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Orthodontic Blog


The Pros and Cons of Invisalign Treatment for Adults and Teens

By Orthodontics 10 Comments

Dr. Richard Chan has perfected a lot of smiles with Invisalign in Bothell, Monroe and Mill Creek, Washington as well as at his Juneau, Alaska orthodontic offices (yup, he’s an orthodontist on the move!). Considering how dedicated he is to technology, it’s no wonder he’s a proponent of the innovative treatment. However, it’s important to know that orthodontics isn’t one-size-fits-all and understanding the advantages and disadvantages of Invisalign, as well as keeping in mind your own unique needs and diagnosis, will be the key to making an informed decision about your care. This guide will help if you’re trying to determine if you should opt for braces or Invisalign.

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causes of crooked teeth

8 Common Causes of Crooked Teeth

By Orthodontics No Comments

There’s always that one friend or family member with perfectly straight teeth who never needed braces or Invisalign. It can make you wonder how that’s possible and what’s behind your own misaligned teeth or jaw.

Are crooked teeth genetic? Why do some people have crooked teeth while others don’t? Can misalignment be prevented? In this post, our Bothell, Monroe, Mill Creek, Everett and Juneau orthodontist will be diving into 8 common causes of crooked teeth and what you can do about it.

Are Crooked Teeth in Kids Always a Concern?

Before we cover the causes of crooked teeth, let’s talk about primary teeth. Parents sometimes panic when their child’s teeth aren’t straight, but crooked teeth in kids are not always indicative of a problem.

If your kiddo has crooked baby teeth, they won’t necessarily have crooked permanent teeth. This is especially true for spacing. Spaces or gaps between baby teeth can be a good thing since the permanent teeth are larger and will take up more room once they erupt. For this same reason, however, if your child has significantly crowded baby teeth, there is a chance that the permanent teeth will be crowded too.

The American Association of Orthodontists recommends children have their first orthodontic evaluation by age 7. This might sound really young, but it’s for a good reason. At this age, Dr. Chan can see how your child’s bite is shaping up. We always treat kids conservatively at our practice and most won’t need treatment right away. They’ll simply come in occasionally over the years, so we can pinpoint the ideal time for them to start braces or Invisalign when they’re teenagers.

However, if Dr. Chan does identify red flags like abnormalities with jaw or facial growth or severe crowding, sometimes, intervening early will bring about the best results. In certain cases, he may recommend phase 1 orthodontic treatment, which is when we use orthodontic appliances to guide jaw and facial growth (dentofacial orthopedics) while a child is still developing.

The goal is to correct any skeletal abnormalities and make room for the permanent teeth to come in correctly. When early orthodontic treatment is necessary, it can make later treatment easier and prevent the need for corrective jaw surgery or the extraction of permanent teeth.

Other times, if we identify myofunctional or oral habits (i.e., thumb sucking, tongue thrust, mouth breathing, etc.), which we’ll talk about shortly, we can give parents guidance on correcting the habit. Stopping the habit might not prevent crooked teeth entirely, but it may ward off more serious malocclusion (improper bite) that would require extensive treatment.

What Causes Crooked Teeth?

So, what causes crooked teeth? Here are 8 common culprits:

