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Off to the Braces


Growing up in Wilkes-Barre/Scranton, Pa., William Raineri didn’t exactly aspire to be an orthodontist. But he was certainly drawn to the idea of doing something to help others.

Dr. Raineri still remembers the swimming coach who gave him the opportunity to improve his health, compete athletically and ultimately grow into a confident teenager. Raineri says he wanted a career that would allow him to influence others just as strongly and positively.

Today, after more than 20 years in practice, Raineri is helping more people that ever, young and old, as they seek his help to gain a better smile and a better sense of self.

Once viewed as a luxury, orthodontic care such as straightening and correcting problem tooth alignment is now considered essential for improving long-term oral health. By diminishing bite problems and narrowing large gaps between teeth, patients' ability to clean tooth surface area is improved and dental problems such as decay and gum disease can be reduced, Raineri says.

Raineri, a married father of three grown daughters, began his Central New York-based career alongside Dr. Donald Baxter in Fayetteville. He now splits his time between offices in Liverpool and Baldwinsville.

He "couldn't even begin to guess" how many patients he currently has, but even a brief visit to his Liverpool office offers a hint as to why he is so busy. The office was designed as a stress-free environment for his patients, and Raineri is unflappably upbeat while talking about his work.

Q: It seems kids are beginning orthodontic treatment at younger ages than, say, 20 years ago. Is that a misconception?

A: We started seeing kids earlier, thinking that perhaps we can ward off some problems from becoming too severe. And that's true; when permanent and front teeth first come in, they can get into positions that can (do damage). They can wear enamel away or wear the gums away because of how they've come in.

A checkpoint that the American Dental Association recommends is that every child be looked at at age 7. However, not every child should have treatment at age 7. From there, we kind of generalized and thought, “If we can get the front teeth in and straight then perhaps the other teeth will come in straighter and they would need less extensive treatment and perhaps no treatment.”

But now the research is showing us that aside from some wear and perhaps some gum problems, it didn't make that much difference. They still had braces, it took just as long, and in some cases it may have been even more expensive because they had phases of treatment.

Q: So, the trend is moving away from that now?

A: I think we are picking and choosing the early treatment methods that really make a difference for kids. The ideal time for most garden-variety problems now is that transition when kids are going from their last baby teeth to the permanent teeth. We can still gain a lot of space, change bites and not have multiple phases of treatment that really are not making a difference. It's easier for kids, too. We're trying to keep it simpler for the kids because they get overwhelmed.

The other trend is we're asking kids to wear their retainers longer. Generally, once (braces) are out, you will have to wear some form of a retainer for as long as you want to keep them straight. Just as the rest of our bodies age and change, our teeth do, too. Unfortunately, they don't get better. In the 1990s we saw a lot of adults, because people who had had braces noticed the teeth had begun to shift. Before that, orthodontic patients were mostly kids.

Q: Are the reasons for seeking orthodontic care changing?

A: In general, we're seeing more crowding and overbite problems. It seems with this generation, our mouths are getting smaller and our brain cases are getting a little bigger. I don't know what the statistics are, but we as a profession are certainly treating a higher population with malocclusions. And I think cosmetic and health concerns are also on the rise.

Another thing I do see these days: We're so cosmetic-conscious, kids will come in and want braces when it's just not all that bad. And I'll have to say, "It's just not worth going through a lot of treatment for that. You won't improve them much."

Q: You've turned them away?

A: Oh, absolutely. My policy is just to be honest. If it was my kid, what would I do?

Q: And you put braces on all three of your girls!

A: We had three levels of complexity; one was cosmetic, one was totally health-related, and one was a terrible overbite.

Q: Besides braces, retainers and headgears, what other processes may be part of treatment

A: There are auxiliary appliances that "help" braces: headgears, expanders, holding arches. There are a variety of apparatus. Braces themselves have been the most tried and true method to be really fastidious in (figuring) out where each tooth should go. You can have control of each tooth and get it where it should be.

The newest thing that's developed is Invisalign. They are clear--not really braces--they're aligners. A lab will make you multiple aligners and you change them about every two weeks.

Another recommendation for growing kids is that, at times, if we can see on the X-ray that under the gum line they're growing out of position, we may recommend that some baby teeth be taken out. That often doesn't solve the problem, but it intercepts them from getting into a bad spot.

You check with the first (permanent) tooth that comes in in the front at age 7. I tend to follow kids every year (to see) if there are things to do that will get that on a better track or to head off major things. It could be simple appliance like space makers, space maintainers, headgears, or it could be selectively removing a baby tooth. The finishing appliances are braces or Invisalign.

Q: Did being a dad change your perception of what the kids go through?

A: Absolutely! There were some things in the 1980s we were asking kids to do--European techniques, some of these apparatus were amazingly complex. We would ask kids to wear them 24 hours a day for five to 10 years. When I got my own kids into treatment, I began to say, "What, are you crazy? We have to make this easier for kids."

It has to be the kind of thing where the kids come out winners. It's not going to be so easy, like getting a haircut. They hit some snags along the way and they've mastered some things and taken responsibility for their health. For many, this is the first time they are taking responsibility for their health. You really want it to be a growing experience for them.

Q: What can a parent expect at the first visit?

A: (The child will have) an examination, perhaps X-rays, perhaps pictures to identify the problem areas. The second decision is determine when to treat so the process is as easy as possible. The days of prolonged stages of orthodontics are over, thank goodness. Every case is different, and that's the most confusing part for the general public. The third thing is what appliances you will use to treat the case based on the information. What to expect as far as financial plans and insurance is also discussed.

Q: Orthodontics is commonly associated with a couple of negatives--pain in addition to high cost. Are those misconceptions?

A: Back when we had just stainless steel wires, that hurt. On a scale of 1 to 10, that was probably a 6 or an 8. With titanium wires, the forces are gentler, longer lasting, and not so abrupt. On a scale of 1 to 10 it's probably a 2 or a 3. Kids do amazingly well.

Q: Parents of young children always worry about their children using pacifiers or sucking their thumbs. Are those legitimate concerns?

A: Not all thumbs cause problems. The vast majority of kids will have the thumb (issue) dwindle away before age 10. Pacifiers? We're seeing not much change. They're not bad. If a child has an overbite, it's an overbite from their genetics. The vast majority give up those things when they're ready. We used to be quite authoritative about that and parents used to be quite guilty about it. If they are going to have problems, the thumb is often an innocent bystander.

Q: This is obviously very rewarding work. Is there a downside?

Least rewarding? I still have to put things in their mouth, it still takes time. It's still a hassle; the hassle factor is still there. I'm always wondering, "How can we make this easier?"

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