Orthodontics for Children and Adults
1063 W Northwest Blvd
Winston-Salem, NC 27101
Phone: 336-725-5757
Fax: 336-354-4477

Frequently Asked Questions

Orthodontics involves the sciences of human growth and development. Because of this, a trained orthodontist can often anticipate later malocclusions from early signs. The American Association of Orthodontists recommends that children be seen for their initial consultation around 7 years of age, when they’ve lost their baby front teeth and the permanent front teeth have erupted.

Orthodontic treatment is best done during a child’s growth spurt in their teens. This growth is a very individual thing, with some children being ready as early as 7 or 8 years of age, while others need additional growth before starting. The average age of starting orthodontic treatment is 12-13 years old. But children who have ceased growing and adults are also able to have orthodontic treatment without the help of the growth spurt – their treatment may simply be of longer duration or need surgical assistance to achieve the desired results.

The “average” for orthodontic treatment is 24 months, but many types of malocclusions may be treated in as few as 15-18 months. Simple Invisalign treatment of mild crowding may take only a year. Dr. Shoaf will discuss estimated treatment time at your initial consultation, as it differs with the severity of the malocclusion and the goals of treatment.

Moving teeth is done by pushing the teeth against their surrounding bone, creating changes in the cell structure around the teeth. Often, patients will experience some discomfort, particularly the first few days after the braces are placed or after an adjustment. Invisalign treatment tends to create less discomfort, as smaller forces are placed on the teeth. In both cases, this aching is short-lived and easily treated with salt water rinses (1 teaspoon salt mixed in a quart of warm water; swish mouthfuls of this solution for 5 minutes 4 times a day), ibuprofen (Advils, Motrin, etc. – two tablets taken every four hours with 10 ounces of water), and even Chloroseptic spray on the gums.

As an orthodontic office, we will concentrate on moving your teeth into proper alignment. We request that you continue to see your general dentist for cleanings and checkups during your entire treatment. These checkups for cavities with your regular dentist are crucial during orthodontic treatment – the appliances make it more difficult to keep your teeth clean therefore you are more likely to develop cavities. Without good cleanings and checkups, you could suffer damage to your teeth that would require extensive repair and expense.

Flossing involves moving the floss up and down between the teeth. When you wear braces, the wires that move the teeth will get in the way of regular flossing techniques. There are special “floss threaders” that are used to get the floss underneath the braces. When you get your braces put on, we will show you how to work the floss underneath the braces to continue your good hygiene. Threaders are available at drug stores, as well as our office.

Insurance policies are chosen by employers for what they can do for their employees at a reasonable cost. Some employers select dental plans that do not include orthodontic coverage, or limit orthodontic coverage to a partial payment. There may be age limits on certain plans, or lifetime maximums for orthodontics on certain plans. Early preventive treatments that are recommended may not be fully covered by your insurance. We ask that you look at your coverage and consult your employer’s Human Resources department for details on what and how much is covered by your policy. Please remember that you are responsible for any portion not paid by your insurance.

North Carolina Medicaid is very strict on who they will cover for orthodontic treatment costs. We are required to submit your models, x-rays, pictures, and treatment plan to the main Medicaid office for approval. If they feel your case is not severe enough, they can deny treatment coverage. Dr. Shoaf has a long history of Medicaid treatment, and knows well the Medicaid office criteria for acceptance. If she feels that you would not qualify, alternatives such as payment plans for milder treatments will be discussed. For those who are denied treatment, we are happy to arrange payment plans.

Invisalign treatment is an exciting alternative to the traditional wires and brackets, and is especially attractive to adults who want to adjust their smiles without looking like teenagers. Many malocclusions can be corrected by Invisalign with a series of removable aligners. At one time, Invisalign was only recommended for non-growing patients, but recent improvements in the system now encompass more teen treatment. If your bad bite can be aligned by Invisalign, Dr. Shoaf will give you the choice of traditional or Invisalign treatment, and offer payment plans for the various treatments. Treatment can be “hassle-free” compared to traditional braces, as well as more esthetic during the course of treatment.

Often, the growth of the face and jaws does not allow enough space for late-erupting teeth to move into the correct position. These teeth may be “stuck” high in the jaws and not be able to erupt on their own. There are special “growth sacs” around these teeth that have cells that tend to multiply rapidly. Any rapidly growing group of cells could develop into tumors. Therefore, we will recommend either the extraction of an impacted tooth, or creating space to bring it into its correct position. This procedure may require an oral surgeon for best results.

General dentists are highly capable of extracting teeth that are erupted to make space for orthodontic alignment. However, some dentists choose not to do extractions, or would prefer that their patients see an oral surgeon for additional anesthesia alternatives. Other procedures are extremely complicated, and require an oral surgeon for their expert skills. We will consult your dentist and refer you as needed either back to your dentist or to an oral surgeon for any necessary procedures.

Often, there are only one or two teeth that appear to be out of alignment when someone smiles. However, in order to move the teeth into their correct positions, it is often necessary to reshape the jaws and move the “straight” teeth on either side of the “crooked” ones. If one jaw is reshaped, the bite when the teeth come together may be disrupted and the teeth may no longer chew together well. So it is often necessary to move both the upper and lower teeth to achieve the alignment of just one or two obviously “crooked” teeth. If Dr. Shoaf feels a retainer is possible, this alternative will be discussed. Invisalign treatment can also be helpful, as it is often able to make small movements over short periods of time to achieve the best smiles.

Dentists used to believe that the eruption of the third molars (wisdom teeth) caused the lower teeth to crowd together as patients grew older. However, the wisdom teeth do not have enough “pushing” power to create the malocclusion. But every time you chew, you push your teeth forward and these chewing forces can create crowding and shifting of the teeth over time. This is also why the continued night wear of retainers after orthodontic treatment is completed is recommend to counteract these chewing forces and avoid shifting of the teeth over time.

Every time you bite, you push your teeth forward. People who have the habit of clenching their teeth or grinding their teeth create even more pushing forces on their teeth. Over time, these forces can cause the teeth to shift. We recommend that patients wear their retainers 24 hours/day for the first year after treatment is completed, and then if no movement is noted, to go to night wear. Teeth will always want to move back to their old positions, so retainers should be worn for as long as patients want their teeth to stay straight.



Salem Smiles Orthodontics
1063 W Northwest Blvd
Winston-Salem, NC 27101
P: (336) 725-5757


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