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!

Rick was born without his permanent lateral incisors (the teeth just to the side of his two front teeth). His other teeth moved over and everything was crooked. When he was nine, it was time for the orthodontist. He wore braces for several years so his teeth could be moved into the proper spaces. Space was left where the missing teeth should have erupted. Rick is now 15 but when his jaw is no longer growing at about age 19 he will have implants placed. Crowns will be placed over the implants in order to fill in the spaces.

In the meantime he needs a temporary solution so he has replacement teeth for the two missing teeth and also to hold the spaces so the teeth don’t drift again. The orthodontist made him a removable retainer, but Rick didn’t like that the retainer was removable. It didn’t look great and it was not comfortable.  Rick asked me what to do.  I recommended a bonded, or Maryland, bridge. This is a fixed bridge that is bonded to the adjacent teeth. It doesn’t require cutting the adjacent teeth and the esthetics can be excellent. It is easily removed when Rick is ready for implants.



Missing teeth.

X0103013Replaced with a bonded or Maryland bridge.

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.

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Good discussion of how to close the gap in today’s New York Times:

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

A lovely young lady came into the office last week with a complaint of brown spots on her teeth.  She needed to know that these brown spots were decayed spots (cavities).  The spots were not merely cosmetic but needed to be restored immediately before further damage occurred to her teeth.  The spots (really pitted areas in the enamel) were caused by plaque accumulation around her orthodontic brackets.  As a teenager her oral care was not as thorough as it could have been.  The acids from the bacteria resting on the plaque destroyed the enamel.  She did not visit the dentist the entire time of her orthodontic treatment.  Luckily I will be able to restore her teeth and she is determined to take better care of her teeth from now on.

From an article in the New York Times titled “Dental Danglers”: Last summer’s craze, Silly Bandz, has been replaced by a bracelet made of rubber links and metal brackets inspired by orthodontic bands and brackets.  Two orthodontists and a jewelry designer came up with this idea and they use real orthodontic materials.  The company is called Bracedlets and can be visited at

Icon is a new treatment which removes dental white spots and incipient decay.  These white spots on the teeth are an early sign of demineralization and they may lead to decay.  White spots on the surface of the teeth may be linked to orthodontic bands and brackets, heavy plaque, a high sugar or acidic diet, trauma or heredity.

For the past century dentists have removed decay by cutting away the decayed areas of a tooth.   But today’s new technologies allow us to remove less tooth structure, emphasizing what we call “minimally invasive dentistry.”  Icon is a product that treats small lesions micro-invasively so the dentist does not have to cut the tooth.  Icon is appropriate to treat smooth surface lesions limited to the enamel.

I have successfully used the Icon treatment to remove white spots often visible after orthodontic treatment.  The Icon treatment takes just one visit; it is painless, it doesn’t involve cutting the tooth, and no anesthesia is needed.  Call our East Setauket dental office and I’ll let you know if Icon is appropriate for your needs.

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.