March 26th, 2019

Your orthodontic treatment is finished, you've so worked hard - Congratulations!

We want you to show of your beautiful smile every chance you get. :)

We also want you to be able to maintain your smile. That's why retainer wear is super important! At Westwalk we use a combination of clear removable retainers and permanent retainers located behind the front teeth to help you keep that amazing smile for life.

Our patients are monitored for multiple years after treatment to help them develop good retainer wearing habits.  At Westwalk, you'll never be pushed out the door when your appliances are removed. And after 2 or more years or retention maintenance, we're always just a phone call away if you need us.

So, make sure you're wearing your retainers as they've been prescribed, that you come in if you ever suspect a problem, and keep smiling!

Drs. Steve Cagliostro and Gary Romeo



Sleep, Airway & Orthodontics Part 4

February 5th, 2019

In the last 3 posts we've discussed that sleep-disordered breathing affects 4% of children, that it can be harmful to both children and adults, that your orthodontist works with primary care doctors and ENTs to screen patients for signs and symptoms of sleep apnea, and that for children, orthodontic appliances can aid in the treatment of sleep disordered breathing.

Many adults are prescribed a CPAP machine to address their sleep apnea - most patients find that their symptoms are relieved with the combination of CPAP use and weight loss.

For patients who can not tolerate a CPAP, your orthodontist or dentist can fabricate a custom-made night brace that moves the lower jaw and tongue forward. These appliances aren't always as effective as CPAP, and aren't for the most severe forms of sleep apnea, but tend to be better tolerated (especially by bed partners). To make the night brace we take a 3D scan of your teeth and plan the movement with the lab that fabricates the appliance. Several similar appliances have become available over-the-counter. Over-the-counter appliances, when not properly adjusted and monitored, can result in dental changes that can negatively affect the health of your teeth and bite.

Some adult patients may benefit from a course of orthodontic treatment or combined orthodontics and oral surgery to relieve a constricted upper jaw and/or small lower jaw  - these problems are addressed individually with each patient.

This marks the end of our series on sleep, airway and orthodontics. We hope you have found it informative and useful.  Sleep medicine is a complicated field, the science is evolving every day. Addressing health concerns such as sleep apnea and sleep disordered breathing and coordinating with other health-care professionals is part of what we do to make our patients happier and healthier.  :)

Drs. Steve Cagliostro and Gary Romeo

Sleep, Airway & Orthodontics, Part 3

January 31st, 2019

grayscale photo of woman doing silent hand sign

Photo by Kristina Flour on Unsplash


Does your partner keep you up at night while they snore? Have you ever noticed your partner stop breathing during the night, only to gasp to catch their breath a few seconds later - all while sleeping? It is possible that he or she has obstructive sleep apnea.

The field of adult sleep medicine has linked sleep apnea to high blood pressure, heart disease, stroke, diabetes, headaches and worsening of ADHD.

The first line of defense when it comes to evaluating a patient for sleep apnea is a sleep study with a sleep physician. These studies can determine how severe of a problem the apnea is.

As in children, the cause of sleep apnea can be multifactorial - it could be obesity, a large neck, a small lower jaw, a constriction in the upper airway or a low tongue posture.

Many patients leave the sleep physician with a CPAP (continuous positive airway pressure) machine to wear while sleeping. This machine is quite effective, but tends to be bulky and loud. For many patients there are alternatives.

Next week we'll discuss treatment options, and how your dentist and/or orthodontist and oral surgeon can aid in the treatment of obstructive sleep apnea.

Drs. Steve Cagliostro and Gary Romeo


Sleep, Airway & Orthodontics, Part 2

January 24th, 2019

Breathe, breathe in the air: Part 3 Does orthodontic treatment cure childhood breathing problems?


Last year an 8 year old patient, we'll call her Lilly, came to see me with her older sister who was finishing up braces. Lilly's mom was telling me that Lilly snores and suffers from sleep apnea, and was about to undergo her second tonsil and adenoid removal surgery in 3 years. Mom and I discussed the role maxillary expansion plays in helping children with constricted upper airways. (click here to learn more about expanders!) We consulted with Lilly's ENT, and he agreed to delay surgery until maxillary expansion could be completed.
Just three weeks after the expander was placed, Lilly's symptoms disappeared. Lilly, Mom, the ENT and I were all thrilled and her surgery was cancelled. It's been almost a year and her symptoms have not returned.
I share this story because it is a common experience that a lot of orthodontists are having. Orthodontics plays an important role in the field of sleep medicine for children and adults.

Airway friendly orthodontics has changed the way I practice. No longer are we looking solely at if there is room to align the permanent teeth and correct the bite, but we are now looking at how orthodontics can benefit children medically and behaviorally. The result is a happier and healthier patient.

Next week we'll start to discuss sleep-disordered breathing in the adult and why it is a concern.

Drs. Steve Cagliostro and Gary Romeo

Sleep, Airway & Orthodontics, Part 1

January 17th, 2019

Sleep and airway related orthodontics in children has become an area of great study over the past several years. We now know that children who snore or sleep with their mouths open on a regular basis tend to have an upper airway constriction. We also know that bed-wetting, ADD, ADHD, disruptive behavior along with sensory processing disorder are all associated with sleep disruptions and sleep-disordered breathing.

Four percent of children have some sort of disrupted sleep - that's why at Westwalk Orthodontic Group, we screen all of our patients under the age of 18 for symptoms associated with sleep disordered breathing.

Unfortunately, just knowing that there is some sort of sleep disordered breathing is only the first step to addressing the problem. The cause of sleep-disordered breathing in children can be multi-faceted. Several possible causes include: enlarged tonsils and/or adenoids, a narrow nasal airway with increased nasal resistance, a low tongue posture, a recessive lower jaw, or even obesity. When necessary, we work with your pediatrician, ENT and speech pathologist to enact the best treatment plan for your child.

Next week, we'll discuss how orthodontic treatment can affect positive change for the child with sleep-disordered breathing.

Drs. Steve Cagliostro and Gary Romeo


When should I bring my child for an evaluation?

