After months of wearing braces, the big day has arrived — they’re finally off! Your teeth have been realigned and your smile is dazzling. You’re finished with orthodontic treatment, right?
Not quite — because if you want to keep your new smile you have one more treatment phase to go — wearing a retainer. Without this phase there’s a distinct possibility you could lose all the time, effort and expense of braces because your teeth could revert to their previous position.
To understand why, we have to consider how teeth can move in the first place. Although it may seem like your teeth are rigidly fastened to the jawbone, they’re actually held in place by the periodontal ligament, a strong, elastic gum tissue that lies between the teeth and the bone. Tiny fibers from the ligament attach to the teeth on one side and to the bone in a similar manner on the other side.
When pressure is applied to the tooth as happens with braces, the bone around the side of the tooth in the direction of the force will begin to dissolve (resorb), allowing the tooth to move in that direction. New bone will then build up on the other side to stabilize the tooth. Once the pressure is removed (when we take the braces off), there’s a tendency for the teeth, bone and gums to “remember” the old position and try to revert back.
The answer is a removable mouth appliance known as a retainer. Custom-designed to fit the teeth’s new position, the retainer helps hold the teeth in place until the bone completely sets around them. In the beginning, you may need to wear the retainer around the clock and then later only at night while you sleep. While you may only need to wear it for a few months (especially if you’re an adolescent or young adult) some patients may need to wear some form of retainer indefinitely. Your orthodontist will advise you how long depending on your individual situation.
While retainers may seem like an inconvenience, they’re extremely important for keeping or “retaining” the teeth in their new and better position. Following through on this important phase of treatment will help ensure you’ll keep your new smile for a long time to come.
If you would like more information on retainers, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Why Orthodontic Retainers?”
You’re ready to have that missing tooth replaced with a dental implant or other life-like restoration. But we may first have to address another problem — moving the teeth around the missing tooth space back to where they should be.
That empty space is the primary reason those teeth are no longer in the right position. Through their attachment to the periodontal ligament that lies between them and the bone, teeth are able to move slightly over time in response to mouth changes. This same mechanism, however, may also cause teeth to “drift” toward each other across the empty space left by a missing tooth; too much drift and there won’t be enough room for the replacement tooth.
A fairly straightforward orthodontic treatment can restore drifted teeth to their original position to make room for the replacement. There is one situation, however, that can complicate this treatment — if you also have periodontal (gum) disease, a plaque-induced bacterial infection. During normal tooth movement bone dissolves (resorbs) in front of the tooth in the direction of movement, while new bone forms behind it to help stabilize the tooth in its new position. Gum disease, however, can weaken the bone around these teeth, inhibiting the natural rebuilding process of bone and connective tissue that could jeopardize the success of the orthodontic treatment.
It’s important, then, to first treat and bring the gum disease under control to restore health to both the gums and bone. It’s also just as important during orthodontic treatment to prevent another infection flare-up through renewed brushing and flossing and regular office cleanings and checkups. Choosing clear aligners over traditional braces to move the teeth could also help — unlike fixed braces that often make oral hygiene difficult, clear aligners can be removed to allow easier cleaning of teeth and gums.
Depending on your situation, the process for preparing your mouth for a tooth replacement can involve several procedures and healing time. But the end result — a brand new tooth that looks amazing — will be something to smile about.
A poor bite (malocclusion) could be more than simply teeth out of alignment. There could be complex causes for the malocclusion, possibly involving the facial bone structure.
An example of this is the development of a cross-bite due to problems with the upper jaw and palate (the roof of the mouth), jointly called the maxilla. The maxilla is in fact formed by two bones fused together in the center of the palate in what's called the midline suture. The suture doesn't completely fuse until after puberty.
Sometimes a maxilla's development doesn't follow a normal track. The upper jaw doesn't widen as it should, which leads to the cross-bite where the upper back teeth abnormally bite inside the lower teeth. The upper front teeth continue to bite normally in front of the lower front teeth. This also can have profound influence on breathing, causing sleep apnea.
We can correct this by using an orthodontic appliance called a palatal expander before the midline suture fuses. The expander gradually widens the upper jaw to its normal width and thus eliminates the cross-bite.
Positioned at the roof of the mouth, the expander has metal arms that extend from a central hinge to exert pressure on the inside of the upper teeth. The patient or a caregiver uses a small key to turn a mechanism that extends the arms toward the teeth a tiny amount each day. This gradually widens the jaw, while at the same time stimulating bone growth at the midline suture. Eventually the gap fills with bone to solidify the new width as the suture fuses.
