One of the most commonly asked questions about dental braces is whether placing them causes any pain or discomfort.  The honest answer is that braces do not hurt at all when they are applied to the teeth, so there is no reason to be anxious.  In most cases, there is mild soreness or discomfort after the orthodontic wire is engaged into the brackets, which may last for a few days.

There are two common types of fixed dental braces used to realign the teeth: ceramic fixed braces and metal fixed braces.  Both types of fixed appliances include brackets which are affixed to each individual tooth and an archwire the orthodontist fits into the bracket slot to gently move the teeth into proper alignment.  Elastic or wire ties will be applied to hold the wire in place.  Some orthodontists may use self-ligating brackets which do not require a rubber or wire tie to secure the wire.

Fixed dental braces are used to treat a wide variety of malocclusions, including overbite, underbite, crossbite, and overcrowding.  If the orthodontist has determined that the malocclusion has been caused by overcrowding, it is possible that teeth may need to be extracted to increase the amount of available space to properly align the teeth.

What to expect when getting braces

Here is an overview of what you can expect when getting braces:

• Placement day – The placement of braces will not be painful in the slightest.  It may take longer to eat meals, but this is largely because it takes some time to adjust to wearing the braces.  In some cases, the teeth may feel more sensitive than usual.  Hard, difficult to chew foods should be avoided in favor of a softer, more liquid-based diet for the first few days after placement of braces.
• Two days after placement – The first several days after placement of braces can be slightly uncomfortable.  This is because the teeth are beginning the realignment process and are not used to the pressure of the archwire and orthodontic elastic bands.  The orthodontist will provide relief wax to apply over the braces as necessary.  Wax helps provide a smooth surface and alleviates irritation on the inner cheeks and lips.  Additionally, over-the-counter pain medication (e.g., Motrin^® and Advil^®) may be taken as directed to relieve mild soreness.
• Five days after placement – After five days, any initial discomfort associated with the braces should be completely gone.  The teeth will have gradually acclimated to the braces, and eating should be much easier.  Certain hard foods may still pose a challenge to the wearer, but normal eating may be resumed at this point.
• Orthodontic appointments – Regular orthodontic appointments are necessary to allow the orthodontist to change the archwire, change the rubber or metal ties, and make adjustments to the braces.  Fixed braces work by gradually moving the teeth into a new and proper alignment, so gentle pressure needs to be applied constantly.  The first several days after an orthodontic adjustment may be slightly uncomfortable, but remember that this discomfort will quickly fade.
• Dealing with discomfort – Over-the-counter pain medication and orthodontic relief wax will help alleviate any mild soreness and discomfort following placement of braces and orthodontic adjustments.  Another effective remedy is to chew sugar-free gum, as this increases blood flow which helps reduces discomfort and can also encourage the teeth to align quicker.

If you have any questions or concerns about orthodontic treatment, please contact our office.

When braces are finally removed, the “retention” phase begins for most individuals.  The objective of this phase is to ensure the teeth do not regress back to their previous position.  A retainer will be used to maintain the improved position of the teeth.  A retainer is a fixed or removable dental appliance which has been custom-made by the orthodontist to fit the teeth.  Retainers are generally made from transparent plastic and thin wires to optimize the comfort of the patient.

Retainers are worn for varying amounts of time, depending on the type of orthodontic treatment and the age of the patient.  Perseverance and commitment are required to make this final stage of treatment successful.  If the retainer is not worn as directed, treatment can fail or take much longer than anticipated. 

What types of retainer are available?

There are a variety of retainers available, each one geared towards treating a different kind of dental problem.  The orthodontist will make a retainer recommendation depending on the nature of the original diagnosis and the orthodontic treatment plan.

The following are some of the most common types of retainers:

• Hawley retainer – The Hawley retainer consists of a metal wire on an acrylic arch.  The metal wire may be periodically adjusted by the orthodontist to ensure the teeth stay in the desired position.  The acrylic arch is designed to fit comfortably on the lingual walls or palate of the mouth.
• Essix – The Essix retainer is the most commonly used vacuum formed retainer (VFR).  A mold is initially made of the teeth in their new alignment, and then clear PVC trays are created to fit over the arch in its entirety.  VFR’s are much cheaper than many other types of retainers and also do not affect the aesthetic appearance of the smile in the same way as the Hawley retainer.  The disadvantage of VFR’s is that they break and scratch more easily than other types of retainers.
• Fixed retainers – A fixed retainer is somewhat similar to a lingual brace in that it is affixed to the tongue side of a few teeth.  Usually, a fixed retainer is used in cases where there has been either rapid or substantial movement of the teeth.  It usually consists of a single wire.  The inclination of the teeth to move rapidly means they are also more likely to regress back to their previous position if a fixed retainer is not placed.

What do I need to consider when using a retainer?

There are a few basic things to consider for proper use and maintenance of your retainer.

