Dr. Noah's Dentistry Blog

Questions About Dentistry Answered

Can an Orthodontic Disaster Be Fixed?

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My mom had me see an orthodontist while I was younger and the orthodontist had two of my teeth pulled because I didn’t have much space. I’m not quite sure why, but he went with the two nearest my two front teeth, which means that my pointier teeth are closer to the front than they should be, if that makes any sense. I’m 26 now and my teeth have shifted some, so now there’s a big gap between those teeth and my front teeth too. It looks so bad. I’ve been considering going in and seeing if an orthodontist will give me braces again to close the gap, but that’s not really what I want. If possible, I’d like the pointier teeth shaved down or moved or something instead. After all these years, is it still possible to correct what the first orthodontist did?

Thank you,

Tammy

Dear Tammy,

It sounds like you had your lateral incisors removed, which isn’t very common because people wind up with the problem you currently have- it never looks quite right. Plus, the canines play a crucial role in the side to side motion of chewing, protecting the back teeth from undue stress, so those are not usually moved much. With that said, what’s done is done and now you want to see about fixing it.

You’re probably right about not just having the gap closed again. Even if you see a really good cosmetic dentist, it would be difficult for him to make your canines look like lateral incisors. The teeth are built so differently. If there isn’t enough space to replace the lateral incisors that were taken, you may have to go that route anyway, though. If you do have a considerable amount of space, you may be able to go through another round of orthodontics to straighten things up and shift the gap, so you could have something like dental implants, a bridge, or partial denture made.

The bottom line with this one is you’ll want to see an orthodontist and a dentist who specializes in cosmetic dentistry to do an exam and x-rays. Every case is a little different and it’s difficult to know how much space you have to work with. With something this extensive, you’ll probably want to get a couple of opinions, so you can get a good feeling for what’s best and you’ll want to see someone who has preferably handled a case similar to yours before. You can fix it and make it look better than it did before, but it’ll never be quite the same as it would have if those teeth weren’t extracted.

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Solutions for a Wonky Tooth

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I have a tooth slightly rotated. My dentist wants me to get braces, but that is a minimum of two years treatment. I’m a senior. I don’t want to look ugly my last year of high school and first year of college. Tell me what my options are.

Caitlin D. – Boston

Caitlin,

You have a couple of great options aside from traditional orthodontics. The first is Invisalign. If you are a candidate, which not everyone is, it can straighten your smile in about half the time as braces. The best part is it truly is invisible. No one will know you’re wearing them.

If you’re not a candidate for Invisalign, or if you have other things you’d like to change about your smile, then I’d suggest porcelain veneers. It’s a strictly cosmetic procedure that can completely remake your smile. It can change the shape, size, and color of your teeth. It’s the type of makeover celebrities get on their teeth.

Invisalign is the more affordable of the two options. I don’t know if budgeting is a factor in your decision. But, if it is you’ll want to consider the cost difference.

Also, if you’re getting porcelain veneers in order to re-make your smile, you won’t just get a veneer for the wonky tooth. You’ll get a minimum of six on your upper arch.

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Why Do I Need a Retainer?

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I just spent four years wearing braces. Do I really need a retainer?

Beth – Kansas City, MO

Beth,

There’s an important reason for retainers after braces. They’re designed to keep your teeth in their new position. If you don’t wear it, your teeth will shift quickly. Retainers are even more important if you’re still growing into adulthood because your growth causes your teeth to shift even more.

Another reason a retainer is necessary is because your new bite needs to stabilize and it may take some time for all of the tissues and the bone to reorganize. Shifting of the teeth occurs naturally so retainers are needed to help keep them in place. Relapse of the teeth is very high the first month after the removal of braces and it usually takes about one year for teeth to stabilize completely after orthodontic treatment. If you had spaces in between your teeth before braces then it takes longer to keep the dentition stable. The rule of thumb is you wear your retainers as long as you wore your braces. So if you wore braces for four years then you wear your retainer for four years.

The good news is not all orthodontic patients need to wear their retainers 24/7. Your orthodontist will recommend what retention plan is best for you. Patients with removable retainers are recommended to wear their retainers on a constant basis for at least the first six months and then usually just at night while they sleep for a few years. Yet some orthodontic patients need only wear their retainers for the first week on a constant basis then after that just at night. A lot of orthodontists apply fixed retainers that are cemented in place to stabilize the teeth which are usually worn for at least five years. This is commonly used for adolescents because it’s common for teenagers not to wear their appliance, plus there’s the possibility of wisdom teeth causing shifting of the teeth while trying to erupt.