  1. Genetics
    For a lot of patients, crooked teeth are genetic. If one or both of your parents have crooked teeth, you could also have crooked teeth. The different types of malocclusion, such as an overbite, underbite, open bite and crossbite, while sometimes caused or worsened by oral habits, are often due to the size or position of the jaw. The size of our jaws and teeth are determined by genetics, but they often do not match each other. For example, we might get a smaller jaw from one side of the family, and then larger teeth from the other side, resulting in excess crowding. Or, if the opposite happens, and we get larger jaws with smaller teeth, then we will have excess spacing.
  2. Oral Habits
    Repetitive oral habits like thumb sucking or prolonged pacifier use, especially if the habit continues once the permanent teeth start to erupt, can also be a cause of crooked teeth and a misaligned bite. As a child sucks on their thumb or pacifier, they exert pressure behind the top front teeth. This pressure can cause changes in their palate, as well as lead to protruding or overjet teeth and issues like an open bite.
  3. Orofacial Myofunctional Disorders
    Orofacial (mouth and face) myofunctional (muscle function) disorders, such as mouth breathing and tongue posturing, are also common causes of crooked teeth. When kids have trouble breathing through their nose, whether due to an airway problem or even allergies, they may resort to mouth breathing. Chronic mouth breathing, in turn, can cause problems with their facial development, leading to crooked teeth and all types of malocclusion.
    Tongue thrust, also called reverse swallowing or immature swallowing, is when the tongue hits against or protrudes in between the front teeth when a person swallows or talks. Although the thrusting movement is not enough to cause crooked teeth, the tongue will usually stay in a forward position when at rest too, which does cause problems. Inside of the mouth, the tongue puts pressure against the teeth while, from the outside, the facial muscles exert pressure. The combination can interfere with craniofacial development and cause crooked teeth and bite issues.
  4. The Early Loss of Primary Teeth
    The primary teeth, or baby teeth, are important. It can seem like no big deal if a child loses a baby tooth early since it would have fallen out anyway, but that’s not the case. The baby teeth help with facial and speech development, aid in chewing and, most importantly, save space for the permanent teeth to come in. When a baby tooth is lost before it’s supposed to fall out, and a space maintainer isn’t placed, the remaining teeth will shift into the gap. The permanent tooth won’t be able to erupt correctly and, in extreme cases, can even become impacted (stuck under the tissue or bone), leading to crowding.
  5. Trauma
    Sustaining a dental injury like an elbow to the mouth while playing sports can displace the teeth. If not treated, not only can the one tooth become crooked, but the other teeth may shift to accommodate the damaged tooth.
  6. Not Replacing Missing Permanent Teeth
    If you lose a permanent tooth from periodontal disease, severe decay, an injury or a health condition, it’s essential to replace it with a dental implant or a restoration like a dental bridge. This is because, just like we talked about with a missing baby tooth, when you have a missing permanent tooth that isn’t replaced, the remaining teeth will shift into the space left behind. This will create changes in your bite and can ultimately cause crooked teeth.
    Additionally, since the jawbone isn’t being stimulated anymore where the tooth is missing, the body will resorb the bone. This bone loss might also impact the alignment of your teeth and even the appearance of your face.
  7. Natural Changes With Age
    As we get older, the bite often deepens and the teeth tend to shift naturally. This is why wearing a retainer after braces or Invisalign is the key to maintaining your results. If you forget to wear your retainer, over time, you will experience a relapse. Even if you didn’t need braces or Invisalign before, you might find that your teeth become crooked as you get older.
  8. Dental Work
    Improperly fitting dental restorations like crowns, bridges and fillings can have a negative impact on your bite, causing pain and reduced function, as well as misaligned teeth.

Can Crooked Teeth be Prevented?

There’s no way to guarantee that you’ll have straight teeth and won’t need braces or Invisalign. Crooked teeth and a misaligned bite often have a genetic component and, if that’s the case, they can’t really be prevented.

That said, stopping oral habits such as thumb sucking and pacifier use and seeking out treatment for issues like tongue thrust/posture and mouth breathing, can prevent some bite issues or, at least, ensure they don’t continue to get worse.

Crowding can also be reduced or, sometimes, prevented, by opting for a dental space maintainer for a baby tooth that’s lost too early or by replacing a missing permanent tooth. Lastly, wearing a mouthguard when playing sports or doing any activity that could result in a blow to the face is good practice and will keep your teeth safe and where you want them.

Why Do Crooked Teeth Need to be Fixed?

There are times when slightly crooked teeth or a small gap can add charm to your smile and might not need to be corrected unless you feel self-conscious. But, the truth is, often, crooked teeth should be fixed because:

  • Most importantly, you want a beautiful smile, and your crooked teeth bother you.
  • Some of the teeth will bear more of the brunt when you chew, resulting in excessive or uneven wear of the enamel.
  • They can make chewing difficult or painful when they are in certain wrong positions.

How to Fix Crooked Teeth

We talked about the causes of crooked teeth, whether they’re a concern in kids and why they should be fixed. Now, let’s go over how to fix crooked teeth. The first step is visiting Richard Chan Orthodontics for a complimentary consultation.

We’ll take any necessary diagnostic records, like photos and digital x-rays, and Dr. Chan will complete a thorough examination. He’ll use his findings to develop an accurate diagnosis and personalized treatment recommendations.

Treatment options could include:

  • Metal BracesMetal braces are the original way to fix crooked teeth and they’re still around today, because they’re effective. Modern metal braces are smaller and more streamlined than those of the past. They’re an excellent treatment option for kids, teens and adults, including those with severe orthodontic issues. They tend to be super popular with our younger patients who love getting to personalize their braces with colorful elastics. We have the common silver metal braces, and we also have gold braces for those who prefer them!
  • Clear BracesClear braces, or ceramic braces, work in the same way as metal braces. However, the brackets are crafted from a durable ceramic material that blends in with your smile. They’re much less noticeable than their metal counterparts. Many of our adult braces patients prefer clear braces.
  • Invisalign or Invisalign TeenIf you’re wondering how to fix crooked teeth without braces, Invisalign could be the solution. The system of clear, removable aligners is a convenient, comfortable treatment option. Dr. Chan designs your ideal smile on a virtual, 3D model of your mouth and the aligners are custom-made for you based on his specifications. As you make your way through your aligners, your smile will gradually take shape. The aligners are virtually invisible and since they’re removable, there are no food restrictions and oral hygiene is simple.Invisalign Teen works in the same way as Invisalign for adults. However, the aligners are designed especially for younger patients with features including eruption tabs to accommodate erupting teeth and free replacement aligners included in the system.

