James had orthodontic treatment as a child in order to correct his protruding teeth. He is now in college and wears a bonded retainer fixed to the inside of his lower teeth. This is a fixed wire attached with composite bonding. It is a common way for orthodontists to fix the teeth in position without the patient having to wear a removable retainer. The problem is: when does the retainer get removed, if ever? The patient has long since stopped seeing the orthodontist for checkup appointments. The retainer may not be serving its purpose; the teeth may be stabilized.
I recommend that the patient return to the orthodontist to have the retainer checked and to see if it is still needed or if it can be replaced with a removable retainer. I am unhappy when a patient has been wearing a retainer for years without supervision. The patient often has difficulty cleaning the teeth under and around the fixed wire. The retainer is a plaque and calculus collector. This leads to decay and gum disease – much more serious than crooked teeth.
I performed periodontal scaling for James in order to remove the hardened calculus deposits. Because of the plaque accumulation which harbors bacteria, he has gingivitis, or inflammation of the gum tissue around the teeth. The gingivitis will subside now that the teeth are clean, provided that he can keep them clean. I showed him how to use a floss threader to clean in between the teeth and also gave him a Go-Between brush by GUM Industries – a new brush that is excellent for cleaning between the teeth, when space allows. We will see James again in three months, to see how he is doing, keeping those teeth clean!
Look at the calculus around this retainer. The patient thought this was part of his teeth.
Look how we removed the calculus. Now you can see his teeth.