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Does My Orthodontist Have to Pull My Teeth?

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My orthodontist wants to pull a couple of my teeth. He says it’s the only way he can make all my teeth straight and keep them that way. I disagree. I’ve never heard of this and I don’t understand why he would want to remove good teeth. Aren’t dentists supposed to be in the business of saving teeth, not pulling them? What should I do? Is this normal and something I have to go along with or is the guy a little off his rocker?

Jeremiah

Dear Jeremiah,

Yes, orthodontists commonly remove teeth as part of treatment. There are a number of reasons why they do, but a lot of time it comes down to not having enough space. If you have a narrow arch and a full set of teeth, there may not be enough room for them to be straightened out and fit properly. This likely is the cause of you having less than straight teeth to begin with. When an orthodontist catches cases like this early on, before the top of a child’s mouth is fused, a metal expander can be used to gradually widen the arch. At a certain age, usually around age 12 or so, the palate becomes hard and can’t adjust, so the only way to make room for everything is to remove some teeth.

There are other reasons why it might be necessary as well, such as to correct an overbite or to prevent the roots of the teeth from becoming exposed during treatment in some cases, but a lot of the time it simply comes down to making room.

Having straight teeth makes it much easier to keep them clean and to clean between them, which in turn helps prevent decay. So, although those teeth are healthy now, keeping them could indirectly affect the health of all your other teeth in the long run. When an orthodontist considers your treatment plan, he takes time to weigh the value of performing extractions. They’re not the easy way out, but they can help produce the results you need.

Should you go along with it? Only you can decide that. However, If you’re on the fence about it, find another orthodontist and have him provide an assessment. You don’t even need to mention your concerns about the extractions- just ask him what the best way to get the results you want is. If he suggests extractions, then you know it’s probably a solid choice. If he doesn’t, then you can see how he feels about it. Best of luck to you.

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Are Retainers Even Necessary?

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I wore braces for three years.  I got them off six months ago.  I know I am supposed to wear my retainer but I just hate it.  Are they really going to move back if I don’t wear it?

Thanks, Angie

Dear Angie,

I know you probably hate it, but your teeth absolutely will move if you don’t wear it.  They may not move completely back to where they were when you first got your braces on but they WILL move.

More than likely, if you had severe crowding, your lower front teeth will start to overlap.  Teeth that were the most difficult to move, like turned teeth, will begin to turn again ever so slightly.  Before you know it you will not be able to wear your retainer because it will no longer fit.  Then you will be too embarrassed to go back to the orthodontist because you think he may say, “I told you so!”  Meanwhile, your teeth will continue to move.

In order to stop the movement, you will need to spend a couple of hundred dollars for a new retainer.  Don’t forget, you will also need to get new impressions and you know how much people love those!  So, wear the retainer….even if you only wear it at night.  It is a small price to pay to keep that beautiful smile.

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Can an Epileptic Get Braces?

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I’ve wanted braces for as long as I can remember. However, because I have epilepsy, my mom was always terrified and seizure would tear up my mouth. I’m an adult now and am considering it again. I was thinking about Invisalign because they’re softer. What do you think?

Anna G. – Alabama

Anna,

I don’t know if you’ve ever seen the meme about how things look to moms. There’s a toddler being gently tossed by the dad. But, what the mom sees is him skyrocketing. Your mom saw the potential for injury and that shut the option down in her mind. It’s because she loves you.

However, you can get orthodontics, even with epilepsy. Obviously, because of the risks, some precautions need to be taken. There is the risk of some soft tissue damage during a seizure, but it’s generally minor.

I’d certainly tell the dentist what medications you’re on. I’d also ask for smaller brackets than the traditional ones.  That is possible. Many epilepsy medication cause swollen and bleeding gums.  Braces can also aggravate that, so diligent oral hygiene will be a must.

You asked about Invisalign. Yes, they are softer, so you wouldn’t have to worry about tissue damage. However, I’d be concerned about the possibility of the aligners dislodging and blocking your airway.  Visit with your orthodontist. There is a way to get your teeth the way you’ve always dreamed.

