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.

Not every orthodontic concern requires full treatment.

Maybe your teeth have started shifting. Maybe there’s one thing about your smile that has bothered you for years. Or maybe you know you could benefit from orthodontic treatment, but a larger financial commitment just isn’t right for you right now.

That doesn’t necessarily mean you have to wait.

At Convivial Dental, orthodontist Dr. Vicky Cartsos will start by understanding what you want to accomplish and what makes sense for you right now. In some cases, a simple touch-up or limited orthodontic treatment may be enough to make a meaningful difference.

Let’s start with a conversation about your options.

Request a Consultation with Dr. Cartsos today.

Sometimes, a little treatment can go a long way.

Orthodontic treatment isn’t always all or nothing. Depending on your smile and your goals, a more limited approach may help you:

• Stop teeth from shifting further

Noticing changes in a smile that was once straight? Addressing movement earlier may help prevent a relatively small concern from becoming more complicated.

• Fix the thing that’s bothering you

One tooth. One space. One area of your smile. If you’re happy overall but there’s something you’d like to change, talk to us about whether limited treatment may be appropriate.

• Touch up a previously treated smile

Teeth can move over time, even after orthodontic treatment. If your smile has shifted since you had braces or aligners, you may not need to start over with comprehensive treatment.

• Buy yourself some time

Not ready for more extensive orthodontic treatment? There may be an appropriate way to address an immediate concern now while giving you more time before considering comprehensive care.

Before you assume orthodontic treatment is too expensive, find out what you actually need.

If cost has been keeping you from scheduling an orthodontic consultation, don’t assume treatment has to be extensive.

Dr. Cartsos can evaluate your smile, listen to what you want to accomplish, and explain what needs attention now, what may be able to wait, and whether a simpler treatment option is appropriate.

You may need comprehensive treatment. You may not.

Either way, you’ll have a clear understanding of your options so you can make an informed decision about what makes sense for you.

The right care starts with the right specialist.

At Convivial Dental, your family has access to pediatric dentistry, general dentistry and orthodontics, all in one practice.

That means children can see a pediatric dental specialist. Adults can receive ongoing general dental care. And when someone in the family needs orthodontic expertise, Dr. Vicky Cartsos is right here.

Having specialists working together also means your orthodontic care can be considered alongside your overall dental health, with communication between the professionals caring for your family's smiles.

One practice. The right specialist for everyone in your family.

What does “starting simple” look like?

1. Tell us what’s bothering you.
We want to understand what you’re seeing, what you’d like to change and what matters most to you.

2. Have your smile evaluated by an orthodontist.
Dr. Cartsos will determine what’s happening and whether it makes sense to address it now.

3. Understand your options.
If a limited approach is appropriate, we’ll explain it. If comprehensive orthodontic treatment would provide a better or healthier result, we’ll explain why.

4. Decide what makes sense for you.
You’ll have the information you need to make a confident decision without assuming you need more treatment than you actually do.

Don’t let cost keep you from finding out what’s possible.

A small orthodontic concern today may not always stay small. And the treatment you’re imagining may be more than you actually need.

Let’s find out. Let’s start simple.

Schedule a Complimentary Consultation Today!