Connect with Dr. Richard Chan Today!

If you’re concerned about crooked teeth and you’re ready to find out which treatment option will bring out the best in your smile, we can help. Schedule a complimentary consultation at our Bothell, Monroe or Mill Creek, WA or Juneau, AK orthodontic offices to get started.

food you can eat with braces

60 Tasty Holiday Food You Can Eat With Braces

By Orthodontics No Comments

Whether you celebrate Thanksgiving, Hanukkah, Christmas, anything in between, or all of the above, we know one thing, the festivities will probably include a whole lot of delicious food. While this is one of our favorite parts of the holiday season, we understand that if you have braces, you might be worried you’ll have to skip your favorite dishes. The good news is, with a few exceptions, you can still eat most of the things you normally would. In fact, the team here at Richard Chan Orthodontics is sharing 60 braces-friendly holiday foods to consider adding to your menu this year.

What Food Can You Eat With Braces?

We know, we know, we promised you a list of mouthwatering holiday treats, but let’s have a quick refresher on the foods to eat with braces first. When you get your braces put on and, sometimes after adjustments, your teeth can feel a little bit tender. You’ll want to stick with soft foods, as well as cold foods and drinks, until the sensitivity subsides.

Some of the best soft foods for braces include mashed potatoes, yogurt, applesauce, protein shakes, smoothies, ripe bananas, oatmeal, scrambled eggs, and soup. When you feel ready to tackle your normal diet again, be sure to cut or break food into small, bitesize pieces and chew with your back teeth. Never bite into food with your front teeth. 

What are the Food You Can’t Eat With Braces?

There are some foods to avoid with braces (believe us, it will be well worth your amazing results!). In general, we tell our Alaska, Bothell, Monroe, Mill Creek, and Everett, WA braces patients to stay away from anything really hard, chewy, or sticky that could damage their appliances. Here are a few common holiday foods you can’t eat with braces that fall into those categories:

  • Nuts (either on their own or in foods like stuffing, pecan pie, or brownies)
  • Hard candy, such as candy canes
  • Caramel 
  • Toffee
  • Whole, raw carrots, and other really hard vegetables
  • Candy apples
  • Hard rolls
  • Hard gingerbread cookies
  • Meat on the bone (off the bone is okay)

As you can see, there aren’t a ton of holiday foods you can’t eat with braces and, in many cases, making some adaptations like taking meat off of the bone or thinly slicing raw veggies will make them braces-friendly

60 Holiday Foods to Eat With Braces


If you’re feeling bummed about not being able to eat those candied nuts this year, you’ll be happy to know there is so much more you can have! Here are 60 of our favorite holiday food you can eat with braces:

  1. Fork-tender turkey (taken off the bone)
  2. Fork-tender beef (i.e., brisket, roast beef, corned beef, etc.)
  3. Fork-tender lamb (off the bone)
  4. Fork-tender chicken (off the bone)
  5. Fork-tender pork, including ham
  6. Fork-tender duck
  7. Soft-cooked fish, shellfish, and seafood
  8. Meatloaf
  9. Meatballs
  10. Plant-based meat alternatives, such as the Gardein Holiday Roast or Tofurkey
  11. Cooked blackeyed peas, lentils, and other legumes
  12. Tofu
  13. Beans
  14. Salad (thinly slice any crunchy vegetables and forgo the croutons)
  15. Soup
  16. Stew
  17. Soft cheese
  18. Spinach and artichoke dip
  19. Hummus
  20. Pita bread, soft tortillas, or crackers that melt in your mouth like Ritz for dipping
  21. Deviled eggs
  22. Mashed potatoes, mashed sweet potatoes, mashed turnips, etc. 
  23. Baked or roasted potatoes, yams, and/or sweet potatoes
  24. Roasted vegetables (e.g., cauliflower, Brussels sprouts, broccoli, etc.)
  25. Steamed/cooked vegetables (e.g., spinach, collard greens, carrots, green beans, etc.)
  26. Creamed corn or creamed spinach
  27. Corn (take it off the cob)
  28. Green bean casserole (hold the almonds!)
  29. Sweet potato casserole
  30. Latkes
  31. Fritters
  32. Stuffing without nuts
  33. Cranberry sauce
  34. Gravy
  35. Macaroni and cheese
  36. Pasta
  37. Lasagna
  38. Tamales
  39. Dumplings
  40. Pierogies
  41. Spoon bread
  42. Biscuits
  43. Soft rolls
  44. Cornbread
  45. Challah bread
  46. Quiche
  47. Rice
  48. Cooked grains (e.g., barley, farro, etc.)
  49. Eggnog
  50. Cider
  51. Hot chocolate
  52. Soft-baked cookies (yup, that includes gingerbread cookies)
  53. Plain chocolate 
  54. Brownies without nuts
  55. Cake
  56. Pumpkin pie, apple pie, and any other fruit pie
  57. Cream pies
  58. Ice cream
  59. Donuts
  60. Pudding 

