Pediatric Dentist

Patient Information

Office Policies

What is an orthodontist?

An orthodontist is a dental specialist who has undergone additional years of training after becoming a dentist. Upon completion of orthodontic training in the Harvard Postdoctoral Orthodontic Residency, Dr. Cognata has limited his practice to the specialty of orthodontics. He has many years of experience both in private practice and teaching Harvard Dental pre and postdoctoral residents in the treatment of child and adult orthodontic malocclusions, and dentofacial developmental problems.

At what age should my child have an orthodontic evaluation?

The American Association of Orthodontists (AAO) recommends an orthodontic screening for children by the age of 7 years. At age 7 the teeth and jaws are developed enough so that the dentist or orthodontist can see if there will be any serious bite problems in the future. Most of the time treatment is not necessary at age 7, but it gives the parents and dentist time to watch the development of the patient and decide on the best mode of treatment. When you have time on your side you can plan ahead and prevent the formation of serious problems.

Why is it important to have orthodontic treatment at a young age?

Research has shown that serious orthodontic problems can be more easily corrected when the patient’s skeleton is still growing and flexible. By correcting the skeletal problems at a younger age we can prepare the mouth for the eventual eruption of the permanent teeth. If the permanent teeth have adequate space to erupt they will come in fairly straight. If the teeth erupt fairly straight their tendency to get crooked again after the braces come off is diminished significantly. After the permanent teeth have erupted, usually from age 12-14, complete braces are placed for final alignment and detailing of the bite. Thus the final stage of treatment is quicker and easier on the patient.

Doing orthodontic treatments in two steps provides excellent results often allowing the doctor to avoid removal of permanent teeth and jaw surgery. The treatment done when some of the baby teeth are still present is called Phase One. The last part of treatment after all the permanent teeth have erupted is called Phase Two.

What causes crooked teeth?

Crowded teeth, thumb sucking, tongue thrusting, premature loss of baby teeth, a poor breathing airway caused by enlarged adenoids or tonsils can all contribute to poor tooth positioning. And then there are the hereditary factors. Extra teeth, large teeth, missing teeth, wide spacing, small jaws – all can be causes of crowded teeth.

How do teeth move?

Tooth movement is a natural response to light pressure over a period of time. Pressure is applied by using a variety of orthodontic hardware (appliances), the most common being a brace or bracket attached to the teeth and connected by an arch wire. Periodic changing of these arch wires puts pressure on the teeth. At different stages of treatment your child may wear a headgear, elastics, a positioner or a retainer. Most orthodontic appointments are scheduled 6 to 8 weeks apart to give the teeth time to move.

Will it hurt?

When teeth are first moved, discomfort may result. This usually lasts about 24 to 72 hours. Patients report a lessening of this as the treatment progresses. Medicines such as acetaminophen (Tylenol) or ibuprofen (Advil) are usually helpful.

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Office Policies

How are appointments scheduled?

We understand that your time is very valuable. Our office attempts to schedule appointments at your convenience and when time is available. Longer appointments, especially for the initial placement of braces are best done in the morning. This is especially true for children because they are fresher and we can work more slowly with them for their comfort. However, the majority of regular orthodontic appointments can be scheduled during the after school hours. Since we have a large adult practice as well, we are sensitive to the needs of our adult patients also. Adult appointments are available early and later in the day to accommodate work schedules and we utilize private adult treatment rooms.

Once treatment has begun, regular orthodontic appointments are usually scheduled at between 6 to 8 week intervals and may require between fifteen and forty five minutes. However, each individual is given specific attention to what they need and this may vary depending on the nature of the treatment. We make every effort to run on schedule during the day. Please rest assured that our goal is to be respectful of your time and that we will give you or your child the same individual and careful attention that we are giving all of our patients.

Since appointed times are reserved exclusively for each patient we ask that you please notify our office 24 hours in advance of your scheduled appointment time if you are unable to keep your appointment to avoid a missed appointment charge. Another patient, who needs our care, could be scheduled if we have sufficient time to notify them. We realize that unexpected things can happen, but we ask for your assistance in this regard.

What about finances?

Fees for orthodontic treatment depend on the amount, type and length of treatment required for you. Payment for professional services for orthodontic treatment is usually by financial contract which is presented to you for your approval in advance of the outset of treatment. We make every effort to provide financial arrangements which fit your budget, and give your child the best possible care. Financial arrangements with our office generally involve convenient no interest monthly payments while accounts are kept current. Overdue accounts may incur service charges. Since orthodontic treatment is ongoing, the monthly payment arrangements are for convenience only by spreading the total cost of treatment over time, but are not related to specific appointments or work done at each appointment. We accept cash, personal checks, debit cards and most major credit cards.

Our office policy regarding dental insurance

Please understand that we file dental insurance as a courtesy to our patients. We do not have a contract with your insurance company, only you do. We are not responsible for how your insurance company handles its claims or for what benefits they pay on a claim. We will assist you in estimating your portion of the cost of treatment and we will submit and accept payments toward your treatment. However, we cannot guarantee what your insurance will or will not do with each claim. While we make every effort to be precise, we cannot be responsible for any errors in filing your insurance. While part of a dental benefits plan, orthodontic insurance coverage is separate from regular dental benefits in that patients with dental insurance do not always have orthodontic coverage. Depending on the dental plan which you have, orthodontic coverage will vary and exclusions especially for adults may apply. We will be happy to check for your available benefits. Specific questions about your plan should be directed to your company’s insurance administrator.

Orthodontic insurance is meant to be an aid in receiving orthodontic treatment. Many patients think that their insurance pays 90%-100% of all orthodontic fees. This is not true. Most plans only pay between 50%-60% of the total orthodontic treatment fees usually with a lifetime maximum per patient of a predetermined amount. Some pay more, some pay less. The percentage paid is usually determined by how much you or your employer has paid for coverage, or the type of contract your employer has set up with the insurance company. Also, deductibles and co pays must be considered and factored in.

Orthodontic insurance benefits are not all paid at the outset of treatment. Rather they are paid out over treatment time according to the insurance company’s schedule. Benefits may be discontinued if a patient is no longer employed by the company providing coverage even if they still in orthodontic treatment.

MOST IMPORTANTLY, please keep us informed of any insurance changes such as benefits, policy name, insurance company address, or a change of employment.


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