January 5th, 2017
We always recommend that patient’s wear retainers for life. There is nothing in life that isn’t affected by aging. Our skin wrinkles, our hair falls out and our stomachs sag. Our teeth are no different. Even if someone never had orthodontic treatment their teeth will crowd over time. Our teeth are the most unstable immediately after orthodontic treatment. Often teeth want to return to their pre-orthdontic position. There are fibers in the gums that take about four months to rearrange, after which teeth are slightly more stable. That is why it’s crucial for patients to wear their retainers immediately after treatment. Ideally we ask for a minimum of 10-12 hours per day for the first four months. After four months patient’s can switch to wearing retainers while they’re sleeping.
There are many different styles of retainers. All of them have their strengths and weaknesses. No retainer can prevent 100% of tooth movement, but as long as retainers are worn everyday for a minimum of 8 hours movement will be minimal. Most retainers last about 2-3 years. Nothing we use everyday will last forever. Just like gym shoes and contacts need to be replaced retainers need to be replaced. How frequently depends on the individual. Some people grind their teeth and need to replace retainers every year. Other people use the same retainer for 10-20 years. We’re always happy to evaluate the shape of your retainer and make any adjustments it may need.
October 31st, 2016
One of the most controversial topics in Orthodontics is the extraction of permanent teeth. Throughout the history of Orthodontics the pendulum has swung back and forth between extraction and non-extraction treatment. In Orthodontics early years almost no teeth were removed. Beginning in the 40's extraction treatment was becoming the norm. More recently the pendulum has swung back and fewer cases are treated with extractions.
No orthodontist likes removing permanent teeth. Extraction treatment is generally more difficult and time consuming. Additionally many parents, patients and referring dentists strongly prefer non-extraction treatment. Taking these factors into consideration why would an orthodontist recommend removing permanent teeth?
Facial esthetics- Our main goal isn’t just straightening teeth. Our main goal is to give patients a beautiful smile that fits their face. All patients can be treated with non-extraction treatment, but there may be undesired consequences. One consequence may be protrusive front teeth that don’t fit a patient’s smile or face. If patient’s teeth are too protrusive they may have trouble closing their lips. In order to prevent this situation an orthodontist may recommend extracting permanent teeth.
Gum health and stability- Again all patients can be treated with non-extraction treatment, but there may be undesirable consequences. If there is too much crowding non-extraction treatment can push teeth outside of their bony housing causing gum recession. This can also lead to an unstable result making relapse and crowding more likely in the future.
Lower arch crowding- There are fewer ways to make room for crowded teeth in the lower jaw compared to the upper jaw. The upper jaw can be orthopedically expanded. The upper jaw is made up of two bones with a suture running down the middle. This suture can be orthopedically opened with an expander. The lower jaw does not have a suture that can be orthopedically expanded so any expansion is simple dental expansion. Too much dental expansion can lead to unhealthy gum support, which may cause recession in the future. Teeth in the upper jaw can also be pushed backwards to a greater extent than teeth in the lower jaw. By pushing the teeth backwards room can be created to relieve crowding. Without these options the only way to relieve lower arch crowding is limited dental expansion, interproximal reduction (removing tooth structure on the sides of teeth) or extracting permanent teeth.
There are several periodontal procedures that can allow for patients with more severe crowding to be treated with non-extraction treatment. These treatments include gum grafts and surgically facilitated orthodontic treatment. If you are a candidate for these treatments we will discuss the procedures at our case presentation appointment. We always customize our treatment plans to fit your specific needs. We will review all of our findings and the pros and cons of all possible treatment options. Patient desires will always factor heavily into our final treatment plan. The vast majority of orthodontic patients can be treated without extractions, but there are cases when permanent teeth require extraction. If an orthodontist says they never extract permanent teeth I would be weary. No matter how much we all dislike extracting permanent teeth there will always be a few cases that require it to give a patient the most esthetic, healthy and stable result possible.
October 5th, 2016
About once a week orthodontists hear a patient say, "My teeth were straight when my braces came off, but my wisdom teeth came in and caused my front teeth to become crowded". Are they right or are wisdom teeth getting a bad rap? Patients generally finish with orthodontic treatment around 12-15 years old and wisdom teeth often erupt a few years after that. Are wisdom teeth the cause of the crowding or is it a mere coincidence in timing?
There have been several good studies examining this question. One study compared incisor crowding among patients congenitally missing wisdom teeth and patients with all four wisdom teeth and found no significant difference in crowding. Another study randomly assigned patients to one of two groups. The first group had their wisdom teeth extracted early before they began to erupt and the second group did not have their wisdom teeth extracted. There was no significant difference in the the amount of crowding. A third study measured the force between tooth contacts before and after wisdom tooth removal. If wisdom teeth were causing teeth in front to crowd you would expect an adequate force to be present before wisdom tooth removal and then a decrease in force after wisdom tooth removal. They study found no difference in the force between the teeth before and after wisdom tooth removal.
As in most medical research you can often find exceptions to the general trend in the literature. Some studies have found an increased rate of crowding in people with wisdom teeth, but these studies often find a small difference. The difference is around 1 mm which may be statistically significant but often isn't clinically significant.
If wisdom teeth are a scape goat what is the cause of lower incisor crowding? Some studies point to late mandibular (lower jaw) growth. After orthodontic treatment the bite often deepens and this in combination with mandibular growth can cause lower incisor crowding. Another cause is lack of retainer wear. Think of orthodontic treatment like a diet. After losing weight it can return quickly unless diet and exercise are maintained. Crowding is a natural process of aging. If treatment is not maintained with retainers (diet and exercise) crowding will occur, even if there was no crowding at the beginning of treatment. Wearing retainers at night for life is the only sure way to prevent lower anterior crowding.
June 28th, 2016
BBC News (UK) (6/27) reports that “89% of Welsh 12 to 14-year-olds” consume high-sugar sports drinks, with 68% consuming these drinks “at least once a week,” according to research from the Cardiff University School of Dentistry. The researchers said many parents and children are unaware these drinks are not suitable for children. Maria Morgan, senior lecturer in dental public health, said, “The purpose of sports drinks are being misunderstood and this study clearly shows evidence of high school age children being attracted to these high sugar and low pH level drinks, leading to an increased risk of dental cavities, enamel erosion and obesity.”
The Daily Mail (6/27, Spencer) reports the researchers found about half of the teenagers are consuming these drinks for “social reasons” rather than performance-enhancing results. “If consumed socially and in large quantities, sports drinks can lead to serious problems, such as obesity, diabetes, heart disease and gout, as well as poor oral health,” the researchers said. “Non-athletes are consuming these drinks simply because of their nice taste.”