Do-it-yourself Orthodontics?

Well now I really have heard everything – this time it’s “do-it-yourself orthodontics.”  What next? Do your own fillings? Make your own crowns or dentures? Is the dentist and dental office a thing of the past? I first heard of “Straighter Teeth, by Mail” several weeks ago when I read an article in The New York Times about remote orthodontics.

By now most people have heard of Invisalign which can straighten teeth by use of successive clear plastic aligners instead of traditional metal orthodontic brackets and wires.  But Invisalign is not within everyone’s budget. So an enterprising dental entrepreneur decided that the dentist and orthodontist were superfluous. People could insert the aligners on their own, with online support. The at-home cost is considerably less than the in-office cost. The client simply purchases a kit to make the dental impressions at home. A how-to video shows the client how to mix the putty, put it in stock trays and take impressions of his teeth. The impressions get mailed to the “Do-it-Yourself” company and a series of clear aligners is made to correct crowded teeth or teeth that are too spread out. A customer representative guides the patient through the process.

This may sound easy and inexpensive – but beware of dental bargains. A thorough exam and xrays are essential before beginning tooth movement. The patient cannot self-diagnose gum disease or decay which must be treated before any tooth movement should begin. Sometimes the misalignment of the teeth is too severe for Invisalign and certainly too severe for do-it-yourself. There needs to be a careful diagnosis and treatment plan and continued supervision by a dental professional. The do-it-yourself program may seem like a bargain, but it could be nothing more than a waste of money.

The Food and Drug Administration considers aligners to be a prescription item. They have approved more than ten kinds. But the FDA does not regulate the practice of dentistry; it is up to the states and their dental boards to decide what is appropriate care.  Recently the American Association of Orthodontists warned people against tooth movement without an initial exam and continuing supervision by an orthodontist.  “Our concern is that patients who don’t see an orthodontist for regular checkups and/or for a complete diagnosis are more likely to be harmed,” said Dr. Rolf Behrents, a spokesman for the AAO.

02teeth2-tmagArticleDo no harm!

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!

 

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Look at the calculus around this retainer. The patient thought this was part of his teeth.

 

 

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Look how we removed the calculus.  Now you can see his teeth.

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Good discussion of how to close the gap in today’s New York Times: http://well.blogs.nytimes.com/2013/09/12/ask-well-gap-toothed-2/?smid=tw-share

When I first met Laurie, she was 15 and in the middle of orthodontic treatment.  Her upper left canine tooth was impacted (hidden in the bone and not in a position to erupt.) We determined that the tooth could not be saved and we elected to extract it and have an implant placed.  The tooth was removed and a bone graft placed. The adjacent teeth were repositioned orthodontically so there would be enough room for the implant.  The implant was placed and it was allowed to integrate to the bone.  During this time Laurie wore a flipper type partial denture to replace the missing tooth.  Once the implant was integrated, the implant was exposed and a screwed in temporary implant crown was placed.

The photos below show the space where the tooth was missing and the temporary crown in place.  The crown looks terrific – but the permanent crown will look even better. Laurie is thrilled not to have to wear the removable denture anymore.  Once further healing of the surrounding gum tissue takes place we will place the final implant abutment and crown.

Laurie just left for college, but she will be back in Coram for Thanksgiving when we will place a permanent implant crown.  This type of dental treatment is complex and cannot be rushed – it takes a lot of planning and coordination among myself as restorative dentist, the orthodontist, the oral surgeon and periodontist.  But is the wait worth it? You bet!

New dental implant long island

New dental implant temporary crown

There are several reasons why tongue piercing is not healthy for you, but I just read of a new reason.  Playing with a tongue stud can cause your front teeth to spread, leaving a gap.  People with tongue studs tend to push the stud up against their front teeth. This can cause the teeth to separate.  Forces cause teeth to move and the stud is a force that acts similarly to an orthodontic appliance.  So, if you have a tongue stud, don’t play with it and don’t push it up against your teeth.  Tongue piercing can also injure the gums and cause mouth infections.

I read a funny but inspiring article last week in the New York Times from the point of view of an adult undergoing orthodontic treatment. Her dentist told her that crowded teeth were harder to clean and her mouth was “headed for trouble” if she didn’t straighten her crooked teeth. The author reminds us that middle aged adults have an average of 15 decayed, filled or missing teeth. (Yes, I see this every day.)

Her treatment began with clear plastic aligners (see my blog entry on Invisalign) but the orthodontist had to switch her to metal brackets and wires to complete the treatment. This occurs more often than the orthodontists like to admit. More than a million adults are being treated orthodontically, representing about 20% of orthodontic patients. People want to look better and have healthier teeth at any age. Great idea!

Contact our East Setauket dental office today and we’ll let you know if you are a candidate for invisible braces.

The Invisalign treatment consists of a series of aligners that are changed approximately every two weeks. Each aligner is custom made to gradually move your teeth into place. The advantages of Invisalign are many. They are clear, so hardly noticeable. They are removable for good oral hygiene so you can brush and floss normally. You can also eat what you want because the Aligners are removable.

But Invisalign won’t solve every malocclusion (bad bite). You need to have a careful examination and diagnosis before we can tell you whether Invisalign will straighten your teeth. Come to our Long Island dental office and we’ll tell you if Invisalign is right for you!

I wrote an entry this week about sibling teeth on the Sibling Blog.  Check it out!  Sibling teeth are inherited, and the form and eruption patterns of sibling teeth can be remarkably similar.  For example, if one of your children has over retained primary teeth, it is likely that her siblings may also have a delayed eruption pattern.  If one child is missing one or more permanent teeth, his siblings may also be missing the same – or mirror – tooth.

But habits also affect the teeth.  Thumb sucking, tongue thrusts, blanket sucking can all affect the development of the jaw bones.  My patient Melissa had a habit of sucking her middle three fingers but her parents sent her for early orthodontic intervention. She is now a young woman with a lovely smile. Her older brother did not have a finger sucking habit but he was older when he had orthodontic treatment and his smile is not quite so beautiful. The siblingstuff blog has lots of good stuff on siblings. Sibling teeth is one topic.

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