When you’re ready to perfect your smile, put your care into the hands of an Carlsbad orthodontist with the experience and technology necessary to provide the perfect treatment. With a variety of orthodontic appliances available, you can rest assured that you’ll be receiving treatment that meets the needs of your lifestyle.


Achieving a proper bite is extremely important. If a patient has an excess overjet (lower teeth too far back), then a Forsus may be used as an alternative to rubber bands in order to achieve the necessary tooth movement. The Forsus is an appliance that reduces the overjet and is usually reserved for more severe cases and/or cases where there may be non-compliance with rubber band wear. It is an excellent alternative solution that can move treatment along if there are compliance issues with elastics and reduce overall treatment time.

How it Works

The Forsus is comprised of a spring module that is attached to the molar bands on the upper six-year molars, and the springs on either side go from the back of the upper teeth to the front of the lower teeth. It is a fixed appliance, which means you cannot remove it on your own, and is generally placed in the middle of orthodontic treatment. The Forsus is usually worn for about 6 – 9 months.

What to Expect

It is normal to experience a short adjustment period after the Forsus is in place. You may feel some pressure, which will make your bite feel different, because the appliance is directing your bite into the ideal position. Once the Forsus is in place, a softer diet may be necessary. You can take over-the-counter medication, such as Advil or Tylenol, to ease any discomfort. Every 6 – 8 weeks, small shims will be added to the rod so the bite will continue to be corrected.

HERBST® Appliance

The Herbst appliance is an advanced functional device that is used to correct a lower jaw deficiency and/or protrusion of the upper teeth. If left untreated, these issues can threaten the long-term health of your teeth, gums, and jaw, and may even require surgical correction. This appliance is an alternative solution to traditional headgear, and has additional benefits:

  • Compliance:  Headgear has to be worn for a specific number of hours each day in order to be truly effective. This can be difficult to keep track of; however, the Herbst appliance is fastened directly to your teeth, so you can be confident that it is working as intended.
  • Aesthetics:  Headgear is generally bulky and has to be strapped to the back of the head or neck. The Herbst is a much more inconspicuous appliance because it is only visible when you speak or open your mouth.

The Herbst appliance consists of crowns cemented over your back teeth like a thimble. The crowns have rods and tubes (hinges) attached to them that hold your lower jaw forward, which moves the teeth and stimulates growth. The rods and tubes can be adjusted throughout treatment to position your jaw and move your teeth as needed. Your teeth will NOT be reduced.

Adjusting to Your Herbst

During your first week, you will experience soreness in your jaw as your muscles, teeth, and joints adjust to the new position. You may take over-the-counter pain medication as needed for the soreness. Eating softer foods in the first week, such as smoothies, yogurt, and potatoes, will help with muscle soreness and help you get comfortable with the appliance. After about a week, you should be back to eating like normal.


You will need to continue to brush your teeth at least twice a day. Aside from brushing your teeth, you will also need to brush around the metal crowns, rods, and tubes. Continue to floss your teeth, as well as in between the metal structure of your Herbst and your teeth.


If anything on your Herbst breaks, becomes unglued, or bends, give us a call right away, as you will have to come in to have it repaired.

Rapid Palatal Expander (RPE)

When a child is suffering from a malocclusion, or a bad bite, early orthodontic treatment helps prevent more serious orthodontic issues from occurring in the future. One of the best ways to treat a malocclusion in a child is by using a rapid palatal expander, also known as an RPE.

Rapid Palatal Expanders create more space in the mouth by gradually widening the upper jaw. Although this may sound scary, it’s really quite easy to do and to tolerate. The upper jaw actually develops as two separate halves that don’t completely fuse together until after puberty. Before that happens, the two bones can gently be separated and stabilized over a period of several months.

What Conditions Are Rapid Palatal Expanders Used For?

RPEs are used to treat a variety of malocclusions, including:

  • Crossbite: The upper jaw is too narrow to fit the lower jaw or the back top teeth are inside the lower jaw
  • Crowding: There is not enough room for permanent teeth and the upper jaw is too narrow
  • Impacted Teeth: A tooth has not yet come in and is being blocked by other teeth, and growing teeth are in the wrong position

Rapid Palatal Expanders are also used to aesthetically broaden the smile, limit the number of teeth to create space, improve breathing, and shorten the overall time your child will need braces.

How the Rapid Palatal Expander Works

The rapid palatal expander is custom-made to fit over most of the top teeth in the back of the mouth. The appliance consists of two halves connected in the middle with a screw. The screw is turned little by little each day to induce tension, which progressively moves the two palatal bones apart. On average, the RPE treatment takes 3-6 months to finish.

What To Expect During Treatment

It’s very common for your child to experience some minor side effects, like soreness and pressure. Your child may also speak and eat a little differently at first, and they may have a small gap between their front teeth – all of this is normal and is not a cause for alarm. However, if your child experiences any severe or long lasting pain or discomfort, please feel free to call our office.


When your braces (or Invisalign) come off, Dr. Hulse will provide either fixed or removable retainers to hold your teeth in their new, straightened position. Retainers are EXTREMELY IMPORTANT because failure to use them properly will result in your teeth moving back to their original position! Detailed instruction on how and when to wear them will be provided upon completion of treatment. The following are guidelines for general retainer usage and care:

Removing Your Retainers

  • Take your retainers out every time you eat, brush your teeth, go swimming, or play sports that require a mouthguard.
  • Remove your retainers when drinking sugary or acidic beverages; keeping the retainers in will trap the liquid.
  • Every time you remove your retainers, store them in the case that was provided to you. Do NOT put your retainers in a napkin on a lunch tray – it will likely get thrown away!
  • Make sure your retainers are kept away from areas that become hot, such as microwaves, washers and dryers, stoves, car dashboards, and dishwashers.
  • Keep your retainer away from pets as well, including cats and dogs. Pets like the smell of the saliva and will chew on them if they can.

Bonded Retainer Guidelines

  • Your retainer has been attached to your teeth with a strong and durable adhesive. However, eating hard or chewy foods may break the bonded retainer off your teeth. Be careful when eating as you were when you had braces on your teeth.
  • Spend more time and effort brushing this part of your mouth.
  • Keep your regular cleaning appointments with your family dentist.
  • Be sure to floss your retainer after meals. Use floss threaders, proxy brushes, or special floss made specifically for braces. Thread it between the teeth and the bonded retainer.
  • If you notice your teeth are shifting, your bonded retainer may be loose. Call any of our offices promptly so we may schedule an appointment to have it re-bonded.

Cleaning Your Retainers

  • After brushing your teeth, apply a small bead of toothpaste on your toothbrush, and gently but thoroughly brush your retainers before putting them back in.
  • Clean your retainers on a daily basis by using one of the following methods:
  • Retainer Brite cleaning tablets – These can be found on
  • Equal parts water and white vinegar – Soak your retainers in this mixture for 20-30 minutes, then rinse well before putting them back in your mouth. Do not use boiling water.
  • To keep your retainers tasting fresh, you can soak them in mouthwash diluted with water for about 10 minutes.

Please be sure to bring your retainers with you to all of your retainer check appointments, so that we can check them in your mouth. If you break or lose your retainer, give us a call right away – you don’t want to give your teeth a chance to move! Lost or broken retainers can be replaced for a fee.