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Metal or Ceramic Braces

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I need to get braces and am having a hard time deciding between metal or ceramic braces.  Can you help? I’ve heard they’re less visible, but can have some other problems.

Dave H. – Montana

Dave,

You’re right that the ceramic brackets are less visible than the metal brackets. However, they will still have the metal wire going through them, so I’m not sure how beneficial that is. Here are some of the downsides to ceramics and you can decide what you feel has more weight to it.

  • Ceramics are stronger than the enamel on your teeth, so if you bite down and hit one of the brackets, you risk chipping a tooth.
  • Some orthodontists charge more for ceramic brackets.
  • Ceramics are harder to remove.

There is an alternative if your goal is to have less visibility on your orthodontic treatment. Have you spoken with your dentist about Invisalign? These are completely invisible, even at a conversational distance.

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Orthodontist vs. General Dentist: Who’s Right?

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I’m having trouble figuring out what’s going on with my son’s teeth. We have a great orthodontist and what I thought was a good dentist, but now I’m not so sure. My son is missing a tooth on the upper right, near the front. We planned to have an implant done for him when he’s older, so the orthodontist straightened everything out and left a space for the implant. He said we could either get a retainer to keep everything in place or have the family dentist make something else. Well, that something else wound up being a “Maryland bridge,” to put a false tooth in place for the next few years. On the first round, the dentist created something with clasps and it fell out right away. He said it was the cement, so he put it back in with something stronger. It fell out again within a few days. Now he wants to have the whole thing remade with metal clasps and I’m a little worried that the same thing will happen. I mentioned it to the orthodontist and he said he wasn’t sure why the family dentist was going this route and suggested we get a flipper instead. I’m really torn. Was the orthodontist saying the dentist did something wrong? Should we switch gears and get a flipper? Do we need a new dentist?

Thanks,

Jocelyn

Dear Jocelyn,

The problem probably wasn’t the cement. It was the way that the teeth were prepared. The adjacent teeth needed notches cut in them to hold the bridge in place, but in an effort to be conservative, the dentist probably made them too shallow. For this reason, the replacement bridge will probably do the exact same thing. The only real fix is to make those grooves deeper, but that will permanently alter the structure of those teeth. Since they’re healthy, that would not be the best form of treatment.

It’s unclear why your dentist chose this route over a flipper to begin with, unless it’s because you passed on the retainer and they’re similar in build. Your best bet is to request the flipper, instead of going forward with a new bridge. This is something that your family dentist should be able to create for you, but if you have trouble, you may want to find out who the orthodontist prefers for general dentistry and get an opinion from that office.

I hope this helps you make a decision.

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I Need Dental Implants and Braces

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Can you advise me? I need some dental implants on two teeth I lost in an accident. I also wanted to get my teeth straightened. which procedure is it important to do first?

Jeannie L. – Portland

Jeannie,

You’ll need to have your teeth straightened before you get your dental implants. Dental Implants are surgically implanted directly into your jawbone. They don’t have the ligaments that allow them to be moved, like your natural teeth can.

One exception would be if you need the implants in your molar. In some cases those need to be placed first.

Either way, I would meet with your orthodontist and your implant dentist and make sure they’re communicating.

If you have a dentist who does both orthodontics and dental implants, that would be ideal.

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Will braces really cost more if I leave my son’s baby teeth alone?

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My son has teeth erupting behind his baby teeth. My dentist thinks I need to have his baby teeth extracted. He says if I don’t it will make the braces harder and more expensive later. To be frank, I think he’s being melodramatic in order to get some more money out of me. I mean, if he’s going to need braces, he’s going to need braces. Why would it be harder if the adult teeth stayed where they are? They’re there now anyway.

Lisa – Delaware

Lisa,

I don’t think your dentist is trying to squeeze extra money out of you. The fact of the matter is, the longer your child’s adult teeth are in the wrong position, the harder it is to move them into the correct position with orthodontics. The more difficult the orthodontic case, the more expensive it is.

If the baby teeth are loose and about to come out, then sure, you may let nature takes its course. But, if they’re holding firm, then I would agree with your dentist. The teeth need to be extracted.

I hope this helps put your mind at ease.

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