trait, genetics are certainly not the only contributing factor.  Some bad habits such as clenching your teeth (stress) or tooth grinding or even thumb sucking in small children can lead to tooth alignment issues.  Here are some examples:

When a child sucks their thumb: 

This tends to make the top jaw narrow and even push out the top front teeth causing them to stick out (often referred to as buck teeth).
When a child pushes their tongue against their front teeth: Referred to as tongue thrusting, this can cause pressures behind the teeth which ultimately can lead to pushing the them forward causing them to stick out.  A similar issue can arise from extended pacifier use in very small children , if not caught in time and corrected this can certainly lead to undo pressures on the jaw leading to tooth problems.

Knocked out teeth: 

Accidental tooth loss in children as may occur while playing sports, can easily lead to crooked teeth if the underlying adult teeth fail to come in properly.  This is one of the reasons why it’s so important to be seen by your dentist regularly so they can catch these things early enough to correct them and if an Orthodontist is needed, they will refer you to the office so a custom plan can be devised for you or your child.

Not flossing:

In adults, something as simple as not properly flossing can cause teeth to become crooked over time!  When deposits harden on your teeth (known as tarter buildup) this has the effect of pushing the gums away from the teeth which would be otherwise closely in contact with the teeth.  Over time, this can loosen the teeth and cause shifting.  That’s another reason why you absolutely should be regularly seen by a dentist.  Bone loss beneath the gumline (which is a serious issue) greatly contributes to this same problem because the teeth simply have less material holding them in place and they become loose and then eventually will shift.  In this case, an adult patient is likely looking at an underlying Periodontal issue and should be assessed immediately.

In summary, Prevention is key!

All these examples point to prevention being one of your biggest assets when maintaining a healthy smile.  There are daily steps you can take to ensure you have the best chances of avoiding crooked teeth.  Here’s a brief guideline that you can follow, but remember, you may just be in that camp of people that has underlying genetic predisposition to certain alignment issues that really require the assistance of an orthodontist to properly correct.

Steps to take to help reduce the risk of crooked teeth

  1. See your dentist or independent dental hygienist for regularly scheduled cleanings  and checkups.  Knowing, really is half the battle!
  2. Make sure you are flossing!  If you have children, instil in them this critically important oral care habit.  Learning it early can help save them much grief later in life.
  3. Invest in a mouthguard, for you and your child while playing sports!
  4. See the orthodontist by age 8 for a consultation in case any preventive work is needed.  Remember, catching potential issues early can help save you both time and money down the road.

So what’s the deal with wisdom teeth?

Before I place braces on any patient, I take a panoramic x-ray to assess the teeth and jaws. And almost always, I discover wisdom teeth developing beneath the gums, behind the other molars. When I tell patients that they have wisdom teeth, I often see a look of dismay on their parents’ faces. Perhaps they remember having their own wisdom teeth removed – or more likely they remember being swollen and eating mush for 3 days. They assume that because their children have wisdom teeth, they will need to get them removed. And this isn’t always true!

In the old days, wisdom teeth were a lot like tonsils – doctors removed them because they were there. But the thinking has changed about wisdom teeth over the past few decades, just as it has for tonsils. These days, we only recommend removing wisdom teeth if we see a problem associated with them or if we believe a problem is imminent. Such problems include infections of the teeth or gums, or damage to the adjacent molars.

“But won’t my wisdom teeth push my other teeth crooked?” you may ask.

And the answer is that they are unlikely to do so, because when braces are finished every patient gets a set of retainers to keep the teeth straight. As long as you are wearing your retainers, your teeth should remain straight, regardless of your wisdom teeth. Of course, if you aren’t wearing your retainer, your teeth may go crooked with or without the influence of your wisdom teeth.
So, the fact that your child has wisdom teeth developing does not necessarily mean that those teeth will need to be pulled, nor does it mean that the teeth will go crooked again unless you have them removed. Rather, the best thing to do is to see your orthodontist for yearly retainer checks, and have a panoramic x-ray done at age 16. Hopefully the x-ray will show healthy teeth developing normally, and extractions won’t be necessary. And if it turns out that the wisdom teeth have to be removed don’t worry…..they may remove the teeth, but your child can keep the wisdom ☺

Gummy Smiles, and how to fix them.

According to the orthodontic literature, a gummy smile is defined as showing more than 1-2 millimeters of gum tissue when smiling naturally. Of course, showing slightly more than 2mm of gum is not necessarily a problem, but when people show much more than that, they are often unhappy with the appearance of their smiles.

Interestingly, gummy smiles often have nothing to do with the gums. Instead, they are usually caused by excessive growth of the upper jaw. In orthodontic lingo, we call this “vertical maxillary excess.”

This can be caused by genetics, or sometimes by habits such as chronic mouth breathing or thumb sucking. The issue is not that the gums themselves have over-grown, but rather that the upper jaw itself has grown too far downward, carrying the teeth and gums along with them.


The following brief animation demonstrates how orthodontics can correct a gummy smile.  For more videos, please be sure to visit our youtube channel or visit our before and after gallery here to see more examples of smile transformations with orthodontics.

 


The treatment of gummy smiles depends on the severity of the problem. Mild to moderate gummy smiles can often be treated with braces. We place braces on the teeth, and apply an upward force to the upper incisors. This force does not push the teeth into the gums, but rather it causes the teeth and gums to move upward together, causing the upper jaw bone to remodel. This reduces the gumminess of the smile without shortening the teeth. For severely gummy smiles, we may recommend a combination of braces and jaw surgery. This type of treatment is a bit more involved than conventional braces, but the results can be spectacular, as seen in the video example above.

If you are bothered by a gummy smile, talk to us about your concerns. We can help!