Straightening your teeth with braces or other orthodontic gear is a positive step toward a healthier and more attractive smile. You'll likely be pleased with your smile when they're removed.

But you may also notice something peculiar once the braces are off—dull, white spots on your teeth. These spots, usually located under or around braces hardware, are where mouth acid has “demineralized” calcium and other minerals in the enamel. As beginning tooth decay, these spots are a sign your hygiene efforts weren't sufficient in cleaning your teeth of plaque.

In many cases, the spots will improve on their own after the braces are removed. We can also strengthen the enamel with fluoride pastes or gels, or inject tooth-colored resin within the spot to restore the enamel's translucence and improve appearance.

But the best approach is to try to prevent white spots from occurring at all. Here's what you need to do.

Keep up your oral hygiene. Even though more difficult with braces, you still need to brush and floss to protect your teeth from tooth decay. To make it easier, take advantage of special brushes designed to clean around orthodontic brackets and wires. A floss threader can also help you better access between teeth—or switch to a water flosser instead of floss thread.

Practice a “tooth-friendly” diet. A diet high in sugar and acid could short-circuit your best hygiene efforts. Certain beverages are big offenders: sodas, energy and sports drinks, and even “natural” juices. Instead, eat foods high in vitamins and minerals like fresh fruits and vegetables, lean proteins and low-fat dairy.

Get your teeth cleaned regularly. While you're seeing your orthodontist for scheduled adjustments, don't neglect regular cleanings with your family dentist. Professional cleanings at least every six months reduce the risk of dental disease. These regular visits are also a good time for your dentist to check your teeth for any signs of dental problems associated with your braces.

It's not easy to keep your teeth clean while wearing braces, but it can be done. With help from a few handy tools and continuing care from your dental professionals, you can avoid unsightly white spots.

If you would like more information on dental care while wearing braces, 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 “White Spots on Teeth During Orthodontic Treatment.”

Teeth crowding is a difficult bite problem (malocclusion) that often involves the entire jaw structure to be evaluated. Normally occurring when the jaw doesn’t have adequate space for normal tooth eruption, teeth coming in later put pressure on other teeth, causing them to develop improperly.

Crowding also makes it difficult to realign teeth with braces because there’s simply not enough room for sufficient movement to take place. The solution may then be to consider the removal of some of the teeth to create enough space for orthodontic treatment.

Not just any tooth can be removed, however — we must first conduct a careful analysis to determine which can be removed to facilitate optimum movement of the remaining teeth without disrupting normal mouth function or affecting appearance. The teeth most frequently removed for this purpose are the bicuspids, located between the cuspids or eyeteeth (which are positioned directly under the eyes) and the molars, the largest teeth in the back of the mouth. Sometimes one premolar tooth on each side of the jaw can be removed without sacrificing future form or function.

There are a few important considerations we must keep in mind when extracting teeth for orthodontic reasons; perhaps the most important is preserving bone at the extraction site. Because continuing bone growth depends on the forces generated by teeth when we bite or chew, bone near a missing tooth socket will tend to diminish over time. If there’s insufficient bone during orthodontic treatment, it may result in gum recession and root exposure — not only damaging to the teeth themselves but also to a person’s smile appearance. To avoid this, we sometimes will consider inserting a bone graft, which will stimulate bone growth, into the empty socket immediately after extraction. While this isn’t commonly done, it’s being considered if the patient’s bone is thin and a concern during healing.

We must also consider how to accommodate other, unrelated tooth loss to assure the final result is visually appealing. It may be necessary in these cases to maintain the space at the missing tooth site for a future restoration once the orthodontics is completed. This takes planning as well as the use of restorations like dental implants, bridges or partial dentures.

Regardless of your bite issues, the field of orthodontics has the appliances and techniques to overcome even the most complicated condition. When necessary, using procedures like tooth extraction can help turn an unappealing, dysfunctional bite problem into a beautiful smile.

If you would like more information on orthodontic teeth extractions, 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 “Tooth Removal for Orthodontic Reasons.”

Moving your teeth to a more functional and attractive alignment is a big undertaking. You can invest months — even years — and a lot of expense to correct a bad bite. But all that effort could be for nothing if your teeth return to their original positions.

The very aspect of dental physiology that makes orthodontics possible can work against you in reverse. Your teeth are not actually rigidly fixed in the bone: they're held in place by an elastic gum tissue known as the periodontal ligament. The ligament lies between the tooth and the bone and attaches to both with tiny fibers.

While this mechanism holds the teeth firmly in place, it also allows the teeth to move in response to changes in the mouth. As we age, for example, and the teeth wear, the ligament allows movement of the teeth to accommodate for the loss of tooth surface that might have been created by the wear.