January 3rd, 2019

breaking habits

Sometimes during a new patient exam we wish that we had the opportunity to see the patient several years earlier. Maybe we could have intercepted a canine tooth before it grew in off course, or maybe we could have helped to alleviate a thumb sucking habit before it caused structural changes to the jaw bones.

For reasons such as these, it is important to remember that every child should have an evaluation with the orthodontist by age 8. Treatment won't be recommended until later in development for a very high percentage of these children, but the children that do require early treatment will benefit greatly from interceptive orthodontics.

Your orthodontist is the health-care professional with the most training in dental and jaw bone development, and can help you navigate if and when is the right time to intervene to affect positive change for your child.

So, the next time you are wondering when is the right time to ask for an orthodontic  consultation, remember that each child should have an evaluation with the orthodontist by age 8.

Drs. Steve Cagliostro and Gary Romeo


Aligner basics - water only!

December 18th, 2018

Most patients are surprised that they shouldn't drink anything other than water with aligners in....Wait, what about my morning coffee? or that post-workout Gatorade?

Unfortunately, liquids can damage your teeth and your aligners. Here's some facts:

  • Any liquid you drink with you aligners in will seep under the aligner and sit on your teeth.
  • Sugary liquids provide a food source for acid-producing bacteria that live in your mouth. This acid can produce cavities on your teeth while you are wearing your aligners.
  • Colored liquids will stain your aligners and teeth, also most colored liquids are acidic which again, isn't good for your enamel!
  • Hot liquids will deform your aligners!  This means your progress will stop and the next set of aligners may not fit!

Any time you eat or drink anything other than water it is recommended that you brush your teeth prior to re-inserting your aligners. When away from a toothbrush, you can consider rinsing vigorously with water, it'll help wash away food particles and neutralize the oral environment.

Thanks for reading!

Drs. Steve Cagliostro and Gary Romeo

Adult orthodontics

December 10th, 2018

Adults are realizing every day that they too can benefit greatly from orthodontic treatment. Whether it's for one little rotation, a small bit of crowding, or more extensive alignment and bite issues, your orthodontist is the health care professional with the most experience in diagnosis and treatment of your alignment and bite problems.
At the new patient exam, we'll assess your chief concerns and give you an idea of what we reasonably could expect as an outcome along with a general timeline. After orthodontic records are taken, a detailed plan is constructed and discussed with you and any other treating dentists or dental specialisits.
Most of our adult patients choose aligner treatment over traditional or tooth-colored braces. Aligner treatment has improved, and at times can produce an outcome as good, if not better, than braces alone! You can learn more about Invisalign by clicking here.
Some patients concerns can be addressed as quickly as several months, others may take up to two years. Office visits average 15 minutes or less once treatment has begun and are spaced by approximately 6 weeks.  In general, fees are commensurate with length and complexity of treatment. Fortunately, we offer easy down payments and monthly payments with no added interest.
We like to be convenient for you, that's why we have early, late and Saturday appointments available in both of our offices.

We love being your family orthodontist in the greater Norwalk and Westport communities!

Drs. Steve Cagliostro and Gary Romeo

Summertime orthodontic guide

June 4th, 2018

Memorial day weekend has passed, the college kids are home, local schools are winding down - we're getting ready for summer at the orthodontic office!

Here's a few helpful points to help you enjoy your summer while undergoing orthodontic treatment.

  • Schedule to come in for a visit prior to any long vacations/camps to make sure there are no long wires or broken brackets.
  • Make sure you have enough aligners to get through your trips.
    • If you wear your aligners less than normal while on vacation, make sure they aren't tight before switching to a new set!
  • If a bracket breaks or a wire shifts while on vacation you can use orthodontic wax to keep the area from irritating your cheek. If you need to see an orthodontist give us a call first - we may know someone in the area!
  • If your aligner or retainer is rubbing your tongue or cheek you can use a clean emery board to smooth any sharp edges.


  • Try to schedule your August appointments as soon as possible, it's one of our busiest months as everyone is coming back from camp and vacation and trying to get in before labor day!

We hope these little pointers are helpful.  As always if you have any questions or concerns feel free to call us!

Drs. Steve Cagliostro and Gary Romeo

Displaying IMG_20170609_122128.jpg

Technology in the orthodontic office

April 19th, 2018

Technology has changed our lives so drastically that it's hard to imagine how we lived without it.

Even though we are one of the longer-established practices in the area, that doesn't mean we're in the stone-age with our tech! We love it, and continue to implement new tech as it improves and can make differences in our patient's experiences.

Here are our top 3 technologies that we love in the office:

Digital molds - the goopy impressions are on their way out! Now we use electronic 3d models of your teeth.

Digital treatment planning software - We put your models, photos and x-rays into our software and can project treatment outcomes, it's pretty great!

Text-message and email appointment reminders - Forgot about your appointment? You'll receive a text the day before to remind you!

Why is all this tech so appealing? Because it improves the service that we can provide to you! We'll continue to implement new technology  - it's exciting to think how orthodontics will change over the next 20 years!

Til next week,

Drs. Steve Cagliostro and Gary Romeo


Image from 3shape product website.



How do teeth actually move?

April 5th, 2018

Maybe you have braces or are wearing aligners and have wondered, how do teeth actually move?
Well, the short of it is teeth respond to any pressure applied to them. That pressure doesn't have to be from braces or aligners, it could be from your tongue during speech or swallowing, it could be from your lips, it can even be from gravity!
Each tooth is connected to the surrounding bone by a ligament called the periodontal ligament - any pressure applied to the tooth is transferred through the tooth and causes the periodontal ligament to stretch and compress. The body responds by adding more bone on the stretching side and removing bone on the compression side - hence the tooth moves!
The key is to apply an appropriate amount of pressure in the right direction to gain the desired effect. Fortunately, plenty of research has been done to help us identify values that are biologically sound and produce efficient tooth movement.
You probably didn't realize that your orthodontist sometimes wears the hat of biologist, and sometimes physicist!
Until next time,
Drs. Steve Cagliostro and Gary Romeo

Image borrowed from Dr. Steve's copy of Contemporary Orthodontics by Dr. Proffit

10 questions to ask when choosing an orthodontist

February 8th, 2018

You have many options when choosing an orthodontist - the goal is not only to find an experienced, competent clinician, but also to find a practice that meets and exceeds your expectations when it comes to service.
We encourage you to ask the following questions on a new patient phone call, make sure you ask us these same questions!

