Orthodontic treatment traditionally begins somewhere between the ages of 10 and 14—but there’s no need to stand on tradition where your family’s dental health is concerned! An orthodontic evaluation will let you know each family member’s best options for healthier, more confident smiles even before the tween years and even after reaching adulthood.

First Visit—By Age 7

Dentists recommend that you schedule a first orthodontic evaluation for your child by age seven (or earlier if any bite problems or jaw asymmetry are apparent). By this age, most children have a mix of both adult and baby teeth, and orthodontists can determine whether the position and development of the teeth and jaws are on track.

During this visit, Drs. Cartsos and Zavras will also carefully assess how your child’s teeth and jaws fit together when biting down. Healthy occlusion, or bite, means that the teeth and jaws are aligned and work together comfortably. A malocclusion, or bad bite, means that there is a problem with this alignment.

Drs. Cartsos and Zavras might discover:

• No issues for concern.
• A possibility for future orthodontic problems. In this case, follow-up appointments might be scheduled to determine whether and when treatment should occur.
• Orthodontic problems which are already evident, with a recommendation for early intervention.

Early Orthodontic Intervention—Ages 6-9

Some children can benefit from “interceptive orthodontics,” first stage orthodontic treatment begun around the ages of six to nine.

Early intervention can help prevent crowded teeth, protect protruding teeth, and correct jaw alignment problems.

• If a child has a small upper dental arch, palatal expanders can gently enlarge the arch to make room for the adult teeth to arrive without crowding.
• When a baby tooth is lost too soon, space maintainers save room for the adult tooth beneath it to erupt in just the right spot.
• Protruding front teeth have a higher risk of injury from falls or collisions, and treatment will help protect them.
• Treatment for malocclusions like overbites, underbites, and open bites helps create a more comfortable, symmetrical, and healthy bite while young bones are growing, and may prevent the necessity for more complicated treatment in the teen years.

Tween and Teen Years—Ages 10-14

It’s common to treat malocclusions during the tween/teen years. During this stage of development, it’s easier for teeth to move to their ideal positions, because most of the adult teeth have arrived and the jawbones haven’t completed their growth.

Today’s orthodontics offers teens a number of treatment options:

• Braces are smaller and more comfortable, and brackets come in a variety of colors and materials to blend in or stand out.
• Clear aligners are almost invisible, and can treat many types of mild to moderate malocclusions.
• Functional appliances like the Herbst® appliance, the Forsus™ device, the twin-block appliance, and headgear work with braces or aligners to help correct more complex malocclusions.

And there’s more—modern orthodontic options are more effective, taking less time to create a beautiful, healthy smile.

Older Patients of Any Age

As you’ve grown older, you may have noticed that your once-straight teeth are becoming a bit crowded. You may be suffering dental pain and injured teeth because of a long-term bite problem. You may have always wanted a more attractive, comfortable smile, but weren’t able to access treatment when you were younger.

Good news! As long as your teeth and gums are healthy, orthodontic treatment can be a great way to keep them healthy. And today’s orthodontics offer a much wider and less noticeable variety of treatment options than the larger metal braces you might remember from decades ago. Depending on your needs, the team at Convivial Dental could recommend:

• Traditional braces—brackets are smaller than ever and come in a choice of several materials and colors, including ceramic, tooth-colored, and clear brackets.
• Clear aligners—an almost invisible way to straighten teeth, and removeable when necessary (as long as they’re worn 20-22 hours each day).
• Lingual braces—the least visible treatment, because brackets and wires are attached behind the teeth.

Crowded teeth and malocclusions often lead to lifelong problems, including worn or cracked enamel, headaches, jaw problems, increased risk of tooth decay and periodontal disease, and decreased self-confidence. Whether you’re graduating high school or getting ready for your golden reunion, it’s not too late for an orthodontic assessment.

If you’re concerned about your own or your child’s orthodontic health, problems with alignment and bite are best treated as early as possible to prevent dental damage, improve self-confidence, and avoid more complicated treatment in the future. So, when’s the best time to schedule an orthodontic assessment in Chestnut Hill, Massachusetts? There’s no better time than today!

Perhaps you’ve heard from parents or older relatives what braces used to be like years ago—obvious, uncomfortable, hard to clean, and with inevitable tooth extractions to start off the whole lengthy process.

Today, brackets are much smaller and wires are more pliable. You can even choose ceramic brackets or clear aligners for an almost invisible effect. New tools make cleaning your braces easier than ever. And new braces technology means that treatment is often shorter. But what about extractions? Are they still inevitable?

For orthodontists like Drs. Cartsos and Zavras, the objective is saving teeth. And modern practices and technology have made this goal more attainable than ever before. There are several ways that modern treatment procedures can help avoid extractions.

• Early Intervention

We recommend that children visit our Chestnut Hill, Massachusetts office for an orthodontic evaluation by age seven. Because a child’s jaw is still forming at this age, early intervention can lead to orthodontic treatment that expands the jaw in order to make room for permanent teeth, or starts correcting bite problems before they become more serious.

