Dr. Noah's Dentistry Blog

Questions About Dentistry Answered

Fixing a Black Triangle

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I’ve just finished my braces and am starting my retainer. My orthodontist ended up shaving off about 2mm of space on the teeth. This ended up creating a black triangle at the gums. Will this go away or will I need to have another procedure done? Would grafting gum tissue to the space fix it?

Emma

Dear Emma,

example of black triangles at bottom teeth

Black Triangles

My guess would be your orthodontist is planning on fixing this by closing the space and just has it this way at the start of your retainer treatment. The first thing I would do is talk to him about it. If he doesn’t plan on doing anything about it and the gums don’t adjust when you’re done wearing a retainer, then you’ll need to take steps.

Gum grafting won’t be a useful procedure for you in this case. Your gums position themselves based on both the positions and shapes of your teeth. Even if you grafted gum tissue there, it would shift to a position based on the teeth in the area.

If your dentist doesn’t close this space and it bothers you, the procedure to fix it would be dental bonding. However, you don’t want to have just any dentist do this. It’s a tricky procedure to get right. You’ll need an expert cosmetic dentist to work on this.

One thing to be aware of with braces is to make sure you’re really getting in there when you brush your teeth. The areas surrounding the brackets gather bacteria. If you aren’t super careful, you’ll end up with white spots on your teeth. You haven’t mentioned this as an issue for you. I’m only bringing it up for the benefit of others who may still be wearing braces.

The Modern Alternative to Braces

These days, there are been tremendous advancements in orthodontics. The best of these advancements is Invisalign. These are sometimes called invisible braces because they use clear aligners to straighten your teeth instead of metal wires and brackets. They are completely invisible even at a conversational distance.

They have another, mostly unknown, benefit as well. The aligners can also double as teeth whitening trays. This will allow you to straighten and whiten your teeth at the same time.

This blog is brought to you by Tulsa Dentist Dr. Ryan Noah.

Orthodontist Shaved My Son’s Teeth

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I’m fuming after a visit to the orthodontist. I took my 12-year-old son in to get started with orthodontic treatment. The doctor said it would be a longer visit because they were getting everything set up, but didn’t really elaborate on everything they’d be doing. It may be on me, but I didn’t clarify. I just thought he was getting braces put on. Come to find out, AFTER the appointment no less, that the dentist shaved his teeth. I had to hear about the procedure from my son. I thought he was mistaken when he came out and told me what they’d done, so I corrected him, and the assistant then told me what my son was saying was accurate. She said it was normal for treatment and that they do it with all their patients. Now, on top of everything else, I’m worried about the long-term damage the orthodontist may have caused. Why did he do this and can it be fixed?

Signed,

Not Ok in OK

Dear Not Ok,

Smiling young woman with braces

Why Did the Orthodontist “Shave Teeth?”

This is done to make space. Once the dentist measures out how much space is there and how much space is necessary for all the teeth once they’re in alignment, it becomes apparent if more space needs to be made. There are several ways to make space, such as palatal expanders and tooth extractions, but reducing the width of teeth is common as well. In short, if the dentist removes just the tiniest amount of structure on the sides of each tooth, it adds up to a fair amount of space overall. This may have been the easiest and least invasive method for your son. It’s referred to as “interproximal reduction.”

Interproximal Reduction is Safe

Although each dentist has his own toolkit he draws upon for various cases, interproximal reduction often earns a place in the toolkit because it is a safe and fast choice. True, some of your son’s enamel is gone now. Nothing will bring it back. However, if the reduction was such that your son would be at an increased risk for decay now, the dentist would have protected the surface with dental bonding. You can confirm if this was necessary with the dentist.

The Dentist Should Have Spoken with You

Despite the fact that this is a safe and trusted procedure, the dentist should have explained it to you in advance. He’s required to get “informed consent” before procedures are carried out, and if he didn’t fully inform you, then you didn’t give consent. That’s not ok. It’s possible he glossed over it or the detail was lost amid all the new information you were being given at the time, but if you’re 100% certain he didn’t discuss it, or even think he should have been more direct about it, then you should mention it to him. Again, it doesn’t sound like his practice was off, but if he’s missing the mark in communication, he needs to address that.

This post was sponsored by Dr. Ryan Noah, a Tulsa orthodontic treatment provider.