1- Are the office and staff welcoming? Am I always greeted with a "hello"?
2- Does the office offer early, evening and Saturday hours to better fit my schedule?
3- Does the office offer zero interest, easy financing?
4- Is the new patient exam an actual clinical exam with the doctor, or is it simply a meet and greet?
5- Does the doctor take time, free from distraction, to review my records and formulate a treatment plan and subsequently discuss that plan in detail with me prior to commencing treatment?
6- Will I see the doctor at every treatment appointment, or are there some appointments when I'll only see an assistant?
7- Does the office offer braces and aligners (i.e. Invisalign, ClearCorrect)? Does the doctor feel confident using aligners?
8- Are emergency visits, the first set of retainers and 2 years of post treatment followup, including x-rays, included in the treatment fee?
9- Does the office use digital records, including a digital intraoral scanner, which is more accurate and less uncomfortable than traditional impressions, and digital x-rays which use much less radiation than traditional film x-rays?
10- Are patients seen in a timely fashion? Can I schedule a new patient exam promptly? Do you respect my time and see me at my scheduled appointment time?

The doctors and staff at Westwalk Orthodontic Group welcome these questions, and any others you may have. We find that the more educated our patients are, the more value they derive from our level of service.

So, give us a call, ask us the hard questions - we're up for the challenge!

What does it mean to be ABO certified?

February 1st, 2018

On occasion, we are asked about our training and board certification, and what it means in orthodontics.  Some people are surprised to hear that all orthodontists are dentists who have pursued further training to become a specialist.

Drs. David, Gary and Steve all attended college, then 4 years of dental school. They scored well on their exams in dental school and chose to further their education as dental specialists. At the conclusion of their orthodontic training (2-3 years), they were granted a certificate as a specialist in "Orthodontics and Dentofacial Orthopedics."

Our doctors voluntarily chose to challenge the American Board of Orthodontists exam to achieve the highest level of certification available to orthodontists.  All three of our doctors are board certified and work hard every day to provide our patients with scientifically backed diagnoses and treatment regimens.

What does this mean for you?

It means that your doctors at Westwalk Orthodontic Group provide the very best in orthodontic treatment for you and your children.

Until next week,

Drs. Steve Cagliostro and Gary Romeo


X-Rays: Diagnostic need and dosage

January 25th, 2018

Today's topic for discussion is x-rays.

The proper use of radiographs is integral to a complete and personalized diagnosis and treatment plan.

Here at Westwalk we routinely take 2 x-rays as part of our diagnostic criteria prior to treatment. These are:
A panoramic x-ray to look at the upper and lower jaw bones along with their respective teeth to evaluate the health of these structures and to evaluate eruption of permanent teeth
And a cephalogram to evaluate the position of the upper and lower jaw bones to each other and the upper and lower front teeth to each other, along with evaluation of potential jaw growth.

We are frequently asked about x-ray exposure, and we want to assure you that every step is taken to minimize your exposure while in our office.
Importantly, we use a state-of-the-art digital pan/ceph machine. The x-ray exposure is approximately equal to the exposure you would receive on a one-way flight from New York to Florida.
Interestingly, according to the CDC, every year the average American is exposed to approximately 3.11mSv of naturally occurring radiation. The x-rays we take as part of your initial records are 0.027mSv, which is approximately 0.8% of your annual average natural radiation exposure.

More importantly, we are mindful to suggest the use of radiographs only when they are needed diagnostically.

We hope today's blog post allows you to feel a bit more comfortable when discussing x-ray need and exposure in our office!

All the best,

Drs. Steve Cagliostro and Gary Romeo


Efficient orthodontics

December 11th, 2017

We live in a world of instant rewards - all we have to do is tap a few times on the screen you're currently looking at and goods or services can be rendered with near immediacy.  In dentistry this can mean same-day implants and crowns. In orthodontics, we work hard every day to most efficiently deliver a service to our patients within the biological constraints of the human body.

Here at Westwalk, we pride ourselves on providing the best quality orthodontic care - this not only means that we take the time to get to know you and your concerns, but we are also up-to-date on our research, use consensus driven processes to determine treatment methodologies, and implement new technology in the practice that is proven and accepted within the community to increase the efficiency and decrease discomfort associated with orthodontic treatment.

Some of these technological advances that we use to increase the efficiency of your treatment are listed below:

  • Nickel-Titanium wires that produce light and continuous, biologically friendly forces, especially during the initial alignment phase of treatment
  • Digital radiography that use much less radiation than traditional radiography and allows for greater manipulation and study
  • Digital study models that are more accurate than traditional impressions for better fitting and faster turn-around with Invisalign aligners, along with faster turn-around for study models for space and tooth size analyses
  • Digital treatment planning of aligner cases
  • Digital scheduling and payment systems
  • And the list goes on....

Things that you can do to increase the efficiency of your orthodontic treatment include:

  • Do a good job keeping you teeth and gums clean, clean teeth not only look better at the end of treatment, but are also proven to move faster!
  • Wear you're prescribed elastics the full duration that we ask - compliant patients almost always finish treatment before non-compliant ones
  • Keep your appointments! - unfortunately, we can't move your treatment along remotely, so please come see us at your regularly scheduled intervals

There are new technologies out there everyday that are gaining prominence within the orthodontic community - most of them have something to do with treatment efficiency and rapidity.  Our promise to you is to continue to review how to best serve our patients while providing the most efficient and time sensitive service we can. If you have a question about a new technique or appliance please ask us! There is a good chance that we have already reviewed it and can help you understand why we have chosen to implement it or not.

Until next week,

Drs. Steve Cagliostro and Gary Romeo




Mouth breathing, why are we concerned about it?

