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?”
Ever since childhood, when her career as a model and actress took off, Brooke Shields has enjoyed worldwide recognition — through advertisements for designer jeans, appearances on The Muppet Show, and starring roles in big-screen films. But not long ago, that familiar face was spotted in an unusual place: wearing a nasal anesthesia mask at the dentist's office. In fact, Shields posted the photo to her own Instagram account, with the caption “More dental surgery! I grind my teeth!” And judging by the number of comments the post received, she's far from alone.
In fact, researchers estimate that around one in ten adults have dental issues that stem from teeth grinding, which is also called bruxism. (Many children also grind their teeth, but it rarely causes serious problems, and is often outgrown.) About half of the people who are teeth grinders report problems like persistent headaches, jaw tenderness and sore teeth. Bruxism may also result in excessive tooth wear, and may damage dental work like crowns and bridges; in severe cases, loosened or fractured teeth have been reported.
Researchers have been studying teeth grinding for many years; their findings seem to indicate that it has no single cause. However, there are a number of factors that play a significant role in this condition. One is the anatomy of the jaw itself, and the effect of worn or misaligned teeth on the bite. Another factor relates to changes in brain activity that occur during the sleep cycle. In fact, nocturnal (nighttime) bruxism is now classified as a sleep-related movement disorder. Still other factors, such as the use of tobacco, alcohol and drugs, and a high level of stress or anxiety, can make an individual more likely to experience bruxism.
What can be done for people whose teeth grinding is causing problems? Since this condition may have many causes, a number of different treatments are available. Successful management of bruxism often begins by striving to eliminate the factors that may cause problems — for example, making lifestyle changes to improve your health, creating a soothing nighttime environment, and trying stress-reduction techniques; these may include anything from warm baths and soft music at bedtime, to meditation and mindfulness exercises.
Several dental treatments are also available, including a custom-made occlusal guard (night guard) that can keep your teeth from being damaged by grinding. In some cases, a bite adjustment may also be recommended: In this procedure, a small amount of enamel is removed from a tooth to change the way it contacts the opposite tooth, thereby lessening the biting force on it. More invasive techniques (such as surgery) are rarely needed.
A little tooth grinding once in a while can be a normal response to stress; in fact, becoming aware of the condition is often the first step to controlling it. But if you begin to notice issues that could stem from bruxism — or if the loud grinding sounds cause problems for your sleeping partner — it may be time to contact us or schedule an appointment. You can read more about bruxism in the Dear Doctor magazine article “Stress and Tooth Habits.”
Most of us are quite familiar with what traditional braces look like. But occasionally we see more complex-looking devices being worn by young orthodontic patients: thicker wires that extend outside the mouth, with straps that may go behind the neck or over the chin. What are these devices, and why are they sometimes needed?
In general, orthodontic appliances with external parts braced by the head, neck or chin are referred to as “headgear.” These devices may be used to handle a number of particular orthodontic situations, but they all have one thing in common: They provide the additional anchorage needed to move teeth into better positions.
It may come as a surprise that teeth, which seem so solid, can actually be moved fairly easily over time. This is because teeth are not fixed directly into bone, but are instead held in place by a hammock-like structure called the periodontal ligament. Using a light, controlled force — such as the force of springy wires and elastics in traditional braces — teeth can be moved slowly through the jaw bone, like a stick being pulled through sand.
Of course, to pull a stick through sand, you need a firm anchorage — your legs, for example, bracing against a rock. Most of the time, the back teeth, with their large, multiple roots, provide plenty of support. But sometimes, the back teeth alone aren’t enough to do the job.
If a very large space between teeth is being closed, for example, the back teeth might be pulled forward as the front teeth are pulled back; this could result in poor alignment and bite problems. In other cases, the front teeth may need to be pulled forward instead of back. The back teeth can’t help here; this is a job for headgear.
Some types of headgear have a strap that goes behind the head or neck; they use the entire head as an anchorage. Other types, called “reverse pull” headgear, have a strap that comes over the chin or the forehead; they can pull teeth forward. Headgear can even influence the proper growth of facial structures — that’s why it is usually seen on preteens, whose growth isn’t yet complete.
Headgear is usually worn for 12 hours per day, for a limited period of time. In some cases, rather than headgear, appliances called “temporary anchorage devices” (TADS) may be recommended. These are tiny screws that are implanted into the jawbone in a minimally invasive procedure, and serve a similar function.
While it may not look pretty, orthodontic headgear is capable of moving teeth into their proper positions in a relatively short period of time — and ending up with a great-looking smile is what orthodontics is all about.