Splotchy Teeth After Braces

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My daughter had braces done. They did straighten her teeth but now several of the teeth are splotchy from being two different colors. She does have thin enamel and I’m wondering if the orthodontist took this into consideration before giving her braces. Are they permanently damaged? Will insurance help me fix them? Would teeth whitening help?

Amelia

Dear Amelia,

Smiling young woman with braces

White spots are a sign of decalcification. This means your daughter wasn’t brushing quite enough where she needed to during her orthodontic treatment. Don’t be too hard on her about that, though. It’s quite hard getting around all those wires and brackets. You pretty much have to keep a toothbrush with you at all times in order to brush after each meal.

Your daughter was particularly susceptible because of her thin enamel. Your daughter’s spots will turn into decay if they’re not dealt with.

Dealing with White Spots After Braces

One thing you could try is Tooth Mousse. This sometimes helps re-mineralize teeth. However, it usually has better success when the cause is from something else. Either way, it’s worth a try.

Unfortunately, teeth whitening won’t work. This will whiten your teeth evenly which will just make the splotchy color more obvious.

Usually, the best solution is for a skilled cosmetic dentist to grind down the soft enamel down to solid tooth structure and then to do dental bonding over it to restore the tooth. This isn’t an easy procedure, so make sure the dentist who does it has the skills necessary.

This blog is brought to you by Tulsa Dentist Dr. Ryan Noah.

How Long Will I Need this Retainer?

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I had braces in my teens. My teeth have done fine in past years but then started to shift again. I went to see a new orthodontist as an adult. He said I had a couple of options. I could re-do braces or wear my retainer again for a while and see if that helps. I opted for the retainer. It does move my teeth back into position. He suggested six months of wearing it full-time, then switching to nighttime wear for an equal amount of time. I followed through on that, but when I “graduated” from the retainer, I noticed that by the next day two of the teeth had shifted again. I’ll put the retainer back in and the cycle repeats. Is there anything I can do about this?

Morgan

Dear Morgan,

While this isn’t considered “normal” it does happen. For some reason, your teeth aren’t ready to stay in place on their own yet. I have a couple of suggestions for you.

When Teeth Won’t Stay in Place After Braces

You will need to wear a retainer full time for an indefinite period of time. One thing you can do in this case is have a lingual retainer made. This is a retainer which will be bonded to the back of your teeth. This is invisible to everyone else. The downside to this procedure is it is very difficult to get the teeth clean. You will need a floss threader to get in there.

Teeth whitening trays in a blue case
Teeth Whitening Trays Can Double as a Retainer

Another option is to use teeth bleaching trays as retainers. These are completely clear so no one will know you are wearing them. They do have the additional benefit of allowing you to whiten your teeth at the same time. Giving you both a straight and white smile simultaneously.

While many cosmetic procedures do require some expertise and post-doctoral training, teeth whitening does not. Any family dentist can do this for you.

My advice is to speak with your orthodontist and discuss these options in depth and decide which you think is best for your situation. It would also be good for him to investigate what is going on with the shifting.

This blog is brought to you by Glenpool Dentist Dr. Ryan Noah.

Are Orthodontics Required to Replace Crowns?

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I have had two crowns on my front teeth for a while. They are starting to show their age and really need to be replaced. For some reasons, my dentist is insisting that I do orthodontics first before he’ll replace my dental crowns. It’s not that I don’t want straight teeth, but I just can’t afford them. Is this just a preference thing or will I face this with every dentist?

Miranda

Dear Miranda,

A dentist and patient
It is unfair to patients when a dentist insists on the ideal treatment, regardless of circumstances

I have to admit that it annoys me when dentists behave this way. Yes, having straight teeth is the ideal, but if you cannot afford orthodontic work, then you can’t afford it.

Obviously, you can have dental crowns placed when your teeth aren’t straight or you wouldn’t have any now. This is a preference issue on the part of your dentist.

In all honesty, I’m going to suggest you find another dentist. Look for one who is willing to work within the budget of his patients. You could do an internet search for an “affordable dentist” in your area.

Benefits of an Affordable Dentist

If you find an affordable dentist, they’ll be willing to work within your budget. They’re also willing to stage treatments, so you don’t have to do everything at once. Additionally, they will often have payment plans. Some of them have in-house plans and some of them work through Care Credit.

Getting a Crown on Your Front Teeth

One thing you want to be careful of, regardless of where you go to get your crowns done, is that they only give you all-porcelain crowns on your front teeth.

A metal-based crown will not look right on front teeth. They will be too opaque. They will also develop a gray line on the gumline.