November 28th, 2017

Are you or your child one of those people that has chronic difficulty breathing through your nose? If you are, you are likely a mouth breather. Mouth breathing and nasal resistance are related, but it's a bit a of chicken or the egg scenario - what we do know is that mouth breathing is problematic, affecting several areas of oral and systemic health, including dental development.
Typically, a mouth breather may have an anterior open bite, where the top and bottom front teeth do not overlap with each other. This can cause difficulty when incising food, such as an apple. These patients also typically have narrow, deep palates, which are associated with posterior dental crossbites and potential crowding or eruption problems in the upper dental arch. These patients many times require palatal expansion as part of their orthodontic treatment. Interestingly, palatal expansion not only aids in correction of the dental problems, but it also decreases nasal resistance - making it easier to breath through the nose.
So, if you ever here us ask - do you have trouble breathing through your nose - you'll know why!

All the best,
Drs. Steve Cagliostro and Gary Romeo


Picture from : http://www.aapd.org/assets/1/25/Ngan-19-02.pdf

This Thanksgiving...

November 22nd, 2017

We've had the food network on in the office, everyone is prepping for the big meal, we're seeing lots of patients who are only in town for the holidays - we're in the spirit of the season here at Westwalk! We want to share what we're thankful for with you.

Every last one of us here at Westwalk is thankful for your continued trust in us. We are honored that you chosen to have us be a part of your lives!

Our staff is so important to the whole operation here, Drs. Gary, Steve and David couldn't provide you with the level of service that you all have become accustomed to without their dedication and attention to detail. Some of the staff wanted to share what they are thankful for this Thanksgiving:

Grazia is thankful for her family, friends and health.

Sue is thankful for her home, her son and her parents.

Sally is thankful for her supportive coworkers.

Christine is thankful for her family and health.

Latravia is thankful for her daughter. She makes her stronger everyday.

Darlene is thankful to be a U.S. citizen and to be a part of the Westwalk family, helping create beautiful smiles for over 39 years!

Dr. Steve is thankful for his wife and son. He finds it truly amazing watching Wesley grow and change with each passing day.

Dr. Gary is thankful for the health of his family - you just cannot afford to take it for granted.

Enjoy the holiday!

Drs. Steve Cagliostro and Gary Romeo




Why are tooth brushing quality and quantity important?

November 14th, 2017

Brushing and flossing are probably the two most important keys to oral health.
When a patient has braces on their teeth, brushing becomes even more important, and flossing becomes more difficult.

Each of our patients sits through an oral hygiene video when braces are first placed. This video demonstrates the proper techniques for brushing, including angling the toothbrush toward the brackets, and then toward the gums to remove any left behind food material. Every patient is provided with floss threaders, which can make it easier to floss. Some patients water flossers easier to use than floss - we carry these in the office if you are interested to learn more.

We recommend brushing no less than three times daily: once in the morning, once in the afternoon, and once before bed, along with flossing once daily to maintain optimal oral health throughout your orthodontic treatment.

Sometimes, patients have some difficulty incorporating the recommended oral hygiene regimen into their daily routine. These patients may experience some inflammation of their gums along with decalcification (or the starts of cavities) on their teeth.

We evaluate each patient's oral hygiene at every visit and discuss if there are ways to help improve oral hygiene. Fortunately, mild gingivitis along with mild decalcifications can be reversed. The more severe these become, however, the more problematic.

The good thing is we've got your back! We'll help you make sure you're doing a great job keeping those pearly whites clean while you're making them straight!

Have a great day!

Drs. Steve Cagliostro and Gary Romeo


Image result for braces toothbrush

Photo courtesy of nextgentoothbrush.com

Orthodontic Records, what and why?

November 6th, 2017

For the orthodontist the new patient exam is like the tip of the iceberg on a fact finding mission. We use the this in-person clinical exam to get to know you, learn about your orthodontic concerns and to gather some initial information about your bite.

Quite frequently, the next step after the clinical exam is orthodontic records. Records are indicated when there is a suspicion that orthodontic intervention may be required. Orthodontic records have several components. In our office these typically include:

  1. A facial photograph for smile evaluation
  2. Facial photographs from the front and the side to evaluate facial soft tissue contours as they relate to a patient's teeth and jaw bones
  3. Intra-oral photos to evaluate the alignment of the upper and lower teeth, along with intra-oral photographs to evaluate the bite from the front and the sides
  4. Digital models of the top and bottom teeth for space analysis and tooth measurements
  5. A panoramic x-ray to look at the upper and lower jaw bones along with their respective teeth to evaluate the health of these structures and to evaluate eruption of permanent teeth
  6. A cephalogram x-ray to evaluate the position of the upper and lower jaw bones to each other and the upper and lower front teeth to each other.  Interestingly we can also evaluate growth potential with this x-ray!

We take a "deep dive" to evaluate each patient's complete orthodontic diagnosis in order to provide you with the most specific, individualized and efficient treatment plan to achieve your goals.

Check out our blog again next week!

Drs. Steve Cagliostro and Gary Romeo

Photo credit: GC Orthodontics Supply company

Halloween, to eat candy or not!?!

October 31st, 2017

So it's Halloween and we're having a great time in the office. One of the most common questions today is "Can I eat candy?"
We recommend soft candy, like Hershey's milk chocolate, M&Ms or Kit-Kat bars. Candy with nuts, or hard candy like lifesavers or jolly ranchers can break brackets if you chew on them.
Most importantly, don't forget to brush your teeth after eating all that candy!
Wear your costume to the office!

Orthodontic Health Month

October 23rd, 2017


October is orthodontic health month. You may be curious, how are orthodontics and health matched up? Below is an example:

Imagine a patient, we'll call her Mary, has some crowding of her lower front teeth. Mary probably finds that those lower front teeth get more plaque and calculus buildup than the rest of her teeth, and they are harder to clean because of the crowding. Unfortunately, the buildup of plaque and calculus results in gingivitis and potentially periodontitis, neither or which are good because they are inflammatory conditions.

Essentially, a clinical condition as simple as crowding making it more difficult to keep teeth clean, a deep impinging overbite, or some sort of traumatic bite has the potential to have negative affects on your health.

Fortunately, most of these problems can be solved with normal orthodontic intervention.

We promise a more uplifting post next week!
Drs. Steve Cagliostro and Gary Romeo

Do braces hurt?

October 16th, 2017

One of the more common questions we get is: "Do braces hurt?"

Here at Westwalk, we do everything we can to make the orthodontic experience easy for you. This includes lessening the amount of discomfort associated with treatment as best as we can.