Don’t lose the appliance – Removable retainers are very easy to lose.  It is advisable to place your retainer in the case it came in while eating, drinking, and brushing.  Leaving a retainer folded in a napkin at a restaurant or in a public restroom can be very costly if lost because a replacement must be created.  A brightly colored case serves as a great reminder.

Don’t drink while wearing a retainer – It is tempting to drink while wearing a retainer because of the unobtrusive nature of the device.  However, excess liquid trapped under the trays can vastly intensify acid exposure to teeth, increasing the probability of tooth decay.

Don’t eat while wearing a retainer – It can be difficult and awkward to eat while wearing a removable retainer and it can also damage the device.  Food can get trapped around a Hawley retainer wire or underneath the palate, causing bad breath.  When worn on the upper and lower arches simultaneously, VFR retainers do not allow the teeth to meet.  This means that chewing is almost impossible.

Clean the retainer properly – Removable retainers can become breeding grounds for calculus and bacteria.  It is essential to clean the inside and outside thoroughly as often as possible.  Hawley retainers can be cleaned with a toothbrush.  Because harsh bristles can damage the PVC surface of a VFR, denture cleaner or a specialized retainer cleaner is recommended for this type of device.

Wear the retainer as directed – This phase of treatment is critical. The hard work has been done; the braces are off, and now it is tempting not to wear the retainer as often as the orthodontist recommends.  Retainers are needed to give the muscles, tissues, and bones time to stabilize the teeth in their new alignment. Failure to wear the retainer as directed can have regrettable consequences, such as teeth returning to their original position, added expense, and lost time.

If you have any questions or concerns about retainers, please contact our office.

Brushing and flossing are of paramount importance to oral hygiene.  Though bi-annual professional dental cleanings remove plaque, tartar, and debris, excellent homecare methods are equally valuable.  Proper brushing and flossing can enhance the health of the mouth, make the smile sparkle, and prevent serious diseases.

Reasons why proper brushing and flossing are essential:

• Prevention of tooth decay – Tooth decay is one of the leading causes of tooth loss, and its treatment often requires complex dental procedures.  Tooth decay occurs when the acids found in plaque erode the natural enamel found on the teeth.  This phenomenon can easily be prevented by using proper home hygiene methods.
• Prevention of periodontal disease – Periodontal disease is a serious, progressive condition which can cause tooth loss, gum recession, and jawbone recession. Periodontal disease is caused by the toxins found in plaque and can lead to serious health problems in other parts of the body. Removing plaque and calculus (tartar) from the surface of the tooth using a toothbrush and from the interdental areas using dental floss, is an excellent way to stave off periodontal problems. 
• Prevention of halitosis – Bad breath or halitosis is usually caused by old food particles on or between the teeth.  These food particles can be removed with regular brushing and flossing, leaving the mouth healthier, and breath smelling fresher.
• Prevention of staining – Staining, or yellowing, of teeth can be caused by a wide variety of factors such as smoking, coffee, and tea.  The more regularly these staining agents are removed from the teeth using brushing and flossing techniques, the less likely it is that the stains will become permanent.

The Proper Way to Brush

The teeth should be brushed at least twice a day, ideally in the morning and before bed.  The perfect toothbrush is small in size with soft, rounded-end bristles, and is no more than three months old. The head of the brush needs to be small enough to access all areas of the mouth, and the bristles should be soft enough so as not to cause undue damage to the gum tissue.  The American Dental Association (ADA) has given electric toothbrushes their seal of approval, stating that those with rotating or oscillating heads are more effective than other toothbrushes. 

Here is a basic guide to proper brushing:

1. Place the toothbrush at a 45-degree angle where the gums and teeth meet.
2. Use small circular motions to gently brush the gumline and teeth. 
3. Do not scrub or apply too much pressure to the teeth, as this can damage the gums and tooth enamel.
4. Brush every surface of every tooth, cheek-side, tongue-side, and chewing surfaces. Place special emphasis on the surfaces of the back teeth.
5. Use back and forth strokes to brush the chewing surfaces.
6. Brush the tongue to remove fungi, food, and debris. 

The Proper Way to Floss

Flossing is a great way to remove plaque from the interdental regions (between the teeth).  Flossing is an especially important tool for preventing periodontal disease and limiting the depth of the gum pockets.  The interdental regions are difficult to reach with a toothbrush and should be cleansed with dental floss on a daily basis.  The flavor and type of floss are unimportant; choose floss that will be easy and pleasant to use.

Here is a basic guide to proper flossing:

1. Cut a piece of floss to around 18 inches long.
2. Wrap one end of the floss around the middle finger of the left hand and the other end around the middle finger of the right hand until the hands are 2-3 inches apart.
3. Work the floss gently between the teeth toward the gum line.
4. Curve the floss in a U-shape around each individual tooth and carefully slide it beneath the gum line.
5. Carefully move the floss up and down several times to remove interdental plaque and debris.
6. Do not pop the floss in and out between the teeth as this will inflame and cut the gums.

If you have any questions about the correct way to brush or floss, please contact our office.