If You Ever Decide to Get Orthodontics

When you do decide you are able to get orthodontics (and that should be completely up to you) you no longer have to get metal wires and brackets. These days, you have the option of “invisible braces”.

Invisalign is the most popular brand which utilizes clear aligners. These gently guide your teeth into their correct position.

I hope this helps you. This blog is brought to you by Tulsa Dentist Dr. Ryan Noah.

Orthodontics before Crowns?

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I’m hoping you can help me. I have had two crowns on my front teeth for a long time. They’ve always looked a little pastier than my other teeth, but now they have this unsightly gray line and they are discolored. I need to get them replaced, but my dentist is insisting I get braces first. I really can’t afford that. Isn’t there any way they can do the crowns without my teeth being perfectly straight?

Martha

Dear Martha,

Tulsa braces for othodontic dental treatment

What your dentist is doing is unfair to you. He is insisting on the ideal treatment. Well, not everyone can afford the ideal. He should be able to do these crowns regardless of whether or not you have orthodontics done. How else would they have been placed on your teeth originally? I’m assuming the needed orthodontics isn’t a new thing.

You may have to see another dentist to work within your budget, but that’s okay. there are affordable dentists who take into consideration that sometimes a patient can’t get everything done at once. This is called phased treatment.

You can either get the crowns done now and put off the ortho until later. You can even skip braces altogether. It is completely up to you.

Orthodontics for Adults

If you decide later on you do want to straighten your teeth, you no longer have to get a mouth full of metal wires and brackets. There are better options for adults these days. Most prefer a brand of invisible braces called Invisalign.

These use clear aligners which allow you to straighten your teeth without anyone even knowing. They truly are invisible, even at a conversational distance.

Crowns for Front Teeth

There was a reason your dental crowns looked pasty when you first had them placed. Your dentist placed porcelain fused to metal crowns. While these are perfectly fine for back teeth, they are way too opaque looking for front teeth.

Plus, as you’ve experienced, they also eventually develop a gray line at the gumline. For front teeth, we recommend all-porcelain crowns. These look much more natural and will never develop that unsightly gray line.

This blog is brought to you by Tulsa Dentist Dr. Ryan Noah.



One Orthodontist Thousands Less

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I don’t know how it is possible for one orthodontist to cost so much less than another. It’s appealing, but I don’t want to make a mistake about this. I’m out of college and in my first PR job. My appearance is important which is why I want to straighten my teeth. However, I’m still paying off student loans, and will be for a while, so I don’t want to spend a fortune. The first dentist suggested Invisalign. The next one suggested Six-Month Smiles. The second one seems to work faster and is thousands of dollars cheaper. How is that possible?

Karyn

Dear Karyn,

A woman placing her Invisaliagn aligners

Do you remember in Algebra when they said you can’t add x’s and y’s? Well, this is sort of like that. Invisalign is a complete orthodontic treatment It will shift your bite into proper position, changing aligners every two weeks.

Six-Month Smiles is a completely different orthodontic option which doesn’t correct your complete bite, but just straightens the front visible teeth. This is also why it takes less time and doesn’t cost as much.

This means the second orthodontist isn’t charging less but offering a completely different treatment option.

Which Option is Best?

Which one you choose really depends on your goals for your smile. Do you just want it to appear straight and beautiful and saving money is the higher priority or are you wanting your bite fixed, while looking straight and beautiful?

There’s not a right or wrong answer unless you’ve had jaw pain or persistent headaches. If you have had those, fixing your bite would likely alleviate both of those. Not fixing it could lead to TMJ problems. I don’t say that to scare you. Headaches don’t necessarily mean TMJ, it is just a symptom.

Combining Procedures

One thing you can do with Invisalign which you can’t do with the Six-Month Smiles clear braces is whiten your teeth at the same time. The aligners can double as teeth whitening trays. Then, by the time your treatment is finished you’ll have both straight teeth and a white smile.

This blog is brought to you by Tulsa Dentist Dr. Ryan Noah.

Dentist Insisting I Get Braces

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I’m at my wit’s end. I know I’ll never be able to have a perfect smile, but I was hoping for something at least not humiliating. I have crowns on my two front teeth. They’re over 15 years old and starting to show their wear. They’re stained and starting to crack. I just wanted to replace them and maybe whiten my teeth if I still had enough money. However, my dentist is insisting I get braces on my teeth before I get my crowns re-done. I just can’t afford that. Is it truly necessary? My teeth stick out a little, but not that much. Why was the last dentist able to do crowns?