In the past, orthodontic wires were stiffer and patients subsequently had high amounts of discomfort.

Today, we use a series of very light memory wires along with temperature-activated wires that make the experience much more comfortable for the orthodontic patient.

Although there have been great advances in orthodontic technology increasing patient comfort, patients still at times report a dull achiness for the first several days after initial wires are placed. This is usually manageable without any intervention, but sometimes a patient may elect to take Tylenol or Advil for 1-2 days.

Lastly, none of the procedures we do here at the office require local anesthesia, so no needles here!

All in all, here at Westwalk we do everything in our power to make the orthodontic process easy for you, the patient.

Thanks for reading!
Drs. Steve Cagliostro and Gary Romeo

Fixed retainers, what are they and why do we use them?

October 10th, 2017

Has a fixed retainer been suggested as part of your retention protocol?
A fixed retainer is usually a metal splint behind either your top or bottom front teeth. It acts jointly with your regular retainer to help maintain the orthodontic finished results.
There are several indications for a fixed retainer, but the two most common are patients who start treatment with crowding of the lower front teeth or a gap between the upper front teeth.
Keeping the teeth and gum tissue adjacent to a fixed retainer clean and healthy can be more difficult with a fixed retainer. We recommend flossing daily using a floss threader or waterpik to help keep the area clean.
Many times patients ask: "How long do I need to have this fixed retainer?" The answer varies, but we personally have seen multiple patients maintain their fixed retainers for 20+ years.

No matter what your retention protocol, maintaining the orthodontic finished results is a life-long pursuit.  Many times, the fixed retainer can make this process easier for you!

Enjoy your week!
Drs. Steve Cagliostro and Gary Romeo

Braces or Invisalign? What's the best option for me?

October 5th, 2017

One of the most common questions in our consults is: "Can you accomplish these goals using Invisalign rather than braces?"

Usually, as long as most of the permanent teeth have erupted, the answer is YES!

There is one large caveat however. To achieve the proposed treatment outcome with Invisalign, the patient needs to wear his or her aligners approximately 22 hours per day (removing them only for eating, drinking and brushing). We recommend brushing your teeth before replacing the aligners after every meal.

With braces, the brackets are glued to the teeth and the wire is ligated to the bracket, therefore, the patient has less to think about and keep track of on a daily basis. We ask that the patient brushes their teeth 3 times daily.

Many patients choose tooth-colored brackets. These brackets, along with white wires, give patients the desired aesthetic effect, while not adding too much to their daily routine.

The choice is yours! Pick the treatment modality that fits your lifestyle and we'll help you achieve the treatment outcome you desire!

All the best!
Drs. Steve Cagliostro and Gary Romeo






February Is Children’s Dental Health Month

February 8th, 2017

If you've seen the updates on our facebook page recently, you may have noticed that February is Children's Dental Health Month. At Westwalk, we want to spread awareness for children's health, and that's why you'll see us in some of the local schools talking with the kids this month.  :)

Enjoy this week's blog post!

THE CDC REPORTS THAT 1 in 5 children (between ages 5 and 11) in the US have untreated tooth decay. Not only should tooth decay be treated in regular dental appointments, it should be prevented! Tooth decay is 100 percent preventable with effective personal care and regular dental cleanings.

In honor of Children’s Dental Health Month, we’re spreading the word about children’s dental health.

YOU Can Help Little Ones Have Healthier Smiles!

  1. Encourage them to brush for two full minutes: Pick a song about two minutes long and sing it to them during brushing time.
  2. Set reminders to brush twice a day: Brushing after breakfast and just before bed are the best times for preventing bacteria growth from food.
  3. Show them flossing is fun, not harmful: Be gentle at first when doing it for them. A bad experience can stop them from flossing on their own.
  4. Be persistent: Don’t let fussy children off the hook. Be motivating! Kids may gladly brush for a sticker or star if you make it an activity.
  5. Set their first dental appointment before age 1: Having positive dental experiences early will make dental visits easier and less frightening when older.

Help Us Spread The Word!

Share this message with your friends and family, and especially with the children in your life. If you have any questions about children’s dental health, don’t hesitate to ask us!

The content on this blog is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of qualified health providers with questions you may have regarding medical conditions.

Simple Steps To Keep Your Orthodontic Treatment On Track

February 2nd, 2017

THE SUCCESS OF YOUR ORTHODONTIC TREATMENT is dependent on a number factors, like your orthodontist or how your teeth respond to braces. It’s important to remember however that a lot of it actually depends on YOU! So, what can you do to make sure you finish your treatment on time and finally get those braces off?

#1. Keep Your Appointments

We know it can be hard to have such frequent appointments when you are undergoing orthodontic treatment. But the better you are at keeping your appointments, the faster your treatment time will be! Postponing or cancelling appointments can significantly prolong treatment time. We also ask that you come on time to your appointments. Having enough time to perform planned procedures is essential to your smile’s progress.

#2. Avoid Damage To Your Braces

Damage to your braces will also delay the completion of treatment. To prevent breaking off a bracket or bending any wires, be sure to wear a mouthguard when playing sports. In addition, avoid these foods while wearing braces:

  • Popcorn
  • Nuts
  • Sticky candy, such as taffy and caramel
  • Ice
  • Hard candy, cookies, or crackers

Remember to cut up other foods that can damage braces such as raw fruits and vegetables, pizza crust and other hard breads and corn on the cob.


#3. Follow Your Orthodontist’s Instructions

If your unique case calls for orthodontic appliances other than braces, it’s crucial to wear them as prescribed. We most often see patients neglecting to wear their elastics, or rubber bands. In general, you’ll only need to take them off when eating a meal, brushing your teeth or wearing a mouthguard. Failure to wear your elastics consistently can extend your treatment time by a lot! So be sure to follow your orthodontist’s instructions.

#4. Be Diligent About Your Oral Hygiene

Healthy teeth are an essential prerequisite for orthodontic treatment. And having healthy teeth during treatment is just as important! Braces can make it harder to keep your teeth clean, so you need to be extra diligent about your oral hygiene when you’re undergoing orthodontic treatment. Cavities and gum disease can complicate and prolong your treatment. So if you want to get those braces off as quickly as possible, brush, floss and visit your dentist every six months!

