No More Mashed Potatoes

As teeth are moved by braces into their new positions, the bone (with periodontal ligaments) and surrounding muscles require a significant period of time to settle.

Removable and permanent retention, if maintained for a number of years, appears to assist in maintaining the new position of the teeth.  Your Orthodontist will discuss your own unique retention needs but keep in mind that tooth stabilization is necessary for at least a year or more after active appliance removal in the maxillary arch, and 3 to 5 years in the mandibular arch.

Permanent fixed lingual retention wires are wires bonded to the inside of some of upper and lower front teeth after braces treatment is completed, in place of using a removable retainer.  With these in place, patients can eat normally, they are comfortable, invisible when you smile, and with correct care, will stay in place permanently.

The problem with removable retainers is that they are removable and every Orthodontist has experienced the frustration of treating their patients, often over several years, with difficult mal-occlusions, seeing a great result, then only to have them return to advise that their teeth have shifted.  This is usually owing to the patient not wearing their removable retainer, having lost it, had the dog chew it or from just becoming ambivalent about wearing it.

However, there are pros and cons to bonded retention.

Pros: By definition bonded retainers are fixed 24 hours and full-time retention preserves orthodontic correction. They remove some of the patient responsibility of wearing a removable retainer, and they rarely interfere with playing musical instruments, sports, speech or appearance.

Cons: They only retain the position of the teeth they are bonded to, and it can be difficult for the patient, hygienist, and dentist to clean the teeth. Patients with no flossing experience and poor oral hygiene during treatment are not eligible for bonded lingual retainers. Your Orthodontist will instruct you on correct brushing and flossing to maintain the health of your teeth and gums.

Similarly, patients who have diets high in excessive junk food, with evidence of multiple decalcifications during treatment, are very high risk when wearing bonded retainers.

Use is not recommended in patients with prolapsed mitral valves, artificial joints, or other serious medical conditions highly susceptible to bacterial infections.

Bonded retainers require regular observation and maintenance appointments to ensure that all bonded areas are intact and that there is no gingival infection, decalcification, or tooth decay. These observation appointments should be performed by the orthodontist and the general dentist.

Occasionally the bonded retainer can come loose, which requires rebonding by the Orthodontist/dentist who attached it.

It is critical that patients and parents understand that bonded retainers must be monitored to ensure that bonds are intact and no dental disease is developing.

Why are they needed in orthodontics?

Ideally one radiograph is taken at the beginning of treatment, one after about six months, and one after the braces come off. But don’t be alarmed  – we don’t blink an eye at the thought of taking an overseas trip by plane, and each of these X-rays exposes a patient to less radiation than they would receive taking a typical airplane flight.

X-rays are essential in orthodontics to help diagnose and treat orthodontic problems and show the position and form of teeth, missing, extra, impacted, or misplaced teeth, and short, long, or misshaped roots. The size, shape, and position of the teeth and bone in X-rays dictate if surgery or tooth extraction will be necessary.

Jaw bones can be too big, too small, asymmetrical (off centre), too far apart, too close together, or misshapen. If problems exist, X-rays provide orthodontists with essential information that helps them determine the best way to correct them. X-rays taken during treatment can demonstrate how treatment, that is not visible visually, is progressing.

It is possible that moving teeth in some individuals (about 2%) causes the roots to shorten and it is critical for Orthodontists to check for this during treatment so they can determine if and how long tooth movement should continue.

To help them finalize the treatment plan, orthodontists observe how the teeth are moving and in many borderline crowding cases and to avoid extractions, some orthodontists begin to align the teeth to see how the teeth and bone respond – the progress X-rays can show how much bone is available to accommodate all of the teeth.

But keep in mind that orthodontists are also dentists and they can use these X-rays to identify any pathologies present, including abscesses and tumours etc. that are not necessarily directly related to straightening the teeth – these problems can then be dealt with by the dentist.

After treatment, a final X-ray is taken to evaluate the outcome of treatment and make recommendations for other necessary procedures (i.e. wisdom teeth).

How sugar causes cavities

I am sure that everyone knows eating too much sugar can lead to tooth decay, but do we all know how that happens?

Our mouths are full of bacteria, some of which are beneficial to our oral health. . However, certain harmful oral bacteria actually feed on the sugars you eat to create acids that destroy the tooth enamel, which is the shiny, protective outer layer of the tooth. Acids leech minerals from the enamel through a process called demineralization and  cavities are a bacterial infection created by acids,  that, without treatment, can progress past the enamel and into the deeper layers of the tooth, causing pain and possible tooth loss.

Fortunately, saliva contains minerals such as calcium and phosphates to help repair the teeth- this natural process of remineralization replaces those minerals and strengthens the teeth all over again so your saliva is a key player. Fluoride is another mineral that helps repair weakened enamel.