• High-Tech Planning

Today’s technology allows us to map out the progression of your treatment before we begin. Scanners, X-rays, and computer programs help us to design a treatment plan which will accurately predict how best to move your teeth and correct your bite, taking into account the size and development of your teeth and jaw.

• Surgical Options

By the time you reach your late teen years, the jaw bones have stopped growing and it’s no longer possible to expand them without surgery. Oral surgery can treat serious jaw problems that impact your teeth and bite, usually as part of a combined treatment plan designed by your orthodontist and your oral surgeon.

Because we always work to keep teeth intact—using these methods and others—you can be sure that, if we recommend extraction, it is absolutely necessary. What could make an extraction necessary?

• Severe overcrowding. Sometimes, there’s just not enough room in the jaw for all of your teeth.
• A tooth or teeth that prevent us from correcting a problem with your bite.
• Wisdom teeth. Usually, orthodontic work takes place before a patient’s wisdom teeth start to erupt. If yours do make an appearance before or during treatment, we can adapt our treatment plan accordingly.
• An extra tooth. It’s rare, but an extra, or supernumerary, tooth sometimes develops, and your jaw is not designed to accommodate extras!

It’s important that you talk to Drs. Cartsos and Zavras about every step of your treatment, including extractions. We want you to understand the treatment plan which will give you your best outcome. If we recommend extraction, it is because this decision is the best way to achieve a healthy bite and alignment, creating your beautiful smile—and protecting it—for a lifetime.

At Convivial Dental, we’re lucky to have dentists with very different backgrounds, specialties, and personalities, but one thing in common: they genuinely care about the people behind every smile. Our practice caters to the needs of both adults and children. Our adult dentists, Dr. Christian Ford and Dr. Anna Liapaki will be portrayed in our next communication. Today, get to know our dental specialists: Dr. Cartsos, Dr. Zavras, and Dr. Rifkin! 

Meet Dr. Vicky Cartsos

Orthodontist | Dentofacial Orthopedics

With 30 years of orthodontic clinical experience, Dr. Cartsos brings a sophisticated understanding of orthodontics, facial development and long-term oral health to the care of children and adults. She specializes in Early Orthodontics and Dentofacial Orthopedics, Full Comprehensive Orthodontic treatment as well as Multidisciplinary Craniofacial orthodontic treatment which involves all dental disciplines including Restorative and Orthognathic (jaw) surgery. She approaches each patient’s care with clinical precision and a thoughtful understanding of their individual needs, esthetics, and lifestyle.

For Dr. Cartsos, great orthodontic care is about more than straight teeth.

Her expertise extends beyond her private practice at Convivial Dental. As an Associate Professor of Orthodontics and Former Clinical Postgraduate Program Director at Tufts University Dental School, she brings the clinical evidence-based knowledge and the newest field related techniques to her everyday clinical practice. She is also a co-founding member of the Tufts Medical Center Craniofacial-Cleft Lip & Palate Team, where she spent over 10 years collaborating across specialties to care for patients with complex needs. This depth of experience is matched by her warm, nurturing approach and belief that exceptional orthodontic care should help patients feel comfortable, understood and confident throughout treatment.

Last year, on November 12, 2025, Dr. Cartsos was inducted in the American Academy of Dental Science based on her profound impact on the academic, clinical and professional contributions in the dental community.

When she’s not treating patients or teaching the next generation of orthodontists, you’ll probably find Dr. Cartsos traveling, playing tennis, skiing, or spending time with her husband, Dr. Zavras, and their two sons, Jason and John.

Meet Dr. Ethan (Athanasios) Zavras

Pediatric Dentist | Dental Director

Dr. Zavras has built his 30+ years career at the intersection of pediatric dentistry, education, research and prevention. His approach is grounded in a deep understanding of how oral health influences a child’s overall well-being. His clinical experience is vast and extends from personalized prevention to restorative dentistry to complex dentistry at Franciscan Children’s Hospital where he treats children that require general anesthesia. 

To deliver a highly personalized and comfortable experience, Dr. Zavras incorporates advanced technology, including CBCT 3D imaging, intraoral scanners, and dental lasers. 

His expertise extends well beyond Convivial Dental. Dr. Zavras serves as tenured Endowed Professor and Chairman of the Department of Public Health and Community Service and Associate Dean for Global Affairs at Tufts University School of Dental Medicine. He also serves at the University Senate, in Governor Healey’s Special Commission on Oral Health for the Commonwealth of Massachusetts and at the International Association of Dental Research.  

In the past, he has been Chair of Pediatric Dentistry at Boston University (2014-2022), Professor and Director at Columbia University College of Dental Medicine (2009-2014) and Professor and Program Director at Harvard University (1999-2009). 

His impact on oral health is recognized by the generations of dentists he has trained, the tens of scientific articles he has published in the most authoritative journals, two USPTO patents on oral diagnostics, his advanced research sponsored by the US government and his work at the World Health Organization in the early 2000s. But what he enjoys most is the friendships he has established at Convivial Dental with so many of our wonderful families and patients and the passion and the challenge of providing the best quality care possible.