It Will All Be Worth It!

Going through orthodontic treatment isn’t an easy process, but it is well worth it. By following these simple steps, you can stay on track and get the smile you’ve always wanted! If you have any more questions, call us today. We’re always here for our amazing patients.

Thank you for letting us be a part of your smile journey!

The content on this blog is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of qualified health providers with questions you may have regarding medical conditions.

Top image by Flickr user Kamilla Oliveira used under Creative Commons Attribution-Sharealike 4.0 license. Image cropped and modified from original.

The link between Oral and Systemic Health

January 17th, 2017

Here's another "did you know" in our series of blog posts. Enjoy!

Taking care of your teeth and mouth is about more than just cosmetics, it’s about your health! When you think of being healthy, your mouth probably isn’t the first thing that comes to mind. But your oral and overall health are more intertwined than you think.

Your Mouth Is The Gateway To The Rest Of Your Body

According to the U.S. Surgeon General’s 2000 report, “Oral health and general health should not be interpreted as separate entities. … As the gateway of the body, the mouth senses and responds to the external world and at the same time reflects what is happening deep inside the body. … You cannot be healthy without oral health.”

Periodontal Disease And Its Connection To Chronic Diseases

Not only can many illnesses and medications have a direct effect on your mouth, your oral health can also affect your body. This is especially true of periodontal or “gum” disease.


Did you know that gum disease affects 22 percent of people diagnosed with diabetes? People with diabetes have a decreased ability to fight off harmful bacteria and are thus more susceptible to gum disease. In like manner, bacteria from the mouth can cause blood sugar to spike and fluctuate, making diabetes harder to manage.

Heart Disease

While health care professionals aren’t completely sure as to why, heart and gum disease often go hand in hand. In fact, up to 91 percent of patients with heart disease have gum disease. It is believed that the link between these two conditions is inflammation.


These statistics may surprise you, but researchers have found that men with gum disease were 54 percent more likely to develop pancreatic cancer, 49 percent more likely to develop kidney cancer and 30 percent more likely to develop blood cancers.

What’s more, cancer treatments often have oral manifestations. Chemotherapy and radiation can cause sores in the mouth, sensitive gums, jaw and facial pain and dry mouth.


Other Complications

Gum disease has also been linked with stroke, kidney disease, osteoporosis, certain lung conditions and rheumatoid arthritis. Pregnant women with gum disease are more likely to have preterm births and low birth-weight babies.

The Health Of Your Mouth Is In Your Hands

As you can see, there is a strong connection between oral and overall health. That’s why it’s important to make your dentist a part of your health care team by going to your regular dental appointments and updating them on your medical history. We care about your whole body health!

The good news is that, for the most part, dental disease is entirely preventable. With orthodontic appliances, we recommend brushing two to three times per day and flossing daily to help keep gum disease at bay and protect you from cavities. Flossing in particular may be more difficult while undergoing orthodontics, and we recommend many of our patients use a water flosser to aid in removing harmful bacteria between their teeth.  Your oral health is in your hands, so choose to be mouth-healthy!

Thank you for supporting our practice!

The content on this blog is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of qualified health providers with questions you may have regarding medical conditions.
Top image by Flickr user Björn Söderqvist used under Creative Commons Attribution-Sharealike 4.0 license. Image cropped and modified from original.

Why Do Teeth Move Even After Braces?

January 13th, 2017

EVERYONE KNOWS THAT the most exciting day for someone with braces is the day they get them off! The final result of a beautiful, straight smile is what makes orthodontic treatment worth it. Now, it’s just a matter of keeping those teeth straight!

Guess What… Your Teeth Can Move, even after braces!

Teeth are dynamic and always moving as pressure and force is applied to them, even after you’ve had braces.

Teeth move naturally as we grow older and our facial structures change. Teeth may also shift in response to things such teeth grinding and clenching, numerous dental restorations, tongue thrusting and certain lifestyle habits such as smoking or nail biting.

Keeping Your Smile Straight Is A Lifelong Commitment

So, what can you do to make sure that your new smile lasts a lifetime? Wear your retainer! After you’ve finished orthodontic treatment, we will tell you how often you need to wear your retainer and for how long. The first 6 to 9 months after the completion of your active treatment is the most critical, and we ask many of our patients to wear their retainers 22 hours per day for this period of time. Over time, patients will only need to wear their retainer at night.

When it comes down to it, every orthodontic patient needs to be aware that the alignment of their teeth will likely change if they do not wear their retainers.  Therefore the patient should ask themselves, “How long do I want my teeth to be straight?” Whatever the answer is, that’s how long you’ll need to wear your retainer.

Check out this video from the AAO:


Keep Smiling

We love our patients! Thank you for trusting us with your orthodontic treatment.

The content on this blog is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of qualified health providers with questions you may have regarding medical conditions.

Happy New Year 2017!

January 3rd, 2017

HAPPY NEW YEAR to all of our wonderful patients, fans, and friends from all of us at Westwalk!

With every new year we have things to look forward to. Here at Westwalk we have a lot of things to be excited about in 2017!

First and foremost, we are excited to continue our 40+ year history of earning the trust of our patients and parents here in Fairfield county.

Providing the highest quality orthodontic care is how we have built and maintained our practice. Both of our locations are recently renovated with some of the latest technology, and we are always on the search for the most impactful elements of the latest and greatest to help provide you with the best care.

On a more personal note, this year will make some of us in the office new & first time parents and grandparents. For 40+ years our practice has been family-focused, and we are eager to warmly welcome our new family members!

We are thrilled to have so many exciting things to look forward to in 2017.

Happy New Year!

How Will My Diet Change With Braces?

December 27th, 2016

We get asked all the time what patients should and should not eat. So, here is a blog post along with a video from the American Association of Orthodontists to answer that very question!

GOOD NUTRITION IS extremely important to having a healthy smile. It also aids in orthodontic treatment!
By eating right during your treatment, you can make sure your teeth are strong enough to support braces as well as avoid any setbacks.