It's important to undertake this treatment before fusion. If you wait until after puberty, you will need to separate the bones first to attempt it. The overall impact and cost is much less if you act promptly in the early years.
Palatal expansion may not be the right treatment in every case, so we'll need to perform a thorough orthodontic exam first. If, however, we do determine it can help, using an expander can improve function, correct future breathing problems and make possible a more attractive future smile.
If you would like more information on orthodontic treatment options, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Palatal Expanders: Orthodontics is more than just Moving Teeth.”
The movie Bohemian Rhapsody celebrates the iconic rock band Queen and its legendary lead vocalist, Freddie Mercury. But when we see pictures of the flamboyant singer, many fans both old and new may wonder—what made Freddie’s toothy smile look the way it did? Here’s the answer: The singer was born with four extra teeth at the back of his mouth, which caused his front teeth to be pushed forward, giving him a noticeable overbite.
The presence of extra teeth—more than 20 primary (baby) teeth or 32 adult teeth—is a relatively rare condition called hyperdontia. Sometimes this condition causes no trouble, and an extra tooth (or two) isn’t even recognized until the person has an oral examination. In other situations, hyperdontia can create problems in the mouth such as crowding, malocclusion (bad bite) and periodontal disease. That’s when treatment may be recommended.
Exactly what kind of treatment is needed? There’s a different answer for each individual, but in many cases the problem can be successfully resolved with tooth extraction (removal) and orthodontic treatment (such as braces). Some people may be concerned about having teeth removed, whether it’s for this problem or another issue. But in skilled hands, this procedure is routine and relatively painless.
Teeth aren’t set rigidly in the jawbone like posts in cement—they are actually held in place dynamically by a fibrous membrane called the periodontal ligament. With careful manipulation of the tooth, these fibers can be dislodged and the tooth can be easily extracted. Of course, you won’t feel this happening because extraction is done under anesthesia (often via a numbing shot). In addition, you may be given a sedative or anti-anxiety medication to help you relax during the procedure.
After extraction, some bone grafting material may be placed in the tooth socket and gauze may be applied to control bleeding; sutures (stitches) are sometimes used as well. You’ll receive instructions on medication and post-extraction care before you go home. While you will probably feel discomfort in the area right after the procedure, in a week or so the healing process will be well underway.
Sometimes, dental problems like hyperdontia need immediate treatment because they can negatively affect your overall health; at other times, the issue may be mainly cosmetic. Freddie Mercury declined treatment because he was afraid dental work might interfere with his vocal range. But the decision to change the way your smile looks is up to you; after an examination, we can help you determine what treatment options are appropriate for your own situation.
If you have questions about tooth extraction or orthodontics, please contact our office or schedule a consultation. You can read more in the Dear Doctor magazine articles “Simple Tooth Extraction” and “The Magic of Orthodontics.”
Overbites, underbites, crossbites—these are just a few of the possible malocclusions (poor bites) you or a family member might be experiencing. But no matter which one, any malocclusion can cause problems.
Besides an unattractive smile, a malocclusion makes it more difficult to chew and to keep the teeth and gums clean of disease-causing bacterial plaque. Thus correcting a malocclusion improves dental health; a more attractive smile is an added bonus.
This art of correction—moving teeth back to the positions where they belong—is the focus of a dental specialty called orthodontics. And, as it has been for several decades, the workhorse for achieving this correction is traditional braces.
Braces are an assembly of metal brackets affixed to the teeth through which the orthodontist laces a metal wire. The wire is anchored in some way (commonly to the back teeth) and then tightened to apply pressure against the teeth. Over time this constant and targeted pressure gradually moves the teeth to their new desired positions.
The reason why this procedure works is because teeth can and do move naturally. Although it may seem like they’re rigidly set within the jawbone, teeth are actually held in place by an elastic tissue network known as the periodontal ligament. The ligament lies between the tooth and bone and keeps the tooth secure through tiny fibers attached to both it and the bone. But the ligament also allows teeth to continually make micro-movements in response to changes in chewing or other environmental factors.
In a sense, braces harness this tooth-moving capability like a sail captures the wind propelling a sailboat. With the constant gentle pressure from the wires regularly adjusted by the orthodontist, the periodontal ligament does the rest. If all goes according to plan, in time the teeth will move to new positions and correct the malocclusion.
In a way, braces are the original “smile makeover”—once crooked teeth can become straight and more visually appealing. More importantly, though, correcting a poor bite improves how the mouth works, especially while eating, and keeping things clean. A straighter smile isn’t just more attractive—it’s healthier.
If you would like more information on correcting misaligned teeth, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Moving Teeth with Orthodontics.”
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