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ABondedRetainerCouldbeaPreferredChoiceoveraRemovableOne

If you've known anyone who has worn braces, you know what comes after — wearing a retainer. This can be kind of a letdown after all those months with braces, but it's absolutely necessary.

That's because teeth have a tendency to “rebound” to their pre-orthodontic positions once the force to move them stops after the braces are removed. Retainers help keep or “retain” moved teeth in their new positions and prevent them from reverting to the old.

When you think “retainer,” you probably picture a removable appliance with a wire that fits over the front of the teeth. While that may be the most common type, it isn't the only one. There's another called a bonded retainer, a thin piece of wire bonded to the back of the teeth that need to be retained. Unlike the other type, a dentist must remove a bonded retainer when it's no longer needed.

The biggest advantage of a bonded retainer is its invisibility — the wire is behind the teeth so no one can see it as with a removable retainer. The wire is bonded to the teeth with a dental composite material and then light-cured to create a strong attachment.

Another advantage is especially pertinent to younger patients. Because it's permanently attached and can't be taken out, there's no constant reminding of the patient to wear it — and no more worries about replacing a lost one.

They can, though, be difficult to floss around leading to potential plaque buildup that increases disease risk. It's very important you receive proper hygiene instruction for cleaning under the bonded retainer. Another concern is that they can break under excessive chewing pressure. And as with the more common retainer, we wouldn't want to remove it as that will result in the teeth's relapse to their old positions.

To learn which retainer is best for your situation, you should discuss the options with your orthodontist. Regardless of which type you choose, though, a retainer is a must for protecting your investment in that new smile.

If you would like more information on orthodontics and 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 “Bonded Retainers.”

YourTeenCouldgetaStraighterSmilewithClearAlignersRatherthanBraces

Your teen is about to embark on an orthodontic journey to a straighter, more attractive smile. But although you're excited about the outcome, you both may be steeling yourselves for a few years of "life with braces."

But maybe not—your teen may be able to take advantage of a different kind of corrective appliance: clear aligners. This 21st Century teeth movement method has a number of advantages over braces. For teens, though, there's one big one that could have a huge impact on their social life—clear aligners are nearly invisible to other people.

Clear aligners consist of a series of clear, removable, computer-generated trays based on photographs, models and x-rays of an individual patient's teeth and bite. Each of the trays is slightly different from the previous one in the series, and by wearing each one for about two weeks before moving on to the next, the aligners gradually move the teeth to the desired new positions.

Besides reducing embarrassment often associated with wearing metal braces, clear aligners have other benefits. Unlike braces, they can be removed for eating, easier oral hygiene or for rare special occasions (although for best effectiveness, they should be worn for 20 to 22 hours each day). Recent developments like added elements that help target certain teeth for movement or "power ridges" for more controlled and efficient force have increased the range of bite problems they can be used to correct.

While this means clear aligners can be used for many bite problems, in some severe cases braces and other orthodontic treatments might still be necessary. And because they're not fixed like braces (only the orthodontist can remove them) the patient must have the maturity and self-discipline to wear them consistently.

Your teen will need to undergo a thorough orthodontic examination to see if clear aligners are a viable option for them. If so, it could make the next few treatment years less stressful for both of you.

If you would like more information on clear aligners, 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 “Clear Aligners for Teens: User-Friendly Orthodontics.”

By Koh Orthodontics
September 01, 2018
Category: Dental Procedures
HowtoTreattheProblemofTeeththatNeverDeveloped

About one-quarter of people have teeth that never developed. While most of these congenitally missing teeth are wisdom teeth, they can also include premolars or lateral incisors (the teeth right next to the two front teeth, the central incisors).

Missing teeth can have an adverse effect on smile appearance. But that’s not all: because each type of tooth performs a specific function, one or more missing teeth can lead to bite problems and disruption of dental function. In the case of missing lateral incisors, the canines (eye teeth) normally positioned beside and toward the back of the mouth from them may begin to drift into the empty space and grow next to the central incisors. This can result in greater difficulty chewing and a smile that “doesn’t look right.”

To correct this situation, we must often first attempt to orthodontically move any out of place teeth to their normal positions. This re-establishes the space needed for the missing teeth to be replaced, which we can then restore with prosthetic (artificial) teeth. If the permanent restoration of choice involves dental implants, we’ll usually need to wait until the completion of jaw development around early adulthood. In the mean time, we can use a retainer appliance to hold the teeth in their new positions with prosthetic teeth attached to fill the empty space for a better smile appearance in the interim.

The real issue is timing—beginning orthodontic treatment when appropriate to a person’s oral development, as well as completing the implant restoration when the mouth has matured sufficiently. There are other considerations such as bone volume, which may have diminished due to the missing teeth. At some point we may need to consider grafting to build up the bone sufficiently to support dental implants.