Avoid Hard, Chewy Foods With Braces
In reality, your diet won’t change much because of orthodontic treatment. There are, however, some foods that you should avoid. Your braces may be sturdy and strong, but they’re not invincible. Do your best to stay away from the following foods while wearing braces:

Hard candies
Chewy, sticky candy such as taffy, gummy bears, caramel, etc.
Hard cookies or crackers
There are also foods that you should eat with caution, such as:

Raw vegetables. It is better to cook vegetables such carrots and broccoli before eating them so they are softer and easier on your braces.
Fruit. Cut up harder fruits such as apples before eating and chew with the back molars. Be careful with the pits of some fruits as well.
Pizza crust and other hard, chewy breads. Bread like baguettes, bagels and pizza crusts are often hard to chew. To soften them, heat them up and cut them into smaller pieces.
Corn. Stay away from corn on the cob. First cut the corn off the cob and then enjoy!
Tough meats. Some meats are more fibrous than others and can be hard to chew. The best varieties of meat for braces are the tender cuts, meat cooked in a slow cooker, and meat cut off the bone. Chicken and seafood are good protein alternatives as well.
Chips. Eat chips carefully and one at a time.

It’s also important to refrain from chewing on pencils, pens and fingernails–this can also do damage to your wires and brackets.

Make Sure You Eat A Balanced Diet
A healthy diet combined with good oral hygiene makes for faster and more effective orthodontic treatment. Unfortunately, some braces wearers resign to a diet of soft foods with little nutritional value because of the above restrictions. Even though you have to be careful with some foods, it’s more important than ever to keep up proper nutrition. Healthy teeth respond better to orthodontic treatment!

Have Questions? We Have Answers!
Do you have any more questions about what you can and can’t eat with braces? Call us or send us a message through social media. We can’t wait to hear from you!

Check out this video from the AAO:

Thank you for the trust you place in our practice!

Top image by Flickr user Loren Kerns used under Creative Commons Attribution-Sharealike 4.0 license. Image cropped and modified from original.

The content on this blog is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of qualified health providers with questions you may have regarding medical conditions.

Baby Teeth Myths—Busted!

December 22nd, 2016

YOU MIGHT THINK that baby teeth don’t matter because “they’re just going to fall out anyway,” but think again!
There are a lot of myths about baby teeth out there, so we’re going to set the record straight: here’s a list of the top four baby teeth myths, BUSTED!

Myth #1: Baby Teeth Aren’t Important
Although baby teeth eventually fall out, they are extremely important to a child’s developing oral health. Not only do they hold the space for permanent teeth to grow in straight (preventing crowding and crooked teeth), they also help the face structure develop properly and ensure that young children can eat and receive plenty of nutrition.

Myth #2: Cavities In Baby Teeth Don’t Matter
You might have heard that babies can’t get cavities at all, or that if they do have them, it’s not a big deal. Both rumors are untrue; not only are cavities painful, they can cause swelling and even infection. In addition, children who have cavities in their baby teeth are three times more likely to develop cavities in their adult teeth. If you think your child may be developing a cavity, marked by discoloration or a small crack, call us right away!

TIP: Don’t let your child fall asleep with a bottle! Juice and milk are full of bacteria-feeding sugars which cause cavities.

Myth #3: You Don’t Need To Brush or Floss Baby Teeth
You should begin “brushing” your children’s teeth even before their first tooth grows in! Just use a soft, wet cloth or bit of gauze to rub their gums to help reduce bacteria and prevent future cavities. Once teeth come in, help get your children in the habit of brushing twice daily with a smear of toothpaste and flossing regularly.

Myth #4: Young Children Don’t Need To See A Dentist
There is a common misconception that children shouldn’t visit the dentist before the age of three, or before they have their full set of 20 primary teeth. The ADA states that children should visit the dentist by the time they get their first tooth, or at least by the age of one.Early check-ups can identify cavities and help prevent and assess other problems.

Need Any More Myths Debunked? We Can Help!
If you have any questions regarding your child’s oral health, give us a call! We love any opportunity to help you, our wonderful patients!

Thank you for being a part of our practice family.

The content on this blog is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of qualified health providers with questions you may have regarding medical conditions.

Top image by Flickr user Donnie Ray Jones used under Creative Commons Attribution-Sharealike 4.0 license. Image cropped and modified from original

Anxiety video blog, part 2

October 24th, 2016

Check out our latest video blog!


More topics to come in the future!

August/September Blog Post

September 29th, 2016

We made our first video blog post. Today's post is about anxiety and the orthodontic visit. Click the link below to see our video!

Video blog link

And while you're on the page, don't forget to like us on facebook to keep up to date with all of our future video blogs. :)

Drs. David, Gary and Steve

June/July Blog Post

July 26th, 2016

“Oh no, I forgot how to activate my palatal expander!”

Your orthodontist prescribed a palatal expander as part of your orthodontic treatment plan. The team did a great job cementing the expander and making you/your child comfortable. They explained why it is a part of the prescribed treatment and how to activate it. You arrived home and went to activate the expander but, UH-OH, forgot how to do it!
So, let’s review the technique again!

Look into the roof of the mouth, in the middle of the expander there is a rectangular platform, this platform has a small activator screw in the middle of it. The activator screw has a small hole that should be facing towards the front of the mouth. Once you have located this hole you take the expander “key” and insert it into the hole. Push the key towards the back of the mouth, the activator screw will turn towards the back of the mouth. Once you have pushed the key as far as it will go you should be able to see the next hole in the activator screw facing the front of the mouth. This is your sign that it is safe to remove the key. To remove the key push the key out of the activator screw towards the back of the mouth.

VOILA, you have activated your expander!

If you are like Dr. Steve and would prefer a video demonstration please click the following link: Palatal Expansion video
If you are curious to learn more about palatal expanders, you can find that on our website by clicking this link: Palatal Expander information
We hope this helped, if you have any questions please feel free to call.

Drs. David, Gary and Steve

April/May 2016 Blog from Westwalk Orthodontic Group PC

May 9th, 2016

When will I get my braces off?