Outside the practice and the University, Dr. Zavras enjoys serving in humanitarian dental missions for children in-need (ask about his next travel to the Island of Lesvos to care for refugee children), building AI agents, bicycling, swimming and traveling with his wife, Dr. Vicky Cartsos.  

Meet Dr. Marissa Rifkin

Pediatric Dentist

Dr. Rifkin brings advanced pediatric training and a thoughtful, highly individualized approach to caring for children. She is experienced in treating patients with a wide range of medical and behavioral needs, with a particular focus on prevention, family education and building the trust that helps children feel comfortable and confident during dental visits.

Her path to pediatric dentistry includes a degree in Human Biology from Cornell University, her DDS from Columbia University College of Dental Medicine, and a pediatric dentistry residency at New York-Presbyterian/Columbia University Irving Medical Center, where she served as Chief Resident.

Dr. Rifkin also has a creative side. While in dental school, she co-authored The Tooth Fairy’s Busy Day, a children’s book designed to make learning about preventive dental care and oral health a little more fun.

Dr. Rifkin’s combination of dental competence, experience and confidence along with her charming, caring and warm approach are the secrets for gaining children’s trust and putting parents at ease.

Originally from Westchester County, NY, Dr. Rifkin now calls Boston home. Outside of dentistry, she enjoys staying active, discovering great restaurants, traveling, and cheering on the Celtics.

One Team, Three Unique Specialized Perspectives

Whether you’re looking for orthodontic care, pediatric dentistry, or a team that takes a thoughtful, prevention-focused approach to oral health, the doctors at Convivial Dental bring their own unique perspective and expertise to every patient they treat.

Most importantly, they’re here to make dental care feel a little more personal, a little more comfortable, and a lot more convivial.

Ready to meet our team? Call Convivial Dental at 617-735-0800. We look forward to welcoming you and your family! 

For new mothers, breastfeeding can be an important part of those first days and weeks with your baby. It provides valuable nutrition while creating an important emotional bond between mother and child. But when nursing is painful or your baby is having difficulty latching or feeding, it can be stressful for the entire family.

At Convivial Dental, we are dedicated to supporting mothers and their newborns throughout Boston, Brookline, Newton, Wellesley, and the surrounding communities. Our team provides infant frenectomy procedures for babies with restricted tongue or lip movement that may be affecting breastfeeding.

What Is a Tongue-Tie or Lip-Tie?

A high or restricted frenum attachment can limit the ability of the tongue and/or upper lip to move appropriately during nursing. A restricted lingual frenum is commonly referred to as a tongue-tie, while a restricted upper lip frenum is often called a lip-tie.

Some signs that your baby may have a restricted tongue or lip include:

• Painful nursing for the mother
• Biting of the nipple
• Prolonged nursing with long breaks or naps between feedings
• Irritability during feeding
• Difficulty gaining weight
• Swallowing excess air that may cause stomach discomfort
• A U-shaped or heart-shaped tongue
• An upper lip that folds inward during nursing

Feeding challenges can have many causes, and not every baby with a restricted frenum requires treatment. Our team will evaluate your baby and discuss whether an infant frenectomy may be appropriate.

A Gentle Approach to Infant Frenectomy

Infant frenectomy is one of the procedures we perform at Convivial Dental. We use a CO₂ superpulsed laser to precisely release the restricted frenum and improve the movement of the tongue and/or upper lip.

We understand that having a procedure performed on your newborn can feel overwhelming. Our goal is to make the experience as gentle and comfortable as possible for both baby and parent.

After swaddling the baby, the doctor will apply a small amount of sugarwater and perform the operation.

Following the procedure, your baby can return to you for nursing within minutes. 

We will also provide you with exercises to help minimize the possibility of the frenum re-attaching during the healing process. Parents are asked to follow these exercises for approximately three to four weeks.

Supporting Your Breastfeeding Journey

We believe that caring for a baby with a restricted frenum is about more than the procedure itself. That’s why Dr. Zavras’ team works in conjunction with speech pathologists, occupational therapists and lactation consultants to improve oral function, speech, swallowing, and nursing.

We also suggest working with an IBCLC lactation consultant or nurse following an infant frenectomy to help support your breastfeeding goals.

Our use of dental laser technology offers several advantages over traditional scalpel surgery, including precise treatment, better control, minimal or no bleeding, less postoperative swelling, and faster healing.

If you’re concerned about your baby’s latch, feeding, or possible tongue-tie or lip-tie, you don’t have to navigate it alone. Our team is here to listen to your concerns, answer your questions, and help you understand your options.

Call Convivial Dental at 617-735-0800 to or click here to schedule a consultation.

We proudly support families throughout Brookline, Brighton, Boston, Cambridge, Wellesley, Needham, Dedham, Jamaica Plain, and surrounding communities, as well as families referred to our practice from throughout New England and beyond.