This all may entail a team approach by various specialties like orthodontics, periodontics and implantology. Working together and coordinating within a timely schedule, a mouth and smile marred by undeveloped teeth can be transformed.

If you would like more information on treating smiles with underdeveloped permanent teeth, 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 “When Permanent Teeth Don’t Grow.”

By Koh Orthodontics
August 22, 2018
Category: Oral Health
InTodaysNFLOralHygieneTakesCenterStage

Everyone knows that in the game of football, quarterbacks are looked up to as team leaders. That's why we're so pleased to see some NFL QB's setting great examples of… wait for it… excellent oral hygiene.

First, at the 2016 season opener against the Broncos, Cam Newton of the Carolina Panthers was spotted on the bench; in his hands was a strand of dental floss. In between plays, the 2105 MVP was observed giving his hard-to-reach tooth surfaces a good cleaning with the floss.

Later, Buffalo Bills QB Tyrod Taylor was seen on the sideline of a game against the 49ers — with a bottle of mouthwash. Taylor took a swig, swished it around his mouth for a minute, and spit it out. Was he trying to make his breath fresher in the huddle when he called out plays?

Maybe… but in fact, a good mouthrinse can be much more than a short-lived breath freshener.

Cosmetic rinses can leave your breath with a minty taste or pleasant smell — but the sensation is only temporary. And while there's nothing wrong with having good-smelling breath, using a cosmetic mouthwash doesn't improve your oral hygiene — in fact, it can actually mask odors that may indicate a problem, such as tooth decay or gum disease.

Using a therapeutic mouthrinse, however, can actually enhance your oral health. Many commonly available therapeutic rinses contain anti-cariogenic (cavity-fighting) ingredients, such as fluoride; these can help prevent tooth decay and cavity formation by strengthening tooth enamel. Others contain antibacterial ingredients; these can help control the harmful oral bacteria found in plaque — the sticky film that can build up on your teeth in between cleanings. Some antibacterial mouthrinses are available over-the-counter, while others are prescription-only. When used along with brushing and flossing, they can reduce gum disease (gingivitis) and promote good oral health.

So why did Taylor rinse? His coach Rex Ryan later explained that he was cleaning out his mouth after a hard hit, which may have caused some bleeding. Ryan also noted, “He [Taylor] does have the best smelling breath in the league for any quarterback.” The coach didn't explain how he knows that — but never mind. The takeaway is that a cosmetic rinse may be OK for a quick fix — but when it comes to good oral hygiene, using a therapeutic mouthrinse as a part of your daily routine (along with flossing and brushing) can really step up your game.

If you would like more information about mouthrinses and oral hygiene, contact us or schedule a consultation.

By Koh Orthodontics
August 12, 2018
Category: Oral Health
Tags: oral hygiene   braces  
BeVigilantwithDentalCareWhileWearingBraces

If you or a family member wears braces, you're used to visiting your orthodontist for adjustments and progress monitoring. But it's just as important that you continue regular visits with your family dentist, especially if you begin noticing abnormalities with your teeth and gums.

We need to be on alert for dental health because risks for disease increase during orthodontic treatment. Most oral infections arise from plaque, a thin film of bacteria and food particles on tooth surfaces. You avoid plaque buildup by brushing and flossing at least once a day and undergoing semi-annual office cleanings for any remaining plaque and calculus (hardened plaque deposits).

Braces, however, can complicate hygiene. It's harder to get into areas blocked by the brackets and wires with your brush or floss. This can quickly give rise to gingivitis, a form of periodontal (gum) disease characterized by gum swelling. If not treated, gum disease could eventually cause the gums to detach from the teeth and lead to bone and tooth loss.

The brackets and wires can also irritate the gums and cause them to swell or overgrow, a condition called hyperplasia. This further complicates proper hygiene, which then increases the risk for infection even more.

It takes more time and effort to brush and floss effectively while wearing braces. But it's necessary to prevent these problems. Interproximal brushes (which fit in the spaces between teeth) can help, as well as special floss threaders. You might also consider a water flosser, which use a high-pressured water spray to remove plaque between teeth.

And, don't neglect seeing us on a regular basis. If you notice gum swelling, redness or bleeding, contact us as soon as possible.

If the swelling is due to hyperplasia, treatment could wait until after the braces come off, as long as there doesn't appear to be any gum detachment from the teeth. If there is, though, you may need to see a periodontist (a gum specialist) for further evaluation. It may be necessary in advanced cases to remove the braces to treat the underlying gum condition.

It pays to keep a close eye on your teeth and gums while wearing braces. Catching problems before they become too serious will help ensure your new smile is just as healthy as it is attractive.

If you would like more information on dental care while undergoing orthodontic treatment, 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 “Gum Swelling during Orthodontics.”





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