If we had a nickel for every time we heard this question we would own Fort Knox.  Understandably patients begin to tire of wearing orthodontic appliances after several months and look forward to the day they will be finished.  However completion dates are merely estimates that can vary significantly.  Factors that influence how quickly Orthodontic treatment progresses are:

Rate of Tooth movement: Tooth movement is a biological process requiring bone resorption and deposition around the teeth being moved.  Often patients anxious to get their braces off will ask us to tighten the braces as much as possible to expedite the movement of the teeth.  However over-tightening the braces can in some instances slow down tooth movement because it adversely effects the cells responsible for bone remodeling and can make your teeth excessively sore.

Frequently orthodontic treatment is started prior to all the teeth coming in for a variety of reasons (refer to our previous blog to learn more).  Often this will allow those teeth to erupt more favorably particularly if those teeth lack the space to come in to their designated positions.  However how quickly those teeth come in is very difficult to predict and can vary by several months.

Facial growth:  How a patients face grows can have a tremendous impact on how quickly treatment progresses.  Orthodontics has researched facial growth for decades in order to predict the direction and type of facial development, as well as the magnitude of growth.  While the orthodontist can get a general idea about this from the orthodontic records taken, there is a significant amount of individual variability

Cooperation:  Nothing influences the rate of treatment in orthodontics and the relative success more than patient cooperation.  Cooperation includes coming to appointments when indicated by the doctor, following instructions in wearing elastics, headgear or other appliances. It also includes good oral hygiene and scheduling with other doctors for procedures necessary to allow treatment to proceed optimally.

There are many other factors that influence tooth movement such as our individual metabolisms, biting forces and habits such as tongue thrusts and skeletal patterns.  These are some of the reasons predicting completion of treatment can only be estimated.

Please keep in mind that the doctor and staff are motivated to try to finish your treatment as efficiently as possible while giving you the best possible result.  Sometimes the last few months in braces can seem to take forever but it may make the difference between and excellent result with optimal stability or a mediocre one with ongoing issues during retention.  We want you to love your smile!

Drs. David and Gary

February/March 2016 Blog from Westwalk Orthodontic Group PC

February 14th, 2016

FAQ about orthodontics

When should I bring my child to the Orthodontist?

As the old saying goes “Timing is everything in life”.  Orthodontics is no different.  Our teeth and jaws are as unique as the rest of us.  Therefore, there is no right answer to when to bring your child to the orthodontist.  Parents should seek the advice of their child’s dentist and should be aware of the fact that children may benefit from some form of orthodontic intervention as young as 7 years of age.  However, not every orthodontic problem requires early treatment, in fact the majority don’t.  Parents sometimes fear that if they bring their child early for an evaluation that treatment is going to be recommended prematurely.  In our practice we strive to avoid such situations.  We want to begin treatment when it is best for the child’s overall situation.  Everyone benefits in that scenario because treatment time is minimized, and the best possible correction can be achieved.  If we recommend an initial phase of treatment, it is in order to reduce the severity of unfavorable development of the teeth and jaws.  Everyone wants a beautiful smile, but the goal of first phase treatment is to allow the patients jaws and teeth to develop as favorably as possible so that an optimal esthetic and functional result can be eventually achieved.

Doesn’t it make sense to wait until all the permanent teeth come in     before seeing the orthodontist?

The answer to this is a resounding NO.  Many opportunities may be lost to aid the development of the teeth and jaws, particularly if a patient has gone through a large part of their pubertal growth spurt. It is unfortunate when parents delay having an orthodontic exam until their child is 14 or 15 years of age because they are waiting for all the permanent teeth.  In some situations this can result in treatment being far more difficult with a potentially less favorable outcome.  Additionally, the need to take out permanent teeth in these situations increases significantly.  The other detrimental element is related to the social implications for the patient.  A 15 year old patient is often very unenthusiastic about undertaking comprehensive orthodontic treatment because the majority of their peers have finished with braces or will be completed very shortly.  Unenthusiastic patients tend to be less cooperative, and make the work of the orthodontist and his staff more difficult.  It sometimes results in terminating treatment with a less than ideal result because the patient just wants the braces off and isn’t concerned about the long term implications.  Parents often yield as well because they tire of the child’s constant complaining.

Additionally by waiting, delayed eruption of some of the permanent teeth may not be properly assessed.  Impacted or abnormally erupting teeth may not be detected until the jaws are more fully developed resulting in much more difficult treatment with the potential for teeth requiring extraction.  One of the most commonly impacted teeth is the cuspid or “eye tooth”.  The patient who is around 15 is faced with the possibility of wearing braces into their senior year in high school to bring these teeth into proper position.  We cannot emphasize enough how waiting can increase the difficulty of treating these situations.

It is also worth noting that in many patients, removal of the baby teeth at an earlier age may prevent impaction of permanent teeth thus sparing the child additional surgical procedures and thousands of dollars in fees.

The bottom line:  If there is evidence that your child may need orthodontics have them evaluated no later than age 12 but preferably sooner. If your dentist recommends an orthodontic consult act promptly.    If you are not comfortable with the orthodontists opinion get another, but don’t avoid it for fear of being talked into treatment that your child doesn’t need.

Our practice has been built on integrity.  We try to offer patients honest and practical opinions regarding treatment for themselves or their children.  Orthodontics is not for everyone, even in situations where it could be potentially beneficial there may be other factors that outweigh those benefits.  For most patients orthodontics is elective in the sense that it is not a life or death decision.  People can live with crooked teeth that are ill fitting.   Our goal is to optimize a patient’s esthetics and oral health using a positive approach. If we believe that there are significant obstacles to achieving a favorable result we will discuss that with you.

Is two phase treatment more expensive?

If a patient can benefit from two phases of treatment it will usually be more costly than one comprehensive phase.  However,  the cost difference usually is about 10 to 20% more which helps to cover the additional time required to treat a patient in that manner.   In many instances you are dividing the treatment into two portions.  The first phase often significantly reduces the difficulty of the second phase.  A first phase usually is about 12 months the second about 12-18 months.  However, orthodontic treatment is not a perfect science so time frames can vary.

It is also worth noting that in some cases a first phase of treatment will alleviate the need for a second, or make a second phase discretionary to address very minor discrepancies.

If you have any questions at all please contact us by phone or email.  We would be more than happy to discuss them with you.

Drs. Gary and David

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