When we employ braces we're changing the mouth environment by applying pressure to the teeth in a certain direction. The teeth move in response to this pressure. But when the pressure is no longer there after removing the braces or other orthodontic devices, the ligament mechanism may then respond with a kind of “muscle memory” to pull the teeth back to where they were before.

To prevent this, we need to help the teeth maintain their new position, at least until they've become firmly set. We do this with an oral appliance known as a retainer. Just as its name implies it helps the teeth “retain” their new position.

We require most patients to initially wear their retainer around the clock. After a while we can scale back to just a few hours a day, usually at nighttime. Younger patients may only need to wear a retainer for eighteen months or so. Adults, though, may need to wear one for much longer or in some cases permanently to maintain their new bite.

Although having to wear a retainer can be tedious at times, it's a crucial part of your orthodontic treatment. By wearing one you'll have a better chance of permanently keeping your new smile.

If you would like more information on caring for your teeth after braces, 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 “The Importance of Orthodontic Retainers.”

At your child's latest dental visit, you found out one of their primary (“baby”) teeth has become decayed and in danger of loss. Of course, you may think, it's only a primary tooth — it's going to come out sooner or later.

But a primary tooth lost “sooner” rather than “later” can create long-term negative consequences for your child's dental health. For the sake of the future permanent tooth, the best treatment strategy could be to put forth the effort and expense to save it.

Besides its role in eating and chewing, a primary tooth's most important function is as a “trailblazer” for the permanent tooth developing below it. A primary tooth doesn't normally loosen and let go until the new permanent tooth is ready to erupt. Until then they hold the new tooth's space in the jaw.

But if the primary tooth is lost prematurely, nearby teeth can drift into and crowd the space so that the permanent tooth comes in out of position. This can result in a malocclusion, or poor bite.

Depending on the state of your child's jaw development, it may be advisable to attempt saving the tooth through a filling or, in the case of deep decay, a modified root canal treatment. If the tooth can't be saved, then placing an orthodontic appliance known as a space maintainer might be necessary. Cemented to a tooth next to the empty space, this appliance has a looped band of metal that butts against the tooth on the other side of the gap, and prevents both teeth from drifting into the space.

Intervening for a decayed primary tooth can seem a waste of time and money since it has a limited lifespan to begin with. But for the health of its companion permanent tooth, as well as possibly avoiding orthodontic treatment, it could be well worth it for your child's long-term dental health.

If you would like more information on dental care for your child, 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 “Importance of Baby Teeth.”

Fans of the primetime TV show The Middle were delighted to see that high school senior Sue, played by Eden Sher, finally got her braces off at the start of Season 6. But since this popular sitcom wouldn’t be complete without some slapstick comedy, this happy event is not without its trials and tribulations: The episode ends with Sue’s whole family diving into a dumpster in search of the teen’s lost retainer. Sue finds it in the garbage and immediately pops it in her mouth. But wait — it doesn’t fit, it’s not even hers!

If you think this scenario is far-fetched, guess again. OK, maybe the part about Sue not washing the retainer upon reclaiming it was just a gag (literally and figuratively), but lost retainers are all too common. Unfortunately, they’re also expensive to replace — so they need to be handled with care. What’s the best way to do that? Retainers should be brushed daily with a soft toothbrush and liquid soap (dish soap works well), and then placed immediately back in your mouth or into the case that came with the retainer. When you are eating a meal at a restaurant, do not wrap your retainer in a napkin and leave it on the table — this is a great way to lose it! Instead, take the case with you, and keep the retainer in it while you’re eating. When you get home, brush your teeth and then put the retainer back in your mouth.

If you do lose your retainer though, let us know right away. Retention is the last step of your orthodontic treatment, and it’s extremely important. You’ve worked hard to get a beautiful smile, and no one wants to see that effort wasted. Yet if you neglect to wear your retainer as instructed, your teeth are likely to shift out of position. Why does this happen?

As you’ve seen firsthand, teeth aren’t rigidly fixed in the jaw — they can be moved in response to light and continuous force. That’s what orthodontic appliances do: apply the right amount of force in a carefully controlled manner. But there are other forces at work on your teeth that can move them in less predictable ways. For example, normal biting and chewing can, over time, cause your teeth to shift position. To get teeth to stay where they’ve been moved orthodontically, new bone needs to form around them and anchor them where they are. That will happen over time, but only if they are held in place with a retainer. That’s why it is so important to wear yours as directed — and notify us immediately if it gets lost.

And if ever you do have to dig your retainer out of a dumpster… be sure to wash it before putting in in your mouth!

If you would like more information on retainers, please contact us or schedule an appointment for a consultation. You can learn more in the Dear Doctor magazine articles “The Importance of Orthodontic Retainers” and “Why Orthodontic Retainers?”