This isn’t an exhaustive list and there are many more braces-friendly options. As long as something is relatively easy to chew and isn’t hard, crunchy, or sticky enough to damage your braces, you’re free to enjoy it. 

Give Yourself the Gift of a Healthy Smile

We hope everyone has a happy and healthy holiday season! And, now that you have at least 60 holiday food you can eat with braces, are you feeling ready to perfect your smile? Book a complimentary consultation with Dr. Richard Chan in Mill Creek, Bothell, or Monroe, WA or Juneau, AK.

why do braces take so long

Why Do Braces Take So Long?

By Uncategorized No Comments

These days, you’re able to use a search engine to find the answer to almost any question in seconds, you can reach family members who live across the country instantly with a text message, and you have the ability to buy things online and have them arrive on your doorstep in a day. Considering we’ve become accustomed to getting what we need at lightning speed, the process of straightening your teeth with braces can seem long.  Read More

invisalign overnight

Can I Just Wear My Invisalign Overnight?

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Invisalign® aligners are virtually invisible, comfortable and removable. Most of our Alaska, Monroe, Bothell and Mill Creek Invisalign patients love these benefits. However, for some, remembering to put the aligners back in after removing them, taking them in and out in public, and keeping track of them is a struggle. This is why we’re occasionally asked: Can I just wear my Invisalign overnight? Will my aligners still work if I don’t wear them for the prescribed amount of time every day? At Richard Chan Orthodontics, we have answers! Read More

invisalign gap teeth before

Can Braces or Invisalign Fix Gaps Between My Teeth?

By Orthodontics No Comments

One of the most common reasons our Juneau, AK and Bothell, Monroe, Mill Creek and Everett braces and Invisalign patients visit us is for spacing. Spacing, sometimes referred to as “gap teeth” in layman’s terms and diastema in doctor speak, is when there are spaces or gaps between two or more teeth. 

When it comes to how to fix gaps in the teeth, the first step is to have your smile evaluated by an orthodontist like Dr. Richard Chan. When you visit us for a braces or Invisalign consultation, Dr. Chan will perform an exam and take necessary diagnostic records in order to develop an accurate diagnosis and determine the underlying cause of your orthodontic concerns. He will then create a personalized treatment plan to close the gaps between the teeth for a beautiful, healthy smile and a functional bite.  Read More

swollen gums with braces and smiling

Why Do I Have Swollen Gums With Braces?

By Orthodontics No Comments

You’re in braces treatment, you check out your smile in the mirror, and you notice your gums look red, inflamed, and swollen. Is it par for the course during orthodontic treatment or is it a sign of an oral health issue that needs to be addressed? To give you peace of mind and help you determine what’s normal and what isn’t, our Juneau, AK, Bothell, Monroe, Mill Creek, and Everett, WA orthodontist is sharing everything you need to know about braces and your gums.  Read More


How To Floss With Braces

By Orthodontics No Comments

The Ultimate Guite To Floss With Braces

When our Alaska, Bothell, Monroe and Mill Creek braces patients first kick-off treatment, we always teach them exactly how to take care of their braces and their smile. Of course, knowing what to do and actually learning new techniques are two different things. For most people, figuring out how to floss with braces takes the most getting used to. To help give you a better idea, we’ll be sharing everything you need to know about flossing with your hardware.  Read More


Can You Drink Soda With Braces or Invisalign?

By Orthodontics No Comments

Can you drink coffee with clear braces? Can you drink with Invisalign aligners in your mouth? Why is soda bad for braces? These are some of the questions we get from our Everett, Bothell, Monroe and Mill Creek Invisalign and braces patients. While most people have a pretty good idea of the ins and outs of eating with orthodontic appliances, not everyone is as well versed when it comes to beverages. To help give you a better idea of what you should know about drinking with Invisalign or braces, we’re covering some of the most common beverage-related questions. 

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