Karen

Dear Karen,

Smiling young woman with braces

This is one of those situations which truly frustrates me. Some dentists will insist on only doing the ideal no matter what type of burden that places on the patient. This is unfair. It’s obvious your crowns need replacing and he’s putting you over a barrel.

As you said, your last dentist was able to do the crowns, why isn’t this one? I think in this case you may need to see a different dentist to get the treatment you want without it costing you a fortune. You can completely do without braces, or you could just get them later if circumstances changed.

Teeth Whitening and Crowns

If you’re serious about getting your teeth whitened, it will save you a lot of money to get them whitened before you have the crowns made. It’s possible to get your teeth whitened in one appointment these days with in-office teeth whitening. That will save you time.

If you wait to whiten your teeth until after your new crowns are made, they won’t match. The whitening gel only works on natural tooth structure, which means your teeth will whiten but not your crowns, causing you to need to purchase new ones unless you want mismatched teeth. Doing the tooth bleaching first prevents that.

Althernative Orthodontics for Adults

If somewhere in your future, you decide you do want orthodontics, you should know it no longer means you have to get uncomfortable wires and metal all over your teeth. These days, Invisalign is a great alternative to traditional braces.

They use clear plastic aligners which are invisible even at a conversational distance.

One other thing to note. Because the crowns are on your front teeth, make sure whatever dentist you settle on gives you all-porcelain crowns. They’ll look much more natural.

This blog is brought to you by Glenpool Dentist Dr. Ryan Noah.

The Aftermath of Thumb Sucking

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Can you help me? I have a teenager who is still sucking her thumb and now her teeth are protruding quite a bit. She’s starting high school soon and I want her to feel beautiful. But, they’re not just an overbite. They’re also kind of curved. What will fix this AND is there anything which can help her with this habit?

Tracy

Dear Tracy,

Smiling young woman with braces

I agree it is important for a young woman to feel confident and attractive. In fact, confidence is attractive. Because of the issues facing your daughter’s teeth, I’d suggest you see an orthodontist. She will need braces. These will fix both the problems of inclination and position simultaneously.

As for aiding her in giving up the thumb sucking, the first thing to do is not use punishments or shaming. You want her to grow up confident, not worried there’s something wrong with her. However, the thumbsucking has to stop or her teeth will continue to go out of alignment.

The easiest way is to use a product called Thum. It’s an unpleasant tasting liquid you can paint on her thumb. It should help her break the habit.

It’s important she’s careful about brushing her teeth during braces. Let her know ahead of time it’s harder. She’ll have to really work to get in there. It would help her to have a water pick too, which helps with getting food trapped around the bits of metal.

Too often we see white spots on teeth after braces. This is decalcification, which is the precursor to decay.

After Orthodontics

When her braces are done, she’ll be given a retainer to wear. It’s important she wears that or her teeth won’t stay in the proper position. You won’t be starting over, but you will have to do some repairs after shifting without that retainer.

With healthy teeth, there usually isn’t much a teenager needs to do cosmetically. However, some prefer to have their teeth whitened after they finally get their braces off, giving them a fresh look along with the straighter teeth.

This blog is brought to you by Tulsa Dentist Dr. Ryan Noah.

Gum Recession During Braces

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I had a problem with gum recession during my braces. This created a black triangle at my gums. Is there a solution for this?

Dave

Dear Dave,

images of teeth with black triangles

Unfortunately, quite a few patients develop this problem with traditional braces. Many patients find it harder to keep up with their oral hygiene as well. Yes, gum recession can lead to black triangles. I’m sorry you’re dealing with this. The first thing I’d do is find out the cause of the gum recession, making sure it’s not a result of gum disease. If gum disease is the cause, that will need to be dealt with first.

There are orthodontic treatments that make it easier to brush and floss properly. For instance, with Invisalign, you simply remove your aligners then brush and floss as you normally would.

Treating Black Triangle After Orthodontics

Sometimes orthodontics can correctly repair a black triangle, but if this happened during your treatment that’s not going to happen. Instead, you’ll need a cosmetic solution.

I’ll be honest with you, not many dentists can do this repair. It’s treated with dental bonding, but because of the placement of the spaces, it requires some real expertise in cosmetics to make this look natural.

Unless your dentist is among the top cosmetic dentists in the country, I’d have him recommend someone for you.

This blog is brought to you by Glenpool Dentist Dr. Ryan Noah