It's no secret that many of Hollywood's brightest stars didn't start out with perfectly aligned, pearly-white teeth. And these days, plenty of celebs are willing to share their stories, showing how dentists help those megawatt smiles shine. In a recent interview with W magazine, Emma Stone, the stunning 28-year-old star of critically-acclaimed films like La La Land and Birdman, explained how orthodontic appliances helped her overcome problems caused by a harmful habit: persistent thumb sucking in childhood.
“I sucked my thumb until I was 11 years old,” she admitted, mischievously adding “It's still so soothing to do it.” Although it may have been comforting, the habit spelled trouble for her bite. “The roof of my mouth is so high-pitched that I had this huge overbite,” she said. “I got this gate when I was in second grade… I had braces, and then they put a gate.”
While her technical terminology isn't quite accurate, Stone is referring to a type of appliance worn in the mouth which dentists call a “tongue crib” or “thumb/finger appliance.” The purpose of these devices is to stop children from engaging in “parafunctional habits” — that is, behaviors like thumb sucking or tongue thrusting, which are unrelated to the normal function of the mouth and can cause serious bite problems. (Other parafunctional habits include nail biting, pencil chewing and teeth grinding.)
When kids develop the habit of regularly pushing the tongue against the front teeth (tongue thrusting) or sucking on an object placed inside the mouth (thumb sucking), the behavior can cause the front teeth to be pushed out of alignment. When the top teeth move forward, the condition is commonly referred to as an overbite. In some cases a more serious situation called an “open bite” may develop, which can be difficult to correct. Here, the top and bottom front teeth do not meet or overlap when the mouth is closed; instead, a vertical gap is left in between.
Orthodontic appliances are often recommended to stop harmful oral habits from causing further misalignment. Most appliances are designed with a block (or gate) that prevents the tongue or finger from pushing on the teeth; this is what the actress mentioned. Normally, when the appliance is worn for a period of months it can be expected to modify the child's behavior. Once the habit has been broken, other appliances like traditional braces or clear aligners can be used to bring the teeth into better alignment.
But in Stone's case, things didn't go so smoothly. “I'd take the gate down and suck my thumb underneath the mouth appliance,” she admitted, “because I was totally ignoring the rule to not suck your thumb while you're trying to straighten out your teeth.” That rule-breaking ended up costing the aspiring star lots of time: she spent a total of 7 years wearing braces.
Fortunately, things worked out for the best for Emma Stone: She now has a brilliant smile and a stellar career — plus a shiny new Golden Globe award! Does your child have a thumb sucking problem or another harmful oral habit? For more information about how to correct it, please contact us or schedule an appointment for a consultation. You can learn more in the Dear Doctor magazine article “How Thumb Sucking Affects the Bite.”
You may not always be able to tell if your child's bite isn't developing properly. Â That's why you should have them undergo an orthodontic evaluation around age 6 to uncover any emerging problems with tooth misalignment.
Still, there are some visible signs all's not well with their bite. As the primary (baby) teeth give way, the permanent teeth erupt sequentially around ages 6 to 8. As they come in, you should notice that each tooth fits uniformly next to each other without excessive gaps or, on the other end of the spectrum, not crowded together in crooked fashion. Upper teeth should also fit slightly over the lower teeth when the jaws are shut.
If their teeth appearance deviates from these norms, they may have a bite problem. Here are 4 abnormalities you should watch for.
Underbite or deep bite. As we mentioned, the front teeth should cover the lower teeth with the jaws shut. In an underbite, the reverse happens — the lower teeth are in front of the upper teeth. It's also a problem if the upper teeth cover the lower teeth too much (often referred to as “deeply”).
Open bite. This occurs when there's a gap between the upper and lower front teeth while the jaws are shut together. One possible cause is late thumb sucking, which can put undue pressure on the front teeth and cause them to develop too far forward while forcing the bottom front teeth further backwards.
Crossbites. This kind of bite occurs when some of the teeth don't fit properly over their counterparts, while others do. Crossbites can occur anywhere in the mouth, for example the upper front teeth fitting behind the lower front teeth while the back teeth overlap normally, or the reverse (front normal, back abnormal).
Misalignments and Abnormal Eruptions. Sometimes upper teeth may align too far forward, a situation known as protrusion. Conversely, lower teeth (or the jaw itself) may come in too far back (retrusion). Because a primary tooth might be out of position or not lost in the proper sequence, a permanent tooth might noticeably erupt out of its proper position.
If you notice any of these situations with your child's teeth see your dentist or orthodontist soon for a full examination. If caught early, we may be able to take action that will lessen or even eliminate the problem.
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