So you can see that it is vital that, to prevent the effects of sugar on teeth, you must limit sweets and starches throughout the day if you want to give your saliva a chance to fix the damage.

By the time we are adults, our jaws have stopped growing and generally there is limited room for improvement. If your teeth are crowded, you may need to have some of them taken out, starting with the wisdom teeth usually, to make room for the other teeth to move into better positions. If there still isn’t enough room, the back bicuspids are usually chosen next. So that your smile will be symmetrical, the same teeth usually must be taken from the top and the bottom. If two teeth are taken from one side, your midline (the place where your front top and bottom teeth meet) may be thrown off, and you may be stuck with a crooked smile. This is why teeth are often extracted in either 2s or (more commonly) 4s.

Extractions and Children

Years ago, extraction for children was common, but this is not the case today. Some orthodontists still routinely extract children’s teeth so please seek several additional opinions before making your decision to allow extractions in children.

There are many methods other than extractions that can be used to make room (palate expansion, headgear, or guided growth methodology). Extracting teeth from children can result in less than optimal facial aesthetics – it will grow longer and flatter instead of fuller.

One exception involves a Class III malocclusion. Class III cases are technically much more difficult and often involve jaw surgery.

DID YOU KNOW….????

A brief history of…TOOTHPASTE

The world’s oldest-known formula for toothpaste, used more than 1,500 years before toothpaste became commercial in the late 1800’s, has been discovered on a piece of dusty papyrus in the basement of a Viennese museum.

In faded black ink, an ancient Egyptian scribe wrote in the fourth century AD, carefully describing what he calls a “powder for white and perfect teeth”.

When mixed with saliva in the mouth, it forms a “clean tooth paste”.

According to the document, the ingredients needed for the perfect smile are one drachma of rock salt – a measure equal to one hundredth of an ounce – two drachmas of mint, one drachma of dried iris flower and 20 grains of pepper, all of them crushed and mixed together.

The result is a pungent paste which one Austrian dentist who tried it said made his gums bleed but was a “big improvement” on some toothpaste formulae used as recently as a century ago.

3000 BC: The first “tooth powder”. Some sources report that Egyptians used tooth powder containing powdered ashes of ox hooves, myrrh, powdered burnt egg shells and pumice. Ancient Egyptians also freshened their breath by chewing on fragrant mixtures with honey.

AD 47: Three early “toothpowders” and “toothpastes”.

1. One containing vinegar, honey and salt;

2. One with radish and finely ground glass;

3. One with a third using ground deer antler, a rare aromatic gum and rock salt.

Another naturally occurring soap-like substance (China) was reportedly used in toothpowder. How about burnt snail shells, burnt gypsum, dried animal parts and herbs (Persia), and chalk (England)? A teeth-strengthening recipe included green lead (Persia).

1824: A soap-containing toothpaste was introduced by Dr Peabody, a dentist.

1880s:  Toothpaste was mass produced in jars (USA), based on Dr Sheffield’s “Crème Dentifrice” invention of1850.

1890s: Toothpaste was sold in collapsible tubes.

1914: Fluoride was added to toothpaste to prevent decay, but not approved by the American Dental Association until the 1950s.

1945: Soap was replaced by other ingredients following the invention of synthetic detergents, making toothpastes smoother.

When I was a child, my parents used either salt or bicarb soda if hey ran out of commercial toothpaste! Today, many innovations have produced toothpastes to combat tartar, gum disease and plaque, for teeth whitening, for fresh breath and for sensitive teeth. There are also toothpastes designed specifically for children and infants.

Before having that piercing, please read the following condensed extract from Science Daily, 2010

‘A dental school survey study of Buffalo high school students revealed that the presence of a barbell implant/stud caused a damaging habit whereby subjects pushed the metal stud up against and between their upper front teeth, a habit commonly referred to among the students as “playing.”

That repeated “playing” with the stud may result in a gap as is demonstrated in a study involving a 26 year-old female patient examined at an orthodontic clinic who complained that a large space had developed between her upper central incisors or upper front teeth.

The patient also had a tongue piercing that held a barbell-shaped tongue stud.

The tongue was pierced seven years earlier and every day for seven years she had pushed the stud between her upper front teeth, creating the space between them and, subsequently, habitually placing it in the space.

The patient did not have a space between her upper front teeth prior to the tongue piercing and photos demonstrated she had no diastema, or space, prior to having her tongue pierced hence it was assumed that positioning of the tongue stud between the maxillary central incisors or “playing” caused the midline space. Her treatment involved a fixed braces appliance to push the front teeth back together.

Tongue piercing can result in serious injury not just to teeth but has also been associated with hemorrhage, infection, chipped and fractured teeth, trauma to the gums and, in the worst cases, brain abscess.’

Urgghhh!  In my nursing career, I have even seen tongue piercings PERMANENTLY embedded!